The doctors built a 3D model of Karen's abdomen using the CT scans taken during the simulation. They measured out three beams to target the three sites. One beam treats the tumor on her left, while the other two both line up with the tumor sites on her right. It sounds like they would have wanted two beams for one area anyway, the one that's close to her small intestine. So rather than treat one of the spots separately all in one go, they are able to treat both areas with overlapping beams. This is possible because both sites are aligned with the large scar from her previous surgery. There will be some scar tissue between the two spots that may fall along the lines of the beams but there's no harm there.
This session, while shorter than simulation, was still much longer than future treatments will be. This is because they wanted to make sure everything lined up with the 3D model they made and that nothing had shifted or moved since the scans. This consists of Karen laying in the custom fit mold they had previously made and having areas measured out on her skin with a marker. They were able to feel the tumors under the skin and see that everything matched as it should. They also covered the three small marks they gave her last time with somewhat larger stickers to help line up the machines in the future. (These stickers are water resistant and should stay on just fine while bathing.) Several pieces of metal were machined to fit perfectly over her abdomin to prevent the beams from going where they shouldn't. These were also fitted to make sure they laid flat against her skin and were smooth and comfortable. There's also a blue, thicker, almost skin like material of a calculated width that they place over other areas to dampen the beams there. Everything was as planned and nothing had to be recalculated or redesigned.
There will be 15 treatments, which means three weeks of radiation. Karen's different had doctors discussed this and rather than get that third week of treatment while on chemotherapy, we'll be waiting three weeks before starting chemo again, instead of the usual two. This way, all radiation treatment will happen while she's off chemo. The first treatment itself was very quick and entirely painless. Everyone involved is very nice and overly cheerful. Karen's pretty happy with the way things are turning out.
