VERT Flashcards
CSI patient positioning for 3DCRT
- Lying prone on a vacbag with their head in a prone head rest
- Customised thermoplastic shell face mould and posterior thermoplastic shell. Chin/head postion should be considered. Need to avoid head positioned too high as skin folds occur in neck. Avoid head positioned too low as it increases SSD in neck region and avoid post beam exiting through mouth anteriorly
- Arms by side with shoulders supported and drawn inferiorly, hands tucked under hips to stop the hands falling off
- Shoulder support
- Stabilising pillow under ankle
CSI technique in treatment setup
- Align ITN to correct indexing on couch
- Fit shell correctly with the patient straight along midline
- Align planning reference marks and move to planned iso centre
- Check all arcs are clear
- Conduct CBCT or IGRT
Prone treatment positioning process
- Set up all equipment ent in advance
- Position patient, straight and level and fit mask using ITN measurements and marks on vacbag to align patient
- Check measurements and relationship between the shell marks for the skull fields and all tattoos on patient for spine fields and adjust patient until all are aligning correctly as per instructions
- When satisfied, set up lateral skull fields
- Set isocentre moving from reference marks on mask according to plan
- Check fields and SSDs
- Check and set daily junction
- Determine correct junction line for current fraction and ensure inf edge passes through it
- Conduct CBCT or IGRT
- Treat lateral skull fields
- Back in the room and position upper spine field centre, palpate spine and set SSD
- Check instructions and junctions - one sup, one inf. Ensure correct junction is used for upper spine and measured gap is correctly drawn on the patient
Some CSI considerations for positioning
Ensure spine is as flat as possible
Support neck
Raise arms anteriorly to give maximum post arc rotations
Support knees to keep lower back as flat as possible
Ensure body has snug fit within vacbag
What are the expected acute side effects for a patient undergoing RT to the brain
Nausea and vomiting
Headaches
Fatigue
Alopecia
Skin erythema
what are the expected acute side effects for a patient undergoing RT to the head and neck
Skin Erythema
Alopecia
Fatigue
Xerostomia (dry mouth, damage to salivary glands)
Mucositis (ulcerative lesions of the oral mucosa)
Dysphagia (difficulty swallowing)
Odynophagia (painful swallowing)
Cough
Dysphonia (hoarseness of voice)
What are the expected acute side effects for a patient undergoing RT to the breast
Skin erythema
Fatigue
Alopecia
What are the expected acute side effect for a patient undergoing RT to the chest and thorax
Fatigue
Skin Erythema
Oesophagitis – inflammation of the oesophagus, causes a sore throat, difficulty swallowing and
eating
Cough
Nausea & Vomiting
What are the expected acute side effects for a patient undergoing RT to the abdomen
Nausea & vomiting
Diarrhoea
Fatigue
Anorexia (caused by loss of appetite or change in taste)
What are the expected acute side effects for a patient undergoing RT to the Pelvis
Proctitis (diarrhoea, rectal urgency, rectal pain)
Fatigue
Bladder symptoms – increased frequency and urgency, dysuria, nocturia, incontinence
Cystitis
Skin Erythema
Nausea and vomiting (particularly for rectal cancer with concomitant chemotherapy) + cervical
cancer
First day chat information
- introduce yourself and state that you are a RT
- check 3Cs
- step by step process for treatment: change into gown, treatment to take 15min each day, setup is identical to CT scan, needs to lie still and breathe normally, dont help us when we move you, machine moves around you, it will come quite close but wont touch you, treatment wont hurt, wont feel anything, buzzing sound as we leave the room, images taken and treatment will be slightly longer, we will leave room when we are ready to start your treatment, there is a camera inside room and to raise hand if needed
- remind patient of nurse education session which outlined skin care routine and appropriate products to be used
- RO review appointment each week
- ask patient if they have any questions
Key elements of active listening
Pay attention
Show that you are listening by using body language and facial expression
Provide feedback by asking relevant questions and seeking clarification
Respond appropriately
Defer judgement
Pitch, yaw and roll
Rotational changes
Pitch - Sagittal
Yaw - coronal
Roll - transverse
Types of automatic alignment tools
Chamfer and MMI
Chamfer
Utilises bony anatomy to align the volume in the defined ROI
