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CSB048 > Head and Neck Lec 3 > Flashcards

Head and Neck Lec 3 Flashcards

1
Q

What are some first day considerations

A
  1. Chemotherapy - timing and the shell fit
  2. Teeth removal
  3. Prophylactic tube insertions NG tube or PEG
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2
Q

What are some of the imaging/s seen for H.N ?

A
  • Cone beam
  • KV
  • MVCT (megavoltage CT) – used in tomo
  • EPI
  • Hard copy film
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3
Q

How has imaging changed in AUS?

A
  • Used to base everything on EPIs in the past
  • Now we have upgraded the linacs we are seeing a lot more KV and volumetric imaging
  • This new imaging has had a significant impact on the H/N field.
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4
Q

Where EPIs are concerned, why would you take an orthogonal image over an oblique set of images?

A
  • because oblique set of images may not give the true translation.
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5
Q

What are the advantages of EPI? (5)

A
  • good soft tissue
  • Easy
  • Fast acquisition
  • Easy storage
  • Makes online correction feasible
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6
Q

What are the disadvantages of EPI? (3)

A
  • Poor image quality
  • Cant see detailed structures
  • Hard to visualise structures.
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7
Q

What is the amor advantage of KV imaging?

A
  • Increased image quality and definition of structures, particularly bony anatomy (which is good for the H/N).
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8
Q

What are the advantages of CBCT for H/N patients?

A
  • allows us to see separation and rotation
  • better patient positioning
  • more effective immobilisation
  • allows us to use new tx techniques
  • allows us to see volumetric tissue comparison.
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9
Q

What affects a CBCT length of image acquisition and quality?

A

-The use of collimation and filters

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10
Q

What type of images are used in tomotherapy?

A

MVCT

  • these images take 2-4 minutes to acquire and mimic a ct scan.
  • dose distribution can be checked via quick calculations which is telling of whether a pt needs a rescan.
  • not as good of quality as KV
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11
Q

What are the 3 domains of isocenter verification

A

1 - software matching methods
2- anatomical match points
3- verification tolerances

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12
Q

What is software matching methods?

A
  • can be very basic e..g using the measurement tool to measure between different anatomical structures
  • may have image overlay/ template matches
  • provides disp. measurement in 3 planes (a/p s/i and l/r)
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13
Q

What are the domains of CBCT matching?

A
  • Soft tissue matching, bony matching and manual tools.

- RO can set a clip box and lock to the most critical area.

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14
Q

What are some of the tools used for CBCT matching

A
  • spy glass
  • checker board
  • image cut
  • image fusion
  • structure overlay on localisation points.
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15
Q

How does the displacement provided differ between CBCT and KV imaging? (what plains)

A 
KV - only 3 plains 
CBCT - 6 cartesian plains 
- ap 
- lr 
- si 
- pitch 
- roll 
- yaw.
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16
Q

What are some match points for H/N

A
  • CV1-2
  • CV 2-5
  • Clivus
17
Q

What is another name for verification tolerance and what does this depend on?

A

Aka. action level.

Depends on;

  • inherent accuracy of the linac
  • conformability of the plan
  • accuracy of the immobilisation equipment
18
Q

What is the action level for H/N treatment?

A
  • usually around 3mm
  • this allows 2mm for the linac tolerance
  • also is achievable using immobilisation devices.
19
Q

What do you do when nothing matches on an image?

A
  • best fit
  • match to the critical points
  • reset the patient.

DONT do nothing

20
Q

What would you do if a shell was spacey and generally not fitting?

A
  • could indicate the need for a re-plan
  • put gel behind the head
  • take an MVCT/ CBCT/ CT to see what effects this will have on the plan.
  • talk to a dietician
  • flag people early
21
Q

What are some of the less common acute side effects?

A
  • reddened patches within the mouth
  • swelling
  • bleeding from gums
  • husky/ raspy voice
  • furry tongue
  • dry cracked lips
22
Q

Advice to patient suffering from a sore mouth? (7)

A
  • Eat soft bland foods
  • Avoid really hot and cold foods
  • brush teeth with a soft tooth brush and mild tp
  • carry a drink bottle
  • rest voice
  • take ‘pink lady’ (zylocane) to numb pain of eating.
  • regular mouth washes using bicarb/salt
23
Q

What would you do if the patient has dysphagia?

A

Notify medical and nursing staff

24
Q

Advice to a patient suffering with a dry mouth and thickened salvia? (6)

A
  • carry a spray bottle
  • drink soda water and rinse mouth with water
  • use dry mouth gel
  • maintain good oral hygiene
  • decrease coffee, alcohol and smoking
  • drink lots of water.
25
Q

What would you advise/ do for a patient who is having trouble with nutritional issues.

A
  • don’t drink alcohol (bc it can further irritate the mouth lining)
  • see a dietician
  • eat protein rich foods to maintain weight
  • may need a nasogastric tube or EPG>
26
Q

What would you advise a patient so they maintain good skincare throughout treatment? (12)

A
  • avoid friction and pat dry
  • do not use sunscreen in the area or makeups/cremes
  • do not use perform/ talc in the area
  • avoid really hot and cold water
  • wash hair with baby shampoo
  • shaving only to be done using an electric razor.
  • avoid sun exposure (wear protective clothing)
  • keep area clean and dry
  • warm water unscented soaps.
  • apply moisturising cream to the area (aqueous)
  • wear loose clothing
  • notify staff of itchy/broken skin
27
Q

What would you advise the pt (in regards to skin care) upon completion of treatment? (5)

A
  • continue gentle skin care
  • wait until full healed to e.g. blade shave again
  • Ros and nursing staff will tend to bad reactions after tx completed
  • need to protect the area from the sun for the rest of life
  • late reactions could mean a thickening of the skin and a change in the pigmentation.
28
Q

What are some side effects that may directly affect tx ?

A
  • Weight loss (dose change, decreases shell immobilisation )
  • Skin reaction (pt may not be able to get into position)
  • General well-being (affects tx compliance)

CSB048 (8 decks)

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