Hats and Scarves 3

Question 1

What are the day 1 considerations for head and neck treatment?

Answer 1

patient understands procedure
possible teeth removal
prophylactic tube insertions (NG tube, PEG)
Effect of chemotherapy timing and shell fit
Claustrophobia

Question 2

What does imaging have to have a balance between?

Answer 2

accuracy and efficiency

Question 3

Why are orthogonal images taken?

Answer 3

generally taken to verify isocentre position (i.e. ant/post and lateral projections)

Question 4

Why would you avoid taking an oblique orthogonal EPI image?

Answer 4

difficult delineation of structures

shadowing

Question 5

What are the advantages of EPI images?

Answer 5

ease of image acquisition
very fast image acquisition 
makes online correction feasible
convenient image storage
good soft tissue imaging

Question 6

What are the problems of EPI images?

Answer 6

image quality
clarity of detailed anatomy
visualisation of structure

Question 7

What are the advantages of kV imaging?

Answer 7

provides the ability to take images that mimic diagnostic images
improved image quality and definition - particularly bony detail
can create CBCT

Question 8

CBCT

Answer 8

filters and collimators effects image quality

full or partial gantry rotation

Question 9

What is Megavoltage computed tomography?

Answer 9

volumetric image produced by Tomotherapy machines
can choose reconstructed slice thickness
2-4 min scan time
images can be used for quick calculation to assess dose distribution differences

Question 10

What are the techniques for isocentre certification?

Answer 10

software matching methods
anatomical match points
verification tolerances

Question 11

What are examples of anatomical match points for head and neck?

Answer 11

cervical vertebrae 1-2
cervical vertebrae 2-5
Clivus 
Chin
Base of skull
Spinous processess
Dens
Vertebrae
Nasal septum
Orbits
Clavicles

Question 12

What is action level?

Answer 12

this is the tolerance at which the displacements indicated on the verification film require action i.e. you need to move the patient to correctly position the isocentre

Question 13

What does the magnitude of this action level depends on a number of factors?

Answer 13

inherent accuracy of linac
accuracy of immobilisation systems
conformality of treatment plan

Question 14

What is the common action level for head and neck cancer?

Answer 14

3mm

accounts for linac tolerance of 2mm and also achievable with immobilisation devices

Question 15

What do you do when nothing matches in an image?

Answer 15

Best fit between structures
match only to point indicated by RO
Re-position patient

Question 16

What are some patient care considerations for sore mouth and throat?

Answer 16

regular mouth washes (salt, bi card soda)
carry a water bottle
eat soft bland foods
avoiding temperature extreme foods/ drinks
brush teeth with a soft toothbrush and mild toothpaste
rest voice
can be given ‘pink lady’ (zylocane) to numb painful throat to assist with eating

Question 17

How to care for dry mouth/ thickened saliva?

Answer 17

drink plenty of fluids
carry a water bottle
use a dry mouth gel
maintain good dental and mouth care
drink some water then rinse mouth out with water
smoking, alcohol and coffee all increase mouth dryness

Question 18

What are the nutritional considerations?

Answer 18

eat protein rich foods (dairy, eggs, legumes, meat) to help maintain weight)
see dietician regularly
alcohol can irritate and dry mouth lining
Patients may require a nasogastric tube or a PEG inserted to increase nutritional intake

Question 19

How can weight loss, skin reaction and general patient wellbeing affect the treatment?

Answer 19

weight loss: dose change, replan, shell not fitting to achieve adequate immobilisation
skin reaction: patient not able to reach or maintain original position
general patient wellbeing: reduction in treatment compliance