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Skin Radiation therapy > miscellaneous` > Flashcards

miscellaneous` Flashcards

1
Q

irreversible cell changes

A 
cellular death (necrosis) 
or changes that eventually become lethal to the cell (apoptosis)
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2
Q

what is apoptosis

A

programmed cell death

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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

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4
Q

most common cause of tissue damage

A

hypoxia

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5
Q

neoplasia definition

A

abnormal process that results in the formation of a neoplasm or tumour

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6
Q

4 phases of the dell cycle

A

G1,S,G2,M

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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

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8
Q

what part of the cel phase is radiosensitive

A

G2-M phase (Mp hase s when PMAT occurs)

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9
Q

free radical definition

A

highly reactive species with unpaired valance shell electron
ex: h2o = H + OH

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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

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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
\

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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

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13
Q

stable abberation examples

A
  • result in genetic mix ups leading to mutations but the cell remains viable
    ex: translocations and inversion aberrations
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14
Q

unstable abberations examples

A

aberrations that kill the cell are unstable aberrations

ex: rings, dicentric,s anaphase bridges

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15
Q

most common endpoint for cells response to xrt

A

reproductive failure

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16
Q

what is interphase death

A

if death of the cell occurs due to XRT of the G1,G2 and S phase

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17
Q

cellular apoptosis has the involvement of what genes

A

P53 and BCL2

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18
Q

Most potent radiosensitizer

A

radio sensitizer enhances cells response to XRT

the most potent radio sensitizer is oxygen

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19
Q

what is OER

A

oxygen enhancement ratio

it compares the response of cells with radiation in the presence and absence of oxygen

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20
Q

what type of cells are considered to be radiosensitive (organs)

A

testes and bone marrow, skin

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21
Q

organs that are considered to be radioresistant

A

liver, muscle, brain and spinal cord

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22
Q

deterministic effects

A

when tissues have a threshold dose associated with a clinical response

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23
Q

phases from radiation syndromes

A
  1. prodromal phase: symptoms correlate to dose and can be go or neurological or both in nature within hrs of exposure
  2. latent phase: period where victim has no symptoms of exposure few days -3wks after exposure
  3. manifest ill stage: effects of exposure are evident and correlate with dose(3-5 wks after exposure)
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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

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25
Q

primary causes of death from hemapoteic syndrome

A

infection and hemorrhaging after destruction of bone marrow

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26
Q

at what dose does the GI syndrome occur

A

1000-10,000cgy

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27
Q

mean time to death for GI syndrome

A

3days-2 weeks

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28
Q

what causes the death in GI syndrome

A

bone marrow image leads to death as a result from infection , dehydration and electrolyte imbalance

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29
Q

3 radiation syndromes

A

hemapoetic syndrome, gastrointestinal syndrome and cerebrovascular syndrome

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30
Q

what dose does cerebrovascular syndrome occur at

A

doses >10,000Cgy

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31
Q

how long does it take for death to occur in cerebrovascular syndrome

A

days

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32
Q

what symptoms occur in the prodromal stage of cerebrovascular syndrome

A

nervousness, confusion, n&v, loss of consciousness and a burning sensation of the skin

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33
Q

what symptoms occur in the manifest illness stage of cerebrovascular syndrome

A

watery duahrrea, convulsions, coma and death

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34
Q

stage of gestation and effects of XRT

A

STAGE GROWTH RETARDATION /MENTAL RETARDATION
preimplantation none none
organogenesis temp v. high risk
fetal perm high risk

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35
Q

previous XRT can cause hat types of cancer

A

skin cancer, leukaemia, osteosarcoma, lung, breast and thyroid cancer

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36
Q

what type of leukemias does XRT not cause

A

CLL

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37
Q

4 R’S OF RADIOBIOLOGY

A
  1. repopulation
  2. redistribution
  3. Repir
  4. reoxygenation
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38
Q

hyperfractination and hypo fractionation

A

hyper: are radiation treatments given BID or TID
hypo: use of dose fractions that are higher than the typical fractionation dose of 2Gy

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39
Q

what does TD5/5 stand for

A

dose required for a minimal (5%) complication rate over 5 years

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40
Q

BED

A

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

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41
Q

WHATS A SIGN VS A SYMPTOM

A

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

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42
Q

paraneoplastci syndrome

A

collection of symptoms that result from substances or hormones produced by the tumour

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43
Q

normal temperature

oral ,rectal and axillary temperature acquisition methods

A

oral: 96.8-98.6F = 36-37 c
rectal: 99.6F (37,5C)
axillary: 97.6 F (36.4C)

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44
Q

normal range for pulse

A

60-100 bpm

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45
Q

normal range for respirations

A

12-18 breaths/ min

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46
Q

normal blood pressure values

A

systolic: 90-140mm Hg
diastolic: 60-80 mmHg

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47
Q

where is blood pressure taken (what artery?)

A

brachial artery

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48
Q

how much should the cuff be inflated by when taking blood presure

A

to 180-200 mmHg or around 30 mmHg above the point where the pulse dissapears

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49
Q

what tool takes blood pressure

A

sphygmomanometer

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50
Q

what is systolic vs diastolic pressure in terms of what is happen with the heart

A

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

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51
Q

sensitivity vs specificity

A

sensitivity: ability of a test to give a true positive result
specificity: ability of the test to get a true negative result

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52
Q

4 factors observed during the taking of the pulse

A

rate, rhythm, size and tension

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53
Q

US uses _____ frequency sound waves

A

high

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54
Q

ionizing radiation and MRI

A

unlike other diagnostic imaging MRI does NOT use ionizing radiation

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55
Q

MRI is better for imaging _____ and CT is much better for imaging ______

A

MRI : soft tissue

CT: bone

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56
Q

normal range for WBC

A

5,000-10,000MM 3

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57
Q

Normal range for RBC

A

3.9-5.4 million mm3

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58
Q

normal range for hemoglobin

A

12-16g/dL

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59
Q

normal hematocrit levels

A

37-47%

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60
Q

normal neutrophil levels

A

42-72%

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61
Q

normal platelet levels

A

150,000-425,000mm3

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62
Q

basophil normal lvls

A

0-2%

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63
Q

normal eosinophil levels

A

0-4%

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64
Q

normal monocytwe levels

A

3-10%

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65
Q

normal lymphocyte levels

A

17-45%

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66
Q

exfoliative cytology means collecting tissue by:

a. needle Bx
b. scraping cells
c. incisional biopsy
d. excisional biopsy

A

B

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67
Q

cathode of a treatment machine

A

source of electrons - side of the X-ray tube

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68
Q

anode of a treatment machine

A

target that the electrons from the cathode hit + portion of the X-ray tube

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69
Q

parts of the cathode

A

filament and focusing cup

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70
Q

what is the filament made of usually

A

tungsten

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71
Q

what charge does the focusing cup have

A

-

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72
Q

what is the focusing cup

A

small oval depression embedded in the cathode, it helps direct e towards the anode in a straighter path

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73
Q

focal spot

A

part of the anode that the electrons from the cathode hit

x-ray photons are produced and begin to fan out divergently from here

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74
Q

thermpoionic emission

A

heat and the release of ions

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75
Q

radiwaves occur between what wavelength and frequency

A

wavelength of 10 exp 0 - 10 exp 6

frequency between 10 exp2 - 10 exp 8

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76
Q

microwaves occur between what wavelength and frequency

A

wavelength 10 exp -1 - 10 exp -4

frequency 10 exp 9- 10 exp 12

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77
Q

infrared occur between what wavelength and frequency

A

wavelength 10 exp -5 - 10 exp -6

frequency 10 exp 13- 10 exp 14

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78
Q

visible light occurs at what wavelength and frequency

A

w l 10 exp -6.5

fq 10 exp 14.5

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79
Q

UV light occurs at what fq and wl

A

wl 10 exp -7 - 10 exp -9

fq 10 exp 15- 10 exp 17

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80
Q

gamma x rays occurs at what fq and WL

A

WL - 10 exp -9 - 10 exp -16

FQ 10 exp 17- 10 exp 24

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81
Q

what % of target interaction is bremstralungh

A

75-80% target interaction is bremstralungh

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82
Q

WL and FQ of XRAY IMAGING

A

WL 10 exp -10 - 10 exp -11

FQ 10 exp 18 - 10 exp 19

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83
Q

MR imagine frequency and WL

A

WL 10 exp 0 - 10 exp2

FQ 10 exp 6- 10 exp 8

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84
Q

characteristic XRT

A

Created by direct interaction of cathode electrons with inner shell electrons of target material

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85
Q

principal and secondary interaction in X-ray production

A 
principal = bremstralung 
secondary = characteristic radiation
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86
Q

ionization events in the ___ or ___ shell of tungsten ago do NOT produce characteristic X-rays

A

o an p shell

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87
Q

3 interactions in the diagnostic range

A

compton
coherent/ unmodified scattering
photoelectric effect

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88
Q

predominant interaction of the therapeutic range

A

compton

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89
Q

what is comtpon scattering

A

freed electron travels a very short distance before attaching to another atom

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90
Q

coherent scattering occurs at what energy levels

A

low energy levels <10kEV

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91
Q

COHERENT SCATTERING DEFINITION

A

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

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92
Q

what interaction has the capacity to produce a useful image on CT detectors

A

photoelectric effect

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93
Q

photoelectric effect definition

A

occurs when the incident photon penetrates deep into the atom and ejects inner shell electron from orbit

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94
Q

the more _____ in the nucleus of the atom the more likely an incident photon will be absorbed through photoelectric effect

A

protons

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95
Q

what interaction is responsible for radioactive contrast

A

photoelectric

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96
Q

which interaction results in the ejection of a k shell electrob

A

photoelectri

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97
Q

density in terms of imaging

A

is the darkness of the i,age

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98
Q

the relationship between distance and density follows ____

A

ISL

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99
Q 
EFFECTIVE ATOMIC NUMBER OF :
FAT
SOFT TISUE
LUNG 
BONE
A
  1. 3
  2. 4
  3. 4
  4. 8
100
Q

T1 and T2 of MRI

A

T1- longitudinal relaxation time

T2- transverse relaxation tie

101
Q

what agent is used in PET imaging

A

FDG 18

102
Q

SSD of orthovoltage

A

59cm

103
Q

what is the purpose of the accelerating wave guide

A

allows electrons produced from the cathode to gain energy until they exit the far end of the accelerator structure

104
Q

4 major components that are found in the drive stand

A

klystron, waveguide, circulator and cooling system

105
Q

klystron definition

A

provides microwave power to accelerate electrons

106
Q

electron gun definition

A

produces electrons and injects them into the accelerator structure

107
Q

steps for XRAY PRODUCTION (1-9)

A
  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
Q

what part of the treatment machine shapes the beam

A

a beam flattning filter

109
Q

whats a scattering foil

A

used in electron mode broadens the pencil like electron beam an produces a flat field across the treatment field

110
Q

dynamic wedge

A

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
Q

what are infections in the health care setting called?

A

nosocomial infections

112
Q

5 transmission routes for infections

A 
contact 
droplet
common vehicle
airborne 
vector borne
113
Q

2 types of contactspread

A

direct and indirect

114
Q

direct spread and ex

A

host makes contact with source of infection

ex: mononucleosi and AIDS

115
Q

Indirect spread and ex

A

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
Q

what is droplet contact and ex

A

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
Q

common vehicle and ex

A

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
Q

airborne transmission

A

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
Q

vector borne and ex

A

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
Q

dose alopecia

A

2000cGy

121
Q

what dose do mouth changes occur at

A

2000-3000cGy

122
Q

what dose does pharyngitis occur at

A

2000-3000cGy

123
Q

what does does laryngitis occur at

A

4000cGy

124
Q

significant vs severe weight loss for 1,3,6 mos

A

time significant wt loss severe wt loss
1 mo 5% >5%
3 mo 7.5% >7.5%
6 mo 10% >10%

125
Q

dose N&V

A

1000-2000CGY

126
Q

Dose diahrea / colic

A

2000-5000cGy

127
Q

dose cystitis

A

3000-4000cGy

128
Q

what is myelosupression

A

reduction in bone marrow function

129
Q

what is anemia

A

decrease in peripheral red blood cell count

130
Q

leukopenia what is it

A

decrease in white blood cell count

131
Q

what is thrombocytopenia

A

decrease in the # of circulating platelets

132
Q

the way that drugs affect the body is ____.

A

pharmacodynamics

133
Q

the way that drugs travel through the body to their receptor site is _____.

A

pharmokinetics

134
Q

what is an idiosyncratic effect

A

inexplicable and unpredictable symptoms caused by a genetic defect in the patient

135
Q

iatrogenic disease

A

this disease results from long term use of a drug that damages organs or causes other diseases with time

136
Q

six rights of medication administration

A
  1. right medication
  2. right dose
  3. right patient
  4. right time
  5. right route
  6. right documentation
137
Q

code white is used for _____situations

A

violent

138
Q

4 core values of patient and family centred care

A
  1. respect
  2. human dignity
  3. patients as leaders
  4. collaboration
139
Q

what type of abuse needs to be / does not legally need to be reported

A

child abuse does need to be reported legally

elder and spousal abuse does NOT need to be reported legally

140
Q

what percent of infections in hospitals are preventable and caused by poor patient care practices:ex: poor hand washing

A

30-50%

141
Q

5 moments for hand hygeine

A
  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
Q

what diseases require airborne precautions and what PPE is used

A

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
Q

what diseases require contact precautions and what PPE is used

A 
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
Q

droplet precautions PPE and diseases

A

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
Q

when is breastfeeding not recommended during the course of cancer treatments

A

not during chemo, safe after art AND RECEIVING CONTRAST

146
Q

What dose is considered safe (Gy) for a fetus to receive

A

<50mGy

147
Q

there has been noted failures in pacemakers that have received a dose of ___Gy

A

15

148
Q

what photon energy would be given to reduce the risk of damage to the pacemaker

A

10Mv

149
Q

whats the recmonded accumulated dose to a pacemaer

A

2Gy

150
Q

what government bodkin canada recommends dose limits for nuclear energy workers

A

CNSC Canadian nuclear safety commission

151
Q

CNSCdose recommendations for NEW

A

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
Q

MRT’s likely to receive 1/_ of recommended ICRP dose should wear a dosimeter to measure XRT exposire

A

1/20th

153
Q

ICRP dose reccomendation

A

(international commission on radiation protection with health canada through safety code 35 recommend 20mSV/yr whole body exposure

154
Q

pregnancy radiation doses

A

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
Q

BACK acronym

A 
mnemonic that encourages nest patient handling practices:
B-back straight
A-avoid twisting
C-close to your body
K-keep smooth
156
Q

radipaqie vs radiolucent contrast

A

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
Q

barium sulphate as contrast media usafe

A

for GI cancers and can be administered rectify off orally

158
Q

ionic vs nonionic contrast and their corresponding osmoalities

A

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
Q

normal BUN and creatinine levels if levels are out of this rage what does this indicate?

A

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
Q

what medication could a patient be tasking that should not be taking when administering IV contrast

A

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
Q

mild reactions to contrast media

A

nausea vomiting and retching no treatment is required

162
Q

severe reactions to contrast media

A

syncope, convulsions, pulmonary edema, caduca arythmeias, cardiac or respiratory arrest

163
Q

types of parenteral drug administration (4)

A 
parenteral drug administration means the drug bypasses the GI system
1.intradermal
2.subcutaneous
3.intramuscular
4/intravenous
164
Q

what should water level and tolerance be for LINAC

A

72+/- 2psi

165
Q

what should water temperature be for LINAC and tolerance

A

40 C +/- 3 C

166
Q

dielectric SF6 pressure and tolerance of LINAC

A

32+/- 2 psi

167
Q

tolerance of crosshairs

A

2mm

168
Q

dose rate tolerance for electrons, photons and VMAT

A

electrons: 400 +/- 20
PHOTONS: 400 +/- 10
VMAT 400+/- 15

169
Q

MU AND DEGREES TOLERANCE for QA`

A

.10Mu

.5 degrees

170
Q

tolerance for the profiler

A

2mm tolerance

171
Q

tolerance or penta guide QA

A

2mm

172
Q

SI unit for activity

A

Bq

173
Q

sources of natural background XRT

A

cosmic XRT .26mSV/yr
terrestrial XRT .16mSV/yr
internal dose .2mSv
radon gas2mSv

174
Q

what is a TLD

A

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
Q

what is an OSL

A

OPTICALLY STIMULATED LUMINESCENCE DOSIMETER

it is a relatively new dosimeter they contain crystals but they are read by laser technology

176
Q

what is a geiger muller detector

A

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
Q

scintillation detectors

A

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
Q

definition of use factor

A

denoted by U, is the fraction of “beam on” time that the beam is pointed toward the area to be shielded

179
Q

occupancy factor definition

A

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
Q

laser localization tolerance on tx machines for nonimrt, imrt and SRS/SBRT

A

non imrt 2mm
iMRT 1.5cm
SRS/SBRT 1mm

181
Q

ODI at sio tolerance for no imrt, imrt, SRS/

A

Non-IMRT 2mm
IMRT 2mm
SRS/SBRT 2mm

182
Q

collimator size indicator IMRT., NON-IMRT and SRS/SBRT

A

non imrt- 2mm
imrt 2mm
SRS/SBRT 1mm

183
Q

action levels in quality assurancre

A

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
Q

3 functions lymphatic system

A
  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
Q

afferent vs efferent lymphatic vessesl

A

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
Q

largest lymphatic organ

A

the spleen

187
Q

function of the spleen

A

filters blood, removed old RBC’s , manufactures lymphocytes (especially B) and stores blood

188
Q

function of the thymus

A

much larger in children than adults and is the place where mature t lymphocytes mature

189
Q

where do the occipital LN drain to

A

1-3 of these LN provide efferent flow to superior deep cervical LN

190
Q

what do the retroauricular LN drain

A

drain scalp auricle and EAM drain towards the superior deep cervical LN

191
Q

deep parotid lN drain what

A

drain the EAM, nose, eyelid and palate

drain deep cervical LN

192
Q

what do the buccal LN drain

A

they drain the eyelid nose and cheeks and they then drain to the submandibular LN

193
Q

what do the submandibular LN drain

A

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
Q

retropharyngeal LN are often involved in what type of tumours

A

commonly involved in nasopharynx tumours

195
Q

submental LN drain what

A

drain lips, tongue, floor of mouth skin of chin, they then drain to the submandibular LN

196
Q

what does the jugulodigastric LN drain

A

drains tonsils and tongue

197
Q

the enlargement of what LN can be indicative of cancer of the tongue

A

enlargement of the jugulomohyoid LN

198
Q

what LN are most commonly involved in lung cancer

A

hilar nodes or bronchopulmonary LN

199
Q

drainage of the rt lung

A

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
Q

drainage of the lt lung

A

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
Q

what muscle extends from the lower 8 ribs

A

external obliques

202
Q

what muscle runs from the iliac crest tocartilage of the last 4 ribs

A

l4internal obliques

203
Q

what muscle runs from iliac crest and last 6 rib cartilages to the xiphi

A

transverse abdominis

204
Q

what muscle is calle the 6 pack

A

rectus abdominus muscle

205
Q

the 3 main groups of LN in the abdomen

A

celiac, superior mesenteri LN and inferior mesenteric LN (aka pre aortic LN)

206
Q

celiac lN drain what

A

stomach, greater momentum, liver, gallbladder, spleen, and most of pancreas and duodenum

207
Q

superior mesenteric LN drain what

A

head of pancreas, part of the duodenum all of the jejunum, ileum, appendix, scum and most of the transverse process

208
Q

what do the inferior mesenteric LN drain

A

inferior mesenteric LN aka pre aortic

drain: descending colon, lt side of mesentery, sigmoid colon and rectum

209
Q

the ____ LN provide efferent drainage of the cisterns chyli

A

para=aortic ln

210
Q

What do the paraaortic LN drain

A

drain uterus, ovary, kidneys and testicles

211
Q

the external iliac drain what ?

A

drain the bladder, prostate, cervix, testes, vag and ovaries

212
Q

what do the internal iliac drain

A

aka hypogastric lN

drain: vagina, cervix, prostate and bladder

213
Q

what do the inguinal LN drain

A

drain vulva, uterus, ovaries, vagina

these lN are often treated with electrons because they are quite superficial

214
Q

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

A

B

215
Q

what is the carina

A

where the trachea bifurcates into 2 bronchi

216
Q

what is EGFR and what is normal EGFR levels

A

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
Q

What is the treatment for urticaria reaction during contrast

A

(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
Q

treatment for laryngeal or facial edema as a result from contrast reaction

A
  1. give alpha agonist epinephrine (epheneheritne if hypotension accompanies edema)
  2. give O2
219
Q

treatment for bronchospasm as a result from contrast reaction

A
  1. give O2

2. give beta agonist inhalers if patient is unresponsive giveepinepherine

220
Q

what % O2 should a CPR team be called

A

88%

221
Q

treatment for hypotension with tachycardia

A

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
Q

treatment for hypotension with bradycardia

A

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
Q

treatment for severe hypertension

A
  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
Q

treatment for seizures/ convulsions

A
  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
Q

treatment for pulmonary edema

A
  1. elevate ptr torso
  2. give O2
  3. give diuretics
  4. consider morphine
  5. transfer to ICYU or emerge
226
Q

how long before CT for brain should IV contrast be given

A

10-30 mins

227
Q

how long before CT should lung head and neck contrast be given

A

seconds before scan

228
Q

What is the Mayord factor

A

it is the inverse square correction of the PDD

229
Q

low z number materials have ___electron density

A

greater

230
Q

what needs to be removed from the linear accelerator to produce electrons

A

removal of the target and flattening filter

also the electron gun current needs to be decreased

231
Q

what are data rays

A

are electrons scattered with enough energy to cause further ionizations and excitations in other atoms

232
Q

what part off the linac does the electron beam emerge from

A

from the accelerator guide at a point called the accelerator window

233
Q

2 methods for widening a pencil beam

A

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
Q

scattering foils

A

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
Q

where is the scatteri3ng foil mounted

A

mounted on a carousel to allow for easy switch from photos to electrons easily

236
Q

scanning beams

A

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
Q

pros and cons of scattering foils

A

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
Q

practical range for electrons

A

practical range = MeV/ 2

239
Q

does dose drop off in electrons reach 0 ? why or why not?

A

dose NOT reach 0 due to bremstralungh interactions

240
Q

what is the depth of the 80% iso line in cm of tissue in the electron e setting

A

80% iso dose = MeV/ 3

241
Q

what is the depth of the 90% iisodose line in cm of tissue in electron setting

A

90% iso dose = MeV/4

242
Q

partial bolus should never be used in ____applications

A

electron

243
Q

hat is edge effect in electrons

A

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
Q

IRS for bolus in electron beams

A

I-incrwase surface dose
R-remive surface irregularities
S-shape iso dose contours at depth

245
Q

shielding thickness for elections equation

A

shielding thickness =

MeV/2 = shielded thickness in mm of Pb

246
Q

what type of material should be used to shield from electrons in internal eye shields

A

low z material

247
Q

main interaction in electrons from 1-20Mev

A

collisional interactions

Skin Radiation therapy (40 decks)

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