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RT Yr 2 Sem 1 > Breast technique > Flashcards

Breast technique Flashcards

1
Q

What are the signs and symptoms of breast cancer? (5)

A
  • Breast lump
  • Axilla lump
  • Change in breast shape or size
  • Skin changes
  • Nipple changes
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2
Q

What are the main skin changes to indicate breast cancer? (3)

A
  • Dimpled or puckered also known as peau d’orange
  • Redness, swelling and increased warmth may be a sign of inflammatory breast cancer
  • Itching of the breast or nipple may be a sign of inflammatory breast cancer
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3
Q

What are the factors associated with increased risk of breast cancer? (11)

A
  • being female
  • increasing age
  • personal/family history
  • inherited gene (most common BRCA 1/2)
  • radiation exposure to chest as child or young adult
  • obesity
  • beginning period at a young age
  • beginning menopause at an older age
  • first child at an older age
  • postmenopausal hormone therapy
  • drinking alcohol
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4
Q

What can cause the nipple to invert?

A
  • when the cancer is behind the nipple or areola

- can occur naturally for whole life for less then 1 in 100, but check with doctor

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5
Q

What are the later sign and symptoms of breast cancer? (9)

A
  • bone pain
  • nausea
  • loss of appetite
  • weight loss
  • pleural effusion (cough, dyspnea)
  • headache
  • double vision
  • muscle weakness
  • jaundice
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6
Q

What equipment is used to cheap the patient stable? (5)

A
  • headrest
  • elbow rest
  • arm rest
  • knee support
  • footboard
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7
Q

Why are the arms lifted superioly when in the supine position? (4)

A
  • it lifts breasts superioly, reducing cardiac dose
  • provides symmetry if contralateral breast needs to be irradiated
  • better access to chest area
  • avoid treating through the arms
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8
Q

What is the benefit of having the sternum horizontal/ breast board inclined?

A
  • decreases need for collimater angulation
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9
Q

What can decrease skin folds when treating the SCF field?

A
  • turning the head to the non treatment side
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10
Q

What can be used to decrease folds in the breast tissue?

A
  • breast cast or orfit
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11
Q

What does the breast cast do to the breast?

A
  • brings the lateral an inferior part anterioly from the heart, lung and abdomen
  • better skin reaction in the inframammary fold
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12
Q

What are the scan limits for a breast?

A
  • superioly include chin and neck

- inferioly include all of the ipsilateral lung and 5 cm below breast tissue

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13
Q

Why is it important that the entire lung is scanned?

A
  • for the lung DVH which is used from determining fibrosis and pneumonitis which are late effects from treatment
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14
Q

What are the critical structures for a breast patient?

A
  • heart
  • lung
  • contralateral breast
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15
Q

Why is the whole breast usually treated?

A
  • hard to treat partially due to it being highly mobile and composed of interconnected fatty and glandular tissue
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16
Q

What are the three main nodel regions likely to also need irradiation?

A
  • supraclivicular fossa
  • axilla
  • internal mammary nodes
17
Q

How is the isocentre established?

A
  • setting the bed height or setting an anterior SSD to known chest mark and moving laterally to the affected breast as specified by the moves on the treatment sheet
18
Q

Where is the isocentre usually placed for a breast patient?

A
  • mid-separation (medial/lateral and chest wall/anterior skin surface)
19
Q

Why is a zero jaw used at the inferior edge?

A
  • to reduce beam divergence into lung
20
Q

What are the SCF RT field margins?

A
  • inferior = 2nd costal cartilage
  • medial = 1-2cm off midline
  • lateral = at coracoid process
  • superior = cricoid cartilage
21
Q

What are the prognosis factors associated with SCF node recurrence?

A
  • lymphovascular invasion
  • extracapsular extension
  • the number and level of involved axillary nodes
    NOTE: for patient with 2 or more factors, SCF irradiaion is highly reccomended
22
Q

What can restrict using a monoisocentric technique?

A
  • by field size if the breast is in excess of 20cm may require a divergent field superioly
23
Q

What are the most common electron boost doses?

A
  • 10Gy/5#
  • 14GY/5#
  • 16Gy/10#
24
Q

Why is the applicator for an electron boost bigger then the target volume?

A
  • due to the lateral penumbra of electron beams
25
Q

What is hypofractionation?

A
  • RT in which the total dose of radiation is divided into large doses and treatments are given less than once a day
26
Q

What are the benefits of hypofractionation?

A
  • decreased overall treatment for patient
  • decreased waiting time
  • increased number of patients treated per year
27
Q

What are the criteria for a patient to recieve 42.5Gy/16#?

A
  • breast cancer treated with lumpectomy
  • lymph node negative
  • tumour <5cm (stage 1 or 2)
  • breasts <25cm width
  • no bilateral disease
  • no age limit
28
Q

What are the options for partial breast irradiation?

A
  • brachytherapy - interstitial, intracavity, intraoperative
  • mammosite
  • TARGIT - superficial therapy small distance of dose delivery
  • ELIOT - intraoperative electron beam
  • 3DCRT to partial volumes
29
Q

What are the main ways of verification?

A
  • imbolisation device settings, room lasers, set-up instructions and rendered images
30
Q

What imaging is usually used?

A
  • first 3 fractions and then weekly check-ups which are compared to the images taken at CT
  • 5mm tolerance for isocentre position
31
Q

What are the measurements used to determine image verification?

A
  • CFD: central flash distance
  • CLD: central lung distance
  • ICM: inferior central-axis margin
32
Q

What are the acute side effects of treatment?

A
  • skin changes: erythema, dry desquamation, moist desquamation
33
Q

What are the late side effects of treatment? (8)

A
  • breast odema
  • shrinkage
  • pain and tenderness
  • rib fracture
  • skin telangiectasia
  • symptomatic lung fibrosis
  • cardiac morbidity
  • lymphoedema (if nodes are treated)
34
Q

What are some patient care considerations? (7)

A
  • avoid abrasion when washing
  • use simple soap
  • aqueous cream applied twice daily at least 2hrs before and after treatment
  • 1% hydrocortisone cream for moist desquamation
  • Severe = stopped XRT and atrauman gauze with hydrogel sheet
  • wear loose cotton garments
  • gentle arm exercises

RT Yr 2 Sem 1 (5 decks)

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