Lecture 4: Radiation Prescription and Treatment Description

Treatment Chart

• Primary legal document of the patient’s radiation treatment history

  • Adjustments/Corrections:

    • If adjustments are made in the treatment record, the change must be clearly identified, dated, and signed.

• Paper documents:

  • Any corrections must leave the original entry legible

    • Draw one line through the incorrect entry

    • Make the correction

    • Initial and date the correction

    • (things signed, like the treatment consent)

• Electronic chart:

  • A document containing an error would be marked as “unapproved” or “void”

  • A corrected document would be uploaded and all necessary parties would then approve the new document

Parts of the Chart

• Treatment Record/Dose sheet

• Consult notes

• Reports

• Treatment plan

• Consent to treat

• Imaging

Radiation Therapy Prescription

Must have written, signed, and dated radiation prescription from the radiation oncologist.

• legal document written by a radiation oncologist that provides the therapist with the information required to deliver the appropriate radiation treatment

  • Prescription defines the

    • tumor volume

    • intended tumor dose

    • number of treatments

    • dose per treatment

    • frequency of treatment

Treatment Chart (Prescription). Image example

A legal document that defies parameters of the prescription and must include:

• Anatomic site

• Method of delivery

• Total radiation dose

• Fractionation (individual treatment dose)

• Protraction (time period over which treatment is given)

• Treatment technique

• Beam energy

• Portal size

• Gantry angles

• Beam modifiers

• Patient positioning information

What should the therapist do before each treatment?

• The therapists should review the prescription prior to each treatment to apply their knowledge of radiation effects, tumor-lethal doses, and radiation tolerance limits for normal tissues (NTTD)

• Prescriptions appearing to exceed NTTD’s or deviate from standard practice should be reviewed with radiation oncologist prior to treatment

  • The prescription should be reviewed prior to each treatment, as the physician can make modifications to the treatment at any time

  • Common changes could include fraction, total dose, changes in bolus, or beam apertures

    • You are the last line of defense!

Treatment Record (dose sheet) identifies:

• Date of treatment

• Treatment # (number of treatments delivered)

• Elapsed days (total time over which treatment is completed)

• Daily and total dose delivered (BID – note times of delivery)

• Therapist initials and date AND time

• Energy

• Monitor units

• Verification imaging

• Use of beam modifiers (bolus)

• Notes

  • Addition or deletion of beam modifiers (bolus)

  • Any changes to setup or patient position

  • Any changes to image verification

Parts of the Treatment Record (Image example)

Treatment Fields

• The treatment field, port or portal is the volume of tissue exposed to radiation from a single radiation beam.

  • Each one is assigned

    • Identifier

    • Name indicating the targeted anatomy and beam orientation

Field Identification and name

• Field name denotes the targeted anatomy and beam orientation

• Each field treated has an identification number, letter and field name

  • 
    

    • 1A. AP lung

    • 1B. PA lung

    • 2A. AP femur

    • 2B. PA femur

  • Field numbers remain the same within the same for all beams associated with that course

  • New course = field number is changed consecutively

• When F.S., beam shape, or isocenter is changed from original field, label stays the same but prime must be added.

  • “, ‘ to the original number

  • Ex: 1A’. AP lung)

What should be included in a patient’s treatment plan:

• Correct machine

• Intended prescription parameters and technique

• QA measures that may be necessary

Treatment Orders from physician should include treatment modality and intended treatment machine because the output, acceptance parameters and QA are different for each machine

Treatment plans are composed of one or more treatment fields designed to maximize the dose delivered to the tumor while minimizing the dose to normal tissues. Also inclides:

• Treatment plan includes:

• Setup instructions

• Plan QA ran

• Planning images/DRRS

• Treatment isocenter position

• Adjustment or shifts from original setup/isocenter

• Treatment field information

  • Beam angle

  • Energy

  • Monitor units/time

  • Field size

  • Beam modifiers (bolus)

Treatment Intent – curative vs palliative

• Intent of treatment must be in the treatment planning note:

  • Intent refers to whether the treatment is curative or palliative

Consent contains 3 important aspects:

1. Communications

2. Ethics

3. Law

• A person must have legal capacity to give consent.

The patient may agree to or refuse treatment based on the information provided to them from the physician

Consent should include:

• The procedure or treatment

• Risks\Complications

• Side effects

• Potential mortality

• Desired outcome

• Possible alternative treatments or procedures

Treatment Chart

• Primary legal document of the patient’s radiation treatment history

  • Adjustments/Corrections:

    • If adjustments are made in the treatment record, the change must be clearly identified, dated, and signed.

• Paper documents:

  • Any corrections must leave the original entry legible

    • Draw one line through the incorrect entry

    • Make the correction

    • Initial and date the correction

    • (things signed, like the treatment consent)

• Electronic chart:

  • A document containing an error would be marked as “unapproved” or “void”

  • A corrected document would be uploaded and all necessary parties would then approve the new document