Mosby's Flashcards
Define Oncology
the study of a large variety of diseases that behave in a similar way with lethal behavior; the study of neoplastic disease
Define Tumor
Neoplasm composed of cells with abnormal proliferation capacity
What are the two classifications of tumors?
Benign and Malignant
Define Malignant Tumors
Referred to as cancer
Where did the word cancer come from?
Greek physician Hippocrates. Found a group of diseases that resembled a crab and named the disease “karkinos” - greek word meaning crab. Crab is the symbol for the zodiac sign for cancer.
Where did the word cancer come from?
Greek physician Hippocrates. Found a group of diseases that resembled a crab and named the disease “karkinos” - greek word meaning crab. Crab is the symbol for the zodiac sign for cancer.
What are the thee main routes of spread for cancer?
Local extension, lymphatics, and blood
Define Metastasis
when cancer has spread outside of the original locations in the body
Define Epidemiology
The study of cancer as it is distributed in a given population
The study of the incidence f the disease
Define Epidemiologic Studies
Help reveal patterns of incidence in a given population
How are epidemiological studies of incidence divided in populations?
Race, gender, common social habits, occupation, geographical location, age, religion, marital status, among others
Define Etiology
Study of cancer causes and risk factors study of the cause of the disease -identifying carcinogens -genetic factors - helps provide screening programs ad preventative cancer education
What are some etiologic factors?
smoking, asbestos exposure, arsenic exposure, ultraviolet radiation, nickel compounds, among many others.
What does the American Cancer Society recommend based on epidemiological and etiologic factors?
Cancer screenings
Define Carcinogens
Cancer causing agents
Define Carcinogenesis
The multistage process the occurs following exposure to a carcinogen leading to a malignancy
How many mutations in the stem cells of the tissue of origin is likely required for a tumor to develop?
2
How may carcinogens be categorized?
Chemical factors, physical factors, viral agents, or genetic factors
What are some known chemicals that increase the likelihood of developing cancer?
soot, tar, nickel compounds, asbestos, arsenic, and benzene
All mammalian cells contain genes known as:
protoncogenes, oncogenes, and antioncogenes (tumor suppressor genes)
What are protoncogenes responsible for? How can they be transformed?
controlling cellular proliferation. Can be transformed into oncogenes when activated by the presence of certain viruses or chemical agents
Cancers attributable to extrinsic (non-inherited) factors are classified as:
Sporadic
Inherited cancers are classified as:
familial
Sporadic cancers are typically caused by multiple:
outside factors
These cancers are likely due to a change in cell genes following multiple encounters with a carcinogenic agent
These show up in families who share a common environment and/or genetic abnormality that is passed down through generations:
Familial Cancers (the mothers side tends to be most influential)
Medical history should include these 7 things:
- Chief complaint and main symptoms
- Details of known or present illness
- Review of all body systems
- Past medical history
- Social history
- Family history
- Work history
Upon physical examination, the examiner should check the status of :
the skin, lymph nodes, oral cavity, breast, testis, perineum, and central nervous system.
What is the perineum?
the area between the anus and the scrotum or vulva
Define dysphagia
Difficulty swallowing
Define cachexia
loss of weight, muscle atrophy, fatigue, weakness, and significant loss of appetite in someone who is not actively trying to lose weight
What is CAUTION?
7 warning signs of cancer by the American Cancer Society
Define CAUTION
C change in bowel habits A a sore that will not heal U unusual bleeding or discharge T thickening or lump I indigestion or difficulty swallowing O obvious change in a wort or mole N nagging, persistent cough
Define biopsy
the removal of tissue or cells for microscopic evaluation
Name the different types of biopsies:
- Collection of body secretions: sputum or urine
- Scraping or curettage
- Aspiration of fluid as from the chest, fluid-filled mass, or other body cavity
- Core needle sampling
- Dermal punch
- Scalpel incision or excision
- Direct biopsy or endoscopy
- Open surgery
Tumors are classified and sorted by:
- Biologic behavior
- Anatomic site - breast, prostate, pancreas
- Tissue origin - epithelial, connective, reticule-endothelial
- Differentiation aka tumor grade
- Stage
What is differentiation?
how well the cells can carry out the normal functions of cells of this origin; how well the cells exhibit normal physical characteristics; aka tumor grade
What is a well-differentiated tumor cell?
Well-differentiated cancer cells look more like normal cells and tend to grow and spread more slowly than poorly differentiated or undifferentiated cancer cells.
What is an undifferentiated tumor cell?
the cells are very immature and “primitive” and do not look like cells in the tissue from it arose. As a rule, an undifferentiated cancer is more malignant than a cancer of that type which is well differentiated. Undifferentiated cells are said to be anaplastic
What is anaplastic?
refers to a lack of differentiation in neoplastic cells
What are neoplastic cells?
abnormal growth of cells to form a tumor
What is the vena cava?
a large vein carrying deoxygenated blood into the heart
What is the superior vena cavas function?
carrying blood from the head, arms, and upper body
What is the inferior vena cavas function?
carrying blood from the lower body
Define aorta
the main artery of the body, supplying oxygenated blood to the circulatory system. In humans it passes over the heart from the left ventricle and runs down in front of the backbone
Left ventricle function:
the thickest of the heart’s chambers and is responsible for pumping oxygenated blood to tissues all over the body
Right ventricle function:
solely pumps blood to the lungs
How does blood enter and exit the heart?
Blood enters the heart through the two atria and exits through the two ventricles
Right and left atria functions?
function as receiving chambers for blood entering the heart
Cancerous tissues originating in epithelial tissues are referred to as:
carcinomas
Cell types that form epithelial tissues include:
Basal cells, squamous cells, and transitional cells
Epithelial tissues:
line, cover, or are glandular
Define adenocarcinoma:
cancerous tumor of glandular epithelium
Cancerous tissues originating in connective tissues are referred to as:
sarcomas
If distance is doubled, the intensity of radiation will be? Why?
Reduced by a factor of four
-The inverse square law applies here. The change in distance will result in a change in intensity by a quart of the distance change.
How many Rem is 1 Sievert?
100
1 rem = ? mrem
1000
A stochastic effect is defined as one in which:
probability is dose dependent
Define electromagnetic radiation:
a kind of radiation including visible light, radio waves, gamma rays, and X-rays, in which electric and magnetic fields vary simultaneously
Define prodromal:
relating to or denoting the period between the appearance of initial symptoms and the full development of a rash or fever. nausea or vomiting
What is the SI (system international) unit for activity?
becquerel
photons produced during the orbital transitions of electrons from a higher to lower energy shell are called? Why?
Characteristic radiation
-when electrons from a higher shell drop down to a lower shell, characteristic radiation is emitted
two or more chemicals with the same chemical formula, but having different nuclear states are known as:
isomers
wavelengths of x-rays are measured in:
angstroms
What is hematopoietic syndrome caused by?
reduced blood cells
Two or more chemicals with the same chemical formula, but having different nuclear states are known as:
isomers
Which is not true of the electromagnetic spectrum? All photons in the spectrum have the same:
energy
What is the latent period?
The time between exposure and the manifestation of any late effects
The process of cellular growth and development is called:
proliferation
Which of the following cells has the highest radiosensitivity? Why?
- neurons
- chondrocytes
- osteoblasts
- lymphocytes
Osteoblasts
-They’re the most sensitive because these bone cells are young and immature. Therefore they are still dividing, making them the most sensitive.
What is Bragg peak?
maximum ionization near the end of the range of a heavy, charged particle
A joule is a unit of:
energy
What is the half-life of iodine-125?
60.2 days
What is the half-life of radon?
4 days
How many joules are in one electron volt?
1.6 x 10 to 19 joules in 1 electron volt
what is adenocarcinoma?
cancerous tumor of glandular epithelium
what is an osteosarcoma?
cancerous tumor of the bone
cancerous tumors originating in connective tissues are referred to as:
sarcomas
The suffix -OMA means?
benign growths in various tissues
What are some exceptions to the root + suffix rule?
lymphoma, leukemia, glioma
What is a glioma?
malignancy originating in the central nervous system
What is leukemia?
malignancy originating in the blood
What is lymphoma?
malignancy originating in the lymphatic system
What is the lymphatic system?
the network of vessels through which lymph drains from the tissues into the blood
What is lymph?
a colorless fluid containing white blood cells, that bathes the tissues and drains through the lymphatic system into the bloodstream
What are the main functions of the lymphatic system?
- It is responsible for the removal of interstitial fluid from tissues.
- It absorbs and transports fatty acids and fats as chyle from the digestive system.
- It transports white blood cells to and from the lymph nodes into the bones
Pathologic staging requires the use of:
imaging and histologic study
-CT, MRI, PET, and tissue sampling
What is the most widely used and internationally accepted staging system?
TNM
What does the TNM system describe?
- The tumor’s size, circumference, depth of invasion, or mobility status
- the involvement of lymph nods, their size, and mobility are also evaluated.
- the presence of distant metastasis
How many stages are there in the TNM staging system?
IV
What are the three main cancer management modalities?
surgery, chemotherapy, radiation therapy
What is an up and coming cancer management modality that is not yet widely used?
immunotherapy
-may become more prevalent as we continue studying the mechanisms for carcinogenesis, remission, and recurrent disease
What is a local approach used to diagnose or aid in disease staging, palliate symptoms, curatively manage, or as an adjunct to other cancer management modalities?
Surgery
Surgical lymph node dissections can be helpful in staging that kinds of cancers?
Breast and Head and Neck
What kind of cancers are easily cured with surgery?
small and localized with no evidence of distant metastasis
What is localized cancer?
usually found only in the tissue or organ where it began, and has not spread to nearby lymph nodes or to other parts of the body.
Define prophylactic:
intended to prevent disease.
-example: bilateral mastectomy for a patient with diagnosed breast cancer in one breast, who is at an increased risk of developing cancer in both breasts
The use of anticancer drugs (cytotoxic drugs) or hormonal agents to cure, palliate, maintain remission, or as a prophylactic measure is known as:
Chemotherapy
How is chemotherapy administered?
intravenously, orally, topically, or locally
What are the two categories of cytotoxic drugs?
Phase-specific and non-phase-specific
What are phase-specific drugs?
drugs that specifically work during the time in which the tumor cell is dividing
What are non-phase-specific drugs?
Drugs that can be given at any stage of cell division and may be effective on tumor cell populations that are no longer or sparsely dividing
What are the 5 classes of cytotoxic drugs?
- Alkylating agents
- Antitumor antibiotics
- Antimetabolites
- Plant alkaloids
- Nitrosoureas
Cytotoxics are intended to act as a _____ to malignant cells.
poison
Why are hormones administered?
to counteract the body’s response to the presence of certain types of cancers.
What does BRM stand for?
Biologic Response Modifiers
What is a biologic response modifier?
Used in cancer management and are administered to induce or enhance the body’s natural response to the presence of disease or physiologic imbalance
What can decrease swelling in central nervous system cancers?
an anti-inflammatory such as dexamethasone
chemotherapy agents that sensitize the cancerous tissues to other cancer therapy such as radiation are called:
radiosensitizers
Some chemical agents protect normal tissues from other therapy such as radiation, these are known as:
radioprotectors
What is the equivalent square for a field size?
2xlengthxwidth / length+width
Example:
15cm x 20 cm field size
Equivalent Square is 17.1 cm
During radiation treatment, the arm should be:
consistent throughout the treatment fraction
Your px being treated for bronchogenic adenocarcinoma complains of difficulty swallowing. His symptom is likely caused by:
esophagitis
Landmarks around the mouth are generally not very accurate due to:
extreme flexibility in the area
What does “renal” refer to?
The kidneys
What is the equivalent square for a field size ?
2xlengthxwidth / length+width
A joule is a unit of:
Energy
A T1 glottic larynx will likely be treated with parallel opposed laterals with field sizes of about:
6 x 6
Landmarks around the mouth are generally not very accurate due to:
Extreme flexibility in the area
What does “renal refer to?
The kidneys
Soft tissue sarcomas usually spread:
Along the muscle plane and compartment where it originated
-even neighboring compartments typically go unaffected by tumor growth
Which type of chemotherapy is known to cause hearing loss?
cisplatin
-as well as renal dysfunction
Your patient being treated for bronchogenic adenocarcinoma complains of difficulty swallowing. His symptom is likely caused by:
esophagitis
What is the density of water?
1
Deodorants should not be used in areas treated with radiation because:
The deodorant may cause a bolus effect
Soft tissue sarcomas usually spread:
Along the muscle plane and compartment where it originated
Which type of chemotherapy is known to cause hearing loss?
cisplatin
Placing marks on the central axis only is:
insufficient for daily realignment and targeting
What is the density of bone?
1.65 to 1.85
What are 4 methods of disposing of depleted radioactive materials?
- flushing into a holdup tank
- incineration
- transfer to an authorized recipient
- burial
What is the SI unit of exposure?
coulomb
What is the tradition unit of exposure?
roentgen
A surgical procedure in which an incision is made through the abdominal wall to examine lymph nodes and establish the extent of disease is called:
laparoscopy
The does at the point where the axis of the beam emerges from the patient is known as the:
Exit dose
The energy loss of mega voltage (MeV) electron beams in water is approximately ____ MeV/cm.
2
-Electrom beams lose about 2 MnV per centimeter of tissue
What is lidocaine?
Lidocaine is a local anesthetic that works by causing temporary numbness/loss of feeling in the skin and mucous membranes.
Lucite is often used as the material for positioning devices. One major concern when this material is in the path of the treatment beam is:
beam attenuation
What is the average diastolic pressure in an adult?
60-90 mm og Hg
The iliac breast is located at about the level of lumbar vertebrae number:
4
How many lumbar vertebrae are there?
5
How many cervical vertebrae are there?
7
What is C1 also referred to as?
Axis
What is C2 also referred to as?
Atlas
How many thoracic vertebrae are there?
12
How many ribs are there?
12
Which ribs are floating?
11 & 12
What is above the sternum?
manubrium
Partial breast irradiation may involve treatment techniques that employ all of the following except:
5-field breast technique
Which of the following would influence the onset or duration of action for a certain drug?
- purity
- kidney function
- nutrition
- liver function
nutrition (fluid and electrolyte balance)
-may be influenced by many things including the route of administration, dose, patient’s age, health, ethnicity, state of mind, weight, and nutrition
The angle between two beams is known as the:
hinge angle
What is caudad?
toward the feet/ tail/posterior
When breathing in the diaphragm moves:
caudad
Which of the following reduces the skin sparing effect in photon beams?
bolus
The rate of kinetic energy lost per unit path length is referred to as:
stopping power
Varying the beam size and shape using multi-leaf collimators during treatment is known as:
intensity modulated radiation therapy
How do you figure this out and what is the answer:
The closest blocked equivalent for a 10 x 20 rectangular field with a 4 x 6 block in the field is:
Subtract the area of the block from the area of the open field, and them take the square root.
10x20 = 200 4x6 = 24 200-24 = 176
square root of
176 = 13.3
In radiation therapy, which of the following interactions with matter are least important?
photoelectric effect
What is the advantage of a rotating anode versus a stationary anode in an X-ray tube?
Larger exposures are possible without overheating the tube
The spinal cord proper extends in the adult from the:
foramen magnum to the second lumbar spine
How many sacral vertebra are there?
5 fused sacral vertebrae
How many coccygeal vertebrae are there?
4
coccyx
How far does the cauda equina extend?
2nd lumbar spine to the approximate level of the coccyx
What is the cauda equina?
a bundle of spinal nerves and spinal nerve rootlets, consisting of the second through fifth lumbar nerve pairs, the first through fifth sacral nerve pairs, and the coccygeal nerve, all of which arise from the lumbar enlargement and the conus medullaris of the spinal cord
What is the dural sac (aka thecal sac) and where does it terminate?
- membranous sheath or tube of dura mater that surrounds the spinal cord and the cauda equina
- at the approximate level of the second sacral body
When using rotational arc therapy, monitor units or treatment time should be calculated using which of the following methods?
TAR method- tissue air ratio
Every stage ovarian cancer can be successfully treated with:
surgery followed by chemotherapy
The following would be appropriate advice for a patient receiving radiation to the whole brain EXCEPT:
when dry desquamation occurs, use a dandruff shampoo
The dDmax dose for a 250 cGy tumor dose if the depth dose percentage is 96% would be:
What formula do you use?
-the applied dose formula
Applied dose = TD/%DD
So,
250/96% = 260
Which of the following examination instruments is necessary for examination of the pharynx?
laryngeal mirror
Anatomical data for CT imaging and reconstruction is acquired through the :
transverse plane
The equivalent square field size must be determined in order to calculate the:
dose to be delivered to the central axis of an irregular field
For patients with pancreatic cancer, extra care is taken to limit the dose to the radiosensitive:
liver, kidney and spinal cord
The method by which all healthcare workers can control the transmission of blood borne diseases is known as:
universal precautions
When clinically setting up an electron field, the electron cone should not be pointed obliquely to the patient surface because:
- The depth of Dmax in the patient can shift toward the surface
- beam penetration can be reduced
- side scatter to the patient increases
- all of the above
all of the above
What does the blood brain barrier do?
protects the brain from potentially toxic substances
What is dyspnea?
difficulty breathing
What is the semi Fowler’s position?
Upright at 90 degrees is full or high Fowler’s position. Semi-Fowler’s would be tilted back to approximately 30 degrees.
A well healed skin graft would be treated: With a decreased dose With increased dose Would not be treated Same as normal tissue
Same as normal tissue
A tracheostomy is usually: blocked bolused Treated, not bolused boosted
bolus
If the chart states that the patient is ambulatory, this means that: They can walk They cannot walk They need a wheelchair They need a walker
They can walk
What is a normal platelet count range?
200,000-450,000
What is the shape of an isodose curve for tandem and ovoids? Elliptical Pear-shaped Round oval
pear-shaped
Which of the following implants are permanent? Cesium Radium Gold Iridium
gold
The iliac crest is at the level of: T12 L1 L4 S1
L4
The tip of the xiphoid is at level: T10 T12 L1 L4
T10
What is the xiphoid?
small cartilaginous process (extension) of the lower (inferior) part of the sternum
Which drug makes the heart more sensitive? Bleomycin Chlorambucil Methotrexate Adriamycin
adriamycin
What is adriamycin?
In some cases health care professionals may use the trade names Adriamycin® or Rubex® when referring to the generic drug name Doxorubicin. Drug Type: Doxorubicin is an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug
What is the target in a linear accelerator?
tungsten
Which drug is not used for diarrhea? Lomotil Imodium Decadron Kaopectate
decadron
Highest skin dose is with: Grenz rays Orthovoltage x-rays 9 MeV electrons 4 MV x-rays
Grenz Rays
What are grenz rays?
Grenz rays are a form of radiation, similar to ultraviolet radiation, x-rays and gamma rays. The difference is that Grenz rays are produced at low kilovoltages giving them a very low penetration power. They are absorbed within the first 2 mm of skin, which means they do not penetrate beneath the dermis of the skin.
What is decadron?
Decadron (dexamethasone) is a corticosteroid, similar to a natural hormone produced by the adrenal glands, used to treat arthritis, skin, blood, kidney, eye, thyroid, intestinal disorders, severe allergies, and asthm
Radiation myelopathy occurs: During treatment 2-4 days after treatment 2-4 weeks after treatment 2-4 months after treatment
2-4 months after treatment
An adenoma is a tumor of: Glandular tissue Skin Muscle Mucous membrane
glandular tissue
Which of the following is most radioresponsive? Seminoma Dysgerminoma Teratoma Choriocarcinoma
seminoma
What is dyspnea? Difficulty speaking Difficulty swallowing Difficulty chewing Difficulty breathing
difficulty breathing
Where are the vallate papilla located? In the epiglottis In the intestines At the back of the tongue At the junction of the esophagus and stomach
At the back of the tongue
Where is the ramus?
jawbone
Where are the seminal vesicles?
superior to the prostate
Halfway through a treatment you notice that the wrong wedge was used. You should: Continue treatment Change the wedge and continue Recalculate Report to doctor 1 and 4 1 and 3 2 and 3 2, 3 and 4
2, 3, and 4
A patient suffering from emesis is at risk for: Dyspnea Aspiration Anaphylaxis Syncope
Aspiration
Whole brain x-ray therapy causes all but: Skin irritation Headaches Memory loss epilation
memory loss
Half beam blocks are used mainly for: Skin sparing Abutting fields Reducing cord dose Reducing hotspots
abutting fields
When moving a patient with a tumor in the midshaft of the bone, you need to support: The proximal aspect The distal aspect The midshaft 1 only 2 only 1 and 2 2 and 3
1 and 2
When the patient is experiencing dyspnea, you want to position the patient in the \_\_\_\_\_ position. Supine Prone Semi Fowler’s Sims’
semi fowler’s
How do you make a 10 year old feel comfortable with their treatment? Tell the truth Tell them it will not hurt Let them watch someone else get treated Let their mother explain the procedure
Tell the truth
When contrast is to be injected into a patient, ensure that \_\_\_\_\_ is available. Prednisone Atropine Epinephrine Albuterol
epinephrine
At what level does the abdominal aorta bifurcate? T10 L1 L4 S2
L4
The principal advantage to using an electron beam is:
Skin sparing
High skin dose
Rapid fall off of dose with increasing depth
Rapid fall off of dose with decreasing depth
Rapid fall off of dose with increasing depth
If the patient’s platelet count is 225,000, you should: Hold treatment and report to doctor Treat, but report to doctor Send patient home Continue treatment as normal
continue treatment as normal
A brachytherapy source can be disposed of when it has gone through \_\_\_\_\_ half lives. 2 5 10 20
10
What diet should a patient being treated for cancer of the bladder be on? Low residue High residue Low fat High fat
low residue
A surgical opening in the small bowel. Colostomy Ileostomy Laparotomy gastrectomy
ileostomy
A mastectomy patient should: Avoid blood pressure and needle sticks in affected arm Keep arm immobile Not lift heavy objects a and c
a and c
What does the scattering foil do? Shape the x-ray beam Filter the x-ray beam Spread the electron beam Remove low energy electrons
spread the electron beam
Linear accelerators have what type of target? Rotating anode Reflexion Thick transmission Thin transmission
thick transmission
In an isocentric treatment, the machine field size is set: At the isocenter At the collimator At the central axis On the skin surface
at the isocenter
Highest skin dose is with: Grenz rays Orthovoltage x-rays 9 MeV electrons 4 MV x-rays
grenz rays
Surgical clips may be used to help define the treatment area for all but: Breast Prostate Lung Multiple myeloma
multiple myeloma
what is multiple myeloma?
Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Plasma cells help you fight infections by making antibodies that recognize and attack germs. Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells.
What is the myeloma prefix?
spinal cord or bone marrow
What is the prefix “dys”?
difficulty
what is the suffix “pnea” mean?
breathing
medical term: anemia
“without blood” - Low Red Blood Count
medical term: excise
to cut out
medical term: uria
presence of a substance in the urine
medical term: poly
many
medical term: ectomy
excision/ to cut out
medical term: incision
to cut into
medical term: excision
to remove or take out
medical term: cholecyst/o
gallbladder
medical term: chondr/o
cartilage
medical term: col/o
colon
medical term: colp/o
vagina
medical term: cost/o
rib
medical term: cyst/o
bladder
medical term: encephala/o
brain
medical term: hepa or hepat/o
liver
medical term: hyster/o
uterus
medical term: mast/o
breast
medical term: nephr/o
kidney
medical term: proct/o
rectum, anus
medical term: pyel/o
pelvis of kidney
medical term: spondyl/o
vertebrae
medical term: ostomy
new permanent opening
medical term: otomy
incision into
medical term: gyne
woman
medical term: ile/o
ilium (small intestine)
medical term: laryng/o
larynx (voice box)
medical term: metr/o
uterus
medical term: oophor/o
ovary
medical term: phleb/o
vein
medical term: -ectasis or ectasia
stretching/dilating
medical term: -osis, iasis
condition of
medical term: -algia or dynia
pain
medical term: -cele
hernia, swelling
medical term: -orrhagia
excessive bleeding
medical term: a-, an-, ar- (ie, anemic)
without or not
medical term: ad- (ie, adduction)
near, toward
medical term: ab- (ie, abnormal)
away from
medical term: dis- (i.e. disease)
from
medical term: hemi- (i.e. hemiplegia)
half
medical term: -plegia
paralysis
medical term: inter- (i.e. intercostal)
in between
What are the pelvis lymph nodes?
iliac, inguinal, femoral
What are the abdominal lymph nodes?
mesenteric, paraaortic, spleen
medical term: oma
tumor or growth
What is foramen?
holes in the bone for large vessels and nerves to pass through
Where are the mesenteric lymph nodes?
lower right abdomen
What is fossa?
depressions or hollows
What is fossa?
depressions or hollows
What is a film’s tumor?
kidney
What are the thoracic lymph nodes?
mediastinal, hilar, axillary, pectoral, more?
If blocks for shielding the eyes during radiation treatment are incorrectly placed, what would be a serious complication? Retinitis Cataract Erythema Otitis
cataract
Why does a therapist wear gloves when tattooing a patient?
To prevent infecting the patient
Instead of washing hands
To protect self against body fluids
One should always wear gloves when touching a patient
To protect self against body fluids
What is an hypophysectomy? Surgery of hypopharynx Thyroid disease Removal of ovaries Removal of pituitary
removal of pituitary
The most radiosensitive part of a child’s bone is the: Epiphysis Diaphysis Periosteum Endosteum
epiphysis
TD5/5 for the liver is \_\_\_\_\_ cGY. 1500 2500 3500 4500
2500
Where is the corpus luteum located? Uterus Ovary Heart Testes
ovary
Are benign tumors cancerous or non-cancerous?
non-cancerous
Teo tumor classifications?
Malignant and benign
5 characteristics of benign tumors:
- normal to slightly increased growth
- encapsulated
- well differentiated
- not usually life threatening
- non-cancerous
5 characteristics of malignant tumors:
- cancerous
- normal to increased mitotic rate
- can metastasize
- well differentiated to anaplastic
- life threatening
What percent of tumors are carcinomas?
75-85%
What percent of tumors are sarcomas?
10-15%
5 characteristics of carcinomas:
- 75-85% of tumors
- originate from the epithelium
- squamous cell carcinomas
- glandular cells (adenocarcinomas)
- generally spread by lymphatics
4 characteristics of sarcomas:
- 10-15% of tumors
- originate from bone, connective tissue, or soft tissue
- generally spread through the blood
- most common metastatic site is the lungs
What is a screening test for the prostate?
blood PSA (prostate specific antigen)
Define neoplasm
a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer
Measurements of absorbed dose:
Rad (Radiation absorbed dose)
1 Gy = ____ rads
100
1 cGy = ____ rad
1
What does KERMA stand for?
kinetic energy released in a medium
Measure of exposure:
roentgen
What does Rem stand for?
Roentgen equivalent man
1 sievert = ___ rem
100
0.1 rem = ___ mrem
100
1msv = ___rem
0.1
matter in its smallest form is composed of:
atoms
Define ionization:
any interaction that would cause an electron to be totally removed from the atom
once an atom is ionized, it is no longer _____
stable
what is the least number of electron volts needed for ionization? and wavelength?
124 eV and wavelength shorter than 10^-6 cm
What are the common energy ranges for radiation therapy?
200KeV - 50 MeV
What does KeV stand for?
kilo electron volt
1 KeV is 10^3 or 1000 electron volts
What does MeV stand for?
Mega electron volts
10^6 or 1,000,000 electron volts
all radiation in the electromagnetic spectrum are:
photons
Electromagnetic Spectrum Radiation includes:
- visible light
- heat
- radio
- microwaves
- ultraviolet rays
- gamma rays
- x-rays
What is frequency measured in?
cycles using hertz
What is wavelength measured in?
meters using angstrom
What is energy measured in?
joules/expressed in electron volts
What are some characteristics of x-rays and gamma rays?
found at the upper end of the spectrum, short wavelengths, high frequency and high energies
____ are a result of natural nuclear radiation
gamma rays
Name some heavy charged particles:
protons, neutrons, alpha particles, or deutrons
Energy deposit increases to a max and produces a more dense near the end of its path is:
Bragg Peak
What are the two types of electron interactions?
- collision - excitation and ionization
- radiative
X-ray production requires:
high voltage source, cathode, anode, glass envelope, vacuum
What are the two main types of x-ray production?
characteristic and bremsstrahlung
5 major type of photon interactions:
- photodisintegration
- coherent scattering
- photoelectric effect
- compton effect
- pair production
Define beam intensity:
the amount of energy per unit of time per unit of area perpendicular to the beam direction
beam qulaity:
energy of the beam expressed in electron volts or the absorbing potential/ penetrating power of the beam expressed in half value layers (HVL) of material
What two things effect intensity of the beam?
attenuation and bam divergence
Define beam attenuation:
removal of energy from the beam
Define beam divergence:
expression of the scattering of photons away from the original point source
Define beam hardening:
when the effective energy of the beam increases as it passes through the filter
Isotopes:
same # of protons but diff # of neutrons
Isotones:
same # of neutrons, diff ## protons
Isobars:
same # nucleons, diff # protons and neutrons
isomers:
same # protons and neutrons but in a diff nuclear state
What is HVL?
half value layer
the thickness of the material at which the intensity of radiation entering it is reduced by one half.
Define half-life:
the time taken for the radioactivity of a specified isotope to fall to half its original value.
the time required for any specified property (e.g., the concentration of a substance in the body) to decrease by half.
somatic cells
nonreproductive cells
cellular differentiation
occurs when a cell undergoes mitosis and divides into daughter cells. the cells continue to divide and differentiate until a mature cell with a specific function results
protooncogenes
normal genes that play a part in controlling normal growth and differentiation
oncogenes
gene that regulate and develope growth of cancerous tissues (cancer gene)
anti-oncogenes
tumor suppressor gene
mitosis
cellular division
cell cycle phases (in order)
G0, G1, S, G2, and M
G1
first growth phase, characterized by rapid growth and active metabolism
S
synthesis phase, period in which DNA is replicated to ensure that the resulting daughter cell will have identical genetic material
G2
second growth phase, the period where cells prepare for actual division
tumors are classified by what
anatomic site, cell of origin, biologic behavior
tumors that arise from the mesenchymal cells
sarcomas (include connective tissue and bone)
tumors that originate in the epithelium
carcinoma (include cancers that cover a surface or line a cavity)
epithelial cells that are glandular are called
adenocarcinoma
the american cancer society estimates that ____new cases of cancer will be diagnosed each year, with ______deaths.
665,000 new cases, 585,700 deaths
most common types of invasive cancer in the Unites States
prostate, lung, colorectal in men and breast lung and colorectal in women
etiology
study of the cause of the disease
epidemiology
study of the disease incidence
interferons
naturally occurring body proteins capable of killing or slowing down the growth of cancer cells
what type of tumors have a better prognosis
exophytic (grow outward)
what is tumor dissemination
spread (can be accomplished through blood, lymphatics, and seeding)
prostate cancer commonly metastasized to
bone
branch of medicine devoted to the study of disease
pathology
extravasation
accidental leakage of IV drugs into the tissue surrounding the venipuncture
six important causes of cell damage
radiation, hypoxia, chemicals, microorganisms, immunological reactions, neosplasms
cancer cells that exhibit no differentiation
anaplastic
great variability in size and shape of undifferentiated tumor cells
pleomorphic
Where is the perineal area?
The perineum is generally defined as the surface region in both males and females between the pubic symphysis and the coccyx. The perineum is below the pelvic diaphragm and between the legs. It is a diamond-shaped area that includes the anus and, in females, the vagina.
What are some side effects of city-toxic drugs?
nausea, myelosuppression, cardiac toxicity
Define parenteral:
Administered by some means other than oral or rectal intake, particularly intravenously or by injection.
Define lithotomy position:
a supine position of the body with the legs separated, flexed, and supported in raised stirrups, originally used for lithotomy and later also for childbirth.
Define trendelenberg position
In the Trendelenburg position, the body is laid supine, or flat on the back with the feet higher than the head by 15-30 degrees.
The reverse Trendelenburg position similarly has the body flat, but the head is 15-30 degrees higher than the feet.
define postural hypotension:
dizzy feeling associated with sitting or standing after a prolonged period of rest. caused by a drop in blood pressure and then a sudden increase
High blood pressure is also know as:
hypertension
What is a normal blood pressure range?
120/80 - 140/90
Normal heart rate:
60-100 beats per minute
normal respiration:
12-20 breaths per minute
normal platelet count:
150,000-450,000 platelets per microliter of blood
systolic pressure represents:
the highest point reached during contraction of the ventricles
What are the 6 tissue response factors?
- total dose
- radiation type
- cellular sensitivity to radiation
- volume of tissue irradiated
- protraction (period of time over which total dose is absorbed)
- fractionation (fraction of total dose given per unit of time)
Define acute response:
rad exposure response after short period of time
Define latent response:
rad exposure response after a long period of time
what’s the most major molecule in body?
H2O
How are molecules formed?
Atoms in living tissue come together to form them
What percent of the body is water?
60-80%
it is believed that because of this encounters between water molecules and radiation are what lead to manifested responses in living tissue
What does irradiation of water do?
causes the breaking of the chemical bond between hydrogen and oxygen atoms - leading to production of free radicals
______ is an unchanged molecule that contains a single unpaired electron in its outer shell, making it unstable and carry excess energy.
Free Radical
What are the largest organic molecules?
Nuclic Acids: DNA and RNA
What are DNA and RNA responsible for?
- cellular structure and function
- provide the map for developing cells
What are some other molecules (besides water) that are demonstrated in the effects of radiation exposure?
proteins, lipids, carbohydrates, nucleic acids
Where is DNA located in the cell?
Nucleus
______ is a direct encounter w/ DNA as the target and creates the greatest image in the cell.
Direct Effect
_____ is DNA damage that may be repaired leaving the cells to recover and resume normal function
Lethal Damage
What does the functional integrity of the cell depend on?
parenchymal and stroll cells within it
Do all cells differ in their sensitivity to radiation?
Yes
What does the law of Bergonie and Tribondeau state?
cells that are rapidly dividing have a long mitotic future and are undifferentiated - these are the most responsive to radiation
What is cell division in germ cells termed?
meiosis
What is cell division called? (other cells, not germ cells)
mitosis
What are the 4 phases of cell division in the correct order of sequence?
G1, S, G2, M
What phase of cell division is most sensitive to radiation?
M phase
Which cell division phase is most resistant to radiation?`
S phase
What is the average energy deposited per unit of path length to a medium by ionizing radiation as it passes through a medium called?
LET - Linear Energy Transfer
What is RBE? Describe. What is the formula?
Relative Biologic Effectiveness
provides a relative comparison of the effectiveness of a test radiation to the dose of 250 kv x-ray. Relates the ability of radiation with different LETs delivered under the same conditions to provide the same biologic effect.
250 kv dose for a given effect RBE = -----------------------------------------------
Dose for test radiation for same effect
What are the main tissue types in the body?
Epithelial, connective, muscle, nerve, and membranes
What are the 4 cardinal signs for injury?
- redness
- swelling
- heat
- pain
Define non stochastic Effects:
Changes seen within days/weeks
Deine stochastic effects:
changes seen after months/ years
Are immediate (nonstochastic) effects more likely seen in radiation therapy or nuclear accidents?
Nuclear accidents
What are some tissue responses following significant doses?
vascular dilation, cellular inflammation, tissue necrosis (high doses)
Tissue response when absorbed dose exceeds 50 Gy:
- Epilation
- Erythema
- Dry desquamation
- Wet desquamation
What is the onset dose of erythema to the skin? (acute effects)
20 Gy
Onset dose of dry, then wet, desquamation to the skin? (acute effects)
dry - 30 Gy
wet - 40 Gy
Onset dose of mild, patchy mucositis to the oral mucosa?
Confluent mucositis?
(acute effects)
30 Gy
40 Gy
Onset dose of esophagitis to the esophagus? (acute effects)
25 Gy
Onset dose of xerostomia to the salivary glands? (acute effects)
20 Gy
What is xerostomia?
also known as dry mouth and dry mouth syndrome, is dryness in the mouth
Onset dose proctitis after treatment to the rectum? (acute effects)
30 Gy
Onset dose decreased sperm from treatment of the testis? (acute effects)
0.25 Gy
Onset does leading to lowered blood count after treatment of the bone marrow?
Extensive hypoplasia?
(acute effects)
4 Gy
50 Gy
Onset dose of gastritis after treatment to the stomach? (acute effects)
20 Gy
TD 5/5 skin:
Injury?
55 Gy
ulceration/fibrosis
TD 5/5 intestine:
Injury?
45 Gy
stricture
TD 5/5 salivary glands:
Injury?
40 Gy
permanent xerostomia
TD 5/5 kidneys:
Injury?
23 Gy
kidney failure
TD 5/5 testis/ovary:
Injury?
5-15
sterility
TD 5/5 bone:
(child)
(adult)
Injury?
child - 20 Gy arrested growth
adult - 60 Gy necrosis
TD 5/5 bone marrow:
Injury?
20 Gy
reduced cellularity
TD 5/5 spinal cord:
Injury?
45 Gy
necrosis
Define necrosis:
the death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply
TD 5/5 lens:
Injury?
5 Gy
cataract
TD 5/5 brain:
Injury?
50 Gy
necrosis
What is TD 5/5?
5% of n exposed population to realize an adverse latent (late) effect in 5 years following exposure
What is TD 50/5?
Dose that would likely cause 50% of n exposed population to realize an adverse late effect after 5 years following exposure
T/F: Any deviation from the standard fractionation scheme results in a different biologic response in both normal and cancerous tissue.
True
What is BED? Describe.
What’s the formula?
Biologic Effective Dose
Formula used when standard fractionation is interrupted or varied
BED = (nd) relative effectiveness
nd - total dose
relative effectiveness - lt d/d (????)
What are Isoeffect Lines?
they show the relationship between total dose and overall treatment time for a specific tissue response or late tissue responses
What are dose response curves?
Another visual representation of tissue response to radiation exposure. May be linear or nonlinear, have a threshold or not have a threshold.
What are the two types of dose response curves? What’s the difference?
- Deterministic dose response curves - no threshold and linear
- Stochastic Dose Response curves - have a threshold and may be linear/nonlinear
What is the response progression to whole body radiation?
Prodromal, manifest syndromes, and latent
What is prodromal?
relating to or denoting the period between the appearance of initial symptoms and the full development of a rash or fever.
any symptom that signals the impending onset of a disease.
an early sign or symptom
T/F: A one time dose of 300-500 cGy could lead to death within 30-60 days w/out medical intervention
True
what is LD 50/30?
Lethal death of 50% of the population within 30 days
what is LD 50/60?
Lethal death of 50% of the population within 60 days
What is the whole body syndrome for doses between 300-800 cGy? time until death?
ARS - Acute Radiation Syndrome
Hematopoietic Syndrome (bone marrow syndrome) 10-15 days
What is the whole body syndrome for doses between 1000-5000 cGy? time until death?
ARS - Acute Radiation Syndrome
Gastrointestinal syndrome
3-10 days
What is the whole body syndrome for doses between > 5000 cGy? time until death?
ARS - Acute Radiation Syndrome
cerebrovascular syndrome
hours - 3 days
What is Hematopoietic Syndrome?
aka bone marrow syndrome
Destruction of blood-forming tissue, especially bone marrow, due to radiation exposure, usually a dose from 10 to 1000 rads.
What is ARS?
Acute Radiation syndrome
Radiation sickness
a term used to describe a constellation of signs and symptoms that occurs after whole-body or significant partial-body irradiation of certain amount of radiation
What is. cerebrovascular syndrome?
is an extremely severe in-jury of Central Nervous System (CNS) and Peripheral Nervous System (PNS). CvARS can be induced by the high doses of neutron, heavy ions, or gamma radiation
What is gastrointestinal syndrome?
occurs at doses of between 6 and 15 Gy. Clinical signs and symptoms are due to the lack of replacement of cells in the surface of the villi because stem and proliferating cells located in the crypts are damaged by radiation and die in mitosis.
1 Gy = ___ rad
100
what does rad stand for?
radiation absorbed dose
What SI unit replaced the curie?
becquerel
What does the becquerel measure?
activity
What SI unit replaced the roentgen?
coulomb
What does the coulomb measure?
exposure
What SI unit replaced the rem? (roentgen equivalent man)
sievert - Sv
What does the sievert measure?
dose equivalent
What SI unit replaced the rad?
gray - Gy
What does gray measure?
dose
What are the four R’s of radiobiology?
Repair, Reoxygenation, Repopulation, Redistribution (reassortment)
What are radioprotectors?
chemicals that may scavenge free radicals/facilitate direct chemical repair at sites of DNA damage in normal tissue. Founded on principles of repair and reoxygenation
What is protraction?
the period over which radiation is delivered
Define hematologic malignancy:
cancers that affect the blood and lymph system
Define genetic effects:
cell damages that pass on to succeeding cell generations.
Define Deterministic (Non-Stochastic) Effects
Deterministic effects have a threshold below which the effect does not occur. The threshold may be very low and may vary from person to person. However, once the threshold has been exceeded, the severity of an effect increases with dose
Define fistula
an abnormal or surgically made passage between a hollow or tubular organ and the body surface, or between two hollow or tubular organs.
define somatic effects:
effects limited to the exposed individual - not future generations
Radiation exposure to the fetus should not exceed what for the entire gestation period?
0.5 rem
The term Quality Factor (Q):
varies w Dif types of radiation
organization in the us responsible for recommending rad dose limits
NRC
Annual dose limit for the occupational workers lens:
150 mSv/15 rem
Annual dose limit for the occupational workers skin:
500 mSv
Define use factor:
fraction of time that a rad beam is directed at a specific area
annual radiation dose to the lung from radon gas is _____
200 mrem
Dose equivalent is measured in:
sievert
example of deterministic effect:
cataracts
What are the two groups of radiation sources?
- natural background radiation
- man-made radiation
What are the 3 key terms for keeping radiation exposure low?
time, distance, shielding
What does ALARA stand for?
As Low As Reasonably Achievable
What does inverse square law directly relate to?
What is the formula?
Distance from the source
I1(D1)^2 = I2(D2)^2
What are the different types of natural background radiation?
- Cosmic rays from nuclear reactions in space
- terrestrial from natural, radioactive earth elements
- Internal - from radiation always present in the human body: carbon-14, hydrogen-3, strontium-90, potassium-40
What are the different types of man-made radiation?
- x-ray equipment,
- radioactive sources produced for nuclear medicine and brachytherapy
- TV
- Nuclear reactors
What is the ICRP? What do they do?
International Commission on Radiologic protection
develop standards of protection for users of x-rays and other ionizing radiation
What is the NCRP? What d they do?
National Council on Radiation Protection
national group of experts who make recommendations for protection against exposure
What is the NRC? What do they do?
Nuclear Regulatory Commission
national group that collaborates with states to establish regulations that are incorporated into federal and state law.
What is the ARRT?
The American Registry of Radiologic Technologists (ARRT) is the world’s largest organization offering credentials in medical imaging, interventional procedures, and radiation therapy. We certify and register technologists in a range of disciplines by overseeing and administering education, ethics, and examination requirements
What is the ASRT?
The American Society of Radiologic Technologists, located in Albuquerque, New Mexico, is a professional membership association for medical imaging technologists, radiation therapists and radiologic science students
What are some other agencies involved in radiation protection?
DOT- Department of Transportation
FDA - Federal Drug Administration
OSHA - Occupational Safety and Health Administration
EPA - Environmental Protection Agency
What was the original term for radiation dose limits?
Erythema Doses
Who was the roentgen named after?
Wilhelm Roentgen
What are the most common personnel exposure monitors?
- film badge
- thermoluminescent dosimeters TLD
- OSL - optimal stimulated luminescence
- pocket ionization chambers
at what point should personnel be monitored?
when they receive 1/10 the recommended dose
What are some characteristics of the film badge?
- measures kv, mv photons, electrons, gamma rays
- can detect approx. energy
- inexpensive
- can be damaged by: light, heat and humidity
- has to be sent out of facility for reading
- error margin+-20%
What are some characteristics of the TLD lithium fluoride?
- measures photons, electrons, and other particles
- very accurate
- small; can fit in a ring badge
- humidity won’t damage
- can be processed and read on site
- cannot establish energy of radiation exposure
What are some characteristics of the pocket dosimeter?
- immediate reading
- high cost at first, but save in the end
- small
- very accurate, +- 2%
- humidity can damage it
What are some characteristics of the OSL aluminum oxide?
- can be reanalyzed
- wide range of accuracy, very sensitive
- more sensitive than TLD
- more expensive
- not well understood - new technology
What is the effective equivalent dose?
E = Wt(Wr) x absorbed dose
What kind of dose limits are students under 18 subject to?
Dose limits same as those recommended to the public
T/F: pregnant workers dose limits for the unborn take precedence
true
How much radiation can a restricted are receive per week?
less than 1 mSv/week
How much radiation can an unrestricted are receive per week?
less than 1 mSv/year
What are common barriers used for barriers? What is the most common and why?
concrete, lead, iron
concrete because it is the cheapest
What are some radiation detectors and applications?
ion chamber - cutie pie, Geiger counter
