Intro to Radiation Therapy Final

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ams217
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Intro to Radiation Therapy Final
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2013-12-03 21:25:35
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radiation therapy
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cumulative final for intro to radiation therapy
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  1. Diagnostic radiologic sciences (medical imaging)
    • radiography
    • sonography
    • nuclear medicine
  2. Therapeutic radiologic sciences (medical imaging)
    • radiation therapy
    • nuclear medicine
  3. radiography of the skeleton / chest films produce what type of image?
    static image
  4. radiography (fluoroscopy) with barium studies such as the gastrointestinal system produce what type of image?
    dynamic image
  5. radiography of breast
    specialization
    important in early detection of breast cancer
    screening tool used for diagnosis, localization of mass and core needle biopsy, or guided biopsy
    mammography
  6. diagnostic and therapeutic
    uses catheters, contrast material to visualize heart and blood vessels
    therapeutic: venous filtering (prevent clots) and stenting
    cardiovascular imaging
  7. uses radiopharmaceuticals
    most primary radiation is gamma rays
    equipment DOES NOT emit radiation but acts like a camera to detect radiation emitted by substances in the patient and images are produced
    nuclear medicine
  8. uses sound waves produced by a transducer
    images similar to sonar waves
    popular in obstectrics and gynecology
    sonography/ultrasound
  9. does not diagnose
    treats disease
    uses high energy radiation to treat malignancy while sparring normal surrounding tissue
    maybe used alone or in combination with other modalities (surgery & chemo)
    radiation therapy
  10. discovered x-rays; produced image by accident on November 8, 1895
    William Roentgen
  11. first to treat breast cancer using x-rays therapeutically
    Grubbe
  12. reported emission of rays from uranium
    Becquerel
  13. reported radioactivity of uranium and radium to treat patients
    Madame Curie and her husband Pierre
  14. radiography using barium
    fluoroscopy
  15. gamma camera is used by which imaging science?
    nuclear medicine
  16. "work-horse" used prior to linear accelerators; only produced Gamma Rays; used as a radium substitute and produced in a nuclear reactor
    Cobalt 60
  17. produces photons and electrons (dual energy); can penetrate deeper
    linear accelerator
  18. physician for chemotherapy
    Medical Oncologist
  19. physician for Radiography, Sonography and Nuclear Medicine
    Radiologist
  20. physician for Radiation Therapy
    Radiation Oncologist
  21. very common benign tumor treated with radiation therapy
    pituitary tumor
  22. 3 most important modalities in fight against cancer
    • radiation therapy
    • chemotherapy
    • surgery
  23. built the first electrostatic generator with higher penetration beams
    VandeGraaff
  24. method for measuring radiation developed in 1930 and still used today
    Quimby system
  25. built the first Betatron (Cobalt 60) in 1940 with the ability to provide different types of radiation for patient treatment
    Kerst
  26. radium has a half-life of...
    1626 years
  27. produced during WWII; used for patient treatment during the 1950's; ability to penetrate to deeper depths in tissue; offered skin sparring to reduce reactions to skin
    linear accelerator
  28. first two radiation therapy programs opened in...
    1962
  29. first radiation therapy educational standards established in...
    1967
  30. first examination in radiation therapy to establish credentials was in...
    1964
  31. provides national exam in RT given after graduation; 90 day window
    ARRT
  32. provides license based on ARRT exam sucess
    Department of Health-Radiation Control
  33. ensures quality of the program
    voluntary peer review
    non government grants public recognition
    established educational standards
    initial and subsequent periodic evaluations
    encourages continued quality improvement
    assures acceptable educational quality
    protects students
    Accreditation - JRCERT
  34. dose measured in air
    roentgen
  35. measurment of absorbed dose
    rad
  36. measurement used today in external beam treatment
    • gray (g)
    • centi gray (cGy)
  37. fraction (fx)
    day
  38. any state with a license to practice is an...
    agreement state
  39. agreement states are regulated by the...
    Nuclear Regulatory Commission (NRC)
  40. occurs when a patient goes on "break" without treatments for an extended period of time
    repopulation of the tumor
  41. 3 main reasons a patient would miss treatments
    • sick - NVD (nausea, vomiting, diarrhea)
    • reaction - skin (errythema)
    • blood count decrease
  42. patient undergoing both radiation therapy and chemotherapy
    synergistic effect
  43. major area of concern when blood count levels go below...
    • 2,000 WBC
    • 50,000 platelets
  44. early detection for uterine cervix
    PAP
  45. early detection for prostate cancer
    • PSA (prostate specific antigen)
    • DRE (digital rectal exam)
  46. early detection for breast cancer
    • Mammogram
    • BSE (breast self examination)
  47. if the PSA test is increased, it could be ___________ instead of prostate cancer
    benign prostatic hypertrophy
  48. authority grants an individual who has met predetermined qualifications the authority to use a specific title
    title: R.T.(T)
    yearly renewel (12 CEU per year for FL)
    Certification - ARRT
  49. agency grants permission to work in a specific area after attaining minimal degree pf competency
    most restrictive form of occupational regulation
    certification ensures this
    Licensure - DOH office of radiation
  50. defines role and responsibilities of the radiation therapist
    scope of practice
  51. set of moral principles and standard governing of the conduct of a radiation therapist
    code of ethics
  52. plan radiation treatments and calculate radiation dosage
    dosimetrists
  53. Graduate Radiation Therapists Career Mobility include:
    • Dosimetrist
    • Quality Improvement (quality control)
    • Management/Administration
    • Education
  54. advance the profession of radiation and imaging specialties, maintain high standards of education, enhance quality patient care, further welfare and social economics of all members
    main focus is education
    appoints representatives to ARRT, JRCERT, AAMD, JRCENM
    publishes two journals: Radiologic Technology & Radiation Therapy - monthly publication
    ASRT - American Society of Radiologic Technology
  55. AERS
    Association of Educators in Radiologic Sciences
  56. largest medical group organization
    raise medical education and establish code of ethics
    governed by house of delegates reps from all areas of health care
    high level of contact and lobbying local, state and federal government
    organization for all physicians in US
    AMA - American Medical Association
  57. international "red" journal
    ASTRO - American Society of Therapeutic Radiation Oncologists
  58. involves radiologic physics of ionizing radiation and radiation safety
    medical physics journal published bimonthly
    AAPM - American  Association of Physicists in Medicine
  59. used as a "bone seeker" for bone scans in nuclear medicine
    Tc99
  60. thyroid ablation
    I131
  61. external laser system: 3 points to set up patient - 2 Lats & 1 Sagittal
    computer: beam planning (then sent to dosimetrists)
    DRR - digitally reconstructed radiograph (result of procedure)
    CT
  62. accreditation of school (HCC)
    SACS
  63. accreditation of program (Radiation Therapy)
    JRCERT
  64. examination and certification
    ARRT
  65. state license - needed in FL once ARRT exam is passed
    DOH Office of Radiation Control
  66. in charge of all radiation in US
    (agreement states)
    NRC
  67. accreditation for large health care facilities (directly related to medicare reimbursements)
    Joint Commision
  68. accreditation for smaller health care facilities
    ACR - American College of Radiology
  69. publishes the gray journal
    RSNA
  70. BID patients have a space of at least how many hours between treatments (head and neck)
    6
  71. The ARRT establishes eligibility by these three mechanisms...
    • didactic instruction
    • clinical competency
    • ethics
  72. Standards for an Accredited Educational Program in Radiologic Sciences - JRCERT Standards
    • Mission/Goals, Outcomes and Effectiveness
    • Program Integrity
    • Organization and Administration
    • Curriculum and Academic Practices
    • Resources and Student Services
    • Human Resources
    • Students
    • Radiation Safety
    • Fiscal Responsibility
  73. Radiation Oncology Team
    • Radiation Oncologist - physician
    • Radiation Physicist - quality assurance of equipment; oversees all treatment planning and radiation safety programs and is involved with the clinical physics procedures
    • Dosimetrist - responsible for designing the patient's treatment to accompany the physician's precription
    • Radiation Therapists - performs simulation and treatment; assess the patient's reaction to treatment and general medical condition
    • Nurses
    • Support and Staff members
    • Clerical Staff members
  74. According to the JRCET, curriculum should provide...
    competency based curriculum, integration of theory, clinical practice and professional values
  75. clinicals should provide
    • one to one patient contact
    • communication and critical thinking
    • information and instruction
    • theory and knowledge
    • laboratories
  76. domains of learning
    • cognitive
    • psychmotor
    • affective
  77. This learning requires various levels of thought, knowledge, understanding, reason and judgment
    Cognitive
  78. This learning includes behavior involving physical actions, neuromuscular manipulation, and coordination
    Psychomotor
  79. This learning includes behaviors guided by feelings and emotions that are influenced by individual attitudes, interests, values and beliefs, empathy
    Affective
  80. observation of the successful performance
    competency
  81. confidentiality of health information, this act was passed in 1996 top guarantee patient confidentiality of medical information. This is an ethical standard that MUST be maintained.
    HIPPA or HIPAA - Health Insurance Portability Accountability Act
  82. how the field is set up on the patient
    field arrangement
  83. position preferred for spine
    prone
  84. most common field arrangement
    spine
  85. "simple set-ups" / field arrangements
    • single field
    • 2 field
    • 4 field
    • 3 field
    • conformal
    • IMRT (oblique)
    • oblique at multiple fields at multiple gantry angles
  86. set up that is not as common any more
    single field
  87. set up - paralell apposed (POP)
    AP-PA or Rt. Lat- Lt. Lat or Obliques
    2 field
  88. set up - AP-PA and Rt. Lat-Lt. Lat
    pelvic area common
    4 field
  89. set up - AP/PA/obliques
    AP/lats (Rt. & Lt.)
    nasopharynx tumor
    3 field
  90. set up - 6 fields 
    prostate common
    conformal
  91. IMRT
    intensively moderated radiation therapy
  92. IGRT
    integrated radiation therapy
  93. OBI
    onboard imager
  94. 2nd century 
    wrote extensively about cancer
    result of excessive bile-surgery make it worse "black bile"
    favored systemic approach to tx of tumors, diet modifications, purgatives
    these theories derived from studies of animal anatomy
    Galen
  95. 5th Century
    began the classification of tumors by observation
    Hippocrates
  96. 5th century
    discovery of this made it possible to begin to classify tumors by cellular characteristics
    microscope
  97. 16th century
    refuted Galen's theories on anatomy and opened the door to modern cancer surgery
    Velasius and Harvey
  98. 16th Century
    studied lymphatics and lymph node dissection;
    cancer surgery
    foundations for modern breast surgery
    lymph node excision and skin preservation
    first colostomy rectal carcinoma - 1797
    Malpigi
  99. anesthetic was first used in
    1846
  100. death rates declined due to the identification of clinical superiority of asepsis and benefits of antiseptic agents by...
    Lister
  101. this surgeon began the use of the radical mastectomy that was widely used in the 1970's; he traced metastisis
    Halstead
  102. radical approach to treatment of breast cancer
    based on the belief that cancer spread in an orderly progression
    aggressive local intervention - one step ahead of the disease
    at the time this intervention was the best hope
    mastectomy
  103. unit of absorbed dose, RAD, became the standard unit in radiation therapy in...
    1953
  104. Gray equals 100 rads
    new unit of absorbed dose, replaced the RAD; still used
    1980
  105. Coutard theory of protracted fractionation (breaking up treatments); still used today
    1930
  106. serious problems with skin reactions
    high absorption in bone
    poor dose delivery into deep seated lesions
    complex setups
    severe acute reactions to tx
    superficial (140kVp) / orthovoltage (200-300 kVp)
  107. Cobalt 60 most common tx unit
    capable of delivering high energy beam
    famed reliability; lack of down time
    source of radiation in head of the gantry
    megavoltage
  108. fuzzy edge around the treatment field
    pneumbra
  109. use of chemical compounds to control disease process by suppression or destruction of pathogenic organisms or abnormal cells
    chemotherapy
  110. discovered the first alkylating agent
    Ehrlich
  111. 1st chemotherapy treatment during the 1940's by accident; showed dramatic decrease in white blood cells
    nitrogen mustard
  112. adjunct
    one primary form of treatment accompanying another
  113. drawbacks/side effects to chemotherapy
    • toxicity
    • carcinogenic
    • resistance to other drugs
  114. main ways cancer spreads
    • lymphatics
    • blood
    • direct extension (projections that invade surrounding tissue)
    • seeding
  115. total number of days patient is on tx including weekends
    protracted fractionation
  116. new start
    first day patient is on machine for tx
  117. conventional dose
    200cGy/fx or 180cGy/fx
  118. EPID
    electronic portal image device
  119. 1st group of drugs used to tx Hodgkins disease
    MOPP
  120. current group of drugs used to tx Hodgkins disease
    ABVD
  121. TD 5/5 kidney
    2300
  122. TD 5/5 Spinal Cord
    20cm/4700
  123. TD 5/5 Eye Lens
    1000
  124. TD 5/5 Eye Retina
    4500
  125. TD 5/5 Small intestine (small bowel)
    4000
  126. common metastatic sites
    • whole brain
    • hip
    • extremity
    • spine
  127. identifies ways to eradicate a malignancy by stimulation of host own defenses to repress neoplastic process
    immunotherapy
  128. substances target specific tumor associated antigens in cancer cells
    monoclonal antibodies
  129. when disrupted daughter cells continue to divide it causes
    abnormal cell proliferation
  130. cancer is a disease of the...
    genes
  131. normal genes
    precursors to oncogenes
    can occur through mutations, translocation, gene amplification
    -DNA mutations
    protooncogenes
  132. abnormal cell proliferation
    oncogenes
  133. cancer suppressor genes inactivation allows growth
    antioncogenes
  134. tumors are classified by
    • anatomic site
    • cell of origin
    • biologic behavior
  135. well differentiated, do not metastasize or invade surrounding tissue, are encapsulated and slow growing, do little harm to host but can grow and expand, designated by suffix OMA
    benign
  136. well differentiated to undifferentiated, ability to metastasize, are not encapsulated, invade and destroy surrounding tissue, can cause death if not treated
    malignant
  137. arise from epithelial tissue - tissue that covers a surface or lines a body cavity
    carcinoma
  138. epithelial cells that are glandular are known as
    adenocarcinoma
  139. arise from mesenchymal tissue; connective tissue, cartilage and bone
    sarcoma
  140. NCI
    National Cancer Institute
  141. tumor sensitive to radiation and responds well to radiation therapy
    radiosensitive
  142. tumor doesn't respond well to radiation therapy
    radioresistant
  143. curative dose
    5040 cGy +
  144. palliative dose
    3000 cGy
  145. the study of disease causes
    etiology
  146. the study of disease incidence
    epidemiology
  147. defining the tumor size and extent at the time of diagnosis
    provides a means of communicaiton - same page
    helps determine best treatment
    aids in predicting prognosis
    means for continuing research
    changes with increased knowledge
    tumor staging
  148. common staging system
    TNM system
  149. TNM
    • T: tumor size or extent
    • N: designates the status of lymph nodes and extent of lymph node involvement
    • M: defines the presence and extent of metastasis
  150. staging for GYN cancer
    FIGO
  151. staging for Hodgkins disease
    AnnArbor
  152. gives information about the aggressiveness of the tumor
    based on degree of differentiation
    Grading
  153. treatment given to relieve patient symptoms
    palliative
  154. giving one modality along with another
    (chemo + radiation)
    adjuvant
  155. given before
    (surgery and radiation therapy)
    neoadjuvant
  156. effect of the treatment is enhanced
    (chemo + radiation therapy)
    synergistic effect
  157. vital signs include
    • temperature
    • respiration
    • pulse
    • blood pressure
  158. normal temperature range
    • 97.6-100
    • average oral 98.6
  159. normal respiration for
    adult:
    child:
    • adult:12-20 breaths per minute
    • child: 20-30 breaths per minute
  160. normal pulse for
    adult:
    child:
    • adult: 60-100 beats per minute
    • child: 70-120 beats per minute
  161. normal blood pressure:
    120 mm Hg (systolic) / 80 mm Hg (diastolic)

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