miscellaneous` Flashcards
1
Q
irreversible cell changes
A
cellular death (necrosis) or changes that eventually become lethal to the cell (apoptosis)
2
Q
what is apoptosis
A
programmed cell death
3
Q
extravasation
A
accidental leakage of iv drugs into tissue either through the weak portion of the vein or because the needle punctured vein and infusion goes directly into surrounding tissue or because needle punctures the vein and the infusion goest directly into the surrounding tissue
4
Q
most common cause of tissue damage
A
hypoxia
5
Q
neoplasia definition
A
abnormal process that results in the formation of a neoplasm or tumour
6
Q
4 phases of the dell cycle
A
G1,S,G2,M
7
Q
what part of the cell cycle is radio resistant
A
S Phase, worst part of the cell cycle for XRT to be delivered
8
Q
what part of the cel phase is radiosensitive
A
G2-M phase (Mp hase s when PMAT occurs)
9
Q
free radical definition
A
highly reactive species with unpaired valance shell electron
ex: h2o = H + OH
10
Q
direct ionization
occurs more often with _____
considered ____radiations
A
occurs more often wth densely ionizing XRT (protons alpha particles)
considered high LET XRT
fast electron DIRECTLY ionizes DNA molecule causing damage
11
Q
indirect ionization
occurs more often when _____
A
occurs more often with sparsely ionizing XRT (xreays, gamma rays)
causes damage to the DNA molecule from splitting H20
\
12
Q
RBE
A
relative biologic effectiveness
atio of biological effectiveness of one type of ionizing radiation relative to another, given the same amount of absorbed energy
13
Q
stable abberation examples
A
- result in genetic mix ups leading to mutations but the cell remains viable
ex: translocations and inversion aberrations
14
Q
unstable abberations examples
A
aberrations that kill the cell are unstable aberrations
ex: rings, dicentric,s anaphase bridges
15
Q
most common endpoint for cells response to xrt
A
reproductive failure
16
Q
what is interphase death
A
if death of the cell occurs due to XRT of the G1,G2 and S phase
17
Q
cellular apoptosis has the involvement of what genes
A
P53 and BCL2
18
Q
Most potent radiosensitizer
A
radio sensitizer enhances cells response to XRT
the most potent radio sensitizer is oxygen
19
Q
what is OER
A
oxygen enhancement ratio
it compares the response of cells with radiation in the presence and absence of oxygen
20
Q
what type of cells are considered to be radiosensitive (organs)
A
testes and bone marrow, skin
21
Q
organs that are considered to be radioresistant
A
liver, muscle, brain and spinal cord
22
Q
deterministic effects
A
when tissues have a threshold dose associated with a clinical response
23
Q
phases from radiation syndromes
A
- prodromal phase: symptoms correlate to dose and can be go or neurological or both in nature within hrs of exposure
- latent phase: period where victim has no symptoms of exposure few days -3wks after exposure
- manifest ill stage: effects of exposure are evident and correlate with dose(3-5 wks after exposure)
24
Q
how long does it take for death to occu hemapotic syndromer:
300-500cGy
500-100cgy
A
<300Cgy patient usually recovers in 3-6 dos
300-500cgY PATIENT DIES 4-6 WEEKS
500-1000Cgy occurs within 2 weeks
25
primary causes of death from hemapoteic syndrome
infection and hemorrhaging after destruction of bone marrow
26
at what dose does the GI syndrome occur
1000-10,000cgy
27
mean time to death for GI syndrome
3days-2 weeks
28
what causes the death in GI syndrome
bone marrow image leads to death as a result from infection , dehydration and electrolyte imbalance
29
3 radiation syndromes
hemapoetic syndrome, gastrointestinal syndrome and cerebrovascular syndrome
30
what dose does cerebrovascular syndrome occur at
doses >10,000Cgy
31
how long does it take for death to occur in cerebrovascular syndrome
days
32
what symptoms occur in the prodromal stage of cerebrovascular syndrome
nervousness, confusion, n&v, loss of consciousness and a burning sensation of the skin
33
what symptoms occur in the manifest illness stage of cerebrovascular syndrome
watery duahrrea, convulsions, coma and death
34
stage of gestation and effects of XRT
STAGE GROWTH RETARDATION /MENTAL RETARDATION
preimplantation none none
organogenesis temp v. high risk
fetal perm high risk
35
previous XRT can cause hat types of cancer
skin cancer, leukaemia, osteosarcoma, lung, breast and thyroid cancer
36
what type of leukemias does XRT not cause
CLL
37
4 R'S OF RADIOBIOLOGY
1. repopulation
2. redistribution
3. Repir
4. reoxygenation
38
hyperfractination and hypo fractionation
hyper: are radiation treatments given BID or TID
hypo: use of dose fractions that are higher than the typical fractionation dose of 2Gy
39
what does TD5/5 stand for
dose required for a minimal (5%) complication rate over 5 years
40
BED
biological effective dose
is a measure of the true biological dose delivered by a particular combination of dose per fraction and total dose to a particular tissue characterized by a specific α/β ratio
41
WHATS A SIGN VS A SYMPTOM
sign is an object of finding that can be seen by an examiner
a symptom is subjective indication of a disease or change in condition as perceived by a patient
42
paraneoplastci syndrome
collection of symptoms that result from substances or hormones produced by the tumour
43
normal temperature
| oral ,rectal and axillary temperature acquisition methods
oral: 96.8-98.6F = 36-37 c
rectal: 99.6F (37,5C)
axillary: 97.6 F (36.4C)
44
normal range for pulse
60-100 bpm
45
normal range for respirations
12-18 breaths/ min
46
normal blood pressure values
systolic: 90-140mm Hg
diastolic: 60-80 mmHg
47
where is blood pressure taken (what artery?)
brachial artery
48
how much should the cuff be inflated by when taking blood presure
to 180-200 mmHg or around 30 mmHg above the point where the pulse dissapears
49
what tool takes blood pressure
sphygmomanometer
50
what is systolic vs diastolic pressure in terms of what is happen with the heart
systolic is when pressure in the blood vessels when the heart contracts
diastolic pressure is when is pressure in the blood vessels when the heart relaxes
51
sensitivity vs specificity
sensitivity: ability of a test to give a true positive result
specificity: ability of the test to get a true negative result
52
4 factors observed during the taking of the pulse
rate, rhythm, size and tension
53
US uses _____ frequency sound waves
high
54
ionizing radiation and MRI
unlike other diagnostic imaging MRI does NOT use ionizing radiation
55
MRI is better for imaging _____ and CT is much better for imaging ______
MRI : soft tissue
| CT: bone
56
normal range for WBC
5,000-10,000MM 3
57
Normal range for RBC
3.9-5.4 million mm3
58
normal range for hemoglobin
12-16g/dL
59
normal hematocrit levels
37-47%
60
normal neutrophil levels
42-72%
61
normal platelet levels
150,000-425,000mm3
62
basophil normal lvls
0-2%
63
normal eosinophil levels
0-4%
64
normal monocytwe levels
3-10%
65
normal lymphocyte levels
17-45%
66
exfoliative cytology means collecting tissue by:
a. needle Bx
b. scraping cells
c. incisional biopsy
d. excisional biopsy
B
67
cathode of a treatment machine
source of electrons - side of the X-ray tube
68
anode of a treatment machine
target that the electrons from the cathode hit + portion of the X-ray tube
69
parts of the cathode
filament and focusing cup
70
what is the filament made of usually
tungsten
71
what charge does the focusing cup have
-
72
what is the focusing cup
small oval depression embedded in the cathode, it helps direct e towards the anode in a straighter path
73
focal spot
part of the anode that the electrons from the cathode hit
| x-ray photons are produced and begin to fan out divergently from here
74
thermpoionic emission
heat and the release of ions
75
radiwaves occur between what wavelength and frequency
wavelength of 10 exp 0 - 10 exp 6
| frequency between 10 exp2 - 10 exp 8
76
microwaves occur between what wavelength and frequency
wavelength 10 exp -1 - 10 exp -4
| frequency 10 exp 9- 10 exp 12
77
infrared occur between what wavelength and frequency
wavelength 10 exp -5 - 10 exp -6
| frequency 10 exp 13- 10 exp 14
78
visible light occurs at what wavelength and frequency
w l 10 exp -6.5
| fq 10 exp 14.5
79
UV light occurs at what fq and wl
wl 10 exp -7 - 10 exp -9
| fq 10 exp 15- 10 exp 17
80
gamma x rays occurs at what fq and WL
WL - 10 exp -9 - 10 exp -16
| FQ 10 exp 17- 10 exp 24
81
what % of target interaction is bremstralungh
75-80% target interaction is bremstralungh
82
WL and FQ of XRAY IMAGING
WL 10 exp -10 - 10 exp -11
| FQ 10 exp 18 - 10 exp 19
83
MR imagine frequency and WL
WL 10 exp 0 - 10 exp2
| FQ 10 exp 6- 10 exp 8
84
characteristic XRT
Created by direct interaction of cathode electrons with inner shell electrons of target material
85
principal and secondary interaction in X-ray production
```
principal = bremstralung
secondary = characteristic radiation
```
86
ionization events in the ___ or ___ shell of tungsten ago do NOT produce characteristic X-rays
o an p shell
87
3 interactions in the diagnostic range
compton
coherent/ unmodified scattering
photoelectric effect
88
predominant interaction of the therapeutic range
compton
89
what is comtpon scattering
freed electron travels a very short distance before attaching to another atom
90
coherent scattering occurs at what energy levels
low energy levels <10kEV
91
COHERENT SCATTERING DEFINITION
results in a change in the incident photons direction but no change in energy there is not enough energy to eject an electron from its orbit t
92
what interaction has the capacity to produce a useful image on CT detectors
photoelectric effect
93
photoelectric effect definition
occurs when the incident photon penetrates deep into the atom and ejects inner shell electron from orbit
94
the more _____ in the nucleus of the atom the more likely an incident photon will be absorbed through photoelectric effect
protons
95
what interaction is responsible for radioactive contrast
photoelectric
96
which interaction results in the ejection of a k shell electrob
photoelectri
97
density in terms of imaging
is the darkness of the i,age
98
the relationship between distance and density follows ____
ISL
99
```
EFFECTIVE ATOMIC NUMBER OF :
FAT
SOFT TISUE
LUNG
BONE
```
6. 3
7. 4
7. 4
13. 8
100
T1 and T2 of MRI
T1- longitudinal relaxation time
| T2- transverse relaxation tie
101
what agent is used in PET imaging
FDG 18
102
SSD of orthovoltage
59cm
103
what is the purpose of the accelerating wave guide
allows electrons produced from the cathode to gain energy until they exit the far end of the accelerator structure
104
4 major components that are found in the drive stand
klystron, waveguide, circulator and cooling system
105
klystron definition
provides microwave power to accelerate electrons
106
electron gun definition
produces electrons and injects them into the accelerator structure
107
steps for XRAY PRODUCTION (1-9)
1. klystron tube generates microwaves
2. wave guide carries microwaves from klystron to accelerator guide
3. electron gun injects electrons into accelerator
4. accelorator guide accelerates electrons in a straight path
5. beam of electrons is accelerated
6. magnet causes beam to turn to 270 degreed
7. electrons hits the target (if target is removed electron beam is used)
8. collimators shape X-ray beam
9. xray beam is directed to treat patient
108
what part of the treatment machine shapes the beam
a beam flattning filter
109
whats a scattering foil
used in electron mode broadens the pencil like electron beam an produces a flat field across the treatment field
110
dynamic wedge
aka virtual wedge is used for computerized shaping of the treatment field it is located below the ion chamber and above MLCs it is in 15,30,45 and 60 degreed
111
what are infections in the health care setting called?
nosocomial infections
112
5 transmission routes for infections
```
contact
droplet
common vehicle
airborne
vector borne
```
113
2 types of contactspread
direct and indirect
114
direct spread and ex
host makes contact with source of infection
| ex: mononucleosi and AIDS
115
Indirect spread and ex
object is contaminated from contact with infectious agent and them comes into contact with an infectious agent and then comes in contact and infects another individual
ex: HCW gets a needlestik infected with HIV
116
what is droplet contact and ex
fast transmission of infectious agents through the air over short distances <3ft when someone coughs, sneezes close to someone else. droplets are large >5um
ex: rubella, flu, colds
117
common vehicle and ex
contains a contaminated intimate object called a formite (ex: food, water, medication, equipment) for transmission of infectious agent to multiple people e
ex: blood contaminated with HIV or HBV that was spread to multiple ppl before the invention of screening tests
118
airborne transmission
spread that involves an infectious agent disseminated through the air over a large distance >6ft they are smaller than 5um (remainder of droplet) and they remain in the air longer
exTB, varicella,
119
vector borne and ex
involves a vector that transports an infectious agent to a host
ex: fly that transports an infectious agent on its body or legs and passes it onto a human ex: malaria in mosquitos
ex: malaria, lyme disease, rocky mountain spotted fever
120
dose alopecia
2000cGy
121
what dose do mouth changes occur at
2000-3000cGy
122
what dose does pharyngitis occur at
2000-3000cGy
123
what does does laryngitis occur at
4000cGy
124
significant vs severe weight loss for 1,3,6 mos
time significant wt loss severe wt loss
1 mo 5% >5%
3 mo 7.5% >7.5%
6 mo 10% >10%
125
dose N&V
1000-2000CGY
126
Dose diahrea / colic
2000-5000cGy
127
dose cystitis
3000-4000cGy
128
what is myelosupression
reduction in bone marrow function
129
what is anemia
decrease in peripheral red blood cell count
130
leukopenia what is it
decrease in white blood cell count
131
what is thrombocytopenia
decrease in the # of circulating platelets
132
the way that drugs affect the body is ____.
pharmacodynamics
133
the way that drugs travel through the body to their receptor site is _____.
pharmokinetics
134
what is an idiosyncratic effect
inexplicable and unpredictable symptoms caused by a genetic defect in the patient
135
iatrogenic disease
this disease results from long term use of a drug that damages organs or causes other diseases with time
136
six rights of medication administration
1. right medication
2. right dose
3. right patient
4. right time
5. right route
6. right documentation
137
code white is used for _____situations
violent
138
4 core values of patient and family centred care
1. respect
2. human dignity
3. patients as leaders
4. collaboration
139
what type of abuse needs to be / does not legally need to be reported
child abuse does need to be reported legally
| elder and spousal abuse does NOT need to be reported legally
140
what percent of infections in hospitals are preventable and caused by poor patient care practices:ex: poor hand washing
30-50%
141
5 moments for hand hygeine
1. before touching a pt
2. before clean, aseptic procedure
3. after body fluid exposure
4. after touching a paient
5. after touching patient surroundings
142
what diseases require airborne precautions and what PPE is used
diseases: MMR
Varicella
TB
PPE: N95
Surgical mask for HCP without N95 and for patients
limit movement and transport of these patients
keep room doors closed and instruct its to be cognizant of their coughing
143
what diseases require contact precautions and what PPE is used
```
diseases: MRSA, VRE, C.diff.
PPE: strict hand hygiene for all in contact with pt
gloves and gowns
carefully dispose of gloves and gowns
clean equipment in contact with pt
```
144
droplet precautions PPE and diseases
diseases: Flu, meningitis, whooping cough
PPE: Surgical mask for pt, HCP and those in contact with pt
gloves and gowns
eye protection when you are close to pt 1-2m away
limit mvmnt and transport of pts
145
when is breastfeeding not recommended during the course of cancer treatments
not during chemo, safe after art AND RECEIVING CONTRAST
146
What dose is considered safe (Gy) for a fetus to receive
<50mGy
147
there has been noted failures in pacemakers that have received a dose of ___Gy
15
148
what photon energy would be given to reduce the risk of damage to the pacemaker
10Mv
149
whats the recmonded accumulated dose to a pacemaer
2Gy
150
what government bodkin canada recommends dose limits for nuclear energy workers
CNSC Canadian nuclear safety commission
151
CNSCdose recommendations for NEW
100mSV/5 years with an absolute maximum off 50msv/year with an average of 20mSV/YR
cumulative lifetime dose s/b 10mSV x age
152
MRT's likely to receive 1/_ of recommended ICRP dose should wear a dosimeter to measure XRT exposire
1/20th
153
ICRP dose reccomendation
(international commission on radiation protection with health canada through safety code 35 recommend 20mSV/yr whole body exposure
154
pregnancy radiation doses
whole body effective dose is 4mSVfrom beginning trend of pregnancy
after pregnancy is declared the surface of the abdomen should not exceed 2mSV using the entire pregnancy
155
BACK acronym
```
mnemonic that encourages nest patient handling practices:
B-back straight
A-avoid twisting
C-close to your body
K-keep smooth
```
156
radipaqie vs radiolucent contrast
radiopaque is + contrast media, high atomic #, absorbs X-rays and appears white on film
radiolucent is - contrast media, low atomic #, easily penetrated by X-rays
157
barium sulphate as contrast media usafe
for GI cancers and can be administered rectify off orally
158
ionic vs nonionic contrast and their corresponding osmoalities
ionic contrast has high osmolality (molecules split into 2 particles (one with + one with - charge) chemical structure causes fluids to be pulled from the cells causes fluid imbalance in the body
nonionic contrast has low osmolality (iodides remain intact (more $$$ than ionic contrast reserved for its with allergies)
159
normal BUN and creatinine levels if levels are out of this rage what does this indicate?
BUN (blood urea nitrogen)
7-20mg/ul
creatinine: .6-1.4 mg/dl
if the levels are outside this it indicates the kidney function cannot excrete effectively and the patient should not receive IV contrast media
160
what medication could a patient be tasking that should not be taking when administering IV contrast
metformin antihyperglycemic agent and it is given to patients with type 2 diabetes myelitispatients should not take this medication 48 hours before the administration of IV contrast
161
mild reactions to contrast media
nausea vomiting and retching no treatment is required
162
severe reactions to contrast media
syncope, convulsions, pulmonary edema, caduca arythmeias, cardiac or respiratory arrest
163
types of parenteral drug administration (4)
```
parenteral drug administration means the drug bypasses the GI system
1.intradermal
2.subcutaneous
3.intramuscular
4/intravenous
```
164
what should water level and tolerance be for LINAC
72+/- 2psi
165
what should water temperature be for LINAC and tolerance
40 C +/- 3 C
166
dielectric SF6 pressure and tolerance of LINAC
32+/- 2 psi
167
tolerance of crosshairs
2mm
168
dose rate tolerance for electrons, photons and VMAT
electrons: 400 +/- 20
PHOTONS: 400 +/- 10
VMAT 400+/- 15
169
MU AND DEGREES TOLERANCE for QA`
.10Mu
| .5 degrees
170
tolerance for the profiler
2mm tolerance
171
tolerance or penta guide QA
2mm
172
SI unit for activity
Bq
173
sources of natural background XRT
cosmic XRT .26mSV/yr
terrestrial XRT .16mSV/yr
internal dose .2mSv
radon gas2mSv
174
what is a TLD
a thermoluminescent dosimeter , it contains a crystal substance that when irradiated has electrons displaced in its crystal lattice contains LiF the dose received is proportional to the damage of the crystal
175
what is an OSL
OPTICALLY STIMULATED LUMINESCENCE DOSIMETER
| it is a relatively new dosimeter they contain crystals but they are read by laser technology
176
what is a geiger muller detector
clicking detector it is a gas filled tube multiplied by a factor of 10 ^6 geiger counters are very sensitive and can detect background XRT, LESS EXPENSIVE THAN ION CHAMBERS they are used to detect contamination they are also used in HDR rooms pulse/ event detector
177
scintillation detectors
do not rely on gasses, crystals are used to detect ionization the most common crystals used is NaI they are very sensitive and is used for nuclear medicine imaging they use a photomultiplier tube used to find missing sources, pulse/ event detector
178
definition of use factor
denoted by U, is the fraction of "beam on" time that the beam is pointed toward the area to be shielded
179
occupancy factor definition
denoted by T is the fraction of time that the space that is shielded is occupied the occupancy factor for controlled areas must always be 1
180
laser localization tolerance on tx machines for nonimrt, imrt and SRS/SBRT
non imrt 2mm
iMRT 1.5cm
SRS/SBRT 1mm
181
ODI at sio tolerance for no imrt, imrt, SRS/
Non-IMRT 2mm
IMRT 2mm
SRS/SBRT 2mm
182
collimator size indicator IMRT., NON-IMRT and SRS/SBRT
non imrt- 2mm
imrt 2mm
SRS/SBRT 1mm
183
action levels in quality assurancre
these levells are set by a medical physicist and
level 1 is inspection of action treatment can continue but deviation should be investigated
level 2 a scheduled action where you can continue treating but the intervention should be scheduled within 1-2 working days
level 3 requires immediate action or corrective action
184
3 functions lymphatic system
1. drain tissues of interstitial fluid, filters it and returns it to the blood stream
2. absorbs fats and transports it to the blood stream,
3. provides body immunity
185
afferent vs efferent lymphatic vessesl
each lymph node contains afferent and efferent lymphatic vessels
afferent has a one way valve bringing lymph into the lymph node
efferent lymphatic vessels facilitates flow away from the lymph node and are much smaller than their afferent counterparts
186
largest lymphatic organ
the spleen
187
function of the spleen
filters blood, removed old RBC's , manufactures lymphocytes (especially B) and stores blood
188
function of the thymus
much larger in children than adults and is the place where mature t lymphocytes mature
189
where do the occipital LN drain to
1-3 of these LN provide efferent flow to superior deep cervical LN
190
what do the retroauricular LN drain
drain scalp auricle and EAM drain towards the superior deep cervical LN
191
deep parotid lN drain what
drain the EAM, nose, eyelid and palate
| drain deep cervical LN
192
what do the buccal LN drain
they drain the eyelid nose and cheeks and they then drain to the submandibular LN
193
what do the submandibular LN drain
n drain scalp, nose cheeks, floor of mouth, ant 2/3 of tongue, gums, teeth,, lips, frontal, maxillary andethmoid sinuses they then drain to the sup deep cervical LN
194
retropharyngeal LN are often involved in what type of tumours
commonly involved in nasopharynx tumours
195
submental LN drain what
drain lips, tongue, floor of mouth skin of chin, they then drain to the submandibular LN
196
what does the jugulodigastric LN drain
drains tonsils and tongue
197
the enlargement of what LN can be indicative of cancer of the tongue
enlargement of the jugulomohyoid LN
198
what LN are most commonly involved in lung cancer
hilar nodes or bronchopulmonary LN
199
drainage of the rt lung
all lobes drain to the intrapulmonary and hilar LN --> carinal LN ----> lt superior tracheal LN ----> brachiocephalic vein through scalene node then rt lymphatic duct
200
drainage of the lt lung
upper lobe drains to pulmonary and hilar ln --> carinal Ln, lt superior paratrachel LN
lower lobe drains to pulmonary and hilar LN ---> right paratracheal LN
201
what muscle extends from the lower 8 ribs
external obliques
202
what muscle runs from the iliac crest tocartilage of the last 4 ribs
l4internal obliques
203
what muscle runs from iliac crest and last 6 rib cartilages to the xiphi
transverse abdominis
204
what muscle is calle the 6 pack
rectus abdominus muscle
205
the 3 main groups of LN in the abdomen
celiac, superior mesenteri LN and inferior mesenteric LN (aka pre aortic LN)
206
celiac lN drain what
stomach, greater momentum, liver, gallbladder, spleen, and most of pancreas and duodenum
207
superior mesenteric LN drain what
head of pancreas, part of the duodenum all of the jejunum, ileum, appendix, scum and most of the transverse process
208
what do the inferior mesenteric LN drain
inferior mesenteric LN aka pre aortic
| drain: descending colon, lt side of mesentery, sigmoid colon and rectum
209
the ____ LN provide efferent drainage of the cisterns chyli
para=aortic ln
210
What do the paraaortic LN drain
drain uterus, ovary, kidneys and testicles
211
the external iliac drain what ?
drain the bladder, prostate, cervix, testes, vag and ovaries
212
what do the internal iliac drain
aka hypogastric lN
| drain: vagina, cervix, prostate and bladder
213
what do the inguinal LN drain
drain vulva, uterus, ovaries, vagina
| these lN are often treated with electrons because they are quite superficial
214
if puncture lacrimal is overiradiatedd what is the first sign of this
a) dry eye
b) constantly crying eye
c) cataracts
d) ocular muscle atrophy
B
215
what is the carina
where the trachea bifurcates into 2 bronchi
216
what is EGFR and what is normal EGFR levels
estimated globular filtration rate and ts used to determine if pt can get IV contrast or not if the level is <60 the pt will get a decreased amount of EBFR
217
What is the treatment for urticaria reaction during contrast
(rash)
1. discontinue injection
2. usually no treatment is required
3. if medication required 1st .give benadryl
4. if severe give alpha agonist
5. epinepherine can also be given if there is no cardiac contraindications
218
treatment for laryngeal or facial edema as a result from contrast reaction
1. give alpha agonist epinephrine (epheneheritne if hypotension accompanies edema)
2. give O2
219
treatment for bronchospasm as a result from contrast reaction
1. give O2
| 2. give beta agonist inhalers if patient is unresponsive giveepinepherine
220
what % O2 should a CPR team be called
88%
221
treatment for hypotension with tachycardia
Tachycardia (too fast heart rate)
1. elevate its legs by 60 degrees or more or in trendelenburg position
2. monitor EKG, pulse oximeter and BP
3. rapid IV of saline
4. if pt is unresponsive inject epinephrine
5. still no response call CPR team
222
treatment for hypotension with bradycardia
bradycardia is t low heart rate
1.monitor vital signs
2 place pt with legs at 60 degree off more incline or trendelenburg position
3.secure airway and give O2
4.administer IV of line
5.give atropine , if pt does not respond repeat steps 2-4
6use phentolamine for pheochromocytoma (benign tumour of the adrenal gland
223
treatment for severe hypertension
1. give 0]o2
2. MONITOR ekg, pulse oximiter and Bp
3. give nitroglycerin
4. if no response consider labetalol (beta blocker)
5. transfer to ICU or emerge
6. give phentolamine if pt has pheochromocytoma
224
treatment for seizures/ convulsions
1. give O2
2. consider diazepam (valium) through IV
3. if longer effect needed consult RO consider phenytoin (dilantin)
4. carefully administer vital signs
5. consider CPR team for intubation if required
225
treatment for pulmonary edema
1. elevate ptr torso
2. give O2
3. give diuretics
4. consider morphine
5. transfer to ICYU or emerge
226
how long before CT for brain should IV contrast be given
10-30 mins
227
how long before CT should lung head and neck contrast be given
seconds before scan
228
What is the Mayord factor
it is the inverse square correction of the PDD
229
low z number materials have ___electron density
greater
230
what needs to be removed from the linear accelerator to produce electrons
removal of the target and flattening filter
| also the electron gun current needs to be decreased
231
what are data rays
are electrons scattered with enough energy to cause further ionizations and excitations in other atoms
232
what part off the linac does the electron beam emerge from
from the accelerator guide at a point called the accelerator window
233
2 methods for widening a pencil beam
may be widened for clinicL USE of a scattering foil and a scanning electron beam which widens a pencil beam of electrons to a usable size
234
scattering foils
thin sheet of high z material placed in the pencil beam of ELECTRONS the first foil is used to widen the beam
a second scattering foil may be used to improve the flatness of the beam
235
where is the scatteri3ng foil mounted
mounted on a carousel to allow for easy switch from photos to electrons easily
236
scanning beams
a second way of making election beams wide enough for clinical use this constantly scanning pencil beam evenly distributes the dose through the field this is especially useful when the energy is >25mEV
237
pros and cons of scattering foils
pros: easy and reliable method of creating wide, usable beams when comparing to the scanning electron method
cons: production of bremstralungh contamination by electron beams interaction with the scattering foil
238
practical range for electrons
practical range = MeV/ 2
239
does dose drop off in electrons reach 0 ? why or why not?
dose NOT reach 0 due to bremstralungh interactions
240
what is the depth of the 80% iso line in cm of tissue in the electron e setting
80% iso dose = MeV/ 3
241
what is the depth of the 90% iisodose line in cm of tissue in electron setting
90% iso dose = MeV/4
242
partial bolus should never be used in ____applications
electron
243
hat is edge effect in electrons
use of a large bolus with an edge perpendicular to the surface cross the portion of a treatment field areas of increased and decreased dose of 20-30% may be produced areas of increased and decreased dose of 20-30% can result
244
IRS for bolus in electron beams
I-incrwase surface dose
R-remive surface irregularities
S-shape iso dose contours at depth
245
shielding thickness for elections equation
shielding thickness =
| MeV/2 = shielded thickness in mm of Pb
246
what type of material should be used to shield from electrons in internal eye shields
low z material
247
main interaction in electrons from 1-20Mev
collisional interactions
