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Treatment Procedures

Treatment Tasks• Review of the chart (signature??)• Preparation of room• Identify and greet• Assist onto table into position• Locate marks• Raise couch• Move patient into position• Rotate gantry & collimator• Position beam modifiers and shapers• Leave room• Monitor the patient• Set controls• Beam on• Record treatment• Assist patient out of room

Rad Onc record

• Separate from hospital chart• Contains:– Diagnosis to include pathology etc.– Consultation – Consent– Response to treatment– Monitoring of treatment

Rad Onc chart cont.

• EMR• Record & Verify• Quality Assurance

Treatment Preparation

• Patient Identification (photo)• Signed prescription• Detailed positioning and immobilization information• Dosimetry plans• Calculations• Treatment record

– Documents delivery– Records fractional and cumulative doses– Machine settings– Verification imaging– Any rx. change

Radiation Prescription

• Anatomic site• Total radiation dose• Fractionation• Protraction• Treatment technique• May have:– Energy– Port size and angles– Beam modifiers

Radiation Prescription cont.

• Be aware of changes:– Signature must accompany changes– Fractionation– Total dose– Addition/deletion of blocks/bolus

Treatment Plan Description and Reference

• Treatment field syn. With field portal or port• Each field has a different name• Changes are denoted with a subscript,

numbers or prime marks• Specifies field size (w X l), orientation and

beam modifiers• Images

Treatment Record

• Documents implementation of treatment• Should be able to tell:– Last treatment– How far along– Films needed– Changes to rx.

• Treatment date, number, elapsed days, fractional and total dose delivered, notations, initials

Verification Images

• Hard film• Electronic Image• Usually weekly• Graticule (BB tray)

Treatment Room

• Isocenter (3 axes of rotation)• Lasers• Lighting• Treatment couch• Cleaning supplies• Treatment accessories/devices

Patient Transfers

• Wheelchair transfer• Gurney transfer

Patient position, isocenter, and field placement

• Patient positioning• Localization• Isocenter positioning• Verification Imaging

Beam Positioning and Shape

• MLC• Blocks

MLC

Blocks

Beam Modifying Devices

• Bolus• Compensators• Wedge• Transmission Filters

Bolus

Compensators

Wedges

• YouTube - Wedge It

Electron beam modifiers

• Collimation• Internal Shielding• Bolus• Shaping

Assessment and acceptance of treatment parameters

• Patient monitoring systems• Console

Treatment Delivery

• Beam on/off• Interruptions

Common treatment techniques

• Multiple fields• Adjacent fields• IMRT• IGRT