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RT PROCEDURES EXAM 3 (CHAPTERS 8 &15)

Terms in this set (60)

Which of the following organs that can be affected by motion?
I. Lung
II. Liver
III. Pancreas
a.
I and II
b.
II and III
c.
I and III
d.
I, II, and III
ANS: D
Respiratory motion is near these organs and thus affects them.
Which of the following is a goal of radiation oncology?
a.
Reduce side effects
b.
Deliver accurate and precise treatments
c.
Increase toxic effects
d.
All of the above
ANS: A
One of the goals is to reduce side effects.
Besides the patient and reference frame being registered, the stereotactic treatment must also ___________________.
a.
control motion
b.
conform to the fiducial
c.
increase target volume
d.
reduce treatment time
ANS: A
Stereotactic treatments can use large fraction size, so motion must be controlled to avoid more dose to normal tissue.
Heavy charged particles like protons have a(n) __________ fall-off in tissue that is desirable.
a.
continuous
b.
sharp
c.
shortened
d.
absent
ANS: B
An advantage of proton treatment is the Bragg Peak and the sharp fall-off.
Respiratory motion can be managed by which of the following?
I. Rapid CT scanning
II. 4DCT
III. Two-breath-hold CT
a.
I and II
b.
II and III
c.
I and III
d.
I, II, and III
ANS: B
Three different computed tomography (CT) approaches are slow CT scanning, two-breath-hold CT, and 4DCT.
Devices that are on the linear accelerator for imaging include all except which of the following?
a.
OBI
b.
EPID
c.
CT-on-rails
d.
Cone beam CT (CBCT)
ANS: C
CT-on-rails is not located on the linear accelerator but rather is separate.
Cone beam CT, TomoTherapy, and CT-on rails correct for _________ motion.
a.
interfraction
b.
intrafraction
ANS: A
Those imaging modalities define interfraction motion.
Cranial stereotactic treatments began with which of the following?
a.
Cyber knife
b.
Proton accelerator
c.
Gamma knife
d.
SBRT
ANS: C
The first gamma knife treatment occurred in 1951.
Stereotactic treatments have been improved on linear accelerators because of which of the following advances?
a.
High-quality in-room imaging
b.
Tighter mechanical specifications
c.
Small field treatments
d.
Only a and b
ANS: D
Imaging and mechanical advances have improved stereotactic treatments but the fields remain small and precise.
Radiation therapists and radiation oncologists prefer the kV images because the _______________________.
a.
contrast is better
b.
metal artifacts are reduced
c.
timing is more efficient
d.
resolution is not an issue
ANS: A
The kV images provide better soft tissue contrast than MV images.
TomoTherapy differs from some other volumetric imaging techniques because it __________________________.
a.
is both a CT and a linear accelerator
b.
uses kV and MV imaging
c.
delivers customized fields
d.
uses the same source for imaging and treating
ANS: D
The TomoTherapy unit is a combined linear accelerator and CT unit that uses the same source for imaging and treating. The unit can only treat and image in a helical fashion.
Which of the following is the motion management method that defines an internal target volume?
a.
OBI
b.
compression
c.
conservative
d.
MIP
ANS: C
The internal target volume approach is simple and encompasses the maximum extent of the target through the breathing cycle, thus making it conservative.
The cyber knife can treat anywhere in the body because it uses a(n) ___________ technique.
a.
nonisocentric
b.
repetitive
c.
real-time
d.
isocentric
ANS: A
The cyber knife uses a nonisocentric technique, which uses near real-time imaging.
Electronic portal imaging devices (EPID) can ___________________.
I. use MV and kV
II. take orthogonal images
III. send images to multiple locations
a.
I and II
b.
II and III
c.
I and III
d.
I, II, and III
ANS: B
EPID uses only MV to create beam's-eye view images
For the ultrasound unit to know where it is in reference to the linear accelerator, it must be ________________ with the treatment delivery unit.
a.
localized
b.
attenuated
c.
B-moded
d.
registered
ANS: D
The ultrasound machine must be registered to the linear accelerator to ensure its location in space is known.
Forced shallow breathing technique is used to control which of the following?
a.
Compression
b.
Imaging
c.
Motion
d.
Interfraction dose
ANS: C
Forced shallow breathing is used to control motion in lung and liver treatments
Protons are ________________.
a.
highly imaged
b.
heavy charged particles
c.
extended range
d.
electrons
ANS: B
Protons are heavy charged particles with limited range.
A single fraction of radiation to a brain metastasis would be what kind of stereotactic treatment?
a.
Stereotactic radiation therapy (SRT)
b.
Stereotactic body radiation therapy (SBRT)
c.
Stereotactic radiosurgery (SRS)
ANS: C
Single fraction using stereotactic radiation therapy is SRS.
A four-dimensional CT scan uses a(n)__________________.
a.
oversampled spiral CT scan
b.
pitch of 1.5
c.
scanner rotation of 0.5 second
d.
auditory respiratory signal
ANS: A
4DCT uses an oversampled spiral CT, a pitch of 0.5, a scanner rotation of 1.5, and an external respiratory signal.
Turning the radiation on and off when the target is within the treatment volume represents which of the following?
a.
A fiducial system
b.
Gated treatments
c.
A 4DCT data set
d.
Forced shallow breathing
ANS: B
Gated treatments are performed when the radiation is turned on when the target is in the treatment volume and turned off when the target is outside the treatment volume.
Which of the following is the only approach to managing motion that allows for real-time feedback?
a.
4DCT
b.
Gated treatment
c.
RPM system
d.
Electromagnetic transponder
ANS: D
Electromagnetic transponder provides real-time feedback; the target isocenter can be monitored up to 10 times per second.
Cone beam CT _______________________.
a.
uses a fan beam
b.
has a 3D extended digital array
c.
has an area detector with 2D extended digital array
d.
has multiple rotational speeds
ANS: C
CBCT has an area detector that is a 2D extended digital array
Which of the following is a process that aligns multiple data sets into a single coordinate system so that the spatial locations of corresponding points coincide?
a.
Registration
b.
Recombination
c.
IGRT
d.
MIP
ANS: A
Registration is the process that aligns multiple data sets into a single coordinate system so that the spatial locations of corresponding points coincide.
Image-guided radiation therapy is useful because it can ____________________.
I. result in a more focused treatment
II. account for interfraction and intrafraction motion
III. compare in-room image set with treatment planning image set
a.
I and II
b.
II and III
c.
I and III
d.
I, II, and III
ANS: D
IGRT is being developed to allow for all three of the answers presented, as studies have now been conducted showing not only tumor motion during treatment but also critical organ motion.
The typical width of the spread-out proton Bragg's peak (SOBP) is _____________.
a.
2 to 16 mm
b.
2 to 16 cm
c.
1 to 25 mm
d.
1 to 25 cm
ANS: B
Typically, the widths of the SOBPs can vary, such as 2 to 16 cm.
The radiation therapist is responsible for which of the following?I. Delivering radiation therapy treatmentsII. Monitoring and operating sophisticated equipmentIII. Maintaining detailed records of treatmentIV. Producing the patient's treatment plan
I, II, and III: Radiation therapists deliver radiation therapy treatments, monitor and operate sophisticated radiation-producing equipment, and maintain detailed treatment records. Producing the patient's treatment plan is the responsibility of a dosimetrist.
Informed consent consists of which of the following?I. PurposeII. Treatment alternativesIII. Benefits and risksIV. Disclaimer
I, II, III, and IV: Before receiving treatment, patients must receive an explanation of their status, treatment alternatives, and consequences associated with and without treatment, to provide informed consent to any procedures.
Quality assurance (QA) program
series of documentation and activities performed with the purpose of optimizing patient care
Which of the following is not considered a part of the radiation oncology team responsible for the department's quality assurance?
a. Dosimetrist
b. Radiation therapist
c. Medical oncologist
d. Radiation oncologist
c. medical oncologist
Safety and care in the assessment of pain, mobility, and other factors affecting the patient's well-being are the responsibility of which of the following?
a. Radiation therapist
b. Patient's family
c. Radiation oncologist
d. Radiation oncology nurse
a. radiation therapist: As the team member interacting with the patient most frequently, the therapist applies knowledge to the physical and emotional well-being of the patient on a daily basis. When needed, patients are directed to the physician or other professional, as specific needs arise.
The goal of radiation therapy planning is to deliver an evenly distributed radiation dose to the ________ while minimizing the dose to the normal surrounding tissue.
target volume; Treatment plans are composed of one or more treatment fields designed to maximize the dose delivered to the tumor while minimizing the dose to normal surrounding structures.
Arrange the following tasks involved in delivering a dose of radiation therapy in the proper order.I. Complete the treatment record.II. Initiate the beam-on setting, and monitor the patient and equipment.III. Align the field using lasers, light field, and surface landmarks.IV. Prepare the room.
IV, III, II, I; Task analysis for treatment procedures consists of 18 step
Individual treatment doses may be defined as which of the following?
Fractionation; The radiation prescription must consist of the anatomic site, total radiation dose to be delivered with its fractionation designated (individual treatment dose), and protraction (period of time over which treatment is given). The prescription also identifies the treatment techniques (number and orientation of treatment fields) to be applied. All of this is accompanied by the physician's signature.
Which of the following clinical situations do not lend themselves to the reproducible placement of localization marks?
I. Mobile skin surfaces
II. Elderly or obese patients
III. Areas covered by dressings
IV. Sloping surfaces such as the breast
I, II, III, and IV; With the patient in the precise treatment position, the isocenter is positioned relative to the localization landmarks. For many clinical situations, this is not practical. Examples include mobile skin surfaces such as those treated with tangential fields, irregular surfaces, and areas covered by dressings.
In radiation therapy, which of the following refers to materials whose interactions with the radiation beam mimic those of tissue?
a. Internal or external shield
b. Electron cutout
c. Wedge
d. bolus
d. bolus; In radiation therapy, bolus refers to material whose interactions with the radiation beam mimic those of tissue. The purpose of a bolus is to compensate for variation in surface contour or to eliminate air gaps in cavities. Thus, it brings the area of maximum dose deposition to the patient's surface.
Based partially on historic studies showing a reduction in treatment error associated with increased portal imaging, ________ portal imaging for radical cases has become an accepted but not universally implemented standard.
weekly
Which of the following opposing field techniques is specifically designed for treatment of the breast?
a. Tangential fields
b. AP/PA arrangement
c. Right and left laterals
d. Box technique
a. tangential fields; Superficial volumes on curved surfaces such as the breast or ribs may require opposing fields, which flash off the surface of the patient. These fields are called tangential fields, tangents, or tangs. This is the most commonly used setup treatment for breast cancer.
Which of the following is one of the main advantages of a multileaf collimator (MLC)?
a. Correct for tissue inhomogeneity
b. Replace the need for interlock system of holding blocks
c. Eliminate skin sparing
d. customize treatment volume
d. Customize treatment volume; By reducing the need for the position of heavy blocks, an MLC improves customization of treatment volumes and increases safety for patient and radiation therapists.
Which of the following is the measurement of the angle between central rays of two intersecting treatment beams?
a. Hinge angle
b. Isodose angle
c. Central axis angle
d. wedge angle
a. hinge angle; The orientation of multiple fields to one another during treatment may produce inhomogeneous dose distributions over the target volume. The wedge is designed to change the angle of the isodose curve relative to the beam axis at a specified depth within the patient. The hinge angle (measure of the angle between central rays of two intersecting treatment beams) decreases and doses delivered to overlapping areas vary significantly, thus creating areas of high- and low-dose regions in the desired target volume.
Wedge systems used include which of the following? I. Global II. Universal III. Virtual
a. I and III
b. I and II
c. II and III
d. I, II, III
c. II and III; Standard wedge systems use externally mounted wedges that must be positioned on a tray above the patient. Treatment units using internal wedging methods allow for customizing the wedge angle for each treatment plan. One system uses a 60-degree universal wedge. Other systems use a virtual wedge system in which a dynamic, or moving, jaw starts at one side of the field and opens to a full field over the course of dose delivery.
Which of the following is used in shaping the field of an electron beam treatment?
a. MLC
b. Cerrobend cutout
c. Aluminum
d. bolus
b. cerrobend cutout
Where would the radiation therapist find the information regarding the status of the treatment unit?
a. Console
b. Patient record
c. Cameras in the room
d. Interlock system of the unit
a. console
Patients are monitored during treatment delivery with megavoltage treatment units by using which of the following?I. Direct visualII. Closed-circuit televisionIII. Two-way audio
a. I and II
b. II and III
c. I, II, and III
d. I and III
b. II and III; With low-energy treatment, visualization of the patient may be done directly through leaded glass windows. With megavoltage units, an indirect monitoring system must be used. For patient safety and accuracy of treatment, audio and visual contact is maintained at all times, by at least two cameras and an audio system.
Which of the following two-field arrangements is considered parallel opposed?
a. Field 1 gantry = 180; Field 2 gantry = 10
b. Field 1 gantry = 310; Field 2 gantry = 130
c. Field 1 gantry = 90; Field 2 gantry = 280
d. Field 1 gantry = 0; Field 2 gantry = 90
b. Field 1 gantry = 310; Field 2 gantry = 130; Parallel opposed fields are defined as those with a hinge angle of 180°.
Structures that would be localized using pre treatment sonography
Seminal vesicles, rectum, prostate
The difference between stereotactic radio surgery and stereotactic radiation therapy
Radiosurgery = 1 fraction
radiation therapy = multiple fractions
How are protons more beneficial than photon treatments
Protons fall off quickly so they deliver the dose to a specified point and fall off avoiding surrounding tissue
True/False: A treatment that is precise will always hit the target
False
Gamma knife
uses Co-60 sources
Goal of gaited simulation/treatment
accounts for patient motion
Protons
heavy charged particles
Healthy breathing cycle
12-16 breaths per minute
Concept that drives all of the technology development in radiation oncology
send the higher tdose to the tumor and the lowest possible to surrounding structures.
Beam's eye view imaging is characterized by
high resolution and soft tissue contrast
Hinge angle
the measure of the angle between the central axis of two intersecting treatment beams
treated with beams that have co-planar central axis
whole brain, AP/PA spine
direct monitoring
viewing a patient through a lead lined window
indirect monitoring
viewing a patient through a closed circuit system; listening for a patient over the intercom
internal sheilding
placing a lead shield behind a patients lips for treatment using electrons for a lip lesion
True/False: a backup timer is usually set lower than the primary timer
False: it is set higher
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