Head and Neck Treatment Flashcards
Day 1 Considerations
Patient understanding of procedure
Chemotherapy status
Possible teeth removal
Prophylactic Tube Insertion (NG or PEG)
Claustrophobia, Anxiety (support mechanisms)
Potential Support Mechanisms for Anxious Patients
OT assistance
Breathing techniques
Stress balls
Music
Relaxant medications
Why Verification of isocentre positioning is vital
Maintain accuracy of treatment (minimise dose to NTT, maximise dose to planned targets)
Why is it important to balance accuracy with efficiency?
The longer the imaging process, the more likely the patient is to move from setup position -> result in less accurate treatment
Head and Neck Treatment Imaging
CBCT and kV imaging is most commonly used
Advantages of EPI imaging
Ease of image acquisition
Fast image acquisition
Online correction is feasible
Convenient image storage
Good soft tissue imaging
Disadvantages of EPI
Image quality
Clarity of detailed anatomy
Visualisation of structures
Why are EPIs taken
To verify isocentre position (e.g., ant/post or lateral)
Advantages of kV imaging
Ability to take images that mimic diagnostic images
Better image quality and definition, particularly bony detail, compared to EPI
Advantages of CBCT
Can better estimate patient position
Provides volumetric tissue information
Allows for the rationale of VMAT and IMRT
Can perfrom with full arc or partial arc (dependent on area being treated)
MVCT application in Head and Neck
Volumetric image produced by TomoTherapy
Can choose reconstructed slice thickness
Typical scan time is 2-4 minutes
Different Methods used for Isocentre Verification
Software matching methods
Anatomical match points
verification tolerances
Software matching methods
Involves an overlay image and template matching
Use of measuring tools to measure from different anatomical locations
CBCT image matching
Can use various methods (manual tools, soft tissue matching, bony matching)
Can define areas with a clip box (typically most critical area)
Can use viewing tools (image blending, spy glass, checkerboard, image cut)
Provides displacement in 6 different planes (sup/inf, ant/post, left/right, pitch, roll, yaw)
Anatomical Match Points
RO indicates a match point based on information about the tumour
Useful to know when all anatomical points of interest do not align in relation to one another when matching
Examples: Cervical Vertebrae, Clivus
Appropriate anatomical points to use when image matching
Base of skull
Spinous processes
Dens
Vertebrae
Nasal septum
Orbits
Clavicles
Verification tolerances (action level)
Tolerance at which the displacement indicated requires action (e.g., moving the patient to correctly position the isocentre
For HN, common is 3mm
What to do when nothing matches in the images
No one size fits all
You may go in and re position the patient if necessary, check the setup notes, ask advice of other RTs or RO
Advantages of SGRT for HN
Non-invasive
Doesnt utilise ionising radiation for image capture
Decreases magnitude and errors of translational couch shifts
Improved set up accuracy
Reduction in patient set up time
Common Acute side effects of HN
Lethargy
Nausea and vomiting
Skin reaction (erythema, dry and moist desquamation)
Dysphagia
Mucositis
Altered taste
Altered saliva consistency
Coated, ‘furry’ tongue
Dry, cracked lips
Husky or raspy voice
Reddened patches within the mouth
Swollen tissues
Mouth ulcers
Mouth and throat pain
Bleeding from gums, lips, mouth and throat
Common Late Side Effects
Xerostomia
Radiation caries
Alopecia
Trismus
Second malignancy
Mucosal atrophy
Methods to overcome Sore Mouth and Throat
Regular mouth washes (salt, bi carb soda)
Carry a water bottle (keep mouth moist)
Eat soft, bland foods (avoid spicy and acidic foods)
Avoid eating and drinking anything that is too hot or
cold
Brush teeth with a soft toothbrush and mild toothpaste
Rest your voice as much as possible
Can be given ‘pink lady’ (zylocane) to numb painful
throat to assist with eating
Methods to overcome dysphagia
Notify nursing and medical staff
Methods to overcome dry mouth and thickened saliva
Drink plenty of fluids
Carry a water or spray bottle around to moisten mouth
Use a dry mouth gel
Maintain good dental and mouth care
Drink soda water then rinse mouth out with water
Smoking, alcohol and coffee all increase mouth dryness
Nutritional Issues
Eat protein rich foods (dairy, eggs, legumes, meat) to
help maintain weight
See a dietician regularly (usually organised through the
department)
Alcohol not recommended as it can further irritate and
dry mouth lining
Patients may require a nasogastric tube or a PEG
inserted to increase nutritional intake
Methods to overcome Fatigue
This can be a side effect that surprises patients with how
much it effects them
Important that patients learn to ‘listen to their body’ –
take things easier when they need to
Fatigue can last a lot longer after the completion of
treatment than many patients realise also
Methods to care for skin reactions
Keep skin clean and dry
Gentle bathing with warm water and mild unscented
soap (baby soap)
Avoid very hot or cold water
No talc or deodorant in the treatment area
Wash hair with baby shampoo
Do not rub skin – pat dry with soft towel
Shaving only to be done with electric razor
Apply moisturizing cream to area (aqueous or
something similar)
How can weight loss, skin reactions and patient wellbeing affect treatment
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
