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RAD 370 - Techniques and Applications > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

RT is used in head and neck (H&N) treatments because _____ of the body’s LNs are in the H&N but sensitive organs are also in this area

A

1/3

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2
Q

2 clinical presentations of H&N disease

A

Endophytic

Exophytic

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3
Q

Growth pattern that invades within, more aggressive

A

Endophytic

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4
Q

Noninvasive neoplasm that projects out from epithelium, usually presents with raised borders on skin

A

Exophytic

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5
Q

4 diagnosis tools for H&N disease

A

Laryngoscopy
Palpation
Fiberoptic endoscopy
Biopsy

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6
Q

Gingiva

A

Gums

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7
Q

Triangular-shaped area behind molars

A

Retromolar trigone

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8
Q

7 parts of the oral cavity

A 
Lips
Buccal mucosa
Gingiva
Retromolar trigone
Hard palate
Floor of mouth
Anterior two thirds of tongue
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9
Q

3 lymphatic drainage sites of the lips

A

Submandibular nodes
Preauricular
Facial nodes

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10
Q

2 lymphatic drainage sites of the buccal mucosa

A

Submaxillary nodes

Submental nodes

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11
Q

2 lymphatic drainage sites of the gingiva and retromolar trigone

A

Submaxillary nodes

Jugulodigastric nodes

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12
Q

2 lymphatic drainage sites of the hard palate and anterior two thirds of the tongue

A

Submaxillary nodes

Upper jugular nodes

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13
Q

2 lymphatic drainage sites of the floor of the mouth

A

Submaxillary nodes

Middle and upper jugular nodes

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14
Q

4 parts of the oropharynx

A

Base of the tongue
Tonsillar fossa
Soft palate
Pharyngeal walls

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15
Q

3 lymphatic drainage sites of the base of the tongue

A

Jugulodigastric nodes
Low cervical
Retropharyngeal nodes

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16
Q

2 lymphatic drainage sites of the tonsillar fossa

A

Jugulodigastric nodes

Submaxillary nodes

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17
Q

3 lymphatic drainage sites of the soft palate

A

Jugulodigastric nodes
Submaxillary
Spinal accessory nodes

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18
Q

3 lymphatic drainage sites of the pharyngeal walls

A

Retropharyngeal nodes
Pharyngeal
Jugulodigastric nodes

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19
Q

2 lymphatic drainage sites of the retropharyngeal nodes of the nasopharynx

A

Superior jugular nodes

Posterior cervical nodes

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20
Q

2 lymphatic drainage sites of the sinuses

A

Retropharyngeal nodes

Superior cervical nodes

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21
Q

3 parts of the larynx/voice box

A

Glottis
Subglottis
Supraglottis

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22
Q

2 lymphatic drainage sites of the subglottis

A

Peritracheal nodes

Low cervical nodes

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23
Q

3 lymphatic drainage sites of the supraglottis

A

Peritracheal nodes
Cervical submental
Submaxillary nodes

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24
Q

Ear pain

A

Otaglia

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25
Q

Don’t know where cancer (CA) arose from, undifferentiated; treat like nasopharynx

A

Unknown primary

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26
Q

Pillar

A

Arch

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27
Q

Taste buds at back of tongue

A

Circumvallate papilla

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28
Q

“Spit trap”

A

Vallecula

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29
Q

4 H&N position and immobilization devices

A

Immobilization aquaplast mask: nose and zygomatic arches fit tightly but not on eyes; have minimal bolus effect and increase surface dose
Bite block
Arm stretcher
Neck sponge: B or C head sponge

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30
Q

Keep tongue still or out of field

A

Bite block

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31
Q

Spinal cord of great concern at 4500 cGy; electrons posterior and photons anterior

A

Anterior triangles

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32
Q

2 H&N interstitial sources

A

Iridium

Iodine

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33
Q

Average head diameter and SSD

A

Diameter: 15 cm
SSD: 92.5 cm

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34
Q

___-___ MV photons for oral cavity treatment

A

4-6 MV

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35
Q

Most common aerodigestive tract carcinomas

A

Oral cavity

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36
Q

Combined organs and tissues of respiratory tract and upper digestive tract including lips, mouth, tongue, nose, throat, vocal cords, and part of esophagus and windpipe

A

Aerodigestive tract

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37
Q

4 oral cavity maligancies

A

Tongue disease usually in lateral borders near middle or posterior 1/3 of tongue
Floor of mouth or anterior surface any side of midline
Lips and gum treated similar to skin CA
Retromolar trigone, hard palate (rare), buccal mucosa, and gingival ridge

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38
Q

Gingival ridge

A

Gumline

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39
Q

Oral cavity superior and lower borders

A

Superior = skin-vermillion junction to posterior border of hard palate
Down to circumvallate papillae/base of tongue

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40
Q

Where lips and skin connect

A

Skin-vermillion junction

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41
Q

Oral cavity opposed lateral and boost dose

A

Lateral: 4500 cGy
Boost: 65-70 Gy

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42
Q

Oral cavity T3-T4 dose

A

Up to 80 Gy

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43
Q

Oral cavity IMRT dose to primary lesion

A

Over 2 Gy

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44
Q

Oral cavity superclav field dose

A

45-5000 cGy

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45
Q

Parotid TD5/5

A

3200 cGy

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46
Q

Level of oropharynx

A

C2-C3

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47
Q

5 disease sites of the oropharynx

A 
Tonsils most common
Base of tongue
Lateropharyngeal walls
Soft palate
Uvula
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48
Q

Upper, anterior, inferior and posterior oropharynx borders

A

Upper: zygomatic arch, shield ear
Anterior: clinically 2 cm beyond tumor
Inferior: thyroid notch
Posterior: cover cervical LNs

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49
Q

Initial dose, dose with posterior triangles, and dose with final boost for the oropharynx

A

Initial: 4500 cGy
Posterior triangles: 6000 cGy
Boost: 65-75 Gy

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50
Q

Higher dose per fraction to reduce number of weeks patient has to be treated

A

Accelerated

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51
Q

C3-C6, epiglottis to cricoid cartilage
Lower posterior pharyngeal wall, posterior cricoid area, and pyriform sinuses
IMRT and arcing field VMAT

A

Hypopharynx

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52
Q

Sinuses on either side of larynx

A

Pyriform sinuses

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53
Q

Preop and postop hypopharynx dose

A

Preop: 40-4500 cGy
Postop: 60-65 Gy

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54
Q

Doesn’t have direct drainage to LN chain and doesn’t commonly metastasize

A

Larynx

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55
Q

Space between vocal cords, 65% of larynx CAs here

A

Glottis

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56
Q

Above vocal cords

A

Supraglottis

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57
Q

Below vocal cords

A

Subglottis

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58
Q

Treat larynx with ___x___ or ___x___ lateral or anterior oblique fields for early stage disease

A

5x5 or 6x6

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59
Q

Treat larynx with ___-___MV, ___cm of flash anteriorly

A

4-6MV

1cm

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60
Q

Less than 200 cGy per fraction to larynx results in greater risk of recurrence; treat with over ___-___ cGy per fraction

A

200-225 cGy

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61
Q

BID larynx treatment dose and dose per fraction

A

7440-7900 cGy

240 cGy per fraction

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62
Q

T1, T2, and T3 larynx disease dose

A

T1: 66 Gy
T2: 70 Gy
T3: 6850-7075 cGy (advanced disease)

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63
Q

Larynx superclav dose

A

46-50 Gy

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64
Q

Early stage larynx port superior, inferior, anterior, and posterior borders

A

Superior: top of hyoid bone
Inferior: cricoid cartilage/lower border of C6
Anterior: 1-1.5cm flash/shine
Posterior: early no LN cervical, anterior to vertebral body

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65
Q

Arytenoid

A

Cartilage

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66
Q

Lies at zygomatic arch to EAM, extends inferiorly down to mastoid tip behind nasal cavity above level of soft palate
3D and IMRT

A

Nasopharynx

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67
Q

Initial dose and boost dose for T1 and T2 nasopharynx disease

A

Initial: 5000 cGy
T1: 6500 cGy
T2: 70-75 Gy

68
Q

Take similar skin to replace skin where disease caused it to be removed

A

Interoplation flap

69
Q

Doesn’t repair/regrow
Don’t often metastasize but are locally invasive and can create significant problems for patient
Combined modality treatments: surgery, RT, and lipid soluble chemo to pass blood-brain barrier (BBB)

A

Central nervous system (CNS) malignancy

70
Q

4 CNS treatment techniques

A

Radical surgery is the best chance for a good outcome
Debulking surgery followed by RT to residual tumor that can’t be completely excised, positive margins, or inaccessible tumor and metastatic lesions
RT
Stereotactic radiosurgery-Gamma knife

71
Q

4 things RT dose for CNS disease depends on

A

Tumor type
Grade
Patterns of recurrence
Radio-responsiveness

72
Q

2 reasons whole-brain irradiation for CNS disease is done, setup like H&N treatments

A

Mets

Meningeal disease

73
Q

3 layers of the meninges from inside out

A

Pia
Arachnoid
Dura mater

74
Q

Curative CNS dose and palliative dose and number of treatments

A

Curative: 50-60 Gy
Palliative: 30-3750 cGy in 10-15 treatments

75
Q

Brain TD5/5

A

4500 cGy

76
Q

Brainstem and posterior fossa dose and dose in fractions

A

5500-6000 cGy in fractions less than 200 cGy

77
Q

Precision very important because high dose to small area, less fractions than SRT

A

Stereotactic radiosurgery (SRS)

78
Q

SRS brain mets dose and fractions for small number of lesions (less than 4)

A

20-30 Gy in 1 fraction

79
Q

SRS astrocytoma dose and fractions

A

1600-5000 cGy in 1-2 fractions

80
Q

Usually nonmalignant bundle of vessels in brain, can cause strokes and is the leading cause of stroke in yound people

A

Arteriovenous malformation (AVM)

81
Q

SRS AVM dose, radiation clogs vessels and they begin to deteriorate

A

20-25 Gy up to 12000 cGy

82
Q

Cobalt and photon SRS without linac

A

Cobalt: gamma knife
Photon: cyberknife

83
Q

2 diseases craniospinal irradiations (CSI) are commonly used for in kids

A

Pediatric germinomas

Astroblastomas

84
Q

Two opposed lateral fields for whole brain with spinal fields (1-2 depending on how long patient is)
Prone and tilt chin up to avoid oral mucosa from PA spine field divergence

A

Craniospinal irradiation (CSI)

85
Q

Overlapping spine field with whole brain treatments require us to do ______ and _______ rotation to match angle of divergence; overlapping PA spine fields require us to do __________ to avoid over radiating spinal cord

A 
Couch, collimator
Gap calculation (calc)
86
Q

Rotate cranial field to match divergence from PA spinal field (SSD)

A

Collimator rotation

87
Q

Rotate PA spine field to account for divergence from cranial fields (SAD)

A

Couch kick

88
Q

CSI dose, dose for high risk recurrence patients, and boost to primary brain site

A

Dose: 3000 cGy
High risk: 3600 cGy
Boost: 5400-5580 cGy

89
Q

Gap calc

A

(1/2)(L1)(d/SSD) + (1/2)(L2)(d/SSD)

90
Q

Opposite over adjacent

A

Inverse tangent function (tan^-1)

91
Q

Collimator angle formula

A

tan^-1(L1/SSD)

92
Q

Couch kick formula

A

tan^-1(L1/SAD)

93
Q

Migration of gap between treatment fields through treatment course; move junction on neck to reduce areas receiving radiation from overlap

A

Feathering

94
Q

How far, at what dose, and what is the total dose that a CSI should be feathered?

A

Move 1 cm every 1000 cGy, total of 3000 cGy

95
Q

5 CNS malignancies

A 
Gliomas
Medulloblastoma
Craniopharyngioma
Meningioma
Lymphoma of the CNS
96
Q

Pituitary gland dose and dose for tumors over 2cm

A

Dose: 45-5400 cGy

>2cm: up to 5400 cGy

97
Q

2 digestive system malignancies

A

Colorectal

Pancreatic

98
Q

Most common gastrointestinal malignancy, best prognosis

A

Colorectal

99
Q

4 colorectal treatment techniques

A

Surgery: treatment of choice
Adjuvant or neoadjuvant RT in conjunction with chemo
Endocavitary RT/sphincter-preserving method/technique
Chemo

100
Q

Curative for patients with low to middle third rectal CAs, early stage disease confined to bowel wall
Lidocaine relaxes sphincter, proctoscope inserted for doctor to see lesion; hose inserted and electrons administered
Don’t get deep dose with electrons

A

Endocavitary RT

Sphincter-preserving method/technique

101
Q

Number of electron treatments with probe, dose per treatment, total dose, and time between treatments for endocavitary RT/sphincter-preserving method/technique

A

4 electron treatments at 3000 cGy = 12000 cGy total, treatments separated for 2 weeks

102
Q

2 colorectal chemo regimens

A

5FU and leucovorin

FOLFOX

103
Q

FOLFOX

A

5FU
Leucovorin
Oxiplatin

104
Q

EBRT ___-___ weeks before endocavitary RT/sphincter-preserving method/technique which is given as a boost

A

7-8 weeks

105
Q

___ colorectal cure rate with endocavitary RT/sphincter-preserving method/technique

A

90%

106
Q

Colorectal dose and coned down dose

A

Dose: 4500 cGy
Coned: 50-55 Gy

107
Q

Small bowel (SB) TD5/5

A

40 Gy

108
Q

Colorectal IMRT and VMAT dose for microscopic and gross residual disease (give higher dose because it’s more conformal)

A

Microscopic: 60 Gy or more

Gross residual: 70 Gy or more

109
Q

Colorectal treatment fields encompass ______________ and ______ with _______ field techniques or IMRT/VMAT

A

Primary tumor volume, LNs

Shrinking

110
Q

2 LNs encompassed by colorectal treatment fields

A

Internal iliacs

Pre-sacrals

111
Q

2 colorectal field arrangements determined by anterior structures and if they need dose (wedge with toes to AP and heels to PA)

A

AP/PA and 2 laterals

PA and 2 laterals

112
Q

3 ways to get SB out of treatment field

A

Full bladder
Stomach/belly board
False tabletop

113
Q

Linac in surgery, treat are with disease

Mobile accelerators that provide high energy electrons

A 
Intraoperative RT (IORT)
Precision therapy
114
Q

IORT dose in single fraction to tumor bed

A

1000-1200 cGy

115
Q

With 4 field colorectal treatments, _______ structures (bladder, etc.) receive more dose

A

Anterior

116
Q

2 multimodality esophageal CA treatment techniques

A

Surgery: superior/upper connected to oral cavity leading to decreased quality of life (QOL)
Radiation and chemo: non-surgical treatment of choice; IMRT and VMAT boost

117
Q

2 most common sites of esophageal disease

A

Middle esophagus

Distal esophagus

118
Q

Most patients have locally advanced or metastatic esophageal disease leading to the use of ______ fields/portals because of potential for longitudinal spread

A

Large

119
Q

Can see lesions 5cm from primary

A

Skip lesions

120
Q

Upper esophageal treatment fields

A

2 anterior obliques

121
Q

______ position is more comfortable but gravity can pull esophagus closer to spinal cord, ______ less comfortable but allows more distance between esophagus and spine

A

Supine, prone

122
Q

Initial dose and dose per day to esophagus with AP/PA and obliques and first and second boost dose

A

Initial: 4500 cGy
Per day: 180-200 cGy
1st: 5000 cGy
2nd: 60-70 Gy

123
Q

Esophageal dose for just RT and no chemo and dose with RT and chemo

A

RT: 65 Gy
Chemo: 50 Gy

124
Q

Esophageal tumor infiltrates at tracheobronchial tree can lead to a fistula close to aorta that can rupture so we must lower the fractionated dose to _____cGy per day and use more fractions to still get close to total dose

A

150 cGy

125
Q

2 pancreatic CA techniques

A

Surgery

RT and chemo preferred treatment for locally advanced or unresectable disease

126
Q

Treatment of choice for pancreatic cancer
Remove head of pancreas, duodenum, gallbladder, common bile duct, distal stomach, and possible vagotomy
Can double median survival but most tumors are unresectable due to advanced disease

A

Whipple procedure

127
Q

Most important diagnostic tool of pancreatic CA

A

CT

128
Q

4 field technique for pancreatic cancer; supine, arms above head

A

AP/PA and 2 laterals

129
Q

6 dose limiting structures contained in the area of the pancreatic treamtent field

A 
Liver
Kidneys
Heart
Spinal cord
SB
Stomach
130
Q

Liver, kidneys, heard, spinal cord, and stomach TD5/5

A 
Liver: 3000 cGy
Kidneys: 2300 cGy
Heart: 4000 cGy
Spinal cord: 4700 cGy
Stomach: 5000 cGy
131
Q

Pancreatic dose and dose per fraction; worry about kidneys on laterals

A

45-50 Gy at 180 cGy per fraction

132
Q

AP and inferior pancreatic margins

A

AP: T11-L3, adequate margin; T12-L1 vessels
Inferior: L2-L3, block kidneys

133
Q

Pancreatic EBRT and IORT dose

A

EBRT first: 5040 cGy

IORT: 10-25 Gy (20 Gy)

134
Q

3 gynecological malignancy

A

Uterine
Cervix
Endometrial

135
Q

Fields for gynecological malignancies

A

4 field AP/PA and 2 laterals

Primary tumor and regional LNs

136
Q

Distal end of anal canal forming a transitional zone between the epithelium of the anal canal and perianal skin

A

Anal verge

137
Q

7 structures to worry about during the treatment of gynecological malignancies

A 
Fleshy portion over pubis bone
Clitoris
Urethra meatus
Labia major and minor
Ovaries
Cervix
Endometrium
138
Q

Obese patients whose large abdomen marks move a lot, stomach creates _______ and skin breakdown occurs under fold

A

Bolus

139
Q

Will not treat over ______cGy if SB is in field

A

5000 cGy

140
Q

Treatment for early stage (carcinoma in situ, 0, IA2) cervix disease based on involvement and treatment for childbearing

A

Total abdominal hysterectomy (TAH) and vaginal cuff

Conization

141
Q

Inoperable early stage cervical disease in one implant with tandem and ovoids dose

A

45-55 Gy

142
Q

Inoperable early stage cervical disease in one or two implants with tandem and ovoids dose for stage IA2

A

60-75 Gy

143
Q

Initial EBRT dose for bulky/later stage cervix disease IIB3 and 4A; brachytherapy implant dose to low volume disease and bulky disease

A

EBRT: 40-50 Gy (45 Gy)
Low volume: 70 Gy
Bulky: 85-90 Gy

144
Q

Ensure outer dose to cervical area with this block mounted in middle of AP/PA field allows dose to peripheral structures like LNs

A

Pogo
Step wedge
Midline block

145
Q

Cervix superior, inferior, lateral, anterior, and posterior borders

A

Superior: AP/PA L4-L5
Inferior: BIT, BOF, or 4 cm below lowest extent of disease
Lateral: 1.5-2 cm lateral of bony pelvis
Anterior: lateral field anterior to symphysis pubis
Posterior: transect sacrum at S3-S4

146
Q

2 cm lateral to tandem and 2 cm superior to cervical oss or end of tandem, point where uterine vessels cross ureters (dose-limiting structure)

A

Point A

147
Q

3 cm lateral to point A

A

Point B

148
Q

1 cm lateral to point B

A

Point P

149
Q

At point of foley catheter

A

Bladder

150
Q

5 mm posterior to vaginal wall

A

Rectum

151
Q

Lining of uterus

A

Endometrium

152
Q

Stage IA, grade I (early stage) endometrial disease treatment

A

Hysterectomy only, encompassed in removed area

153
Q

Stage IB, grade I, II endometrial disease post TAH brachytherapy dose

A

60-70 Gy or 5-7 Gy to 0.5 cm in three applications

154
Q

Stage IC or higher, grade III endometrial disease post TAH external and implant dose

A

External: 45-50 Gy
Implant: 80 Gy

155
Q

Stage IC or higher, grade III endometrial disease post TAH 4 field dose, boost dose for gross involvement, and brachytherapy boost to endometrial cavity with Heyman capsules and tandem

A

4 field: 50-60 Gy
Boost: 65 Gy
Brachytherapy: 75-90 Gy

156
Q

If hysterectomy, no tandem or Heyman capsules, use ______ and ________

A

Ovoids

Vaginal cylinder

157
Q

Bladder and rectum TD5/5

A

Bladder: 6500 cGy
Rectum: 6000 cGy

158
Q

When treating endometrium, keep badder and rectum at this lower dose

A

60-75 Gy

159
Q

Stage III, IV endometrial disease EBRT dose, brachytherapy dose, and bulky disease dose with shield

A

EBRT: 50 Gy
Brachy: 75 Gy
Bulky: 100 Gy

160
Q

2 structures wing blocks during endometrial treatments decrease dose to

A

Bone marrow

Femoral heads

161
Q

Post op whole abdomen EBRT dose and boost to paraaortic and pelvic LNs for ovarian disease

A

EBRT: 2550-3000 cGy
Boost: 40-50 Gy

162
Q

7 ways to increase anterior dose when treating vulva to minimize dose to femoral heads and rectum

A

Anterior weighting pulls dose anteriorly
Lower anterior energy and high posterior energy pushes dose anteriorly
Anterior electron field
Anterior bolus
Partial transmission blocks
Narrow PA fields to protect femoral head and neck by closing in beam but may need to supplement inguinal LNs
IMRT spares healthy tissue

163
Q

External, treat with wide excision and EBRT
Primary site and pelvic LNs
Frog-leg to reduce bolus from folds and skin breakdown
Wire scars/palpable nodes for gross disease and bolus over scar
RT, surgery for recurrence

A

Vulva CA

164
Q

Brachytherapy alone dose and EBRT first and brachytherapy dose for primary or macrodisease for vulva CA

A

Brachy: 60 Gy
EBRT: 45-50 Gy, brachy: 65-80 Gy

165
Q

Midline block when treating vulva after ___Gy for early invasive disease and after ___Gy for stages IIB or higher to get tumor dose to critical structures as close as possible

A

20 Gy, 40 Gy

RAD 370 - Techniques and Applications (6 decks)

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