Simulation and Treatment Planning

If radiation treatment is recommended, the next step is planning it to make sure your treatment is done as accurately as possible.  To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given.

To ensure that this planning doesn't need to be done each day of treatment, your doctor and treatment team will design an individualized plan for you.  This planning process is called "simulation" because it designs the treatment and "simulates" it but no radiation treatment is given at this stage.

During simulation, your radiation oncologist and radiation therapist will place you on the simulation machine in the exact position you will be in during the actual treatment. Certain measurements may be taken, and once the correct position is determined the radiation therapist may place permanent ink tattoos on your skin.  When needed, these marks ensure that radiation treatment will be accurate and reproducible each day you come to the cancer center.

Sometimes, we need to make sure that we can safely avoid radiation to normal parts of the body.  This may require molds, casts, headrests or other devices that are constructed to help you remain in the same position during the entire treatment. These devices are used to make you more comfortable to ensure you can stay in the same position for the time it takes to treat you.

After your simulation, you will be given an appointment card with the time and date of your first appointment for treatment.  If your ideal time isn't available at the beginning of treatment, we will do our best to ensure that you can switch to that time once it becomes available.


Using all the information from your medical history, previous records and the simulation process, a medical dosimetrist and physicist work collaboratively with your doctor to design your treatment plan.  If information from MRI, PET scan or ultrasound are needed, image fusion can be integrated into your treatment plan to ensure accurate targeting and sparing normal, healthy tissues.

The time from simulation to starting radiation treatment may vary, depending upon how complex the plan is and when it is medically best for you to start.  Should you have any questions, discuss it with your treatment team at the time of simulation or contact us if you have already completed your simulation.


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Lahey Clinic - Burlington, MA Concord Hospital - Concord, NH Wentworth-Douglass Hospital - Dover, NH Elliot Regional Cancer Center - Londonderry, NH Lowell General Hospital Cancer Center - Lowell, MA Elliot Regional Cancer Center - Manchester, NH Radiation Center of Greater Nashua - Nashua, NH