Treatment planning Chapter 12(abdomen)
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****The abdomen is defined as the portion of the body that lies between the______and the _____and that contains the__________.
The abdomen is defined as the portion of the body that lies between the thorax and the pelvis and that contains the peritoneal cavity.
The following radioisotopes are sometimes administered intraperitoneally in the treatment of gynecologic malignancies.
32P (chromic phosphate)
*also mentions 198Au (colloidal gold)
The cephalad field margin in whole abdominal irradiation should be set at_______.
- The cephalad field margin in whole abdominal irradiation should be set at the superior aspect of the diaphragm in quiet breathing. (best determined under fluoroscopy )
- *lateral margins should include the peritoneal cavity.
Whole abdomen treatments can be set so that they include some_____and _____tissue.
Whole abdomen treatments can be set so that they include some lung
- *In other words, it is impossible to not include a small amount of lung and heart
****Generally speaking, the kidney tolerance to irradiation in adults is_______.
2000 cGy delivered in 180-200 cGy fractions
Partial kidney shielding in a patient who is likely not to complete the course of treatments is best accomplished by means of ______.
No shielding of the kidneys until the tolerance dose is reached and then the insertion of 5HVT blocks in both the AP and PA fields.
The time/dose schedule in the kidney is the same regardless of which shielding method is used...(True/False)?
The dose under a 5HVT kidney block is approximately____to_____% of the dose delivered at mid-depth on the central axis.
The amount of dose under a 5HVT kidney block depends on(name 3)?
- 1)the size of the field
- 2)the energy of the beam
- 3)the size of the kidney block
******The most common site of pancreatic tumors is____?
The HEAD of the pancreas
The organs in which the normal tissue tolerance is of concerns when treating pancreatic cancer are_____(name 3)?
- 1)the spinal cord
- 2)the kidneys
- 3)the liver
When a three field technique(POP lats + AP) is used in the treatment of pancreatic tumors, the best dose distribution is achieved with_____?
wedges in lateral fields and more weighting in AP field
****Wilms' tumor is a tumor originating in the _____?
- *in children-very aggressive
****Neuroblastoma is a tumor most often originating in the ____?
sympathetic nervous system
When children are treated for Wilms' tumor .....?
the medial field should include the width of the spine.
- *The most common site of metastatic spread at diagnosis is lung with liver second most common. Metastesis can occur if the capsule ruptures preoperatively or from
- seeding during surgery.
TD5/5 Bladder (Emani)
TD/5 Small intestine
- "intestine": pg 81 purple book
- WHOLE: 4000
- 1/3: 5000
Margins for Wilms' tumor:
- 1)The superior, inferior and lateral borders of RT field are placed at the edge of the PTV.
- 2)The medial border of RT field extends across midline to include entire width of vertebral bodies (with a margin of 1 cm) at
- level concerned, but not so as to overlap any part of the contralateral kidney.3)RT field should not extend to the dome of the diaphragm unless tumor extends to that height.
- 4)If positive lymph nodes have been surgically removed, then the entire length of the para-aortic chain of lymph nodes should be
- included in RT field.
- An antero-posterior parallel-opposed technique (AP-PA) is recommended for flank RT
Dose to "tumor bed" after excision of kidney for Wilms' tumor?
10.8 Gy/ 6fx
NEED TO KNOW:
- 1) right lobe of liver
- 2)left lobe of liver
- 7)right kidney
- 8)left kidney
- 9)right adrenal
- 10)left adrenal
- 12)hepatic duct *
- 13)common bile duct *
- 14)pancreatic duct *
- 15) ampulla of vater *
- 17)right ureter
- 18)left ureter
In a whole abdomen treatment the _____field is shorter.
PA field is shorter (AP/PA large fields)
*AP fields includes nodes
With a _____block, which is 5HVL, the shape makes the distance immaterial. A _____block, however, is less than 5HVL and is made for a specific distance.
- full block
- transmission block
ECRP shows the position of the _______?
biliary tree and pancreatic duct
A CT (can/can not) see bowel without contrast?
A CT can not see bowel without contrast?
Neuroblastoma, which is a tumor of the _____ ______ ______, arise in the (name 3)?
Neuroblastoma, which is a tumor of the sympathetic nervous system, arise in the neck, chest, and abdomen.
The function of the opposite ______must be determined before irradiating the abdomen.
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