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list the steps that a patient must undergo in th radiation therapy process
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list the members of the radiation oncology department that are present for the simulation process
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P&P final - nhti
| Question | Answer |
|---|---|
| list the steps that a patient must undergo in th radiation therapy process | diagnosis, therapeutic decisions (method of treatment), target volume localization Locate), fabrication of treatment aids, treatment planning, treatment, patient evaluation during treatment, patient follow up |
| list the members of the radiation oncology department that are present for the simulation process | radiation therapist, oncology nurse, dosimetrist, physician |
| state the 2 types of simulators in use and explain the difference | conventional SIM - DRR (digitally reconstructed radiograph), 2-D, fluoroscopy, locate fields, locate target, shape the field CT - work station, spiral scan, 3-D, locate target, shape field and beams |
| define simulation | procedure of locating the tumor, documenting it with CT or radiograph, creating any immobilization aids you need, constructing any blocks/positioning aids, and taking measurements. |
| state the key of successful simulation | reproducability and accuracy |
| define CAX | central axis |
| define IFD | intrafield distance |
| define PSA | patient support assembly |
| define POP | parallel opposed ports, 2 fields 180 degrees apart |
| define what a radiopaque marker is and describe its use | allows structures to be seen in CT (BB's and wire), shows up white in the beam |
| describe the patient separation measurements | how thick the patient is, use IFD or calipers |
| list and describe the 3 specific target volumes | GTV - gross tumor volume, tumor only CTV - clinical tumor volume, tumor plus subclinical disease PTV - planning tumor volume, CTV & GTV, accounts for patient movement |
| define and describe LPO | left posterior oblique - gantry angle on left side of patient's back |
| define and describe LAO | left anterior oblique - gantry angle on left side of patient's front |
| define and describe RPO | right posterior oblique - ganty angle on right side of patient's back |
| define and describe RAO | right anterior oblique - gantry angle on right side of patient's front |
| define and describe the difference between SAD and SSD | SAD - source to axis distance, distance to axis/treatment point SSD source to skin distance, distance to skin surface |
| define ODI | optical distance indicator |
| define SDD | source to diaphragm distance |
| define SFD | source to film distance |
| define STD | source to target/tray distance |
| define TT | (AT, ^T) - tabletop |
| list the 3 dimensions that tumor localization takes place in | anatomic body planes, CT imaging, conventional simulation and CT simulation |
| state the 3 major anatomic body planes | coronal (frontal, dorsal/ventral) sagittal (right and left) transverse (axial, upper and lower) |
| summarize the difference between CT simulation and diagnostic CT | CT simulation - flat table, Beam's eye view, mimic linear accelerator diagnostic CT - concave table, tells where tumor is located, helps diagnose, which tissue, density, and organs |
| list the information that CT simulation provides the oncologist | where tumor is, densities, BEV, tells what organs laser will travel through |
| decribe beams eye view | image technique used in planning of radiation treatment, view of exactly where te laser will encounter the body |
| define orthogonal fields | 2 fields 90 degrees apart |
| define contrast media and give examples | - a drug to make internal organs visible on CT - barium (GI, colon, rectum), iodinated contrast (vascular system, bladder) (postive shows up white) - positive agents - radiopaque, show up white - negative agents - radiolucent, shows up black (air) |
| summarize the CT simulation procedure | positive pathology consent prepare immobilization devices prepare room explanation make sure flat table simulate patient through apperature |
| summarize the conventional simulation procedure | positive pathology consent prepare immobilization devices prepare the room explanation of simulation procedure sim education simulation (mimics linear accelerator) |
| list several patient factors that affect positioning | |
| state the 3 categories of immobilization and summarize each | positioning aids - provides reproducability, simple aids to assist patient with potion but not hold (head rest, knee sponge) simple immobilization - restricts some movement but not all (velcro, tape) |
| immobilization cont. | complex immobilization - specific for patient, restrain movements (wing board, alpha cradle, vac-loc bags, aquaplast face mask) |
| describe the simulator controls | radiographic components - fluoro & image intensifier (proof and setup) mechanical components - table, gantry, collimator optical components - lasers, ODI, field light |
| define photo timing | cells that are built into the holder where the radiograph is, they recieve the amount of radiation they need, they shut off automatically |
| list several tips for producing high quality radiographic portals | exposure techniques, phototiming cells, film processor, |
| state the most sensitive variable factor in the production of radiographs | film processor |
| list the information that should be recorded on radiographs | where radiograph is taken anatomically (area of interest), preliminaryfied size, fluoroscopy to fine tune field |
| list the patient setup information that is always in the chart | all setup information, picture, SSD, isocenter, couch/gantry/collimator angle, immobilization devices, diagram, patient information, where tattoos are |
| state the 2 ways that patient positioning can be performed | visual positioning - positioning the patient by sight radiographic positioning - using untrasound or xray to confirm patient position |
| explain a patent contour | the outline of a patient's body |
| list the 3 types of patient contour | transverse coronal sagittal |
| list the 3 types of material used for contours and give benefits and difficulties of each | solder wire - plyable, cheap, stay away from open wounds, need pressure to mold plaster strip - cheap, molds, could get into wounds, warm, sticks to hair aquaplast - accurate, reusable, sticks to hair, takes a while to dry |
| list the 3 types of mechanical contours | aluminum pantograph CT (most accurate) |
| summarize treatment verification | vrify that you are treating the right patient, right dose, right field - make sure everythign is right |
| state the benefits and limitations of CT simulation | benefits - beam orientation, outline of critical structures, delineate target volume and lymph nodes, boost fields, BEV limitations - aperture size, flat couch, block verification cannot be performed, lateral cutoff |
| describe room preparation, explanation of procedure to patient and patient positioning for a CT simulation | prepare immobilization devices, bring up patient information, prepare gantry angle. tell patient what's going on, how to set them up, lights low, leaving room, can see and hear, won't feel anything. make sure whole body fits through aperture |
| state the difference between a treatment chart and medical records chart | treatment chart - remains in oncology dept., legal document, primary element of QA progra medical records chart - patient's history |
| most important equipment | chart |
| list the time periods in which the patient response to treatment is monitored and recorded | throughout and following completion of treatment |
| state how many methods of ID are used to confirm patient identity and give several examples | 2 forms of ID - picture recognition, patient bracelet, DOB, area of treatment, license |
| describe a record and verify system and explain its use | verifies patient information and treatment area/dose, makes sure the right patient is receiving the right dose to the right area |
| list the components of a daily treatment record | dose prescription, setup parameters, daily dose record |
| list all of the components of a prescription | anatomic site, total dose, fractionation, treatment technique, beam energy, patient positon |
| explain the process should a correction need to be made in a chart | single line through incorrect information, wrie correct information, initial correction |
| explain universal precautions | treat every patient as if they are carriers of bloodborne pathogens |
| discuss the principles of patient transfer involving a wheelchair and stretcher | get as close as possible, lock the wheels, get help, let patient do as much as possible, be parallel with treatment couch, use movin board, use your knees, 2 people lift, universal precautions (glove up) |
| list the different areas that serve as landmarks for localization | fiducial markers (in a position of trust), palpable anatomic landmarks, tattoos ,carfusion (fuschia ink, paint on body) |
| define verification image and explain its use | image taken to verify that the treatment is working and is treating the correct area |
| state the alternate term for a "field" | port |
| define orthogonal fields | 2 fields 90 degrees apart |
| compare and contrast between a systemic error and a random setup error | systemic error - if not fixed, it would stay that way (clearlyff, setup incorrectly) radom setup error - if not changed, chances are they would go back and be ok |
| state the limitations to the precision of portal images | must take a good image, time factors, poor image quality |
| compare and contrast semipermanent marks versus permanent marks when marking a patient | semipermanent - markers, paint, bleeds on skin, may be toxic, need to be re-touched permanent - tattoos, stay, can always tell where patient has been treated |
| state the 2 techniques that can be used for beam shaping and the 2 shapes that an unblocked beam will appear as | MLC, cerrobend blocks square and rectangle |
| compare the treatment prescription with the treatment plan | treatment prescription - the fractionated dose prescribed to a patient treatment plan - dose the patient will be receiving along with patient setup, immobilization aids and specific details |
| describe the role of the radiation therapist in treatment deliveryq | checks that the right patient is getting the right dose in the right area, mkes sure patient is aware of procedure, makes sure patient is feeling ok and what they need |
| define a gap and the terms hot spots and cold spots | gap - distance between the borders of 2 adjacent fields hot spots - volumes of tissue that receive more radition than the prescribed dose cold spot - tissue volumes that receive less than the prescribed dose |
| discuss the purpose and application of beam modifiers, bolus, wedges | beam modifiers - device that changes the shape of the treatment field or distribution of the radiation at depth bolus - tissue equivalent material that brings beam anterior, evens outskin, increase skin dose wedges - beam modifier, lessens beam dose |
| discuss the purpose and application of compensators | beam modifier, changes radiation output relative to loss of attenuation over a changing patient contour |
| list and define several oncologic emergencies | unexpected complication, unexpected condition, life threatening superior vena cava syndrome pericarditis pericardial effusion malignant pleural effusions spinal cord compression |
| SVC | superior vena cava syndrome - *best known*, lung tumor pressing on superior vena cava, lack of blood flow, blue lips, difficulty breathing, high dose radiation (no biopsy, just treat) |
| pericarditis | inflammation of lining of the heart, radiation induced, chest pain, cough, drugs |
| pericardial effusion | build up of fluid in pericardial space, from breast cancer, leukemia, dyspnea, shortness of breath, dyspnea, surgery or chemo |
| malignant pleural effusions | fluid accumulation in the pleura (between outsie of lung lining and chest cavity), dyspnea, surgery |
| spinal cord compression | bone tumor pressing on spine, metastasis to spine, RT, chemo, or surgery |
| describe electron contamination | dose enhancement caused by scatter from radiation going through lead cutouts |
| discuss the different field arrangements that can be constructed with discussion of new treatment modalities | POP - parallel opposed portals - 180 degrees apart 4 field - AP, PA, right lateral, left lateral wedge-pair - 2 beam with a wedge (head & neck) conformal - several beams, multiple fields (prostate) arc therapy - treatment as gantry moves (beam on), ra |
| discuss the different field arrangements that can be constructed with discussion of new treatment modalities - cont. | stereotactic radiosurgery-fixing patient to table, treating with several angles, pencil thin line TBI-total body irradiation, bone marrow transplant IMRT-intensity modulated radiation therapy, high precision radiation therapy to conform to 3-D tumor vol |
| state the cancers that brachytherapy is currently used for | cervical, vaginal, endometrial, breast, prostate, some head and neck |
| define the term brachytherapy | treatment from a short distance |
| list the main advantage for the use of brachytherapy | cosmetic and functional results, don't have as many side effects, large dose to tumorwith sharp dose fall off to surrounding structures |
| define the radiobiology of brachtherapy with concern to the 4 R's | repair and repopulation of healthy cells - not affected with brachytherapy redistribution - can still treat cells reoxygenation - shrink tumor, center becomes more oxygenated |
| describe the use of brachytherapy as an adjuvant modality | brachytherapy can shrink tumor before another form of treatment or give a boost of radiation to the tumor while not giving dose to surrounding tissue |
| list 3 benign conditions that brachytherapy can be used for | keloid pterygium hyperthyroidism |
| 3 commonly used brachytherapy materials | radium-226 cesium-137 iridium-192 |
| side effects of brachytherapy | fibrosis stenosis atrophy |
| most common prostate seeds used | palladium-103 gold-198 iodine-125 |
| define interstitial | within thetissue or tumor - breast, prostate |
| define intracavitary | within a cavity - cervix |
| define intraluminal | within a tube - esophagus, uterus |
| define intravascular | within a vessel - coronary vessels, stenosis |
| define topical brachytherapy | placing source on the area to be treated - eye, keloids |
| summarize the reasons that source strength is useful in the field of brachytherapy | need source strength for prescription, allows us to identify quantities, helps create the dose - stronger source, less time needed in the body |
| list the terms used for source strength | curie, Becqueral 1 curie = 3.7x10^10 dps (disintegrations per second) 1Bq = 1dps |
| oldest radioactive source | radium-226 |
| define radioactive decay | how active the source is, how much the source is decaying, how much stength the source loses |
| define decay constant | total number of atoms that decay per unit time |
| decay constant formula | .693/t(1/2) = decay constant |
| source activity formula | A = Ao e- (.693/t(1/2)*(T) |
| mean life formula | t(1/2) * 1.44 |
| inverse square law formula | I1/I2 = (D2)2/(D1)2 |
| half life of radium-226 | 1622 years (alpha) |
| half life of cobalt-60 | 5.26 years (gamma) |
| half life of cesium-137 | 30 years (beta) |
| half life of iridium-192 | 74 days (beta) |
| half life of iodine-125 | 59 days (beta) |
| half life of Au-198 | gold-198 - 2.8 days (beta) |
| half life of radon-222 | 3.8 days (beta) |
| half life of copper-64 | 12.8 hours (beta) |
| half life of phosphorus-32 | 14.3 days (beta) |
| half life of iodine-131 | 8 days (beta) |
| half life od strontium-90 | 28 years (beta) |
| average energy of 60Co | cobalt60 - 1.25MeV |
| average energy of 226Ra | radium226 - 830KeV (.83MeV) |
| average energy of 137Cs | cesium137 - 662KeV (.662MeV) |
| average energy of 192Ra | iridium192 - 380KeV (.38MeV) |
| define mean life | average lifetime for decay |
| describe 137Cs | radium substitute high dose rate afterloader uterine and cervix 30 year half life - long half life 662 KeV energy temporary implant |
| describe 192Ir | radium substitute 74 day half life seeds sewn on ribbon, threaded through patient head, neck, breast |
| describe 60Co | 5.26 year half life energy 1.25MeV external treatment ocular melanoma - plaque on eye |
| describe 198Au | 2.8 day half life 412 KeV energy seeds - brain, prostate encapsulated in platinum permanent implant - leave it in |
| describe 125I | 60.2 day half life 35.5 KeV energy daughter product of Xenon gas interstitial or ocular melanoma |
| describe radium | 1622 year half life 830KeV energy decays to radon gas then to lead (becomes more stable) pellets |
| describe and differentiate between low dose rate and high dose rate brachytherapy | low dose rate - up to 12Gy/hr dose rate, in patient, in hospital for a few days high dose rate - any dose rate above 12 Gy/hr, preferable, after loader(cesium), out patient, can go home, (high dose, short time), less expoure to staff |
| advantages to high dose rate brachytherapy | out patient, can go home high dose short time less exposure to staff patient gets a specific dose |
| describe an interstitial applicator and list its use | seeds put through tissue via hollow needles breast and prostate Au198, I125 don't need to remove, short half life permaanent or temporary implants |
| describe an external applicator and list its use | for surfaace lesions - to fit snugly on surface molds, eye plaques |
| describe an intracavitary applicator and list its use | insertion of radiioactive source into body cavity sparing dose to adjacent sensitive structures rectum, bladder tandems and ovoids |
| describe an intraluminal applicator and list its use | esophagus and trachea seeds or implants placed in tubes |
| describe an endobronchial applicator and list its use | 192Ir high dose rate afterloader radioactive source placed in bronchus catheters placed n bronchus |
| state the 4 types of systems used for brachytherapy dosimetry | Patterson-Parker system - Manchester system *most common* the Quimby/memorial system the Paris system computer calculations |
| summarize radiation therapy and nursing procedures for brachytherapy | intracavitary implants - patient must hold still interstitial implants - painful (head and neck) swelling in that area unsealed I131 - no capsule, excreted through sweat, blood, feces, urine |
| define hyperbaric therapy | process of introducing oxygen to the body to help repair tissues damaged by radiation therapy |
| list the cases in which hyperbaric therapy has been used | revascularize tissues, prohibit soft tissue damage |
| describe how the patient is treated using a hyperbaric machine | patient is put in the pressurized tube, they breath in pure oxygen for 30 minutes to 2 hours patient may feel tired, light headed can get oxygen toxicity, can't go in if have lung issues |
| state the genetic material used for gene therapy | DNA or RNA |
| list the 6 general ways in which gene therapy is used | replace missinf/altered genes radiosensitizers - weaken cell, more susceptible radioprotection - make body stronger improve immune response - able to fight suicide genes - genes that self destruct prevent development of new blood vessels |
| describe risks of gene therapy | low level virus mutate healthy cells into becoming cancerous |
| describe how a gene is introduced into a cell | tag a gene onto a virus, viruses attaches to cell, cell gets let in (inject material, or get enveloped) |
| compare and contrast photons and protons | photon - when radiation striked a medium and an energy transfer occurs proton - uses proton (chargeed particles), Bragg peak (travel to certain depth, give off all energy, no exit dose), pediatric, head and neck, ocular melanoma, producedin cyclotron |
| state the physical property that makes a proton useful | positive charge Bragg peak - travel to certain depth, give off all energy, exit dose pediatric, head and neck, ocular melanoma |
| describe how a proton is made | produced in cyclotron, sprial acceleration of H particles split into H+ and OH- |
| What is DART | dynamic adaptive radiation therapy |
| Dart techniques | respiratory gating IGRT IGBT |
| describe respiratory gating | beam on/beam off, sensor on chest to account for patient breathing |
| describe IGRT | image guided radiation therapy administer Kv (clear) or cone beam CT (takes images while gantry on) |
| describe IGBT | image guided brachytherapy using image guiding while brachytherapy in patient via ultrasound |
Created by:
Kayleeh18