Rad Practice Test 1 - radiation therapy PDF

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Radiation Practice Test One Cancer Management Team: Radiation Oncology Members: ●

Department Director- oversees the department

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Radiation oncologist- clinical evaluation, therapeutic decision, target volume localization, tumor volume, shielding blocks/treatment aids, analysis of alternate plans, simulation/verification of treatment plan, treatment, first day set up, periodic evaluation, and follow up evaluation

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Radiation Dosimetrist- target volume localization, treatment planning, selection of XRT plan, dose calculation

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Radiation physicist- treatment planning, treatment, shielding blocks/treatment aids, analysis of alternate plans,

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Radiation therapist- (Sim therapist)-simulation/verification of treatment planning, treatment, first day set up, dosimetry check/initial chart check,

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Support personnel - sim tech,

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Nurses- periodic evaluation, follow up evaluation

Interdisciplinary cancer team: ● ●

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Surgical Oncology ○ Diagnostic role (biopsy) or primary treatment (can be used as palliative) Radiation Oncology ○ Goal is tumor control (local control, some systemic) ○ Curative ○ Palliative Medical Oncology ○ Systemic treatment with chemotherapeutic agents. Hormones, immunotherapeutic agents ○ Chemo not primary treatment except for leukemia/lymphoma (non-solid tumors) ○ Most rapidly developing treatment Diagnostic Services ○ Medical imaging, pathology, lab Rehab Services ○ Physical therapy, reconstructive surgery, and psychosocial support

Continuum of Care=  it covers the entire scope of cancer treatment that the patient receives. ●

Includes palliative care, curative care, pain management, hospice care, and death

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It can start at anytime in the loop and the standard for evaluating cure is 5 years.

Patient focused care (the cooperative model)=  patients have an active role in their care. More active in planning and administering their own treatment. They should be informed about their disease and all of their options for treatment (informed consumers) ●

Patient has rights and responsibilities

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Advanced directives, hospice, living wills, and pain management

● “The patient is a customer who has expectation of quality product” ○

Concentrates on the processes necessary to provide care services in an inpatient unit

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Physicians has long recognized the need for a team approach

Radiation therapists duties and roles ●

Plans and delivers prescribed doses

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Controls the linear accelerator by computer equipment

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Schedules for patient treatment

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Daily treatment

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Schedule treatments

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Port films and imaging

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Monitors Patient’s reactions to treatment

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Weekly check up

● Simulation and verification of treatment plan ● Treatment including-first day set-up, localization films, dosimetry checks/initial chart ● Check-repositioning/retreatment Radiation Therapy Organization: ●

ARRT= American Registry of Radiologic Technologists. They provide professional credentialing. Awards certification. They have the credentialing exam for radiation therapist to become nationally certified. ○

Formed in 1922 - xray techs need own organization

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Renewable based on CE credits ■

1 clock hour = 1 CE credit

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State licensing coordinated by the state.

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ASRT= American Society of Radiologic Technologists. They provide voluntary professional organization -known as membership association. ○

Founded in 1920

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JRCERT= Joint Review Committee on Education of Radiologic Technology. They provide program accreditation. Development and review of educational standards. ○

Responsible for development and review of education standards since 1944 ■

Consistency of program, profession/job

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RT separate science in 1964

Formal education: learning in the classroom. Diadacted Informal education: learning from life experiences. Critical thinking: Freedom to use the cognitive process to allow mastery of theory and practical experiences. Incorporates the use of cognitive, affective and psychomotor domains in learning. Process of question and critique, understand and relate, able to make clinical judgments

Clinical Oncologic Problem: ●

More cancers are cured by surgery than any other modality ○

Excision of slow growing cancers

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Palliation

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Combination approach

Surgical oncology=  not a well defined discipline, due to the variety of surgical specialities that are based on disease site or organ Providing selection of definitive surgical treatment of localized malignancies based on a careful staging diagnostic procedure Knowledge of and ability to consult with other modalities Reconstruction and rehabilitation for resected organs When the tumor is unresectable, providing debulking of residual cancer to improve effectiveness of other modes of treatment Surgery for palliation and for oncologic emergencies Biopsy= surgical procedure used to identify histology and cellular characteristics of the mass Types: Fine Needle Aspiration (FNA)= used to determine histology of tumor; sample cells are collected in the needle from the mass and are examined under a microscope Core Needle Biopsy=  a larger gauge needle (14/16) is used to collect a core from the tissue Incisional Biopsy=  a sample of the tissue is removed (incised) with no attempt to remove the whole tumor Excisional Biopsy=  attempts to remove the entire tumor and any possible local spread

Endoscopic procedures = bronchoscopy or colonoscopy; where suspicious tissue is collected with flexible biopsy tool. Tissue samples can be frozen or embedded in paraffin and sectioned to be examined under the microscope. Types of tumors: Patterns of spread- the growth characteristics and spread patterns of a tumor Exophytic= tumors grow outward beyond the surface epithelium from which it originates. It is non-invasive and has a better prognosis than those that invade and ulcerate underlying tissues Multicentric= tumors have more than one focus of disease and may be more difficult to treat Tumor dissemination=  can occur through blood, lymphatics, or seeding

Epidemiology and Etiology: Etiology= the cause of the disease or the study of the cause ●

To explain, the factors affecting the diseased group are compared with those that affect the normal group

Epidemiology= the study of the disease incidence - study of patterns, cause, and control of disease ●

Like etiology, but carries it one step further

Why collect data? - tumor registries; predict incidence and treatment options/success ● ● ●

Info collected about disease incidence and the population it affects allows scientific predictions to be made Collected data allows new, pertinent questions about cancer and its causes to be developed Reports can help identify common factors and become instrumental in identifying cancer causes

Stratified data= the researcher has identified several factors and sorts data according to these factors Measures of Risks: Absolute risk/rate=  measures the actual cancer occurrence in a population or subgroup Relative risk=  compares the risk of developing cancer among those who have a particular characteristic or exposure with those who do not. The likelihood that a person who has a certain risk factor will actually get the disease Uses of Data: ●

Knowing the cause is the most efficient way of solving any problem

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Statistics on cancer incidence or mortality provide understanding about the reasons that cancer exists - used for education, prevention, detection, and management of the department

Data Bases: ● ● ●

CDC- center of disease control and prevention ACS- American cancer society ○ Encourages local and national collection of cancer data SEER- National Cancer Institute’s Surveillance, Epidemiology, and End Result ○ Collects and compiles data from cancer registries across the country

Cancer Overview: Microscopic examinations of cells: ●

Normal= uniformly shaped, little variation in size and shape, smaller nucleus, specialized cell features, organized arrangement, defined boundary

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Hyperplasia= tissue growth based on an excessive rate of cell division, leading to a larger than usual number of cells. Cell structure and the orderly arrangement of cells within the tissue remain normal. Normally reversible

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Dysplasia= abnormal type of excessive cell proliferation characterized by loss of normal tissue arrangement and cell structure. Normally revert back to normal behavior but occasionally they gradually become malignant

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Carcinoma in Situ=  (situ means in place) uncontrolled growth of cells that remains in the original location. May develop into an invasive, metastatic malignancy

Naming cancers: ● ● ● ●

Carcinomas- most common, these tumors that originate from the epithelium. These include all tissues that cover a surface or line a cavity Sarcomas- arise from the mesenchymal cells, including connective and supporting tissue such as fat, muscle, cartilage and bone Lymphomas- cancers that arise in the body’s lymph nodes and tissues of the body’s immune system Leukemias- cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream

Tumor classification=  Tumors are classified by their anatomic site, cell or origin, and biologic behavior Histopathic Grade=The  grade of a tumor provides information about its aggressiveness and is based on the degree of differentiation. ● ●

Well-differentiated- tumors that resemble the cell of origin Undifferentiated- cell that do not, so classification is more difficult. Also called anaplastic.

Tumor Grade=  provides information about its aggressiveness and is based on the degree of differentiation; Important prognostic factor Tumor staging=  is a way of defining the tumor size and extension at the time of diagnosis. Provides a means of communication about tumors and helps in determining the best treatment, aids in predicting prognosis. TNM system. T= size or extent 1-4. N= status of the lymph nodes and extent of lymph node involvement, 0-4. M= defines the presence and extent of mets, 0-4. Oncogenes= mutant forms of proto-oncogenes that cause cell growth signal to become hyperactive causing excessive growth Proto-oncogenes= normal genes that control the normal growth and pathway of the cell. Tumor suppressor genes (anti-oncogenes)- normal genes whose ABSENCE can lead to cancer.

DNA repair genes- code for proteins whose normal function is to correct errors that arise when cells duplicate their DNA prior to cell division. Mutations in these genes can lead to a failure in repair, which allows more mutations to accumulate.

Clinical Trials: Randomized studies=  studies that have several methods of treatment. Random selection of eligible patients for one of the treatment arms is done. Helps increase the accuracy of results and conclusions. Allows for approximately equal numbers of patients of each arm. Protocol= ‘operating manual’ for the clinical trial and ensures that researchers in different locations all perform the trial in the same way on the patients with the same characteristics. Retrospective= these review information from a group of patients treated in the past. ● ●

Advantages- can be done quickly. Information is collected and analyzed Disadvantages- outside factors not always known, results are not controlled and may not be document well, info can be incomplete

Prospective= a clinical trial that is planned before treatment. ●

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Advantages- eligibility criteria for patient selection, better control of external factors, investigators know the info necessary to the study ahead of time, leading to more accurate and complete documentation Disadvantages- the length of time it may take to complete, depending on the length of the follow-up necessary to accurately assess the results

Phase I-IV of clinical trials ● Phase I- toxicity, used to determine the maximum tolerance dose for a specific treatment ● Phase II- search for efficacy, used to determine if phase I treatment is significantly effective given the acute and/or long term side effects ● Phase III- demonstrate if more effective than standard therapy, given to a larger group of people to confirm effectiveness, monitor side effects, and compare to commonly used treatments, and collect information ● Phase IV- post marketing studies, helps delineate additional information including risks, benefits, and optimal use Possible outcomes: ● ● ● ●

Positive trial- the clinical trial that shows that the new treatment has a large beneficial effect and is superior to standard treatment Non-inferior trial- the clinical trial shows that the new treatment is equivalent to standard treatment (non-inferiority trial) Inconclusive trial- the clinical trial shows that the new treatment is neither clearly superior nor clearly inferior to the standard treatment Negative trial- the clinical trial that shows that a new treatment is inferior to standard treatment.

Stratification-arrangement of something into different groups...