radiation therapy review – Flashcards
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quality factor of xrays, gamma rays, and electons
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1
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quality factor of thermal neutrons
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5
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quality factor of heavy neutrons and alpha
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20
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threshold dose for pair production
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1.022 Mev
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dose for hematopoetic syndrome
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5 Gy death 3-6 weeks
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dose for GI syndrome
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5-20 Gy death 1 week
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dose for CNS syndrome
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100 Gy + death within hours
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dose for prodromal
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1 Gy
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non-stochastic effects
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erythema, temp sterility, epilation, desquamation
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stochastic effects
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cancer, embryologic effects
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most sensitive trimester
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1st
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trimester most likely to develop leukemia
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2nd
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absorbed dose
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Gray
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dose equivalent
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Rem/sv
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exposure
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roentgen
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ionization chambers
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gas filled enclosure containing positive and negative electrodes
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cutie pie
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measures dose in AIR
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geiger mueller detector
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detects radioactive particles (lost seeds, etc)
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TLD
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LiF crystals, heat and light. need to be annealed
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film badges
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Aluminum and copper, collected monthly. temp and humidity cause fogging
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scintillation detector
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Nal, CaF2 crystals. light emission
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OSL
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no annealing. light.
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used for personnel monitoring
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TLD, OSL, film badges
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annual occupational exposure
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50 mSv
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annual occupational exposure lens of eye
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150 mSv
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annual public exposure
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1 mSv
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embryo/fetus exposure (total)
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5 mSv
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embryo/fetus exposure (monthly)
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0.5 mSv
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advisory groups
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ICRP & NCRP
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lifetime exposure
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age x 10mSv
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NRC regulates
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dose limits
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workload (W)
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# of patients per week
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Occupancy (T)
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time an area is occupied
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use factor (U)
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time beam is aimed at particular wall
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energy and which neutrons are a concern
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10 MV
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if a person becomes contaminated by a film processing material you refer to the
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MSDS
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power source that AMPLIFIES
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klystron
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power source that generates
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mangentron
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most common bending magnet
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270 (narrow beam)
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air gap for electron cone
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5 cm
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celcius to farenheit
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C (9/5) + 32
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farenheit to celcius
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(F-32) (5/9)
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how to check jaw symmetry
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mechanical distance indicator
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split-field test
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checks beam alignment. double exposing 2 films at 180 degrees apart
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flatness
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maximum % of variation from average dose across the central 80% of the full width at half maximum of the profile in a plane tranverse to the beam axis
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flatness should be checked at which depths
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10cm and dmax
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x-ray and electron output
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3% daily
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light field coincidence
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2mm or 1% monthly
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gantry angle
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1 degree monthly
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treatment couch
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1 degree or 2mm monthly
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lasers
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2mm daily
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odi
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2mm daily
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door interlock/AV
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daily
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most common interaction in rad therapy
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compton
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inner shell interaction
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photoelectric effect
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energy threshold for pair production
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1.022 MeV (common above 10 MV)
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window width
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the range of CT numbers (in Hounsfield units) included in the gray scale
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window
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shades of grays / ex. changing from lung to brain
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mAs
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beam QUANTITY. directly proportional with density
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kVp
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beam QUALITY = E. inversely proportional with contrast
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pitch
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table increment distance per 360 rotation / slice thickness. 1 = adjacent rotations
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most common sign of lung ca
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hemoptysis
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fluid build up outside of the lungs
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plural effusion
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tumor in superior sulcus (apex) of lung
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pancoast tumor
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disorder of nervous system, contracted pupils, drooping eyelids
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horner's syndrome
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most common benign tumor of breast
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fibroadenoma
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symptoms of layngeal ca
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hoarseness, l'hermittes
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impairment of speech
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dysphasia
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difficulty swallowing
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dyshpagia
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painful swallowing
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odynophagia
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nosebleed
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epistaxis
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deviation of the eyes, sensation similar to electric shock
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l'hermittes
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diameter (skin cancer)
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;6mm
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most common symptom CNS
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headache (AM)
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behavioral and cognitive decline
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frontal lobe
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language deficit
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temporal lobe
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sensory problems
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parietal lobe
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incoordination
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cerebellum
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karnofsky scale measures
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neruologic and functional status
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high risk breast nodal involvement
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;4
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cancers that begin in cells that line internal organs that have glandular (secretory) properties
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adenocarcinomas
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location of parotid
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2.5 inf and 2.5 ant EAM
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part of larynx where true vocal cords are located
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glottis
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forms the cortex, or outer part of cerebrum
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gray matter
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nodal spread lip
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submandibular
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nodal spread buccal mucosa
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submaxillary
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nodal spread tongue
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submaxillary
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nodal spread BOT
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jugolodiagastric
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nodal spread larynx
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jugulodiagastric
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nasopharynx and sinus spread
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jugulodiagastric, retropharyngeal, cervical
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most common met spread to brain is from
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lung
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lung mets to
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bone, brain
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obstruction of bloodflow to SVC
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SVC syndrome
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breast mets to
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bone, brain, lung, liver
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head and neck mets
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lung!! also bone
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most common metastic bone tumors are from
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prostate, lung, breast
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location of bone mets
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proximal femur and humerus, spine
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STS mets to
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lung! bone, brain, liver
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most common type of NSCLC
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adenocarcinoma
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small cell is also called
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oat cell
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squamous nsclc arises
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from metastatic bronchial epithelium, hilum
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adenocarcinoma nsclc arises
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in the periphery of the lung
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breast cancer that does not metastasize
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DCIS
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most common histology bone ca
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osteosarcoma
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most common adult CNS malignancy
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glioblastoma
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most common childhood CNS
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astrocycoma
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tx of choice for lung ca
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surgery
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normal tx dose for lung ca
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4500-5400
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radical mastectomy
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removal of entire breast
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modified radical mastectomy
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removes breast and nodes
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energy and dose for breast ca tx
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6 MV, 4500-5000 boost to 6000
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tx doses for H;n ca
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7000
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OAR for h; n ca
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spinal cord
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hyperfractionation
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reduces size of indivdual fractions
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accelerated fractionation
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individual fractions are increased dose
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tx for bone cancer mets
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strontium 89 (beta emitter)
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STS most common tx
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surgery
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STS rad dose
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5000
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method of removing skin cancer one layer at a time
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mohs technique
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skin ca rad dose
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4800
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tx of choice for brain tumors
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surgery
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gapped fields are used for tx of
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spinal cord
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dose for CNS tumors (not whole brain)
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6000
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radioresistant STS tumor
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fibrosarcoma
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bone tumor in children
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ewing's sarcoma (radiosensitive)
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radioresistant tumor in femur, humerus
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chondrosarcoma
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malignant primary neoplasm of bone marrow
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myeloma
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most bone cancers are
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metastatic
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cutaneous t cell lymphoma
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mycosis fungoides
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abdominal pediatric cancer
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neuroblastoma (ADRENAL)
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most common STS in children
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rhabdosarcoma (mesynchemal cells)
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tumor of kidney in children
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wilm's tumor, dose 2000
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spinal cord ends at
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L2
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normal PSA
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0.4-4 ng/ml
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lymphatic spread of prostate ca
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external and common illiac, PARAORTIC
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dose for prostate ca
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7000-7200
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treatment modalities for prostate ca
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radiation, surgery (TURP), HDR, hormone therapy
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penis and urethra histology
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SCC
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penis nodal spread
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external and internal illiac, inguinal
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bladder ca histology
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transitonal cell ca
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bladder lymph spread
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iliacs
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testicular spread
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lung, liver, sup clav
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testicular dose
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2500
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kidney histology
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transitional cell (RENAL CELL)
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kidney spread
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liver, lung, bone, cns
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removal of kidney only
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partial nephrectomy
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removal of kidney , adrenal, tissue, nodes
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radical nephrectomy
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when patients have polyps, tumors, lipomas, and fibromas
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gardners syndrome
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histology colorectal
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adeno
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colon ca spread
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liver, lungs, brain
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histology anal ca
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SCC
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anal ca spread
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liver, lung
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rectal ca histology
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adeno
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etiology rectal ca
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diet high in fat, polyps
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rectal ca spread
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liver and lung
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upper espohagus histology
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adeno
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lower esophagus histology
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SCC
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pancreatic ca histology
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adeno
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pancreatic ca tx
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whipple procedure
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liver ca spread FROM
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lung, breast, kidney
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vulva histology
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SCC
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staging system for female cancers
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FIGO
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lymphatic spread of cervical ca
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parametrial, paraortic, pelvic
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most common type of femal ca
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endometrial
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histology endometrial
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adeno
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endometrial spread
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iliacs, pelvic, paraortic
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histology of ovarian ca
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EPITHELIAL
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tx for ovarian
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strip field technique
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ovarian spread
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paraortic, inguinal
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virus genome associated with reed sternberg cell
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episten barr
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lymphoma most present in young patient
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hodgkins
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staging for hodgkins
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ann arbor
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B symptoms
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fever, night sweats, weight loss
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A symptoms
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no symptoms
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mantle field
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all lymph nodes above diaphragm
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inverted Y
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iliac nodes, inguinal, paraortic
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which lymphoma spreads predicably?
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hodgkins
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lympoma in adult patients
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NHL
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most common symptoms of HL and NHL
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painless swelling in nodes, neck etc
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tx dose HL
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3000-4000
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most common pediatric malignancy
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ALL
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adult lymphoma
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CLL, AML
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deviation in what gene for CML
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philadelpia chromosome
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diagnostics for leukemia
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CBC
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tx for ALL
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chemotherapy
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pituitary gland location
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2.5 cm sup and 2.5 ant EAM
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tx of choice for adrenal ca
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surgery
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larynx stage 3
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`cord fixation
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cervical stage 3
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involves lower 1/3 of vagina
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hodgkins stage 3
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both sides of diaphragm
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5/5 brain
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4500-6000
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td 5/5 lens
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500
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5/5 fetus death
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500
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5/5 kidney
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1500-2000
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5/5 liver
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3000
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5/5 lung
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1700 whole 3000 partial
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5/5 bladder
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6000 contacture
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5/5 esophagus
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6000 ulceration
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ovary
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200
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cell cycle phases
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Go G1 S G2 M
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therapeutic ratio
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NTTD/TLD
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difference between dose for the probabilty of tumor contol and the dose that minmizes normal tissue damage
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therapeutic ratio
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4 R's
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redistribution, reoxygenation, repair, repopulation
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LDR
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cesium 137
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HDR
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Ir192
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permanent seeds
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au198, i125
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point b is the
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myometrium
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137cs temp seeds used to treat
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cervix
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gross palpable tumor
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GTV
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gross and microscopic disease
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CTV
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volume that includes set up uncertainties
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PTV
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area that receives dose
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TV
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TAR at dmax
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BSF
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BSF equation
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dose at dmax/ dose in air
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BSF depends of
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Energy and field size
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PDD equation
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dose at d / dose at dmax
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TAR equation
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dose @ depth / dose in air
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TMR equation
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dose @ d / dose at dmax
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beam edge is defined at
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50% line
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distance for compensating filters
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20 cm (skin sparing)
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if a beam makes a full 360 its called
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arc therapy
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distance blocks should be from skin
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15 cm
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4MV dmax
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1cm
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8Mv dmax
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2cm
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15MV dmax
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3cm
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if the ODI goes out
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mechanical distance indicator
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daily tx chart should include
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MU, field size, elapsed days, daily dose
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time for BiD
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6 hours
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prescription does not have
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MUs
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kinds of bolus
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wet gauze, superstuff, superflab, water, rice bags
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CNS most important prognostic indicator
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GRADE
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waldeyers ring is in the
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oropharynx
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first node which cancer cells get to
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sentinel node
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chemo for breast
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doxorubicin Adriamycin
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oat cell tumors are always from
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smoking
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bone marrow 5/5
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2500
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early stage bladder cancer surgery
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TURBT
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surgery for testicular cancer
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orchiectomy
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field shape for testicular ca
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"dog leg" includes paraortic and iliac nodes
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early disease surgery for cervical
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TAH
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STS margins
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2-3 cm SPARE A STRIP
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patients bill of rights
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privacy, palliation/ DNR, review medical records, have an advanced directive, obtain information
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a civil injustice or injury
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tort
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written defamation
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libel
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spoken defmation
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slander
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"the thing speaks for itself"
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res ipsa loquitor
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"the master speaks for the servant"
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respondant superior
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dose for cataracts
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500
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dose for desquamation
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3000
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WBC #
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5000-10000. STOP AT 2,000
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RBC
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4-5 million
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platetlets #
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250,000-500,000. stop at 50,000
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pulse
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60-80 bpm
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most common vein for contrast injection
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anticubital vein
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most radiosensitive blood cell
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lymphocytes
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total parenteral nutrition
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IV
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progressive wasting of the body
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marasmus
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severe protein malnutrition
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kwashiorkor (children)
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chest tubes kept to level of
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chest
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urinary bag kept ___ level of patient
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below
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most used contast media
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positive contast agents. high Z
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brain damage takes place in
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3-5 minutes
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most used artery for pulse
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radial
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use of chemicals
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disinfect
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removal of all microorganisms
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sterilization (surgical asepsis)
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most common route of disease transmission
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direct contact
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non living carrier
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fomite
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infected animal
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vector
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airborne contamination (droplet)
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indirect contact
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dose equivalent
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dose (Gy/rem) x QF
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medical event
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total dosage <20%, fraction <50%
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conditions that complicate contrast
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diabetes, bun, creatinine
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size of CT doughnut
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70-80 cm
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4D
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motion gating
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transmission factor
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dose w / dose without
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rapid respiraton and poor air exchange
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COPD
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dose for alopecia
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3000
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mucositis dose
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2000-3000
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xerostomia dose (parotid)
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1800
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fibrosis is a __________ effect
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late
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penumonitis is a ______effect
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early
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long term injury to heart
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pericarditis
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effect of rad on small bowel
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perforation, fistula
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ld 50/30 for humans
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3.5 Gy
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LDR dose rate
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2 Gy/ hr
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HDR dose rate
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>12 Gy/hr
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mag factor equation
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size on film / true size
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to increase contrast you ____ kVp
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lower
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to increase density you ___ mAs
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increase
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to lower contrast you ____ kVp
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increase
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to lower density you ____ mAs
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decrease
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tamoxifen
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breast
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cisplatin
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bladder, lung, ovarian
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doxorubicin
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breast
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5 FU
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breast and pancreas
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cyclophophamide
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radiosensitizer....leukemia, breast
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methotrexate
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radiosensitizer
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paclitaxel
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ovarian and breast
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vinblastine and vincristine
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leukemia, lymphoma, breast
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level =
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light, more black or white
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simple sim
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A single treatment area with either a single port of parallel opposed ports
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intermediate sim
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Three or more converging ports on a single treatment area
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complex sim
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Rotation or arc therapy Highly complex blocking, special wedges or compensators, custom shielding blocks, complex immobilization, complex multi-leaf collimation designs
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stents and bite blocks are examples of
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intermediate devices
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a patient is treated to 2 separate areas what is the charge
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intermediate
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treatment of a spine with no blocks is what charge
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simple
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treatment of an e' scar with no custom insert is what charge
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complex
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why use a midline block for cervical tx?
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block bladder and rectum, boost parametrial nodes
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does the NRC regulate linacs?
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no. they are "man made sources"
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what does the NRC regulate?
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by product materials
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what does a bending magnet bend?
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electrons
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what does the ion chamber monitor?
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output, flatness, symmetry
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a common pre-cancer skin condition
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actinic keratosis
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what does the gleason scale measure?
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differentiation
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alpha, protons, and neutrons have ______ LET
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high
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Dq is the
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quasi threshold dose (shoulder)
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the width of the shoulder represents
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repair
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1Do
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random single hit killing
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Do
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terminal slope (37%)
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OER
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dose without oxygen / dose with
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most common OER
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2-3
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a deterministic effect has a _____ dose
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threshold (Cataracts)
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accelerated fraction total treatment time is _______
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halved
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pre-implantation occurs when
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1st - 10th day
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dysgeusia
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taste changes
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off axis ratio
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accounts for beam flatness - dose at central axis at different depths
