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Safety Flashcards

1
Q

Sources of Rad. - Natural Background Radiation:

A
  • cosmic rays: high energy rad. mainly originating from outside the solar system
  • terrestrial rad. - long-wave electromagnetic rad. originating from earth and its atmosphere
  • internal rad. - human bodies emit electromagnetic rad.
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2
Q

Sources of Rad. -Types of Radiatiation:

A
  • Alpha Paticles

- Beta Particles

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3
Q

Sources of Rad. - What is the half-life of Iodine- 125?

A

59.4 days

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4
Q

Sources of Rad. - What is the half-life of Palladium- 103?

A

17 days

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5
Q

Sources of Rad. - What is the half-life of Cesium- 137?

A

30 years

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6
Q

Sources of Rad. - What is the half-life of Iridium- 192?

A

73.8 days

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7
Q

Sources of Rad. - What is the half-life of Strontium- 90?

A

28.8 years

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8
Q

Sources of Rad. - What is the half-life of Iodine- 131?

A

8 days

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9
Q

Sources of Rad. - Kilovoltage units:

A
  • superficial - 50-150 kv

- orthovoltage - 150-500 kv

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10
Q

Sources of Rad. - megavoltage units:

A
  • linear accelerator (photons and electrons)
  • cyclotron (particle therapy)
  • cobalt-60 (gamma rays)
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11
Q

Basic Properties of Radiation - Electromagnetic Radiation - what is frequency?

A

number of waves that pass a given point in a specified unit of time. the unit is hertz (cycles/second)

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12
Q

Basic Properties of Radiation - Electromagnetic Radiation - what is wavelength?

A

distance between peaks of the wave, measured in meters

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13
Q

Basic Properties of Radiation - Electromagnetic Radiation - what is the energy equation?

A

(E)=hv

v=frequency
h= Plank’s Constant (6.62 x 10^-34)

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14
Q

Basic Properties of Radiation - Electromagnetic Radiation - What does a shorter wavelength mean?

A

greater energy and penetrating power

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15
Q

Basic Properties of Radiation - Electromagnetic Radiation - what has no mass, no charge, and low LET?

A

Photons

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16
Q

Basic Properties of Radiation - Electromagnetic Radiation - photon gamma rays are emitted from the ______.

A

nucleus

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17
Q

Basic Properties of Radiation - Electromagnetic Radiation - photon x-rays are emitted from outside the _____.

A

nucleus

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18
Q

Basic Properties of Radiation - Electromagnetic Radiation - what is attenuation?

A

the reduction of the force, effect, or value of something.

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19
Q

Basic Properties of Radiation - Electromagnetic Radiation - Characteristics of Beta Particles:

A
  • electrons emitted by the nucleus
  • shielded w low Z materials
  • more penetrating than alpha

Beta- Decay, Beta+ Decay, x-ray and gamma ray

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20
Q

Basic Properties of Radiation - Electromagnetic Radiation - Characteristics of Alpha Particles:

A
  • Helium Nucleus
  • emitted from an unstable nucleus
  • travels short distances
  • produces intense ionizations - High Energy Linear Transfer (LET)
  • Extremely hazardous if ingested or inhaled
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21
Q

Basic Properties of Radiation - Electromagnetic Radiation - What is inverse square law?

A

a law stating that the intensity of an effect such as illumination or gravitational force changes in inverse proportion to the square of the distance from the source.

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22
Q

Basic Properties of Radiation - Electromagnetic Radiation - What is Half Value Layer? (HVL)

A

the thickness of a given material that reduces the intensity of the intensity of the rad. beam by one half

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23
Q

Basic Properties of Radiation - Electromagnetic Radiation - what is the attenuation equation used for?

A

used to calculate beam intensities for various absorber thickness

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24
Q

what is monochromatic radiation?

A

all photons in the radiation beam have the same energy

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25
Q

what is polychromatic radiation?

A
  • photons in beam have varying energies
  • an absorber removes lower energy x-rays
  • attenuation of polychromatic rad. results in:
    change in beam quantity
    change in beam quality
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26
Q

higher energy (hard) beams have:

A
  • high half value layer

- high penetrating power

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27
Q

low energy (soft) beams have:

A
  • lower half value layer
  • less penetrating power
  • higher skin dose
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28
Q

Interactions w/ matter: What are the photon interactions with matter?

A

photoelectric effect, Compton scatter, and Pair Production

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29
Q

Interactions w/ matter: What are the electron interactions w matter?

A

Bremsstrahlung and characteristic radiation

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30
Q

Interactions w/ matter: what is attenuation?

A

the reduction in the number of primary photons in the beam through absorption (a total los of rad energy) and scatter (a change in direction of travel that may also involve a partial loss of rad energy) as the beam passes through the pt in it path

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31
Q

Interactions w/ matter: Describe characteristic effect:

A
  • transfer of total energy of a photon to an inner electron of an atom
  • photon interacts w an inne shell (k or l) and ejects an electron from the atom (ionization). photon disappears
  • electron from outer shell fills vacancy and gives off characteristic rad
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32
Q

Interactions w/ matter: what materials is photoelectric effect more common w?

A

materials such as bone - low energy photons and high atomic number (Z) materials

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33
Q

Interactions w/ matter: Describe Compton scatter:

A
  • photon interacts w an outer shell electron (loosely bound), atom absorbs all the photon energy, and electron is ejected from outer shell

-

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34
Q

Interactions w/ matter: what materials is Compton scatter more common w?

A

the dominant interaction w photons in diagnostic and therapeutic energy ranges

-most common interaction w energies used in rad ther

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35
Q

Interactions w/ matter: Describe Pair Production:

A
  • high energy photon interacts w the nucleus
  • incoming photon must have an energy of at least 1.02 MeV (threshold)
  • photon energy creates mass of negative and positive (positron) electrons, photon disappears
  • when positron stops, it undergoes annihilation and creates 2 .51 MeV photons traveling in opposite directions
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36
Q

Interactions w/ matter: describe bremsstrahlung rad:

A
  • “braking radiation”
  • interaction of a charged particle (electron)w the nucleus of an atom
  • the particle loses speed and changes direction
  • the kinetic energy lost by the particle is emitted as bremsstrahlung radiation
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37
Q

Interactions w/ matter: Describe Characteristic Radiation:

A
  • photons interact w an inner shell electron, ejecting it from the atom (ionization)
  • electron from outer shell jumps to fill vacancy and yields characteristic rad equal to the elements electron binding energy
  • energy given off identifies the element. rd given off is characteristic of that element
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38
Q

Interactions w/ matter: What is Linear Energy Transfer?

A

LET - Linear Energy Transfer

  • rate that energy is deposited as it ravels through matter
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39
Q

Interactions w/ matter: Low LET vs. High LET:

A

Low LET: x-rays and gamma rays, secondary electrons: small particles travel great distances

High LET: protons, alpha particles: bulky particles travel small distances

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40
Q

Interactions w/ matter: 2 different radiation interactions:

A
  • direct ionizations
  • indirect ionizations

cause secondary effects within the cells

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41
Q

Interactions w/ matter: Describe Direct Ionizations:

A

more prominent w charged particles such as protons and electrons

-particles interact w the nucleus of an atom causing damage to the DNA of the cell. DNA is the “target” for the radiation and a direct hit will kill the cell

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42
Q

Interactions w/ matter: Describe Indirect Ionizations:

A

usually caused by x-rays, gamma rays and neutrons

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43
Q

Interactions w/ matter: What is radiolysis?

A

splitting of a water molecule to form ions

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44
Q

Components and Operations: How it works: productions of radiation:

A

as the electrons are accelerated down the guide they gain energy. then they strike a high Z target and produce x-rays via bremsstrahlung interactions. if electron therapy is desired, the target and the flattening filter move out of the beams path and the scattering foil moves into the beam’s path

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45
Q

Components and Operations: Radiation Characteristics:

A

Linac photon beam has a broad spectrum of energies. max energy photon is the energy of electron striking target. Avg. energy is usually 1/3 to 1/2 the max energy.

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46
Q

Components and Operations: Linear Accelerators Interactions w Matter:

A

for low energy linacs, Compton scattering is the most prevalent interaction, but as the energy increases, pair production becomes more prevalent. Pair production increases w energy above its threshold of 1.02 MV and is proportional to Z^2, so there is more absorption in bone than soft tissue w higher energy machines.

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47
Q

Components of a Linear Accelerator - what is the modulator?

A

provides electron gun and magnetron w high voltage, square, pulsed power

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48
Q

Components of a Linear Accelerator - what is the electron gun?

A

supplies electrons needed for x-ray production and injects them into the accelerator guide

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49
Q

Components of a Linear Accelerator - what is the magnetron/klystron?

A

supplies RF power for the accelerator guide, pulsed simultaneously w the electron gun. magnetrons are found in lower energy machines and produce microwave. klystrons are found in higher energy machines and amplify microwaves

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50
Q

Components of a Linear Accelerator - what is the waveguide?

A

transports RF power from the magnetron to the accelerator guide. waveguide is filled with hexafluoride to prevent arcing

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51
Q

Components of a Linear Accelerator - what is the circulator?

A

one-way door in the waveguide that allows RF into the accelerator guide but not back out to prevent damage to the magnetron

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52
Q

Components of a Linear Accelerator - what is the accelerator guide?

A

vacuum tube across which electrons are accelerated on the RF power

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53
Q

Components of a Linear Accelerator - what is the bend magnet?

A

forces the electrons around a bend so they exit the gantry head in the appropriate orientation for tx

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54
Q

Components of a Linear Accelerator - what is the transmission target?

A

the electrons strike the target and produce x-rays. the photons exit the target in the same direction as the entering electrons

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55
Q

Components of a Linear Accelerator - what is the flattening filter?

A

the lead filter that attenuates some of the beam in order to provide a more uniform dose distribution

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56
Q

Components of a Linear Accelerator - what is the ion chambers?

A

parallel-plate chambers that check dose rate, integrated dose, and symmetry. these chambers are sealed so their response is not influenced by outside temp. and pressure

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57
Q

Components of a Linear Accelerator - what is the scattering foil?

A

placed in the path of the beam for electron therapy. spreads out the beam of electrons. when in the beams path, the transmission target and flattening filter are removed

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58
Q

Components of a Linear Accelerator - 5 main components of a linac?

A

drive stand, gantry, pt. support assembly (PSA), electronic cabinet, and console

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59
Q

Components of a Linear Accelerator - what is the gantry responsible for?

A

directing the beam out toward the pt.

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60
Q

Components of a Linear Accelerator - what are the major components in the gantry?

A

waveguides, electron gun, accelerator structure and collimator head

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61
Q

CT Simulator: Why were CT simulators invented?

A

to enhance target localization; CT simulators brought the capacity to view anatomic data in three dimensions w all tissue densities easily visualized

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62
Q

CT Simulator: What do the cross-sectional images for CT simulators allow?

A

the planning therapist, dosimetrist, and physician to visualize the target and surrounding tissue

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63
Q

Quality Control Procedures: What does Warm up for linac consist of?

A
  • time delay - real warm up that allows the filament to heat up correctly. when machine is turned on, it automatically goes into time delay. DO NOT BYPASS TIME DELAY
  • Daily Check Out - verifies machine circuitry is functioning properly (e.g. total does, time, and dose rate). operators manual gives warm up procedures for ea machine
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64
Q

Quality Control Procedures: what is the interlocking system?

A

the door - machine will not turn on if door to tx rm is open

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65
Q

Quality Control Procedures: what are the emergency switches?

A
  • emergency off buttons - located on control panel, in tx rm, on tx table, and on machine. designed to disable all control circuits and shut down machine
  • circuit breakers - if emergency off button fails, the main circuit breaker is the next course f action. no normally located in tx rm, but near ctrl panel. when pulled, all power to machine is cut off
  • limit switches - preset switches to prevent machine motion past the limit to prevent damage to the machine. example would be gantry rotation only traveling 360 degrees to prevent damage to the wires in the gantry
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66
Q

Quality Control Procedures: what consists of recording critical machine parameters?

A

during daily warmup the therapist records water pressure, temp., and fluid levels in the log book. values should be comparable to baseline settings and previous readings. if readings are off, notify physicist

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67
Q

Quality Control Procedures: what is an electrical associated machine hazard w linac?

A

linac operate at high voltages, so water can be hazardous

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68
Q

Quality Control Procedures: what is an mechanical associated machine hazard w linac?

A

the gantry and machine table can cause injury by colliding

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69
Q

Quality Control Procedures: what is an laser associated machine hazard w linac?

A

lasers can result in damage to the retina

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70
Q

Quality Control Procedures: what is an gaseous associated machine hazard w linac?

A

tx uses hazardous gases to operate. can also create toxic fumes

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71
Q

Quality Control Procedures: what is the role of sulfur hexafluoride in the linac?

A

colorless, odorless gas used in the tx machine to prevent arcing in the waveguide. non-toxic but can be an asphyxiant displacing oxygen

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72
Q

Quality Control Procedures: what is the role of ozone in the linac?

A

interaction of a high energy electron beam w air can produce ozone and oxides of nitrogen. ozone is a toxic gas that affects the respiratory system. for this reason, it is important that the tx rm be well ventilated. if pungent odor of gas is detected, shut down machine, remove pt., allow sufficient time for gas to be exhaustedly normal rm ventilation

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73
Q

Dose Verifications: constancy of calibration - how often?

A

must be checked weekly for linac and monthly for Cobalt- 60.

*constancy of calibration is referring to radiation output and how often the machine is calibrated

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74
Q

Dose Verifications: constancy of calibration - what are annual calibrations be performed using?

A

ionization chamber and electrometer that has been calibrated by a NIST, lab, and a standard phantom

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75
Q

Dose Verifications: what does NIST stand for? what do they do?

A

National Institute of Standards and Technology

The National Institute of Standards and Technology (NIST) was founded in 1901 and is now part of the U.S. Department of Commerce. NIST is one of the nation’s oldest physical science laboratories. Congress established the agency to remove a major challenge to U.S. industrial competitiveness at the time—a second-rate measurement infrastructure that lagged behind the capabilities of the United Kingdom, Germany, and other economic rivals.
From the smart electric power grid and electronic health records to atomic clocks, advanced nanomaterials, and computer chips, innumerable products and services rely in some way on technology, measurement, and standards provided by the National Institute of Standards and Technology.
Today, NIST measurements support the smallest of technologies to the largest and most complex of human-made creations—from nanoscale devices so tiny that tens of thousands can fit on the end of a single human hair up to earthquake-resistant skyscrapers and global communication networks.

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76
Q

Dose Verifications: What are the effects of barometric pressure, temp, and humidity on ion chambers?

A

these chambers are not sealed and are effected by outside conditions. they are calibrated by NIST labs at 22 degrees C and 760 mm HG pressure.

*All chambers must be corrected for the present conditions using the Temperature and Pressure Correction Factor

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77
Q

Dose Verifications: All chambers must be corrected for the present conditions using the Temperature and Pressure Correction Factor. What is it?

A

T + 273 x 760
CF = ———— ——
295 P

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78
Q

Quality Control Procedures: Light - checking the crosshairs consists of:

A

the crosshair should represent the isocenter (axis rotation for the collimator, gantry, and table). this cn be checked using graph paper by rotating the collimator to ensure there is no “walk-out” of the crosshair. malfunction is due to misalignment of the light field or crosshair (<2mm difference)

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79
Q

Quality Control Procedures: Light - The light Field:

A

the light field should adequately represent the radiation field. check this using film to ensure that the field does not “walk out” for different collimator angles. malfunction may be due to the target, collimator, or light source. if the walk out does not rotate, the target is causing the problem. if it does rotate, it is the collimator or light source causing the problem.

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80
Q

Quality Control Procedures: Collimator -

A

collimator settings should agree w the measured light field. this can be checked w graph paper. malfunction is due to the drive mechanism (<2mm difference)

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81
Q

Quality Control Procedures: Optical Distance Indicator (ODI)

A

ODI must be checked to ensure proper representation of distances from the source/target. This is checked w the front pointer. malfunctions include misalignment of the ODI, replacement of the light bulb, or damage to the front pointer (<2mm difference)

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82
Q

Linear Accelerator: Control Console

A
  • monitoring and controlling of the linear accelerator occurs at the control console.
  • located outside tx rm
  • is a digital display, push-button panel, and/or video display terminal
  • monitoring pt during tx is essential
  • ## emergency off buttons are located on control console
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83
Q

spinal cord T/D

A

4700 cGy-necrosis

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84
Q

Lens T/D

A

1000 cGy-cataracts

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85
Q

Lacrimal Gland t/d

A

2600 cGy-dry eyes

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86
Q

Optic Chiasm t/d

A

5000 cGy -blindness

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87
Q

optic nerve t/d

A

5000 cGy-blindness

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88
Q

Paraotid Gland t/d

A

3200 cGy-xerostomia

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89
Q

temporomandibular joint t/d

A

6000 cgy- limitation of joint function

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90
Q

esophagus t/d

A

5500 cgy-stricture/perforation

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91
Q

thyroid t/d

A

4500 cgy -thyroiditis

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92
Q

larynx t/d

A

4500 cGy - edema

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93
Q

ear t/d

A

3000/5500 cGy acute/chronic serious otitis

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94
Q

heart t/d

A

4000 cGy pericarditis

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95
Q

lung t/d

A

1700 cGy pneumonitis

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96
Q

brachial plexus t/d

A

5500 cGy nerve damage

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97
Q

liver t/d

A

3000 cGy liver failure

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98
Q

kidney t/d

A

2300 cGy nephritis

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99
Q

stomach t/d

A

5500 cGy ulceration/perforation

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100
Q

small bowel t/d

A

4500 cGy obstruction/perforation

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101
Q

large bowel t/d

A

5500 cGy obstruction/perforation

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102
Q

rectum t/d

A

6000 cGy proctitis/necrosis/stenosis

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103
Q

femoral head & neck t/d

A

5200 cGy necrosis

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104
Q

bladder t/d

A

6500 cGy contracture

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105
Q

brain (limited) t/d

A

6000 cGy necrosis/infarction

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106
Q

brain (whole) t/d

A

4500 cGy necrosis/infarction

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107
Q

brain stem t/d

A

5000 cGy necrosis/infarction

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108
Q

optic nerve t/d

A

5000 cGy blindness

109
Q

retina t/d

A

4500 cGy blindness

110
Q

cellular radiosensitivity is dependent on?

A

the specific phase of the cell cycle containing the cells at the time of irradiation (this is referred to as the age response)

111
Q

cells are more radiosensitive and resistant during what phase

A

radiosensitive during G2 and M phase

112
Q

number of atom’s per gram is given by

A

Avogadro’s number 6.0228x10^23

113
Q

ionization

A

when electrons collide and have sufficient energy to overcome there binding energy and eject them from orbit

114
Q

when an X-ray beam passes through matter, the beam undergoes a gradual reduction in the number of photons or exposure rate. this is called

A

attenuation

115
Q

in the human body the rate of attenuation and degree of scattering is determined by

A

tissue thickness, density, and effective atomic number

116
Q

Effects of Whole Body Radiation Exposure: hematopoietic Syndrome

A

Dose: 200-1000cGy(whole body)
mean survival:10-60 days
symptoms: nausea, vomiting, diarrhea, anemia, leukopenia, hemorrhage, fever, infection, dehydration
C.O.D: infection and dehyration

117
Q

Effects of Whole Body Radiation Exposure: Gastrointestinal syndrome

A

dose: 1000-5000 cGy (whole body)
Mean survival: 4-10 days
symptoms: same as hematopoietic plus electrolyte imbalance, lethargy, fatigue, and shock
C.O.D: severe damage to lining of he intestines

118
Q

Effects of Whole Body Radiation Exposure: CNS Syndrome

A

Dose: 2000-5000 cGy (whole body)
Mean survival: 0-3 days
Symptoms: same as G.I plus ataxia, edema, vasculitis, and meningitis
C.O.D: Edema of the brain

119
Q

public radiation dose: embryo/fetus (after declaration)

A

0.5 rem/entire pregnancy

stochastic:
0.5 mSv/month (0.05 rem/month)

120
Q

Somatic Effects: Embryonic and fetal risks

A

lethal effects, congenital abnormalities (present at birth or late effects observed years later), usually involve the CNS and most commonly include microcephaly, mental retardation, sensory organ damage, and stunted growth. skeletal changed are most prevalent when radiation is administered between weeks 3-20 (fetus is more radiosensitive than embryo)

121
Q

carcinogenesis

A

the multistage process that occurs following exposure to a carcinogen leading to malignancy

122
Q

radiosensitizers

A

chemicals and drugs that help enhance the lethal effects of RT: Doxorubicin, Cisplatin (platinol), fluorouracil (5-FU, adrucil)

123
Q

Radioprotectors

A

chemicals and drugs that diminish the response of cell to RT: amifostine (Ethyol)

124
Q

Brachytherapy

A

“short distance” therapy. Uses materials like Cesium-137 (Cs137), iridium-192, palladium-103, or iodine-125. Radioactive sources are placed right next to or directly into the tumor, because the energy of the radioactive sources is low, a high energy is delivered to the tumor

125
Q

intracavitary brachytherapy

A

place radioactive material into a body cavity (used with cervical or endometrial)

126
Q

interluminal brachytherapy

A

radioactive material is placed within a body tube such as the esophagus or bronchial tree. the radioactive material is positioned in the lumen at the tumor sire and removed one the prescribed dose is delivered

127
Q

chemotherapy

A

systemic tx (killing cells of the primary tumor and those that may circulate in the body using cytotoxic drugs (drugs with the ability to kill cancer cells) and hormones

128
Q

alkylating agents

A

first drugs identified to have anticancer activity (related structurally to mustard gas)

129
Q

Law of Bergonie and Tribondeau states what?

A

that cells that are rapidly dividing, have a long mitotic future, and are undifferentiated are the most responsive to radiatio

130
Q

Cell division in germ cells is termed

A

meiosis

131
Q

cell division in non-germ cells is called

A

mitosis

132
Q

4 phases of division in non-germ cell mitosis

A

Mitosis, Gap 1, DNA synthesis, and Gap 2 (a phase known as Gap 0, indicated a period of rest.

133
Q

The phase of cell division most sensitive to radiation is?

A

M phase

134
Q

the phase of cell division most resistant to radiation is

A

S phase

135
Q

the portion of cells in mitosis is called

A

mitotic index

136
Q

changes seen within days or weeks are called

A

deterministic or non stochastic effects (acute), or prodromal

137
Q

changes seen after months or years of exposure may be called

A

stochastic (latent)

138
Q

4 progressive stages of skin response to RT

A
  1. epilation 2. erythema, 3.dry desquamation, 4. wet desquamation
139
Q

beyond what dose may skin necrosis occur?

A

50 Gy

140
Q

Skin acute effects of skin RT (3 and onset dose)

A

Erythema- 20 Gy
Dry desquamation - 30 Gy
Wet desquamation - 40 Gy

141
Q

Acute RT effect oral Mucosa (2 and onset dose)

A

Mild, patchy mucositis -30 Gy

Confluent mucositis - 40 Gy

142
Q

Acute RT effect esophagus and onset dose

A

esophagitis-25Gy

143
Q

Acute RT side effect Salivary Gland and onset dose

A

Xerostomia- 20 Gy

144
Q

Acute RT side effect rectum and onset dose

A

proctitis-30 Gy

145
Q

Acute RT side effect Testis and onset dose

A

decreased sperm- 0.25 Gy

146
Q

Acute RT side effect bone marrow (2 and onset dose)

A

lowered blood count- 2Gy

extensive hypolasia- 50 Gy

147
Q

Acute RT side effect stomach and onset dose

A

Gastritis- 20 Gy

148
Q

Skin T/D 5/5 and injury

A

55 Gy ulceration/fibrosis

149
Q

Intestine T/D 5/5 and injury

A

45 Gy stricture

150
Q

Salivary gland T/D 5/5 and injury

A

45 permanent xerostomia 40 Gy

151
Q

Kidneys T/D 5/5 and injury

A

Failure 23 Gy

152
Q

Testis, Ovary T/D 5/5 and injury

A

Sterility 5-15 Gy

153
Q

Bone T/D 5/5 and injury

A

Arrested growth in child 20 Gy

Necrosis in adult 60 Gy

154
Q

Bone marrow T/D 5/5 and injury

A

reduced cellularity 20 Gy

155
Q

spinal cord T/D 5/5 and injury

A

necrosis 45 Gy

156
Q

Lens T/D 5/5 and injury

A

Cataract 5Gy

157
Q

Brain T/D 5/5 and injury

A

necrosis 50 Gy

158
Q

prodromal symptoms

A

nausea, vomiting, fatigue, fever hypotension, diarrhea

159
Q

manifest syndromes are

A

hematopoietic, gastrointestinal, and cerebrovascular

160
Q

Early RT effects to the unborn embryo or fetus may include what and lethal dose?

A

spontaneous abortion or death in utero; lethal doses as lo as 0.05 Gy could be lethal to the embryo in the first trimester.

as the cells mature during the 2nd and 3rd trimesters, lethal RT doses to the unborn fetus increases

161
Q

Somatic effects of RT

A

(late effects) RT induced cancers, cataract formation, chronic bone marrow depression, shortened life span, and mutations in germ cells.

162
Q

whole body RT syndrome (3, include dose rang and time until death)

A
  1. hematopoietic-300-800 cGy (10-15 days till death)
  2. gastrointestinal- 1000-5000 cGy (3-10 days)
  3. cerebrovascular - >5000 cGy (hours-3 days)
163
Q

clinically accepted RBE (radiobiological effectiveness) for proton therapy

A

1.1.^37

164
Q

what is the gantry and how is it operated?

A

it is responsible for directing the photon (X-ray) or electron beam at the pt tumor, this can be accomplished through single-rotational field or multiple-fixed fields.

the control for the gantry are located on the pendant or outside the room at the console

165
Q

field size for gantry is defined by

A

X1, X2, Y1 and Y2

166
Q

the major components of a linear accelerator include (5 things)

A

drive stand, gantry, patient support assembly (treatment couch), control console, modulator cabinet

167
Q

major components of the gantry (3 things)

A

electron gun, accelerator guide, and treatment head

168
Q

major components of the treatment head in the gantry (4 things)

A

bending magnet, beam-flattening filter, ion chamber, and upper-lower collimator jaws

169
Q

what is vertical movement of the tx table?

A

up and down

170
Q

what is roll on the tx table

A

tilting the table either way (left/right)

171
Q

what is the pitch on the table

A

tilting the table towards pt head or feet

172
Q

what is a lateral move on the tx table

A

moving table left or right

173
Q

what is a longitudinal move on the tx table

A

moving entire table more towards pt head or feet

174
Q

what is rotation of the table

A

moving the table to either side at an angle

175
Q

what is an event (patient safety)

A

something that happens to or involves a patient

176
Q

what is a harmful incident (patient safety)

A

an incident that results in harm to a patient

177
Q

what is healthcare associated harm? (patient safety)

A

harm arising from or associated with plans or actions taken during the provisions of healthcare, rather than from an underlying disease or injury

178
Q

a patient safety incident (patient safety)

A

an event or circumstance that could have resulted or did result in uncessesary harm to a patient

179
Q

a no harm incident (patient safety)

A

is an incident which reached a patient, but no discernible harm resulted

180
Q

a reportable incident (patient safety)

A

is a situation in which there was significant potential for harm, but no incident occurred

181
Q

superficial Dmax (cm below skin)

A

0.0 cm

182
Q

orthovoltage Dmax (cm below skin)

A

0.0 cm

183
Q

cobalt-60 Dmax (cm below skin)

A

0.5 cm

184
Q

4 MV Dmax (cm below skin)

A

1.0 cm

185
Q

6 MV Dmax (cm below skin)

A

1.5 cm

186
Q

10 MV Dmax (cm below skin)

A

2.5 cm

187
Q

15 MV Dmax (cm below skin)

A

3.0 cm

188
Q

20 MV Dmax (cm below skin)

A

3.5 cm

189
Q

25 MV Dmax (cm below skin)

A

5.0 cm

190
Q

4 major components housed in the stand

A

the klystron, waveguide, circulator, cooling system

191
Q

unrestricted area sign

A
  • can be occupied by anyone
  • person in this area would receive less than 2 mrem/hour
  • no one should receive more than .1 rem in one year
192
Q

restricted (controlled area) sign

A
  • occupied by radiation workers

- approx 50 hours/week for workers in area of 2 rem/hour

193
Q

radiation area

A
  • an individual could receive a dose equivalent greater than 5 mrem/hour at 30 cm distance from the source
  • should be marked “caution, radiation area”
194
Q

high radiation area

A
  • can receive dose equivalent greater than .1 rem/hour at 30 cm distance from the source
  • should be marked “caution, high radiation area” or “danger, high radiation”
195
Q

very high radiation area

A
  • an individual could receive an absorbed dose greater than 500 rads/hour at 1 meter from the radiation source
  • should be marked with words “grave danger, very high radiation area”
196
Q

airborne radioactivity areas should have a sign saying

A

“caution, airborne radioactivity area” or “danger, airborne radioactivity area”

197
Q

rooms in which licensed materials are stored could be marked

A

“caution, radioactive materials “ or “danger, radioactive material”

198
Q

containers carrying radioactive material should be marked with what

A

-the radiation symbols and the words “caution radioactive materials” or “danger, radioactive material”

199
Q

most potent radiosensitizer

A

molecular oxygen

200
Q

what does the “Law of Bergonie’ and Tribondeau state?

A

states that ionizing radiation is more effective against cells that 1) are actively mitotic, 2) are undifferentiated, and 3) have a long mitotic future.

201
Q

Cell that _____are more radiosensitive than cell that _____.

A

divide more frequently; divide less frequently, or not at all

202
Q

according to Bergonie’ and Tribndeau, cells that are undifferentiated are what (i.e. immature cells the primary function is to divide and replace more mature cells lost from the population)

A

extremely radiosensitive (these cells are also called stem cells or precursor cells)

203
Q

5 categories of radio sensitivity in mammalian cells based on Rubin and Casarett’s research

A

(from most sensitive to lease sensitive)

1) Vegetative intermitotic cells (VIM)-rapidly dividing, undifferentiated cells with short life spans (ex: basal cell, crypt cells, erythroblasts, and type A spermatogonia)
2) differentiating intermitotic cells(DIM)- these cells are actively mitotic but a little more differentiated than VIM cell
3) multi potential connective tissue cells-divide irregularly and are more differentiated than VIM and DIM (ex:endothelial cells of blood vessels and fibroblasts of connective tissue)
4) reverting postmtotic (RPM)- normally do not divide but are capable of doing so. typically live longer and are more differentiated than other categories, highly differentiated and radioresistant( ex: liver cells and mature lympocyte[however mature lymphocytes are extremely radiosensitive and are an acceptation to the Law of Bergonie’ and Tribondeau)
5) Fixed post mitotic cells (FPM)- most radio resistant group of cells in the body. highly differentiated, do not divide, and may or may not be replaces when they die (ex: certain nerve cells, muscle cells, erythrocytes, and spermatozoa

204
Q

hematopoietic syndrome

A

induced by total-body dose of 100-1000 cGy. median lethal dos3 is LD 50/60 (estimated between 350-450 cGy)

205
Q

the prodromal stage is observed within

A

hours after exposure and is characterized by nausea and vomiting

206
Q

the latent stage occurs and lasts for?

A

occurs after a few days and can last as long as 3 weeks
(during this stage pt. may feel fine but bone marrow stem cells are dying. Depression of all blood cell counts, hemorrhaging, and serious infection occur)

207
Q

pancytopenia

A

depression of all blood cell counts

208
Q

irradiation from 4-11 weeks utero can result in

A

severe CNS and skeletal abnormalities

209
Q

irradiation from 11-16 weeks in utero can result in

A

mental retardation and microcephaly

210
Q

irradiation after 20th week in utero can result in

A

functional defects such as sterility

211
Q

somatic (late) effects of RT

A

leukemia, skin carcinoma, osteosarcoma, lung carcinoma, thyroid carcinoma, breast carcinoma

212
Q

exposure

A

defined as the amount of ionization produced by photons in air per unit of mass of air.

**the use of exposure is limited to photons below 3 MeV

213
Q

unit of exposure

A

roentgen

214
Q

unit of charge (for exposure)

A

coulomb (C)

215
Q

absorbed dose

A

defined as the amount of energy absorbed per mass of any material while radiation interacts with the material

216
Q

traditional and SI unit for absorbed dose

A

traditional unit for absorbed dose is the rad

SI unit for absorbed dose is the gray (Gy)

**1Gy=100rad=

217
Q

dose equivalent

A

accounts for the biological effects of different types of radiations as they interact with tissue

218
Q

traditional and SI unit for dose equivalent

A

traditional- rem
SI- sievert

1 Sv=100 rem

219
Q

unit activity defines

A

the number of radioactive disintegrations (transformations) per unit of time.

220
Q

traditional and SI unit for activity

A

traditional-curie (Ci)
SI- becquerel (Bq)
** 1 Ci=3.7 x10^10 disintegrations/sec**
1 Bq=1 disintegration/sec

221
Q

ionization chamber

A
  • portable
  • detector and electronics are contained in 1 unit
  • device reads directly in exposure per unit of time
222
Q

Geiger-Muller detector

A
  • limited to 100 rem/hour or less
  • useful for lost source or small radioactive contamination
  • gas filled tube
  • the tube has walls that are more or less thick depending on the energy of radiation being detected
  • once ionization occurs in the tube gas multiplication occurs which causes a large pulse

very sensitive and best for finding contamination or other low levels of radiation

223
Q

Thermoluminescent Dosimeter (TLD)

A
  • consists of a crystal substance that when irradiated has electrons displaced in its crystal lattice.
  • a typical crystal substance used for personal monitoring is lithium fluoride (LiF)
  • when the crystal is heated, the electrons return to their normal position
  • *the dose received is equivalent to the radiation damage in the crystal**
224
Q

Optically Stimulated Luminescence Dosimeter (OSL)

A

-also contain crystals but are read by lasers
(can be read as long as 1 year after irradiation)
**for the most part these are replacing film badges)

225
Q

ALARA

A

as low as reasonable achievable

226
Q

3 basic principles of radiation protection

A

time, distance, shielding

  • reduce the amount of “beam on” time, shorten the length of time spent in the room where radiation is produced
  • use as much distance as warranted between the x-ray tube and patient, stand as great a distance as possible from an energizing x-ray beam
  • always shield the patient with appropriate and/or area specific shielding, interposing a radiation-absorbent shielding material between the radiographer and the source of radiation
227
Q

NCRP

A

National Council on Radiation Protection and Measurements

-group of technical experts who make recommendations on radiation protection and units

228
Q

NRC

A

The Nuclear Regulatory Commission

  • determines what will be law for many radiation concerns, not just radiation protection.
  • these laws are listed in the Code of Federal Regulations (CFR) and are usually based on NCRP recommendations
229
Q

NCRP(report #116) Occupational Dose Limits: whole body (stochastic)

A

50 mSv/yr (5 rem/yr)

230
Q

NCRP (report #116)Occupational Dose Limits: Cumulative Dose Limit

A

10 mSv times their age (1rem X age)

231
Q

NCRP(report #116) Occupational Dose Limits: Lens of eye (deterministic)

A

150 mSv/yr (15 rem/yr)

232
Q

NCRP (report #116)Occupational Dose Limits: skin, hands, and feet (deterministic)

A

500 mv/yr (50 rem/yr)

233
Q

NRC (10 CFR, parts 20 & 35) Occupational Dose Limits: Total Effective Dose Equivalent (deep and organ dose)

A

5 rem/year

234
Q

NRC (10 CFR, parts 20 & 35) Occupational Dose Limits: eye dose equivalent

A

15 rem/year

235
Q

NRC (10 CFR, parts 20 & 35) Occupational Dose Limits: shallow dose equivalent (skin or extremity)

A

50 rem/year

236
Q

NRCP (report #116)Public Dose limit (stochastic):

A

1 mSv/year (.1 rem/year)

237
Q

NRC (10 CFR, parts 20 & 35) Public Dose limit for minors

A

10% of dose to adult worker

238
Q

NRC (10 CFR, parts 20 & 35) general Public Dose limit

A

.1 rem/year

239
Q

NRC (10 CFR, parts 20 & 35) Public Dose limit for embryo-fetus (after declaration)

A

.5 rem/pregnancy

240
Q

Alpha beams are blocked by

A

piece of paper

241
Q

Beta beams are blocked by

A

plastic, glass

242
Q

KV photon (x-ray) blocked by

A

lead

243
Q

MV photon beams (X-ray or gamma ray) are blocked by

A

concrete

244
Q

Neutron are blocked by

A

additional shielding required due to the emission of gamma photons. neutrons are slowed and then stopped by hydrogen rich materials such as concrete, water, or borated polyethylene combined with water

245
Q

primary barrier

A

materials in the radiation beam. primary barriers are designed to attenuate the direct radiation beam

246
Q

secondary barrier

A

barriers provided in the floor, wall, and ceiling area. secondary barriers are designed to attenuate stray radiation.

247
Q

dosimeter

A

pocket dosimeters are small ion chambers.

-not routinely use in RT setting

248
Q

cutie pie detector

A
  • portable ion chamber

- useful in determining the exposure rate outside a radioactive implant patient’s room

249
Q

Neutron detectors

A

-ionization chamber filled with a BF3 gas (boron trifluoride) and is surrounded by cadmium-loaded polyethylene sphere to slow neutrons so they can be detected efficiently

250
Q

diodes

A

-small electric probe placed on the body or inside a body cavity to measure the actual amount of radiation being delivered to a predetermined point.

251
Q

film badges

A
  • small piece of film between metal filters
  • the density on the original film is proportional to the exposure
  • inexpensive, easy to process, relatively accurate, but should only be worn for about a month due to fogging of the film
252
Q

shielding for alpha particles

A

piece of paper

253
Q

shielding for beta particles

A

plastic and glass

254
Q

shielding for KV photon (xray)

A

lead

255
Q

shielding for MV photon (X-ray or gamma ray)

A

concrete

256
Q

shielding for neutron

A

additional shielding required due to the emission of gamma photons. neutrons are slowed and then stopped by hydrogen rich materials such as concrete, water, or orated polyethylene combined with lead

257
Q

Records of Accumulated dose are what and how long as they kept?

A
  • state and federal regulations require monitoring of anyone who may receive 10% of the Maximal Permissible Dose
  • when occupational workers change employment, exposure records should be transferred to the new employer
  • institutions must keep records forever
258
Q

handling radioactive materials should be done how?

A
  • should be done using long-handles forceps
  • wear gloves
  • work behind an L block
  • eating or drinking around radioactive material is prohibited
  • the room should have radiation monitors and the person handling should wear a radiation monitor
259
Q

disposal of radiative material should be accomplished how?

A
  • material with short half-lives can be stored until there is sufficient radioactive decay,making the material virtually harm;ess
  • if the radioactive source does not exceed a certain activity limit, it can be released into the sewer system where it will decay
  • can also be correctly labeled and packages and sent away to an authorized recipient
260
Q

side effects of RT for scalp

A
  1. Alopecia-extent hair loss
    • temporary 1500-3000 Cgy
    • permanent 4500 cGy and up
      • minimize by using mild shampoo and soft brush, avoid sun exposure
  2. edema-inflammatory reaction resulting in swelling
    signs: increased intracranial pressure, change in mental status, confusion, hypertension, decrease in pulses and respiration, headaches, nausea, motor and sensory changes, vomiting

management: corticosteroids

261
Q

side effects of RT for head and neck

A
  1. xerostomia- dryness of mucous membranes in the oral cavity
    management: oral lubricants, minimize dental caries (cavities), avoid nicotine, alcohol, and irritating foods
  2. taste alteration-caused by taste bud destruction, reduction in saliva, waste products of cellular destruction and disease process
    management: maintian hydration of mucous membranes
  3. mucositis/stomotitis-inflammatio of mucosal surfaces (candidiasis/thrush, herpes simplex, gram negative bacteria)
  4. pharyngitis/esophagitis-inflammation of esophagus or pharynx resulting in dysphagia
  5. ear pain
  6. late head and neck side effects:
    :atrophy of the skin-4-6 weeks after tx complete
    :lenticular opacities
    :cataracts
    :fistulas and ulcerations
    :osteoradionecrosis
262
Q

RT sideeffects chest/upper back

A
  1. esophagitis-indigestion, nausea, and vomiting
    causes: epithelial cells are destroyed
  2. pneumonitis: caused by the destruction of cells lining the alveoli causing inflammation and fluid accumulation
    -25% or less=asymptomatic
    greater than 25%=cough, dyspnea, fever, weakness
    -76% or more=irreversible damage
263
Q

RT side effects abdomen/lower back

A
  1. nausea/vomiting
  2. diarrhea
  3. cystitis- inflammation of the lining of the bladder
  4. sexual dysfuntion
264
Q

creatinine blood tests

A

evaluated kidney function (important to assess prior to injecting contact media to visualize kidneys

265
Q

hemoglobin blood test (Hb)

A

chemical compound in RBC that carried oxygen. should maintain Hb level >10 g/dl

**low LET RT will have greater effects due to OER

***Normal Values-
Men 15.5 g/dl
Women 13.7 g/dl
average 12-16 g/dl

266
Q

WBC

A

fights infection. *important to assess the Absolute Neutrophil Count (ANC). a low neutrophil count makes a person more vulnerable to infection.

**WBC normal range 4,500-10,000 WBC per microliter (mcL)

267
Q

platelets

A

main function is to aid in coagulation

**normal range-150,000-400,000 mcL (dangerous is count decreases below 50,000 during treatment)

268
Q

medical emergencies:

A
  • allergic reaction-signs are nausea, vomiting, itching, fainting, pain, edema, convulsing, cardiac arrhythmias
  • cardiac arrest-signs are clutching at chest, sweating, pallor. S.O.B, irregular heartbeat
269
Q

information included in Tx record (11 things)

A
  1. prescription
  2. monitor units
  3. target dose (daily and accumulated)
  4. energy and type of radiation
  5. date
  6. time of day (for B.I.D. tx)
  7. fraction
  8. elapsed days
  9. field number and description
  10. doses to other regions of interest
  11. set-up instruction

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