Clinical practicum Final

identify a Digitally Reconstructed Image (DRR)

What type of image is this?

• conventional sim film

What type of image is this?

• MV portal image

What type of image is this?

• CBCT image

What type of image is this?

• KV/KV

Differentiate between a DRR and a Port Image

What are positioning aids?

• items used for comfort and positioning

• doesn’t prevent patient movement

Examples of positioning aids

• head rests/holders

• pillows

• rings

• breast board

• wing board

What are simple immobilization devices?

• devices that restrict some movement

• more cost effective

Examples of simple immobilization devices

• velcro straps

• rubber bands

• bite blocks (tongue depressor)

• hand to foot straps

What are complex immobilization devices

• custom made devices

• restrict the most amount of motion

• more expensive

Examples of complex immobilization devices

• vac-loks

• aquaplasts

• alpha cradles

How is the treatment field size denoted?

• Width (X) times Length (Y)

What is Three-pointing?

• the process of aligning to lateral and AP marks on a patient to align to isocenter before treatment

What is image-guided radiation therapy (IMRT)?

• involves taking daily images prior to radiation treatment delivery

What is surface-guided radiation therapy (SGRT)?

• using a system which looks at the surface of the patient’s body and compares that position to the planned position at time of simulation, to position patients prior to treatment

What is intensity modulated radiation therapy (IMRT)?

• type of treatment in which there are multiple beams of varying intensities where different parts of the tumor will receive different doses

• uses different angles around the patient and use of MLCs

What is volumetric modulated arc therapy (VMAT)?

• type of IMRT treatment where the gantry will rotate in a continuous arc around the patient as radiation is being delivered

What is stereotactic body radiation therapy (SBRT)?

• type of stereotactic treatment to places within the body (brain=SRS/SRT)

What is stereotactic body radiation therapy (SBRT) also called??

• stereotactic ablative radiotherapy (SABR)

What does stereotactic body radiation therapy (SBRT) use?

• uses a highly focused and intense beam with high dose rates to target small amounts of tissue with high doses while sparring healthy tissue.

If a patient can’t stand or pivot what is required to transfer them?

• hoyer lift

• slider board

What is the process for patient oxygen delivery?

• If a patient is on their own oxygen, you will typically hook them up to the oxygen that is

  located in the treatment room.

• Ensure that tubing is long enough for any couch kicks and ensure it is not in the way of the imaging panels or gantry

What are the 6 responsibilities of a radiation therapist?

• complete sims (include starting IV)

• daily QA

• accurate daily treatments

• helping monitor side effects and educate on things like skin care

• placing TLDs on patient if needed for treatment

• completing charting/records of treatment delivery

What are the 4 responsibilities of a dosimetrist?

• reviewing scans from CT/MRI/PET for planning purposes

• contouring organs and tissues on scans

• calculating optimal doses and angles for the radiation beams

• developing the treatment plan

What are the 4 responsibilities of a physicist?

• conducting monthly and annual QA on linear accelerator

• complete any necessary QA testing for individual patients/plans

• treatment planning

• provide TLDs for treatment (therapist will place them, while physicists will provide them and gather the readings)

What are the 5 responsibilities of a physician?

• consulting with patients and determining appropriate treatment plan

• completing weekly visits with current patient and follow-ups with established patients

• approving plans created by the dosimetrist/physicist and helping contour/ create treatment plans

• approving daily images

• providing patient prescriptions

What are the responsibilities of a nurse?

• patient education

• monitoring and managing side effects

• help with weekly follow-up visits and consults

• taking vitals

What are the two things to remember when making an isocenter shift?

1. First, the lasers in the room all converge on isocenter.

2. Second, when you move the table and patient, you are moving the patient to the lasers, not the lasers to the patient.

TRUE/FALSE: your isocenter shift will be in the opposite direction of where you move your table

TRUE

If you need to shift the isocenter 5 cm inferior, what do you do with the table?

• You would move the table 5 cm superior.

If you need to shift the isocenter 2 cm anterior, what do you do with the table?

• You would move the table down (posterior) 2 cm.

If you needed to shift the isocenter 3 cm to the patient’s right, what do you do with the table?

• You would move the table 3 cm to the patient’s left (or 3 cm to the right, viewing it from the foot of the table from the view of the therapist).

What are the components of the radiation therapy prescription?

1. total doses and fractionation (dose per treatment)

2. protraction (time treatment is to be delivered in number of treatments)

3. anatomic site of treatment

4. beam energy

5. treatment technique (protons v. electrons, 3D or IMRT)

6. any beam modifiers or bolus,

Does the prescription need to list information about patient immobilization devices?

• No, this is determined by therapists, dosimetrists, and/or physician at the time of simulation and each patient’s individual needs (mask, vac, etc.).

What is a bolus?

• a substance that mimics tissue and brings the dmax closer to the skin surface

When is the bolus commonly used?

• when the tumor is very close or on the skin surface

5 Examples of when a bolus would be used

• skin cancer

• chest wall

• vulvar

• soft tissue

• other treatments where tumor is relatively surface level

What are two important QA tests that the therapist runs daily?

• Checking for door interlock

• AV (audiovisual) system functionality.

Should treatment proceed if the door interlock or AV system is not functional?

• No, you would not treat if either of these is not functional.

What are some additional QA tests therapists check daily?

• Checking beam output

• laser alignment

• ODI

• imaging coincidence.

What should you do if additional QA tests are not functional?

• Likely repeat testing to see if it was an error in setting up the test, then report issues to your physicists.

Where are emergency off buttons located in a radiation therapy vault?

• These buttons are located in several places within the vault and console area

  • on the couch

  • on the walls in the vault/console area

  • on the Linac stand

  • on the console.

Where are emergency off buttons not located?

• in general public areas

• other areas of the radiation oncology department, such as nursing stations, exam rooms, or receptionist areas.

When should you use an emergency off button?

• In case of extreme emergency, such as

  • fire

  • major technical or safety issues

  • or being trapped in the room while the beam is running.

If a patient is moving, having a medical issue, or needs to get off the table, do you use the emergency off button?

• No, you would typically just stop the beam and enter the room – the emergency off button is rarely needed in situations like this.

What should you do if audio-visual devices are not working in the treatment room?

• You may NOT treat if you cannot see or hear the patient, for safety reasons.

• This must be resolved before treating again.

On which patients is flash mainly checked?

• Flash is mainly checked on breast patients, especially if you are treating tangents and are not imaging daily.

Why is flash checked on breast patients?

• It is a visual way of checking that all breast tissue is within the treatment field.

On which other patients may flash be checked?

• Flash may also be checked on whole brain patients.

Why is flash checked on whole brain patients?

• Traditionally, you would not image whole brains daily and treat with parallel-opposed fields, so therapists set up to marks on the mask and check the field visually.

When would you treat a patient with a full bladder?

• most commonly used for prostate and GYN treatments

• sometimes rectum

When would you treat a patient with a empty bladder?

• treating the bladder itself

What type of radiation can we treat with on a linear accelerator?

• the linear accelerator is capable of treating with

  • photons

  • electrons