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Residency > Intro To Treatment Process > Flashcards

Intro To Treatment Process Flashcards

1
Q

What are some factors in predicting a patient’s prognosis

A 
Tx Site
Prior Tx
Critical Structures
Current Health
Age
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2
Q

How to MDs conclude to treatment dose and fractionation for different sites?

A

RTOG Reports as well as their own judgement

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3
Q

Common Patient positioning and immobilization devices for CT-SIM

A 
Q-Fix
S-Frame
Wing Board
Alpha Cradle/Vac Lock
Masks
Breast Board
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4
Q

MD Consult Workflow Process

A

Patient Referred to RadOnc by Primary Care Physician
Pathology/Diagnostic PET/CT & MRI Done + Possible Surgery
MD reviews patients scans and history and determines Tx Plan
MD will ask family support/workload/housing/travel
Side Effects of Tx/Patient Questions are addressed/Answers questions in Layman’s terms
Decides of Patient is a Candidate for Radiation Tx
If Candidate: CT SIM appointment and MRI scheduled
if NOT Candidate: refer the patient to a surgeon or medical oncologist.

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5
Q

Patient Rad Onc Workflow from Consult to Tx

A 
Referred to RadOnc
Consult with MD
MRI
CT SIM: Setup for Treatment with devices
Therapist sends images to MIM for Dosimetry
Dosimetrist plans tx
MD and Physics plan approval
Physics QA if necessary 
Dry Run
Tx (MD verifies shifts before tx, Physics present for SRS/1st fx SBRT/SRT)
Patient sees MD weekly for OTV
Physics performs weekly chart checks
Therapists perform weekly chart checks
Patient sees MD after last Tx
Physics performs post tx check
Patient has follow up with MD ~12 weeks later
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6
Q

Q-Fix Board

A

used with SRS thermoplastic masks

3-4 mm positioning accuracy

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7
Q

S-Frame

A

HN Masks

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8
Q

Vac Lock / Alpha Cradle

A

Abdomen, Chest, Pelvis

5-9mm positioning accuracy

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9
Q

Wing Board

A

Arms Up

Lung IMRT

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10
Q

Which knee sponge is indexable

A

Red is indexable (SBRT)

Blue is not

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11
Q

Accuform

A

Molded pillow for HN mask/IMRT whole brain

spray with H2O to set

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12
Q

Bellows Device

A

4DCT
Measures respiration cycle to determine need for compression
Liver, Lung, Abdomen

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13
Q

CT Headrest Range

A

A-F

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14
Q

Interfraction vs. Intrafraction

A 
Interfraction = daily setup errors
Intrafraction = patient motion during treatment
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15
Q

SRS Masks

A

Have Front and Back (HN do not have back)

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16
Q

Purpose of TG-119

A

Quantifying the overall performance of an IMRT system and determining reasonable confidence limits

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17
Q

Confidence Limit Equation

A

CL = | mean deviation | + 1.96(SD)

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18
Q

Chamber Measurements Requirements TG119

A

0.125 cm^3 scanning chamber

Measurements in target and avoidance region

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19
Q

Composite Film Measurements Requirements TG119

A

Film placed in coronal plane

analyzed using gamma criteria of 3%, 3mm, 10% threshold

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20
Q

Phantom Selection of TG119

A

Water equiv slabs 15-20 cm thick and 20-30 cm wide

Chamber insert 10cm depth

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21
Q

Tests of TG 119

A

Preliminary: AP/PA, Bands

  1. Complex Multi-Target
  2. Complex Mock Prostate
  3. Complex Mock Head/Neck
  4. Complex C-Shape 1
  5. Complex C-Shape 2
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22
Q

TG119: Preliminary AP/PA Test

A

Parallel Opposed Plan
10x10 field
200 cGy to iso

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23
Q

TG119: Preliminary Bands Test

A

5 bands, 3cm wide

Doses vary per band (40,80,120,160,200 cGy)

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24
Q

TG119: Complex Multi Target Test

A

3 cylinders along axis of rotation (4cm length and diameter)
6MV beams
7 fields at varying angles

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25
Q

TG119: Complex Multi Target Test

A

3 cylinders along axis of rotation (4cm length and diameter)
6MV beams
7 fields at varying angles

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26
Q

T119: Complex Mock Prostate Test

A

7 Fields
50 degree increments
Bladder, Prostate, Rectum

27
Q

TG119: Mock HN Plan

A

9 fields
40 degree increments
Protids, PTV, and Spinal Cord

28
Q

TG119: Complex C Shape 1 Test

A

9 fields
40 degree increments
PTV and avoidance structure (2cm diameter) 50% target dose

29
Q

TG119: Complex C Shape 2 Test

A

9 Fields
40 degree increments
PTV and avoidance structure (2 cm diameter, 20% target dose)

30
Q

MapCheck 2 Sensitivity

A

32 nC/Gy

31
Q

MapCheck Effective Energy Range

A

Co-60 to 25 MV

32
Q

MapCheck # Detectors

A

1527 diodes

33
Q

MapCheck Diode Depth

A

1.2 cm below PMMA surface

34
Q

MapCheck Use

A

Capable of absolute dose measurement with calibration to known dose
More accurate measurements in high gradient areas due to small diodes

35
Q

ArcCheck Sensitivity

A

32 nC/Gy

36
Q

ArcCheck # Detectors

A

`1386 diodes

37
Q

ArcCheck detector array size

A

21 cm length

38
Q

ArcCheck diode depth

A

2.9 cm from surface

39
Q

TG 275 Purpose

A

Provide recommendations on Physics Plan and Chart Reviews

40
Q

Physics Reimbursement Charge

A

77336

41
Q

TG 120 Purpose

A

Dosimetry tools and techniques for IMRT

42
Q

Intracranial lesion dose and fractionation

A

~2000 cGy per 1-5 fx

43
Q

HN dose and fractionation

A

4000-7000 cGy per ~30 fx

44
Q

Breast dose and fractionation

A

4500 cGy per 15-16 fx

45
Q

Lung dose and fractionation (IMRT)

A

6000 cGy per 30 fx

46
Q

Lung dose and fractionation (SBRT)

A

1000 cGy per 5 fx

47
Q

Liver dose and fractionation (SBRT)

A

5000 cGy per 5 fx

48
Q

Prostate dose and fractionation

A

5000-6000 cGy per 28 fx

49
Q

Spinal Cord contour margin

A

1.2 cm circle with 5mm expansion

50
Q

Typical CT Pitch

A

0.059

51
Q

4DCT Time Limit

A

120 seconds

52
Q

CT Mask making time and temperature

A

165 degrees F for 7 minutes

53
Q

CT SIM FOV

A

600 FOV

54
Q

CT SIM FOV Brain Protocol

A

400 FOV

55
Q

DQA3 Purpose

A

Measures and Verifies daily output and beam characteristics

56
Q

DQA3 Chamber Specs

A

13 ion chambers for absolute dose calibration: 1 CAX, 4 on X-Y axes of 16cm light field, 4 on corners of it (0.3cc) and 4 (0.6cc) on corners of innermost light field.
12 diodes used as penumbra detectors: 3 straddle each 20cm light field line along x and y axis

57
Q

Max Hotspot in Breast

A

107% (105% ideal)

58
Q

IMRT Hotspots

A

105%-108%

59
Q

SBRT Hotspots

A

130% - 150%

60
Q

Difference between CT SIM for therapy vs diagnostic

A 
Couch shape (flat for therapy, rounded for diagnostic)
Patient position (Tx setup for therapy, generic setup for diagnostic)
Lasers (present for therapy, absent for diagnostic)
61
Q

3DCRT

A

Uniform fluence
Fixed Gantry Angle per beam
Forward Planning

62
Q

IMRT

A

non uniform fluence
fixed gantry angle per beam
inverse planning
more treatment time than VMAT

63
Q

VMAT

A

Rotating Gantry
Non Uniform Fluence
Dynamic Arc (simultaneous moving MLC, Gantry, Fluence)
Less Treatment Time than IMRT

Residency (1 decks)

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