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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
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