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ZJQ OUHSC Radiation Therapy Program Review

Zjq Ouhsc Radiation Therapy Program Review

by phyzjqk, Jan. 2015

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	Universal principles of biomedical ethics	Autonomy, veracity, beneficence, nonmaleficence, confidentiality, justice, and role fidelity
	Autonomy	Personal self-determination; the right of patients to participate in and decide questions involving their care
	Veracity	Truth telling; the practice of health care is best served in a relationship of trust in which practitioner and patient are bound to the truth
	Confidentiality	The principle that binds the practitioner to hold in strict confidence those things learned about a patient in the course of medical practice
	Beneficence	The principle that imposes on the practitioner a duty to seek the good for patients under all circumstances
	Nonmaleficence	The principle that imposes the duty to avoid or refrain from harming the patient. The practitioner who cannot bring about good for the patient is bound by duty to at least avoid harm.
	Justice	The basic principle that deals with fairness, just deserts, and entitlements in the distribution of goods and services.
	Role Fidelity	Each specialty in health care has a prescribed role of practice. Role fidelity is the faithful practice of the duties contained in the particular practice.
	Informed Consent	In order for patients to be truly autonomous, they must understand the nature of the condition, the treatment options, and the risks involved. This information forms the basis for informed consent.
	Material Risk	A risk or hazard of sufficient significance as to be included within the informed disclosure by the physician. The decision of material risk is made on the basis of whether the information would be significant enough to influence the patient's decision.
	Competency	Having the ability to make sound, authentic judgments for oneself. usually this means that the patient is able to understand the nature of the condition, the options available, and the risks involved in the potential options.
	Therapeutic Privilege	The right of the health care practitioner to provide care for patients without informed consent. Generally, these are rare cases in circumstances that involve emergency care, incompetent patients, or in which sound medical judgment dictates that the truth would be a greater harm to the patient than the overcoming of his or her personal autonomy.
	Benevolent Deception	The view that one can lie to a patient for his own good. It is the mechanism most often used when paternalism is advanced over patient autonomy.
	Paternalism	The belief that one should, on the basis of doing good for the patient, limit the patients' personal autonomy. In the best sense, it is a conflict between the basic principles of autonomy and beneficence.
	Fiduciary Relationship	A special relationship of loyalty and responsibility formed between the patient and practitioner. The practitioner will act with scrupulous good faith and candor. The patient has the right to believe that the practitioner will maintain a higher level of accountability in regard to health care than that expected from most other relationships.
	Principle of Double Effect	A doctrine, first stated by St. Thomas Aquinas, that is commonly used to determine whether an action is morally defensible when it has more than one consequence, usually both favorable and ill. With this concept, secondary effects may be foreseen, but can never be then intended outcomes.
	Professional Code of Ethics	A document usually created by the profession that provides guidelines for the ethical behavior of its membership. These documents are often seen as meeting the self-regulating criteria by which professions are defined. It serves as a guide by which radiation therapist may evaluate their professional conduct as it relates to patients, health care consumers, employers, colleagues, and other members of the health care team.
	Scope of Practice	The tasks that are included withing the practice of a specialty. Often the scope of practice is set forth in the legal regulations that allow the practice within a state. Scope of practice is an important consideration in the determination of questions regarding role fidelity. It is a body of courses and formally established learning experiences presenting the knowledge, principles, values, and skills that are the intended consequences of formal education; the defining document to guide the radiation therapists through the day-to-day responsibilities of the profession.
	Correlative Obligations	In matters of rights, when one person has a right, others have obligations to either refrain from hindrance or provide the required goods and services associated with the right.
	Natural Rights	Rights that grow out of the nature of man and are necessary to fulfill the ends to which nature calls him, as distinguished from those that are created by law and depend upon civilized society.
	Legal Rights	A power, privilege, or immunity guaranteed under a constitution, statutes, or decisional laws.
	Health Insurance Portability and Accountability Act (HIPAA)	Legislation enacted in 1996 to encourage the use of electronic transmission of health information (to assist in cost containment) to provide new safeguards for protecting the security and confidentiality of the information.
	The Emergency Medial Treatment and Labor Act (EMTALA)	This act requires that certain emergency room services be provided upon request prior to transfer to other facilities.
	Harm Principle	When the practitioner can foresee a danger to an individual who is outside the patient-provider relationship, potentially caused by the patient, the harm principle provides the rationale for breaching confidentiality to warn the vulnerable individual.
	Disparagement	To belittle, or criticize the skill, knowledge, or qualifications of another professional.
	Gaming the System	A generic term used for a series of activities designed to get around the system (e.g., adjusting a diagnosis so as to receive the highest potential for payment).
	Gatekeeping	A whole series of activities needed to protect the profession from those who would misuse the appropriate functions of that specialty (e.g., the requirement that one professional report the misconduct of another). The term is also used commonly in managed care situations to describe the monitoring system used to ensure compliance with the particular plans or guidelines.
	Patient Advocate	One who investigates and mediates patients' problems and complaints in relation to the health care services.
	Safe Harbor Rules	Rules that allow a questionable practice such as self-referral to continue due to the special circumstances of a particular case whereby the practice serves the patient's interests.
	Ad litem	A guardian ad litem is a person given the power and duty to act on behalf of another, for example, a legally incapacitated person, for purposes of a lawsuit.
	Authentic Decision	A decision in keeping with the individual's past choices and known preferences.
	Do-Not-Resuscitate Order (DNR)	Those orders issued when a determination is made that the level of life that could be sustained following a resuscitative effort would be such that it would not be in the patient's best interest to perform resuscitation.
	Futile Care	Care that has no efficacy or potential for benefit.
	Patient-Centered Standard	A standard holding that the information needed is that required by the individual to make a rational judgment. This would be a very subjective stand, given that some patients may not meet the criteria of a hypothetical reasonable person.
	Professional Autonomy	Once a patient-health care professional relationship is established, the practitioner has a duty to provide care but is not obliged to perform services that he or she finds morally repugnant. Health care providers may, under such circumstances, withdraw from their obligations to provide services.
	Professional Community Standard	A standard stating that the amount of care or amount of disclosure provided should be judged appropriate if it is equal to that provided by other practitioners in local community.
	Reasonable Patient Standard	A standard that holds that the physician must provide enough information to the patient so that a hypothetical reasonable person could understand and make autonomous decisions.
	Institutional Review Boards	Review boards that examine the protocol design for research to ensure that the research conforms to appropriate standards for humans.
	Distributive Justice	Refers to just distribution in society, structured by various moral, legal, and cultural rules and principles.
	Egalitarianism	A system of allocation that seeks to provide all things equally.
	Formal Justice	The ethical concern of formal justice is that the criteria are applied equally to all similar cases. Formal justice does not tell us whether the criteria are relevant or ethically valid, only that they are equally applied.
	Libertarianism	A system of allocation that is generally based on the free market exchange of goods and services.
	Material Justice	The ethical concern of material justice is that the criteria used in allocation be relevant and ethically valid.
	Medical utility	The allocation of scarce resources to those with the best prognosis.
	Social Utility	The allocation of scarce resources to those who are most useful or valued by the society.
	Triage	A system that divides the patient cases into categories so that care can be allocated effectively.
	Utilitarianism	The doctrine that utility is the sole standard of moral conduct; the doctrine of the greatest happiness for the greatest number.
	Advanced Directives	Documents that relate your wishes in regard to treatment options or in regard to who should make the decisions for you should you lose the ability to relate these matters yourself. Both the living will and the durable power of attorney for health care are considered advance directives, because they clearly describe the wishes of the patient when he or she was considered competent.
	Best-Interest Standard	A proxy decision-making standard in which the guardian is directed to make the decision in the best interest of the individual; often used in cases in which the individual was never in a position to make an autonomous decision.
	Clear and Convincing Evidence Standard	Following the Nancy Cruzan case, the courts have asked for clear and convincing evidence of the individual's wishes in regard to continuing or ceasing life support. This has created a new emphasis on the need of advanced directives.
	Cognitive Sapient State	A condition in which the individual has the ability to reason.
	Ordinary and Extraordinary Care	A differentiation used to determine what level of care is ordinary and therefore required, and to differentiate this from that level of care that might be considered extraordinary and therefore optional due to high costs, low effectiveness, or other criteria.
	Parens Patria	Originates in English common law, whereby the king had the authority to act as guardian for persons with legal disabilities. In the United States, the parens patria function belongs to the states.
	Patient Self-Determination Act of 1990 (PSDA)	Mandates that all health care providers receiving federal reimbursements for services provide information to each patient and offer the option of initiating an advanced directive.
	Substituted-Judgment Standard	A proxy decision-making standard whereby the guardian is directed to make the decision compatible with the previous wishes of the individual.
	Active Euthanasia	Actively assisting the process of death.
	Involuntary Euthanasia	Bringing about the death of someone suffering from terminal illness or intractable pain without the request or consent of the individual.
	Mercy Killing	Active euthanasia, in which the intent is to ease the dying process or end intractable pain.
	Palliative Care	Care designed to provide relief from pain and suffering rather than cure.
	Passive Euthanasia	Ceasing therapies that prolong life so that death can occur.
	Voluntary Euthanasia	Actively assisting the process of death for someone who has requested assistance in the dying process.
	Moral Duty	An act or course of action that is required by one on the basis of moral position.
	Moral Option	The power or right to choose among several alternatives on the basis of a moral question.
	Ethnocentric	Belief in the superiority of one's own ethnic group's customs and traditions and a preference for it when considering other traditions.
	Parenchymal Tissue	The essential functional elements of an organ; generally comprised of epithelial cells.
	Stromal Tissue	Makes up the architecture or structural framework of the organ; generally comprised of mesenchymal cells.
	Epithelial Cells	Cover the external and internal surfaces of the body, including the inner lining of the vessels, ducts, and small spaces; arise from ectoderm and endoderm.
	Mesenchymal Cells	Form the blood and connective tissue which contribute to the structural framework of organs (fibrous tissue) or lend structural support to the body as a whole (bones, cartilage, muscle); arise from mesoderm.
	Hyperplasia	An increase in the number of cells usually in response to increased hormonal or growth factor stimulation; designed to increase the functional capabilities of a tissue; necessitates increased mitotic division.
	Dysplasia	An atypical or abnormal growth of cells that is usually induced by chronic irritation or stimulation; generally regarded as a potential precursor to malignant neoplasia which is a permanent abnormal growth of cells.
	Metaplasia	A substitution of one mature cell type for another mature cell type. In most instances, metaplasia is a process in which a new harsher environment induces a change to a more protective tissue type (such as stratified squamous epithelium replacing ciliated columnar epithelium in the lungs of smokers).
	Hypertrophy	An increase in the size of individual cells in response to an increased functional demand.
	Atrophy	A decrease in the size (or in some instances the number) of individual cells that had previously been of normal size.
	Apoptosis	A distinctive form of cell death which involves individual cells or small clusters of cells. It is an energy-dependent, active process under strict regulatory control. There is sudden cell shrinkage with eosinophilia of the cytoplasm and extreme condensation of the nuclear chromatin. The cell then breaks up into membrane bound fragments (apoptotic bodies) which are subsequently phagocytized by neighboring parenchymal cells or macrophages and then degraded intracellularly without inducing immunologic activation.
	Necrosis	A corm of cell death initiated by overwhelming exogenous injury to the cell. The morphologic expression of necrosis is caused by the physical deterioration of an irreversibly injured cell in living tissue. It is associated with inflammation and subsequent tissue repair.
	Free Radical	These are extremely unstable and reactive molecules which are missing an outer shell electron. They are inactivated by spontaneous decay, naturally occurring antioxidants, or by interaction with specific enzymes. These can lead to irreversible cell membrane damage. The impact of injury is dependent on the balance between the rate of formation and the rate of inactivation. Ionizing radiation may cause cellular injury by the transfer of radiant energy which may, through radiolysis of intracellular water, induce the formation of free radicals and cause acute death of the cell.
	Edema	The accumulation of excess fluid in cells or tissues.
	Types of Leukocytes (White Blood Cells)	Neutrophils, Eosinophils, Basophils, Lymphocytes, Monocytes, and Platelets.
	Requirements for Proper Wound Healing	Adequate blood supply Adequate Nutrition Adequate Cleansing Protection from Trauma
	Ascites	Accumulation of fluid within the peritoneal cavity due to increased hydrostatic pressure within the portal venous system.
	Dyspnea	Shortness of breath
	Lymphedema	Obstruction of lymphatic tissue resulting in lymph fluid not being drained from the area distal to the obstruction.
	Antigen	Any molecule that evokes an immune response because the body perceives it as "foreign"; it induces the formation of antibodies
	Fibrosis	The formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process.
	Neoplasia	new growth of abnormal tissue that serves no physiologic function and, for the most part, is independent of normal restraints on orderly growth.
	Carcinoma	Malignancies arising from epithelial cells.
	Sarcoma	Malignancies arising from mesenchymal cells/connective tissue.
	Melanoma	Malignant neoplasm of melanocytes.
	Lymphoma	Malignant neoplasm of lymphoid tissue.
	Glioma	Malignant neoplasms of supporting tissue of the CNS.
	Blastoma	Malignant tumors arising from early, partially differentiated embryonal tissue.
	Adeno-	Arising from glandular epithelium.
	Fibro-	Arising from fibrous connective tissue.
	Leiomyo-	Arising from smooth muscle.
	Rhabdomyo-	Arising from skeletal muscle.
	Lipo-	Arising from adipose tissue.
	Chondro-	Arising from cartilage.
	Osteo-	Arising from bone.
	Hemangio-	Arising from a blood vessel.
	Squamous	Arising from squamous epithelium.
	Transitional	Arising from transitional epithelium.
	Scirrhous	Hard due to excessive production of tumor stroma.
	Medullary	Soft, resembling marrow, due to scant production of tumor stroma.
	Colloid	Gelatinous or mucinous.
	Cystic	Fluid or gas filled spaces.
	Follicular	A growth patter that forms follicles.
	Papillary	A growth pattern that forms "nipple-like" projections.
	Villous	A growth pattern that forms shaggy, "finger-like" projections.
	Tubular	A growth patter that forms cylindrical tubules.
	Cribriform	A growth pattern pierced by small holes.
	Anaplastic	Lacking differentiation.
	Hydrocephalus	Results from obstruction of CSF flow, an increase in CSF production, or a decrease in reabsorption that results in ventricular distention and increased intracranial pressure.
	Gynecomastia	Hypertrophy/hyperplasia of the male breast.
	Endometriosis	This refers to the presence of functional endometrial tissue outside of the uterus.
	Jaundice	A yellow-green discoloration of the tissues that is caused by increased levels of either unconjugated or conjugated bilirubin circulating in the blood.
	Cirrhosis of the Liver	There is presence of hepatic fibrosis with evidence of regenerative parenchymal nodules. It is the end result of may different processes that cause liver necrosis.
	Ethics	A set of moral principles that govern one's course of actions.
	Sanctity of Life	The right to life is the highest good and nobody has the right to judge that another person's quality of life is so poor that his or her life is not of value. You cannot make life or death decisions about a patient based on your own personal values.
	Respect for Property	Keeping the patient's belongings safe and taking care not to intentionally damage or wast equipment or supplies.
	Criminal Law	Protects a community from certain acts such as terrorism, destruction of property, or death; these are felonies or misdemeanors.
	Civil Law	Protects another person's private legal rights; law that governs relationships between individuals; punishment is usually a fine to repair the damage.
	Tort Law	Protects the violator of a law from being sued for an act of vengeance, to determine fault, and to compensate an injured party; involves personal injury or damage resulting in civil action or litigation to obtain reparation for damage incurred. Type of law that governs rights between individuals in noncriminal actions. This law deals with violations of civil as opposed to criminal law.
	Intentional Tort	A purposeful deed committed with the intention of producing the consequences of the deep.
	Unintentional Tort	An injury resulting from negligence in the performance of patient care.
	Incident Reports	Documentation of an injury to a patient or any error made by healthcare personnel during care.
	Supine	Patient flat on their back, facing up.
	Prone	Patient is lying face down, with back up.
	Lateral Recumbent Position	Patient is on their side with both knees flexed.
	High Fowler's Position	Patient semi-sits with head raised 45-90 degrees.
	Semi-Fowler's Position	Patient's lying down with head raised 15-30 degrees.
	Sim's Position	Patient on either left or right side with the forward arm flexed and the posterior arm extended behind the body, the top knee is bent sharply and the bottom knee is slightly bent.
	Trendelenburg Position	The bed or table is inclined with the patient's head lower than the rest of the body.
	Medical Asepsis	Clean technique; goal is reduction of microbes and infection control.
	Surgical Asepsis	Sterile technique; complete removal of microbes and spores.
	Standard Precautions	Reduces the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals. Precautions that should be followed because of potential contact with body fluids. These precautions include wearing gloves, a mask, and protective eyewear; properly handling needles; and disposing of used equipment into containers for biohazardous material.
	Nosocomial Infection	Illness acquired during hospitalization.
	Pharmacokinetics	The interaction of drugs with body tissues; explores what the body does to the drug.
	Pharmacodynamics	The study of the mechanism of drug action on living tissues; the response of tissue to chemical agents at various sites; explores what a drug does to the body.
	Side Effect	Expected unintended effect that is essentially not harmful.
	Therapeutic Effect	The intended effect of the medication or treatment.
	The 5 Rights of Medication Administration	Right Patient Right Medication Right Dose Right Route Right Time
	The 3 Checks of Medication	1st: When you get the medication or dosage package 2nd: Before putting the medications in medication cup or pouring liquid medication 3rd: After all medications have been prepared, before taken to the patient
	Infiltration	Fluid passing into body tissues; swelling around the injection site accompanied by cool, pale skin and possibly hard patches or localized pain.
	Extravasation	The tissue damage caused by an irritating chemical infiltrating into the body tissue; accidental leakage into the surrounding tissues; a discharge or escape (e.g., of blood) from a vessel into the tissues
	Vital Signs	Body Temperature Pulse Respiratory Rates Blood Pressure
	Personal Protective Equipment (PPE)	Equipment and supplies necessary to minimize or prevent exposure to infectious material, including gloves, gowns, masks, and protective eye gear.
	Bradycardia	Abnormally slow rate of breathing
	Dysrhythmia	An abnormal cardiac rhythm; synonym is arrhythmia.
	Hypertension	Blood pressure elevated above the upper limit of normal.
	Hypotension	Blood pressure below the lower limit of normal.
	Orthostatic Hypotension	Temporary fall in blood pressure associated with assuming an upright position; synonym for postural hypotension.
	Tachycardia	Abnormally rapid rate of breathing.
	Normal Adult Pulse	60-100 beats/minute
	Normal Adult Respirations	12-20 breaths/minute
	Normal Adult Blood Pressure	120/80 mm Hg
	Auscultation	Act of listening with a stethoscope to sounds produced within the body.
	Cyanosis	Bluish or grayish discoloration of the skin in response to inadequate oxygenation.
	Pallor	Paleness of the skin.
	Transmission-based precautions	precautions used in addition to Standard Precautions for patients in hospitals who are suspected of being infected with pathogens that can be transmitted by airborne, droplet, or contact routes
	Basic Principles of Surgical Asepsis	Only a sterile object can touch another sterile object. Open sterile packages so that the first edge of the wrapper is directed away from the worker. Avoid spilling any solution on a cloth or paper used as a field for a sterile setup. Hold sterile objects above waist level. Avoid talking, coughing, sneezing, or reaching over a sterile field or object. Never walk away from or turn you back on a sterile field. All items brought into contact with broken skin, used to penetrate the skin to inject substances into the body, or used to enter normally sterile body cavities should be sterile. Use dry, sterile forceps when necessary. Consider an object contaminated if you have any doubt about its sterility.
	Adverse drug effect	undesirable effects other than the intended therapeutic effect in medication administration
	Ampule	a glass flask that contains a single dose of medication for parenteral administration
	The "Three Checks" of drug administration	(1) when you reach for the container or unit dose package, (2) after retrieval from the drawer and compared with the Computer-generated Medication Administration Record (CMAR), or compared with the CMAR immediately before pouring from a multidose container, and (3) When replacing the container to the drawer or shelf or before giving the unit dose medication to the patient.
	Atelectasis	Incomplete expansion or collapse of a part of the lungs
	Elective Surgery	Surgery that is recommended but can be omitted or delayed without a negative effect
	Alopecia	Baldness
	Caries	Cavities of the teeth
	Halitosis	Offensive breath
	Gingivitis	Inflammation of the gingivae (gums)
	Pyorrhea	Extensive inflammation of the gums and alveolar tissues; synonym for periodontitis
	Ecchymosis	Discoloration of an area resulting from infiltration of blood into the subcutaneous tissue
	Edema	Accumulation of fluid in the interstitial tissues
	Erythema	Redness or inflammation of an area as a result of dilation and congestion of capillaries; Increased warmth and redness in tissue.
	Exudate	Fluid that accumulates in a wound; may contain serum, cellular debris, bacteria, and white blood cells
	Ischemia	Insufficient blood supply to a body part due to obstruction of circulation
	Necrosis	Localized tissue death
	Pressure ulcer	Lesion caused by unrelieved pressure that results in damage to underlying tissue
	Abduction	Movement away from the center or median line of the body
	Adduction	Movement toward the center or median line of the body
	Contracture	Permanent shortening or tightening of a muscle due to spasm or paralysis
	Contusion	An injury in which the skin is not broken; a bruise
	Deep-Vein Thrombosis	A blood clot in a blood vessel originating in the large veins of the legs
	Extension	The return movement from flexion; the joint angle is increased
	Flexion	Bending of a joint so that the angle of the joint diminishes
	Hyperextension	Extreme or abnormal extension
	Patient Care Ergonomics	The practice of designing equipment and work tasks to conform to the capability of the worker in relation to patient care. It provides a means for adjusting the work environment and work practices to prevent injuries before they occur and is part of best practices for providing safe patient care.
	Peripheral Vascular Disease	Pathologic conditions of the vascular system characterized by reduced blood flow through the peripheral blood vessels
	Rotation	Process of turning on an axis; twisting or revolving
	Supination	Turning of the palm or foot upward
	Pronation	The act of turning the hand so the palm faces downward or backward
	Thrombophlebitis	A blood clot that accompanies vein inflammation
	Venous Stasis	Decrease in blood flow in the venous system related to dysfunctional valves or inactivity of the muscles of the affected extremity
	Principles of Body Mechanics	Correct body alignment is important to prevent undue strain on joints, muscles, tendons, and ligaments while maintaining balance. Face the direction of your movement. Avoid twisting your body. Maintaining balance involves keeping the spine in vertical alignment, body weight close to the center of gravity, and fee spread for a broad base of support. Using the body's major muscle groups and natural levers and fulcrums allows for coordinated movement to avoid musculoskeletal strain and injury. Assess the situation before acting so that you can plan to use good body mechanics. Use the large muscle groups in the legs to provide force for movement. Keep the back straight, with hips and knees bent. Slide, roll, push, or pull rather than lift an object. Perform work at the appropriate height for your body position, close to your center of gravity. Use mechanical lifts and/or assistance to ease the movement.
	Transferring a patient from the bed to a stretcher	If the patient is partially able to asst or not at all able: >200 pounds-use a friction reducing device and 3 caregivers. Logroll patient, insert transfer board, flatten patient, using the transfer board slide the patient over, logroll patient, remove transfer board, and flatten patient again. <200 pounds-use a friction reducing device.
	Transferring a patient from the bed to a chair	If the patient is partially able to assist: stand and pivot technique using a gait/transfer belt (1 caregiver) or powered standing assist life (1 caregiver). If the patient cannot assist and is uncooperative, use full body sling lift and 2 caregivers. If the patient cannot assist and is cooperative, use seated transfer aid or gait/transfer belt.
	Acute Pain	Pain that is generally rapid in onset and varies in intensity from mild to severe.
	Adjuvant	Substances or treatments that enhance the effect of another treatment; especially substances that enhance the effect of drugs.
	Breakthrough Pain	A temporary flare-up of moderate to severe pain that occurs even when the patient is taking around-the-clock medication for persistent pain.
	Chronic Pain	Pain that may be limited, intermittent, or persistent but lasts beyond the normal healing period.
	Intractable Pain	Pain that is resistant to therapy and persists despite a variety of interventions
	Neuropathic Pain	Pain that results from an injury to or abnormal functioning of peripheral nerves or the central nervous system
	Pain Threshold	The lowest intensity of a stimulus that causes the subject to recognize pain.
	Pain Tolerance	Point beyond which a person is no longer willing to endure pain
	Aspiration	The misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract.
	Dysphagia	Difficulty swallowing or the inability to swallow
	Enteral nutrition	Alternate form of feeding that involves passing a tube into the gastrointestinal tract to allow instillation of the appropriate formula
	Ketosis	Catabolism of fatty acids that occurs when an individual's carbohydrate intake is not adequate; without adequate glucose, the catabolism is incomplete and ketones are formed, resulting in increased ketones.
	Nasogastric (NG) Tube	A tube inserted through the nose and into the stomach.
	Nasointestinal (NI) Tube	A tube inserted through the nose and into the upper portion of the small intestine
	NPO (nothing by mouth)	Nothing can be consumed by mouth, including medications, unless ordered otherwise
	Percutaneous endoscopic gastrostomy tube (PEG)	A surgically or laparoscopically plased gastrostomy tube
	Percutaneous Endoscopic Jejunostomy Tube (PEJ)	A surgically or laparoscopically placed jejunostomy tube
	Recommended Dietary Allowance (RDA)	Recommendations for average daily amounts of essential nutrients that healthy people should consume over time
	Arteriovenous Fistula	A surgically created passage connecting an artery and a vein, used in hemodialysis
	Arteriovenous Graft	A surgically created connection between an artery and vein using synthetic material; used in hemodialysis
	External Condom Catheter	Soft, pliable sheath made of silicone material, applied externally to the penis, connected to drainage tubing and a collection bag
	Fenestrated	Having a window-like opening
	Ileal Conduit	A surgical diversion formed by bringing the ureters to the ileum; urine is excreted through a stoma.
	Indwelling Urethral Catheter (Retention or Foley Catheters)	A catheter (tube) through the urethra into the bladder for the purpose of continuous drainage of urine; a balloon is inflated to ensure that the catheter remains in the bladder once it is inserted.
	Intermittent Urethral Catheter (Straight Catheter)	A catheter through the urethra into the bladder to drain urine for a short period of time (5-10 minutes)
	Peritonitis	Inflammation of the peritoneal membrane
	Stoma	Artificial opening on the body surface
	Symphysis Pubis	The anterior midline junction of the pubic bones; the bony projection under the pubic hair
	Colostomy	Artificial opening that permits feces from the colon to exit through the stoma
	Constipation	Passage of dry, hard stools
	Defecation	Emptying of the large intestine; also called a bowel movement
	Diarrhea	Passage of excessively liquid, nonformed stool
	Enema	Introduction of a solution into the large intestine
	Fecal Impaction	Prolonged retention or an accumulation of fecal material that forms a hardened mass in the rectum
	Flatus	Intestinal gas
	Hemorrhoids	Abnormally distended veins in the anal area
	Ileostomy	Artificial opening created to allow liquid fecal content from the ileum to be eliminated through a stoma
	Ostomy	A surgically formed opening from the inside of an organ to the outside
	Factors that affect bowel elimination	Mobility Diet Medications Intestinal Diversions
	Endotracheal Tube	Polyvinylchloride airway that is inserted through the nose or moth into the trachea, using a laryngoscope
	Extubation	Removal of a tube (in this case, an endotracheal tube)
	Hemothorax	Blood in the pleural space around the heart
	Nasopharyngeal Airway (nasal trumpet)	A curved, soft rubber or plastic tube inserted into the back of the pharynx through the mouth
	Nasal Cannula	Disposable plastic device with tow protruding prongs for insertion into the nostrils; used to administer oxygen
	Oropharyngeal Airway	A semicircular tube of plastic or rubber inserted into the back of the pharynx through the mouth
	Pneumothorax	Air in the pleural space
	Pule Oximetry	noninvasive technique that measures the oxygen saturation (SpO2) of arterial blood
	Spirometer	Instrument used to measure lung capacity and volume; one type is used to encourage deep breathing (incentive spirometry)
	Subcutaneous Emphysema	Small pockets of air trapped in the subcutaneous tissue; usually found around chest tube insertion sites
	Tracheostomy	Curved tube inserted into an artificial opening made into the trachea; comes in varied angles and multiple sizes
	Autologous Transfusion	A blood transfusion donated by the patient in anticipation that he or she may need the transfusion during a hospital stay
	Central Venous Access Device (CVAD)	A venous access device in which the tip of the catheter terminates in the central venous circulation, usually in the superior vena cava just above the right atrium
	Crossmatching	Determining the compatibility of two blood specimens
	Implanted Port	A type of CVAD; subcutaneous injection port attached to a catheter; distal catheter tip dwells in the lower one third of the superior vena cava to the junction of the superior vena cava and the right atrium
	Nontunneled Percutaneous Central Venous Catheters	A type of CVAD that has a short dwell time (3-10 days); may have double, triple, or quadruple lumens; are more than 8 cm, depending on patient size; introduced through the skin into the internal jugular, subclavian, or femoral veins and sutured into place, and are mainly used in critical care and emergency settings.
	Peripherally Inserted Central Catheter (PICC)	A type of CVAD, more than 20 cm, depending on patient size, that can be introduced into a peripheral vein (usually basilic, brachial, or cephalic vein), and advanced so the distal tip dwells in the lower one third of the superior vena cava to the junction of the superior vena cava and the right atrium
	Peripheral Venous Access Device	A short (less than 3 inches) peripheral catheter placed in a peripheral vein for short-term therapy. This device is not appropriate for certain therapies, such as vesicant chemotherapy, drugs that are classified as irritants, or TPN
	Tunneled Central Venous Catheter	A type of CVAD; intended for long-term use; implanted into the internal or external jugular, or subclavian vein; length of this catheter is more than 8 cm (approximately 90 cm on average), depending on patient size; tunneled in subcutaneous tissue under the skin (usually the midchest area) for 3-6 inches to its exit site
	Arterial Blood Gas (ABG)	A laboratory test that evaluates the oxygen, carbon dioxide, bicarbonate, and pH of an arterial blood sample, determining metabolic or respiratory alkalosis or acidosis.
	Cardiac Arrest	Sudden cessation of functional circulation of the heart (pulse), such as asystole or defibrillation, typically caused by the occlusion of one or more of the coronary arteries or cardiomyopathy
	Cardiac Monitoring	Visualization and monitoring of the cardiac electrical activity stimulating the heartbeat
	Cardiopulmonary Resuscitation (CPR)	also known as basic life support; revival in the absence of spontaneous respirations and heartbeat to preserve heart and brain function while waiting for defibrillation and advanced cardiac life support care. Achieved by manually pumping the heart by compressing the sternum and forcing oxygen into the lungs using mouth-to-mouth or rescue breathing.
	Defibrillation	Stopping fibrillation of the heart by using an electrical device that applies counter-shocks to the heart through electrodes on the chest wall. This counter-shock is given in an attempt to allow the heart's normal pacemaker to take over.
	Electrocardiogram (ECG/EKG)	Graphing of the electrical activity of the heart
	Fibrillation	Small, local, involuntary contraction of muscle, resulting from spontaneous activation of a single muscle fiber or of an isolated bundle of nerve fibers
	Aura	A premonitory or warning sensation of a seizure that can be visual, auditory, or olfactory
	Cerebral Perfusion Pressure (CPP)	A way of calculating cerebral blood flow; the formula is MAP (mean arterial pressure) minus ICP (intracranial pressure) equals CPP; normal CPP for an adult is 60-90 mm Hg
	Coma	A pathologic state of unconsciousness characterized by an unarousable sleep-like state; eyes closed at all times; no speech or sound noted; no spontaneous movement of extremities
	Intracranial Pressure (ICP)	Pressure within the cranial vault; normal ICP is less than 10-15 mm Hg
	Seizure	Temporary alteration in brain function due to excessive and abnormal electrical discharges of neurons in the brain that may result in uncontrolled body movements or a convulsion and alteration of consciousness
	Ventriculostomy	A catheter inserted through a hole made in the skull into the ventricular system of the brain; can be used to monitor ICP and/or drain cerebrospinal fluid
	Logrolling a patient	Hand hygiene and PPE. Identify the patient. Close curtains and explain to patient. Place bed at elbow height. Position at least one caregiver on one side of the bed and two other caregivers on the opposite side of the bed. Place bed in flat position with pillow between patient's knees. Place a friction-reducing sheet under the patient. Ask patient to cross arms on chest. Roll or fan-fold the sheet close to the patient's sides. In unison, gently slide the patient to the side of the bed opposite to that which the patient will be turned. On a signal, turn the patient by holding the sheet taut to support the body. Turn the patient as a unit in one smooth motion toward the side of the bed with the two nurses. Once the patient has been turned, use pillows to support the patient's neck, back, buttocks, and legs in straight alignment in a side-lying position. Raise the side rails. Stand at the foot of the bed and ensure the spinal column is straight without twisting or bending. Lower bed. Assess patient comfort. Remove PPE and perform hand hygiene.
	Expectorate	Expel from the mouth; spit.
	Nasopharynx	Upper portion of the throat (pharynx) located behind the nasal cavity.
	Occult Blood	Blood that is hidden in a stool specimen or cannot be seen on gross examination.
	Tera (T)	10^12
	Giga (G)	10^9
	Mega (M)	10^6
	Kilo (k)	10^3
	Hecto (h)	10^2
	Deca (da)	10^1
	Deci (d)	10^-1
	Centi (c)	10^-2
	Milli (m)	10^-3
	Micro (µ)	10^-6
	Nano (n)	10^-9
	Pico (p)	10^-12
	Frequency (v) Definition Unit Equation	Oscillations per unit time Hertz (cycles per second) v=1/T where T is time (aka period)
	Period (T) Definition Equation	The time it takes to complete one cycle T=1/v
	Wavelength (lambda) Definition Equation	the distance between two corresponding points on a wave c=v x lambda c: speed of light in a vacuum=3.00 x 10^8 m/s v: frequency
	Energy Definition Unit	the ability to do work Joule (J)
	Power Definition Unit	energy/time watt (Joule/sec)
	Atom	fundamental constituent of nature made of subatomic particles that maintains an identity with physical and chemical properties. main subatomic particles: protons, neutrons, and electrons.
	Bohr Model	atom as a solar system with shells around a nucleus for electrons; not accurate but useful for demonstrating
	1 unit of charge equals	1.6 x 10^-19 Coulombs
	Binding Energy Definition Unit	the energy required to remove an electron from its shell eV
	Energy of an eV	1.6 x 10^-19 Joule
	Proton Charge Mass	positive charge 1.6734 x 10^-27 kg
	Neutrons Charge Mass	neutral charge 1.6747 x 10^-27 kg
	Atomic Mass Unit Definition Mass	one-twelfth the mass of a Carbon-12 atom 1 amu=1.6605 x 10^-27 kg
	Mass Defect (aka Mass Deficit) Definition	the mass equivalent of the binding energy Mass defect (in amu)=Binding energy (in MeV)
	Conversion between amu and MeV	1 amu=931 MeV
	Mathematical relationship between mass and energy	E=mc^2 E: energy in J m: mass in kg c: speed of light in m/s
	Chemical Symbol	a z X a: mass number z: atomic number X: symbol of element
	Mass Number	number of protons and neutrons
	Atomic Number	Number of protons
	The two forces present in the nucleus	Electrostatic: like charges repel Binding: force that overcomes the electrostatic forces and holds the nucleus together
	Fusion	take smaller nuclei and fuse them together to create a bigger one; used for generating energy Hydrogen bomb
	Fission	break a big nucleus into smaller ones; used for generating energy Atomic bomb
	Isotope	An atom with the same number or protons but different mass number
	Isotones	An atom with the same number of neutrons but different number of protons
	Isobars	Atoms with the same mass number but different numbers of protons and neutrons
	Isomers	Atoms with the same number of protons and neutrons but differing energy levels
	Radioactivity Definition Why it occurs Unit measured in Common unit SI unit	The spontaneous emission of a charged particle with some radiation or a photon from an unstable nucleus. It is a result of an unstable nucleus due to the neutron to proton ratio being too high or too low. Measured in: disintegrations per second Common unit: Curie (Ci) SI unit: Becquerel (Bq) 1 Bq=1 dps
	Conversion between Curie and Becquerel	1 Ci=3.7 x 10^10 Bq
	Disintegration	the event of decay of an atom with an unstable nuclear configuration that results in the emission of some form of radiation, usually a charged particle
	Half Life (T1/2)	the time required for the decay of half of the atoms in a sample
	Decay Constant (lambda) Definition Equation	predicts the decay rate lambda=0.693/(T1/2)
	3 Activity Equations	A= lambda x N A: activity in dps lambda: decay constant N: number of atoms A= A0 x e^(-lambda x t) A: current activity A0: original activity lambda: decay constant t: time A= A0/(2^n) A: current activity A0: original activity n: number of half lives
	Biologic Half Life	patients’ body excretes 50% of the radionuclide that was put in or that is left in the body (however, the physical half life does not stop)
	Effective Half Life Definition Equation	Half life that takes into account the physical and biologic half lives T1/2e = [T1/2p x T1/2b] / [T1/2p + T1/2b] T1/2p: physical half life T1/2e: effective half life T1/2b: biological half life
	Secular Equilibrium	This occurs when a parent has a much longer half life relative to the daughters. As the daughter decays, its activity increases to the activity of the parent and then appears to decay with the same half life of the parent when it actually decays with its own half life.
	Transient Equilibrium	The half lives between the parent and daughter are not as significant. The activity of the daughter increases to that of the parent and appears to decay at the rate of the parent. This is now observable because the two half lives are closer and can observe the decay of the parent.
	Alpha Particles and their Emission Consists of Charge When it occurs AKA Energy Minimum KE	Consist of: 2 protons and 2 neutrons Charge: +2 Alpha particle emission increases the neutron-to-proton ratio, so it occurs when the neutron to proton ratio is too low. Alpha emission occurs when the atomic number is 82 or greater with 1 exception. AKA a helium nucleus. All alpha particles from a specific radionuclide are monoenergetic. Theoretically, an particle has to have a minimum kinetic energy of 3.8 MeV. In reality, the lowest is 3.93 MeV.
	Energy of an alpha emitter	Q=Mp – Md – Ma – 2Me Q: total energy released Mp: mass of parent Md: mass of daughter Ma: mass of alpha particle Me: mass of electrons lost The answer should be in MeV, so will have to convert from amu.
	Energy of an alpha particle	Ea=Q/[1+(Ma/Md)] Q: total energy released from alpha particle emission Ma: mass of alpha particle Md: mass of daughter
	Beta Particles Definition Charge Mass Atomic Number When it occurs	Essentially the same as an electron, except that they originate in the nucleus. Charge: -1 Mass: .00055 amu Atomic number: -1 Beta emission occurs if the neutron-to-proton ratio is too high.
	Total Energy Released for a Beta Particle	Q=Mp – Md – Mß + Me Q=Mp – Md Q: total energy released in MeV Mp: mass of parent Md: mass of daughter Mß: mass of beta particle Me: mass of electron
	Maximum Energy Released from Beta Particle Emission	Q=Eß=Emax This is the total energy released which is shared by the antineutrinos.
	Antineutrino Charge Mass When released	no charge infinitely small mass released with beta particles
	Average Energy from Beta Emission	Eavg= 1/3 Emax (or Q)
	Positron Definition Charge Mass When it occurs Result	An electron originating in the nucleus with a positive charge. Charge: +1 Mass: .00055 amu These are emitted when the neutron-to-proton ratio is too low and when alpha emission is not possible. These do not exist for long and annihilation radiation results from their destruction.
	Total energy released in positron emission	Q=Mp – Md – Mß – Me Q: total energy released Mp: mass of parent Md: mass of daughter Mß: mass of positron Me: mass of electron lost
	Emissions that occur when the neutron-to-proton ratio is too low	Alpha Emission Positron Emission Electron Capture (Positron emission and electron capture occur when the atomic number is less than 82.)
	Emission that occurs when the neutron-to-proton ratio is too low	Beta Emission
	Electromagnetic Radiation	EM radiation consists of oscillating waves/oscillating magnetic and electric fields. Do not require a medium to travel. Has dual properties.
	Photon	A packet of EM energy that has characteristics of particles; light acting in a particulate way
	The Duality of Light	A property of electromagnetic radiation; meaning that it has dual properties- characteristics of both waves and particles.
	Energy and Frequency Relationship	E=hv E: energy in eV H: planck’s constant (6.62x10-34 Jsec) V: frequency
	Electron Capture Definition When it occurs What results AKA	This is taking an orbital electron and incorporating it into the nucleus by transforming a proton into a neutron It occurs when the neutron-to-proton ratio is too low and when the atomic number is too low for alpha emission The electron being pulled into the nucleus leaves a hole in the orbit which results in characteristic x-rays. AKA K capture
	Gamma Rays Definition It cause	Gamma rays are the result of an excited nucleus (therefore, they are always generated in the nucleus). This excited nucleus may result from excess energy left in the nucleus after particle emission.
	Bremsstrahlung X-rays How they occur X-rays generated Energy	Radiation passes through a medium. A beta negative particle is attracted to the positive nucleus which results in the radial acceleration of the beta particle around the nucleus. When the radial acceleration occurs, some of the KE will be lost through heat and the generation of x-rays. The number of x-rays generated is directly proportional to the atomic number of the medium through which the particle is passing. These are released in a spectrum of energies where the maximum energy is the energy of the incident particle.
	Auger Electron Alternative to Definition Possible result	This is an alternative emission to characteristic x-rays. Instead of characteristic x-rays occurring, the energy that would have come out in the form of a characteristic x-ray gets transferred to an orbital electron and results in that orbital electron being emitted. This is the Auger electron. If an Auger electron is emitted, it creates another hole where characteristic x-rays or another Auger electron can be emitted.
	Conversion Electron Alternative to Definition Possible result	This is an alternative emission to gamma rays. When a particle is emitted and the nucleus is left in an excited state, gamma rays are expected. However, the excitation energy in the nucleus can be transferred to an orbital electron, causing the orbital electron to be emitted. This electron is referred to as a conversion electron. The emission of a conversion electron leaves behind a hole, so characteristic x-rays or an Auger electron may occur.
	Ionization Definition Result	This is when an incident particle or photon interacts with an orbital electron and imparts a sufficient amount of energy to expel it from the atom. Results in an emitted electron.
	Ionization Potential	The amount of energy required to ionize the least tightly bound electron. (However, it actually requires 2-3 times the ionization potential to expel an electron, because the interaction is not always with the least tightly bound electron. Also, there are excitation losses: all interactions do not result in ionization either because the particle doesn't have sufficient energy anymore or the particle does not get close enough to the electron.)
	Excitation	This is when an orbital electron is raised to a higher energy level. An incident particle may give off energy to an orbital electron such that it doesn't get expelled but gets raised to an excited state.
	Specific Ionization	This is the number of ion pairs formed per unit distance traveled by the incident radiation.
	Linear Energy Transfer (LET)	This is the average energy deposited per unit distance.
	High LET radiations Definition Example	Radiation that deposits high energy wit short path length Alpha particles, QF=20 Protons
	Low LET radiations Definition Example Quality Factor	Radiation that deposits smaller energy per unit distance; ionizations and excitations happen in a more spread out fashion Beta particles Electromagnetic radiations (x-rays and gamma rays) QF=1
	Pair Production Definition Minimum Energy Opposite of Result	An incident photon passes near the nucleus, which may result in its energy being converted into a positron and electron. Requires a photon of 1.02 MeV or greater as the minimum energy required. This is the opposite of annihilation radiation, because the photon is converted into mass. The electron and positron then behave like the charged particles that they are: the electron may interact with orbital electrons to ionize or excite and positrons will undergo annihilation giving annihilation radiation.
	Compton Scattering Definition Photon energy Result	This is usually when a moderate energy photon interacts with an outer shell electron. This occurs when the energy of the incident photon is much higher than the binding energy of the electron. Since the energy of the photon is higher than the electron's binding energy, not only does it kick out the electron, but the remaining energy comes out as a scattered photon.
	Photoelectric Absorption Definition Photon Energy Alternative Result Probability	This is usually when a low energy photon interacts with an inner shell electron. This occurs when the incident photon's energy is equal to or less than the binding energy of the electron. If the photon is not sufficiently high, the electron will be left in an excited state instead. The probability of photoelectric interactions increases significantly with the atomic number of the atom. The probability of interaction occurring is directly proportional to the atomic number to the fourth power (Z^4)
	Units of Exposure Definition Common Unit SI Unit	This is the exposure due to x-rays and gamma rays only (not particulate radiation) and is in the air only. Common Unit: Roentgen (R) SI Unit: Coulombs/kg
	Conversion between Roentgen and Coulombs/kg	1 R= 2.58 x 10^-4 Coulombs/kg
	Units of Absorbed Dose Definition Common Unit SI Unit	This is any type of radiation in any medium. Common Unit: RAD [Radiation Absorbed Dose] SI Unit: Gray (Gy)
	Conversion between Gray and RAD	1 Gy=100 RAD
	Units for Equivalent Dose Definition Common Unit SI Unit Common measurement device	This takes into account the quality of radiaiton due to the different biologic effects. Common Unit: REM [Roentgen Equivalent Man] SI Unit: Sievert (Sv) Dosimeters report in mREM.
	Conversion between REM and Sievert	1 Sv=100 REM
	Gamma Constant Definition Equation	This is a constant that can be looked up that takes into account distance and activity to give the exposure rate. Gamma=(R cm2)/(mCi hr)
	Estimating Exposure Rate Definition Equation	When the gamma constant is known, the exposure rate can be estimated. •X=6CE •X: exposure rate in R/hr at 1 foot C: activity in Curies E: energy in MeV
	Inverse Square Law	I1/I2 = [(D2)^2]/[(D1)^2] I1: Exposure rate at distance 1 I2: Exposure rate at distance 2 D1: Distance 1 D2: Distance 2
	Shielding: Alpha Particles	paper or layer of dead skin cells Therefore, these are not external dose factors for radiation exposure. (However, if ingested they collect in bones, lungs, etc.)
	Shielding: Beta Particles	Shielded by low atomic number material, such as Plexiglas
	Shielding: Electromagnetic Radiations How shielded Shielding Formula Half Value Layer Material Exposure rate formula	These are shielded probabilistically, because they have no maximum range. Shielding formula: • I=I0 e^(-µx) µ: 0.693/half value layer x: Thickness of medium I: Exposure rate Half Value Layer: thickness needed to attenuate 50% of the beam. Lead has become the shielding choice because of small HVL, except for radiation therapy where high density concrete has become the shielding of choice. I0/2^n I: Exposure rate N: Number of half value layers
	Things physicists need to know for shielding designs	1. the maximum energy in kV that will be used 2. workload in mAmin 3. use factor: what fraction of the procedures will be aimed at which wall 4. occupancy factor (T): who is sitting outside of that area and for how long
	Restricted Area Exposure Rate Access Posting	Exposure rate is greater than or equal to 2 mR in one hour. General access, including the general public or untrained personnel, is restricted to the area. No signs, labels, postings, or warnings, but have the responsibility to restrict the access.
	Radiation Area Exposure Rate Posting	Exposure rate is greater than or equal to 5 mR per hour and less than 100 mR per hour Requires posting: yellow sign with magenta "caution: radiation area" and radiation symbol on it.
	High Radiation Area	Exposure rate is greater than or equal to 100 mR per hour. Requires posting: yellow sign with purple "caution: high radiation area" and radiation symbol on it.
	Radioactive Materials	Essentially all radioactive rooms are restricted areas due to both exposure rate and national security. Posting: sign for exposure rate and a yellow sign with black "caution: radioactive materials" and black radiation symbol on it.
	Deep Dose Limit Limit Where Measured AKA	5,000 mREM/yr This is a measure of the exposure 1 cm below the level of the skin. AKA whole body dose
	Eye (Lens) Dose Limit	15,000 mREM/yr
	Shallow Dose Limit Limit Where Measured	50,000 mREM/yr This is a measure of exposure at the level of the skin.
	Extremities Dose Limit Limit Applies to	50,000 mREM/yr This is a measure of dose that applies distal to the elbows and knees.
	Fetus Dose Limit Limit per pregnancy Limit per month	500 mREM/pregnancy This averages out to 50 mREM/month
	General Public Limit Limit Application	100 mREM/yr Departments must be designed to where other employees never reach this dose.
	ALARA (As Low As Reasonably Achievable)	This concept means to ensure that employees never reach the maximum permissible doses. Thresholds are established to ensure this, called ALARA triggers.
	Deterministic Effects Definition Caused by Severity Predictability	There is a threshold for the manifestation of the biological effect caused by radiation. Caused by lethal DNA damage Severity increases with dose Very predictable
	Stochastic Effects Definition Caused by Severity Predictability	There is no threshold for the manifestation of a biological effect caused by radiation. Caused by DNA mutation There is no correlation between dose and severity. It is based on probability.
	Cataracts as related to radiation Definition Caused by Dose thresholds Latency Period	This is a deterministic effect. This is caused because there is no mechanism in the lens of the eye to remove dead cells. Dose thresholds: 2 Gy in a single dose 4 Gy in a fractionated dose (over 3 months) Latency Period: about 8 years for a dose of 2.5-6.5 Gy
	Linear No-Threshold Model	For stochastic effects, the risk is proportional to dose at all levels.
	Children's sensitivity to radiation	This is due to rapidly dividing cells and the excess time for late effects
	Irradiation of Pregnant Women Stochastic effect Deterministic effect	Stochastic effect: cancer Deterministic effect: developmental (10-20 RAD)
	Risk estimate for stochastic effects Occupational General Public	Occupational: 4 x 10^-4/REM General Public: 5 x 10^-4/REM
	Early Transient Ischemia of Skin caused by Radiation Typical Threshold Dose Time of Onset	2 Gy Hours
	Temporary Epilation caused by Radiation Typical Threshold Dose Time of Onset	3 Gy 3 weeks
	Main Erythema of Skin caused by Radiation Typical Threshold Dose Time of Onset	6 Gy 10 days
	Permanent Erythema of Skin caused by Radiation Typical Threshold Dose Time of Onset	7 Gy 3 weeks
	Dry Desquamation of Skin caused by Radiation Typical Threshold Dose Time of Onset	10 Gy 4 weeks
	Invasive Fibrosis of Skin caused by Radiation Typical Threshold Dose Time of Onset	10 Gy late effect
	Dermal Atrophy of Skin caused by Radiation Typical Threshold Dose Time of Onset	11 Gy Greater than 14 weeks
	Telangiectasia of Skin caused by Radiation Typical Threshold Dose Time of Onset	12 Gy Greater than 52 weeks
	Moist Desquamation of Skin caused by Radiation Typical Threshold Dose Time of Onset	15 Gy 4 weeks
	Late Erythema of Skin caused by Radiation Typical Threshold Dose Time of Onset	15 Gy 6-10 weeks
	Dermal Necrosis of Skin caused by Radiation Typical Threshold Dose Time of Onset	18 Gy Greater than 10 weeks
	Secondary Ulceration of Skin caused by Radiation Typical Threshold Dose Time of Onset	20 Gy Greater than 6 weeks
	Orthogonal Imaging	Two images taken at 90 degree angle from one another to verify isocenter.
	Attenuation	The removal of photons and electrons from a radiation beam by scatter or absorption as it travels through a medium, typically tissue or tissue equivalent material.
	Bolus	Tissue equivalent material that is usually placed on the patient to increase the skin dose and/or even out irregular contours in the patient.
	Central Axis	The central portion of the beam emanating from the target; the only part of the beam that is not divergent. This is usually directed toward isocenter.
	Isocenter	The point of intersection of the 3 axes of rotation (gantry, collimator, and base of couch) of the treatment unit. It is a point in space 100 cm from the source of x-ray production.
	Optical Distance Indicator (ODI)	This projects a scale onto the patient's skin, which corresponds to the TSD
	Parallel Opposed (POP) Fields	Field geometry in which two treatment fields share common central axes, 180 degrees apart. Ex: AP/PA
	Dmax	The depth at which electronic equilibrium occurs for photon beams. This is the depth of maximum absorbed dose and ionization for photons. The depth of maximum buildup, in which 100% of the dose is deposited beneath the skin. Depth at which electronic equilibrium occurs for photon beams. This is also the depth of maximum absorbed dose and ionization, for photons, from a single treatment field. Depth of maximum ionization and maximum absorbed dose are usually not the same depth for electrons.
	Dmax of 4 MV	1.0 cm
	Dmax of 6 MV	1.5 cm
	Dmax of 10 MV	2.5 cm
	Dmax of 18 MV	3.5 cm
	Dmax of 24 MV	4.0 cm
	Dose Rate	The amount of radiation exposure produced by a treatment machine or source at a specified reference field size and at a specified reference distance AKA output
	Monitor Units (MU)	A unit of output used for linear accelerators.
	Monitor Unit (MU) Formula	MU = [prescribed dose (cGy)] / [Output (cGy/MU) x Output factor x Percent Depth Dose x Tray Factor]
	Percent Depth Dose	The ratio, expressed as a percentage, of the absorbed dose at a given depth to the absorbed dose at a fixed reference depth, usually Dmax
	Divergence	The spreading out of the beam of radiation.
	The Chain of Infection	1. Etiologic Agent 2. Reservoir 3. Portal of Exit 4. Mode of Transmission 5. Portal of Entry 6. Susceptible Host
	Etiologic Agents involved in the Chain of Infection	Metazoa Protozoa Fungi Bacteria Rickettsia Viruses Prions
	Metazoa	Mulitcellular animals, many of which are parasites. Ex: Trichinellosis, Hookworm, And Schistosomiasis
	Protozoa	Single-cell organisms with a well-defined nucleus. Some of these are human parasites. Ex: Malaria, Giardiasis, Toxoplasmosis, Pneumocystis carinii pneumonia (aka PCP)
	Fungi	Non-motile, filamentous organisms that cause diseases that can be very difficult to treat. Ex: Histoplasmosis, Candidiasis
	Bacteria	Single-celled organisms that lack a nucleus. Responsible for ex: tuberculosis, staphylococcal disease, Chlamydia and Gonorrhea, Tetanus and Diphtheria, Pertussis, Haemophilus Influenzae Type B, and Pneumococcal Disease.
	Rickettsia	A genus of bacteria usually found in the cells of lice, ticks, fleas, and mites. They are smaller than most bacteria and share some characteristics of viruses. Ex: Rocky Mountain Spotted Fever and Typhus
	Viruses	Very small, consisting of an RNA or DNA core and an outer coat of protein. They can reproduce and grow only inside of living cells. Ex: influenza, HIV, Rabies, Measels, Mumps, Rubella, and Poliomyelitis.
	Prions	Infectious agents that do not have any genes. They seem to consist of a protein with an aberrant structure, which somehow replicates in animal or human tissue. These can cause severe damage to the brain. Ex: Chronic Wasting Disease of mule, deer, and elk; Bovine Spongiform Encephalopathy in Cows; and Creutzfeld-Jacob Disease in Humans
	Incubatory Carriers	People who are going to become ill, but begin transmitting their infection before their symptoms start.
	Inapparent Infections	People with inapparent infections never develop an illness, but are able to transmit their infection to others.
	Convalescent Carriers	People who continue to be infectious during and even after their recovery from illness.
	Chronic Carriers	People who continue to harbor infections for a year or longer after their recovery.
	Portals of Exit in the Chain of Infections	Respiratory Genitourinary Alimentary Skin Superficial Lesions Percutaneous Transplacental Portals of Entry are usually the same as the portal of exit from the reservoir.
	Direct Transmission	Diseases transmitted by direct contact with the human, animal, or environmental reservoir. Occurs more or less immediately. Droplet spread is considered to be direct transmission.
	Indirect Transmission	The spread of diseases that may occur through animate or inanimate mechanisms.
	Susceptible Host Factors	Genetic Factors General Resistance Factors Specific Acquired Immunity
	Spinal Cord Compression	Emergency Present with pain, weakness, autonomic dysfunction, and sensory loss Most common primaries: lung, breast, prostate, and lymphomas 3-4 cm margin above and below the tumor or 2 vertebral bodies above and below the compression Lateral borders: 7-8 cm wide
	Superior Vena Cava Syndrome	Most common primaries: non-small cell lung and lymphomas Emergency case due to possible airway obstruction or cerebral edema Most commonly presents with dyspnea, facial fullness and swelling, mass on chest x-ray RT fractionation scheme is dependent on the severeity and rapidity of symptom onset Acute onset: 250-400 cGy x 3 followed by a boost to: lung: 60 Gy or more at 1.8 Gy/fraction lymphomas: 35-45 Gy at 1.8 Gy/ fraction
	Brain Metastases	Emergency case Most common primaries: lung, breast, colon, renal cell, melanoma Presents with: headache, decreased mentation, focal neurological deficits, new onset seizures Steroids reduce edema and surgery for local control Radiation: whole brain treatment: ranges from 30 Gy in 10 fractions to 37.5 Gy in 15 fractions and a boost can be prescribed ranging from 15-24 Gy
	Patient Position	It is most important that the patient be in a reproducible and accurate treatment position.
	Anatomical Landmarks Used to Straighten Patients	Superior Orbital Margin Suprasternal Notch Xiphoid Process Pubic Symphysis
	IV Contrast is Mainly Used for	Brain tumors Head and neck primaries Lymphoma
	Oral Contrast is Mainly Used for	Esophageal cancer (gastrografin) Stomach cancer (barium)
	Radiocontrast Agents	A type of medical contrast medium used to improve the visibility of internal bodily structures in x-ray based imaging techniques. Typically iodine or barium compounds
	The Process of Cancer	1. Discovery of Disease 2. Establishing a Diagnosis 3. Staging 4. Treatment Options 5. Treatment Decided 6. Treatment 7. Completion of Treatment 8. Follow Up
	Properties of X-Rays	Travel in straight lines Divergent Different Energies Penetrating Invisible Travel at the speed of light Produce scattered radiation Affect radiographic film Cause fluorescence of some crystals Cause biological damage
	Low Energy Radiation Therapy Equipment	Grenz rays Contact therapy Superficial equipment Orthovoltage equipment
	High Energy Radiation Therapy Equipment	Van de Graaff generator Betatron Cyclotron Linear accelerator Cobalt unit
	Adenocarcinoma	Malignant tumor arising from epithelial cells which are glandular
	Anaplastic	Pathologic description of cells, describing a loss of differentiation and more primitive appearance
	Benign Tumors	Tumors that are generally well differentiated and do not metastasize or invade surrounding normal tissue. Benign tumors are often encapsulated and slow growing.
	Carcinomas	Tumors that originate from the epithelium. These include all the tissues that cover a surface or line a cavity
	Cellular differentiation	Degree to which a cell resembles its cell of origin in morphology and function
	Combination Chemotherapy	Selection of drugs that act on the cell during different phases of the cell cycle, increasing the cell killing potential. In addition, drugs with known toxicities are used for maximum effectiveness, resulting in fewer side effects.
	Epidemiology	Study of defining the distribution and determinants causing disease and injury in human populations
	Etiology	The study of the causes of disease
	Grade	Grade of a tumor provides information about its biological aggressiveness and is based on the degree of cell differentiation. For some tumors, grade is the most important prognostic indicator.
	Intrathecal	injection that requires drugs to be instilled into the space containing cerebrospinal fluid
	Malignant	Tumors that are malignant often invade and destroy normal surrounding tissue and, if left untreated, can cause the death of the host.
	Natural History	The normal progression of a tumor without treatment
	Palliation	This is noncurative treatment to relieve pain and suffering when the disease has reached the stage at which a cure is no longer possible
	Phase I Study	This is the first step in testing a new treatment in humans, assessing the best way to give a new treatment, and the best dose. Dose is usually increased a little at a time to find the highest dose that does not cause harmful side effects.
	Phase II Study	This tests whether a new treatment has an appropriate tumoricidal effect against certain cancers.
	Phase III Study	This compares the results of people taking the standard treatment to prove the safety and efficacy of a new treatment.
	Prognosis	estimation of life expectancy
	Prospective Study	Study in which the theory of the cause of a condition or disease is tested by examining those who have a particular characteristic or trait. Population to be examined is selected in the beginning of the study.
	Radioprotectors	certain chemicals and drugs that diminish the response of cells to radiation
	Radiosensitizers	chemicals and drugs that help enhance the lethal effects of radiation
	Retrospective Studies	study of a group of individuals all having the same disease and common characteristics that might have caused the disease
	Sarcoma	malignancy arising from other than epithelial tissues (connective tissue) of the body
	Sensitive	test that can identify a tumor in its extremely early stage
	Sentinel Node	Primary drainage lymph node of a specific atomic area. For example, the sentinel node for the breast is most commonly located near the axilla.
	Somatic Cells	nonreproductive cells
	Specific	Test that can identify a particular type of cancer
	Systemic Treatment	Cancer management treatment that encompasses the patient’s entire system, generally through venous means. Chemotherapy affects not only cancerous cells but others also because of the systemic nature of its delivery.
	Tumor staging	Means of defining the tumor size and extension at the time of diagnosis. Tumor staging provides a means of communication about tumors, helps in determining the best treatment, aids in predicting prognosis, and provides a means for continuing research.
	Tumoricidal Dose	dose high enough to eradicate the tumor
	Assault	threat of touching in an injurious way
	Battery	touching of a person without permission
	Durable Power of Attorney	legal document that allows an individual to designate anyone willing, 18 years of age or older, to be their surrogate and make decisions in matters of health care
	False Imprisonment	intentional confinement without authorization by a person who physically constricts another with force, threat of force, or confining clothing or structures
	Incident	any happening not consistent with the routine operation of the hospital or routine care of a particular patient
	Invasion of Privacy	revealing confidential information or improperly and unnecessarily exposing a patient’s body
	Law	primarily concerned with the good of a society as a functioning unit
	Legal Concepts	sum of artificial rules and regulations by which society is governed in any formal and legally binding manner
	Legal Ethics	study of the law mandating certain acts and forbidding others under penalty of criminal sanction
	Libel	written defamation of character
	Living Will	purpose of the living will is to allow the competent adult to provide direction to health care providers concerning their choice of treatment under certain conditions, should the individual no longer be competent by reason of illness or other infirmity, to make those decisions
	Medical Record	all components used to document chronologically the care and treatment rendered to a patient
	Negligence	neglect or omission of reasonable care or caution
	Practice Standards	authoritative statements established by the profession for judging the quality of practice, service, and education
	Risk Management	process of avoiding or controlling the risk of financial loss to the staff members and hospital or medical center
	Slander	oral defamation of character
	Values	Core beliefs concerning what is desirable and help assess the worth of intangibles. They provide the foundation for decisions individuals make in their personal and professional lives.
	Genome	complete compliment of hereditary factors as found on a haploid distribution of chromosomes
	Transcription	process resulting in the transfer of genetic information from a molecule of DNA to a molecule of RNA
	Translation	process resulting in the construction of a polypeptide in accordance with genetic information contained in a molecule of RNA
	Tumor-Suppressor Gene	Gene whose presence and proper function produces normal cellular growth and division. Absence or inactivation of such a gene leads to uncontrolled growth or neoplasia.
	Deoxyribonucleic Acid (DNA)	large, double-stranded nucleic acid molecule that carries the genetic material of the cell on the chromosomes. This genetic information is composed of a sequence of nitrogen bases and molecular subunits.
	Law of Bergonie and Tribondeau	stating that ionizing radiation is more effective against cells that are actively mitotic, are undifferentiated, and have a long mitotic future
	Maintenance Therapy	Treatment that is given to help a primary treatment keep working. Maintenance therapy is often given to help keep cancer in remission.
	Oxygen-Enhancement Ratio (OER)	magnitude of the oxygen effect on cell death is termed the OER, which compares the response of cells with radiation in the presence and absence of oxygen
	Radiolysis	initial event in the radiolysis (splitting) of water involves the ionization of a water molecule, thus producing a water ion
	Relative Biologic Effectiveness (RBE)	RBE equals dose from 250 KeV x-ray divided by dose from test radiation to produce the same biologic effect
	Reproductive Failure	decrease in the reproductive integrity or the ability of a cell to undergo an infinite number of divisions after radiation
	TD5/5	dose of radiation that is expected to produce a 5% complication rate within 5 years
	TD50/5	dose of radiation that is expected to produce a 50% complication rate within 5 years
	Excisional Biopsy	removal of the entire tumor by cutting it out so that a diagnosis can be made
	Incisional Biopsy	act of cutting into tissue to remove part of the tumor so that a diagnosis can be made
	Incidence	occurrence of a particular disease over a period of time in relationship to the entire population
	Inspection	the use of sight to observe
	Lymphadenopathy	swelling of any lymph nodes
	Metastases	spread of cancer beyond the primary site
	Palpation	Use of touch to acquire information about the patient. Physician palpates the patient by using the tips of the fingers.
	Paraneoplastic Syndrome	Collective term for disorders arising from metabolic effects of cancer on tissues remote from the tumor. Such disorders may appear as endocrine, hematologic, or neuromuscular disorders.
	Premalignant	physiologic characteristics of predisposing factors that may lead to malignancy
	Prevalence	probability of disease in the entire population at any point in time
	Prevention	Effective strategy for saving lives lost from cancer and diminishing suffering. Prevention includes measures that stop cancer from developing.
	Screening	selecting appropriate tests and studies to check for disease
	Symptom	a subjective indication of a disease or a change in condition as perceived by the patient
	Syndrome	a set of signs or symptoms that arise from a common cause
	Tumor Marker	a substance manufactured and released by the tumor
	Accelerator Structure	Structure resembles a length of pipe and is the basic element of the linear accelerator. Accelerator structure allows electrons produced from a hot cathode to gain energy until they exit the far end of the pipe.
	Beam-Flattening Filter	located on the carousel with the scattering foil, shapes the x-ray beam in its cross-sectional dimension
	Bending Magnet	used in high-energy linear accelerators to bend the electron stream within the head of the gantry, sometimes at right angles
	Betatron	older megavoltage unit that can provide x-ray and electron therapy beams from less than 6 to more than 40 MeV
	Cerrobend	A form of Lipowitz metal used for designing custom shielding blocks and consists of: 50.0% bismuth 26.7% lead 13.3% tin 10.0% cadmium
	Circulator	one of four major components housed in the drive stand, which prevents backflow of microwave power
	Dynamic Wedge	use of a moving collimator jaw to produce a wedged isodose distribution
	Electron Gun	Responsible for producing electrons and injecting them into the accelerator structure. This essential part of the linear accelerator is responsible for producing electrons and injecting them into the accelerator structure.
	Electronic Portal Imaging Device (EPID)	System producing near real-time portal images on a computer screen for evaluation. Most electronic portal-imaging systems are light weight and come with a retracted arm along the gantry’s axis. Arm may be equipped with Amorphous Silicon (aSi) imaging technology, which provides a quick and accurate comparison of its images with reference images.
	Gantry	On a conventional simulator, it is a mechanical c-shaped device that supports the x-ray tube and collimator device at one end. On a CT scanner, it is the circular ring housing the x-ray tube and solid state detectors. On a linear accelerator, it is responsible primarily for directing the photon (x-ray) or electron beam at a patient’s tumor.
	Grenz Ray	low-energy x-ray in the range of 10 to 15 kV
	Image Guided Radiation Therapy (IGRT)	It may be used in a variety of forms, including EPID, an in-room CT scanner, KV cone beam computed tomography, MV cone beam computed tomography, ultrasound and others. Rational for IGRT is to image the patient just prior to treatment, compare the position of external set-up marks and internal anatomy to the treatment plan.
	Indexed Carbon Fiber Couch	a system of numbered or lettered holes, or notches, along the lateral edge of the carbon fiber table top for the positioning of the patient and immobilization devices. This allows for increased accuracy in treatment setup reproducibility from simulation to treatment delivery and through multiple treatments over the course of daily radiation therapy delivery.
	Intensity Modulated Radiation Therapy (IMRT)	therapy that delivers nonuniform exposure across the beam’s eye view (BEV) using a variety of techniques and equipment
	Interlock System	safety switches blocking or terminating radiation production
	Isodose Lines	lines connecting points of equivalent relative radiation dose
	Klystron	equipment that converts kinetic energy to microwave energy in the linear accelerator
	Linear Accelerator	radiation therapy treatment unit that accelerates electrons and produces x-rays or electrons for treatment
	Magnetron	a special type of electron tubes that are used to provide microwave power to accelerate electrons
	Megavoltage Equipment	units using x-rays beams of energy 1 MeV or greater
	Microwaves	Similar to ordinary radiowaves but have frequencies thousands of times higher. Microwave frequencies needed for linear accelerator operation are about 3 billion cycles per second (3,000 MHz).
	Misadministration	incorrect application or delivery of a prescribed dose of radiation therapy, which can be minor or major and may cause death or serious injury to the patient depending on the extent of the dose
	Multileaf Collimator (MLC)	distinct part of the linear accelerator that allows treatment field shaping and blocking through the use of motorized leaves in the head of the machine
	Orthovoltage Therapy	treatments using x-rays produced at potentials ranging from 150 to 500 kV
	Penumbra	area or region at the beam’s edge where the radiation intensity falls to 0
	Scattering Foil	Most common method of producing an electron beam wide enough for clinical use is to use a scattering foil. Scattering foil is a thin sheet of a material that has a high Z number placed in the path of the “pencil beam” of electrons. A second scattering foil may be added to create a “dual scattering foil” arrangement. First scattering foil is used to widen the beam; the second is used to improve the flatness of the beam.
	Drive Stand	Drive stand appears as a large, rectangular cabinet, at least as large as the gantry. As its name indicates, the drive stand is a stand containing the apparatus that drives the linear accelerator.
	Superficial Therapy	treatment with x-rays produced at potentials ranging from 50 to 150 kV
	Teletherapy	treatment at a distance, including external beam radiation therapy
	Treatment Couch	part of the linear accelerator, the treatment couch is the area on which patients are positioned to receive their radiation treatment
	Waveguide	hollow, tube-like structure within the linear accelerator that is used to accelerate injected electrons to near the speed of light prior to striking a target to produce photons
	Beam Modifiers	devices that change the shape of the treatment field or distribution of the radiation at depth
	Beam's Eye View (BEV)	Visualization perspective that is “end-on” or positioned as if looking at a volume from the source or radiation. Made possible from collected CT data, this perspective is essential in three-dimensional planning.
	Collimation	edge definition of radiation beam size and dimensions
	Coplanar	geometric principle describing two radiation fields configured in such a way that the beam edges lie in the same plane (central ray is not parallel opposed)
	Elapsed Days	total time over which radiation treatment is delivered (protracted)
	Feathering	migration of a gap between treatment fields through the course of treatment
	Fiducial Markers	fiducial markers may include natural anatomy or be artificial markers placed internally or at the skin surface or fixed external to the patient to document location through various imaging modalities
	Fractionation	radiation therapy treatments given in daily fractions (segments) over an extended period of time, sometimes up to 6 to 8 weeks
	Hinge Angle	Measure of the angle between central rays of two intersecting treatment beams. If a lateral and anteroposterior beam intersect at the isocenter, the hinge angle would be 90 degrees.
	Immobilization Devices	devices that assist in reproducing the treatment position while restricting movement (i.e. casts, masks, or bite blocks)
	Interfraction	changes occurring between treatment sessions
	Intrafraction	changes or motion during the treatment administration
	Localization	geometrical definition of the tumor and anatomic structures using surface or fiducial marks for reference
	Positioning Devices	common or customized devices that assist in ensuring patient treatment location during treatment
	Protraction	time over which total dose is to be delivered
	Stereoscopic Images	Two images from different angles focused on the same point
	Treatment Field (Portal)	volume exposed to radiation from a single radiation beam
	Treatment Record	documents the delivery of treatments, recording fractional and cumulative doses, machine settings, verification imaging; and the ordering and implementation of prescribed changes
	Treatment Technique	defined method by which a treatment is delivered to the patient
	Triangulation	treatment isocenter is located relative to three setup coordinates on the patient’s surface or on the equipment fixed relative to their anatomy
	Verification Imaging	the documentation of treatment through radiographic or electronic imaging devices
	American Registry of Radiologic Technologists (ARRT)	world’s largest credentialing body tests and certifies radiologic technologists and the radiation therapist for practice in the United States
	American Society of Radiologic Technologists (ASRT)	mission of the ASRT is to foster the professional growth of radiologic technologists by expanding knowledge through education, research, and analysis
	Content Specifications	document that outlines the specific topics with corresponding number of question that may appear on the ARRT certification exam
	Joint Review Committee on Education in Radiologic Technology (JRCERT)	purpose of the JRCERT is to promote excellence in education and enhances quality and safety of patient care through the accreditation of educational programs
	Antibody	protein substance manufactured by the immune system’s plasma cells in a defensive response to the presence of a specific antigen
	Autoclave	A device used for sterilization by steam under pressure
	Colonization	presence of an agent that is infectious but does not initiate an immune response
	Contamination	the presence of microorganisms on the body (commonly on hands) or on inanimate objects
	Convalescence	period of recovery after an illness
	Droplet nuclei	residual remains of airborne pathogens after the evaporation of moisture
	Fomite	any inanimate object (vehicle) involved in the transmission of disease
	Host Specificity	the selectivity of microorganisms as to their host and location they cause disease
	Incubation	time interval between exposure to infection and the appearance of the first sign or symptom characteristic of the disease
	Infection	the reproduction of microorganisms in the human body
	Infective Dose	enough microorganisms are present to elicit an infection
	Nosocomial	infection acquired in the hospital
	Pathogen	an infectious agent
	Pathogenicity	ability of an infectious agent to cause disease
	Recombinant Deoxyribonucleic Acid (RNA)	DNA molecule in which rearrangement of the genes has been artificially induced
	Skin Squames	Superficial skin cells that serve as vehicles for airborne pathogens
	Subclinical Infection	an infection without clinically observable signs and symptoms but does initiate an immune response in the body
	Vector	animal, usually arthropod, that carries and transmits a pathogen capable of causing disease
	Virulence	Relative power of a pathogen to cause disease. Severity expressed in terms of morbidity and mortality.
	Anemia	decrease in the peripheral red cell count
	Assessment	information obtained through a continuous, systematic assessment allows the health care provider to (1) determine the nature of a problem, (2) select an intervention for the problem, and (3) evaluate the effectiveness of the intervention
	Cachexia	state of general ill health and malnutrition with early satiety; electrolyte and water imbalances; and progressive loss of body weight, fat, and muscle
	Cultural Sensitivity	accepting and respecting patients for who they are is an important attribute of oncology caregivers
	Depression	perceived loss of self-esteem resulting in a cluster of affective behavioral (e.g. change in appetite, sleep disturbances, lack of energy, withdrawal, and dependency) and cognitive (e.g. decreased ability to concentrate, indecisiveness, and suicidal ideas) responses
	Empathy	identifying with the feelings, thoughts, or experiences of another person
	Leukopenia	abnormal decrease in the white blood cell count, usually below 5,000 cells per mm3
	Myelosuppression	reduction in bone marrow function
	Quality of Life	person’s subjective sense of well-being derived from current experience of life as a whole
	Reflective Listening	health care workers can reflect the specific content or implied feelings of their nonverbal observation or communication they feel has been omitted or emphasized
	Therapeutic Relationship	Genuine collaborative effort between the patient and health care provider. This requires good reflective listening skills and paying careful attention to all the cues. In addition, these cues need to be interpreted in the context of the patient’s values, beliefs, and culture to be truly meaningful and helpful in treating and respecting the uniqueness of each cancer patient.
	Thrombocytopenia	abnormal decrease in the number of platelets
	Allergic Reaction	reaction resulting from an immunologic reaction to a drug to which the patient has already been sensitized
	Anaphylactic Shock	severe reaction (marked by respiratory arrest and vascular shock) to a sensitizing substance such as insect stings, contrast media, and other drugs
	Cumulative Effect	effect that develops if the body is unable to detoxify and excrete a drug quickly enough or if too large a dose is taken
	Drug	any substance that alters physiologic function, with the potential for affecting health
	Intradermal	shallow injection between the layers of skin
	Medication	drug administered for its therapeutic effects
	Pharmacology	science of drugs and their sources, chemistry, and actions
	Phlebitis	inflammation of a vein
	Syncope	fainting; transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery
	Tolerance	body’s adaptation to a particular drug and requirement of ever greater doses to achieve the desired effect
	Utricaria	hives
	Afterloading	System that was developed to allow devices known as applicators to be inserted into the treatment area first, then loaded with radioactivity quickly and safely. In this way, dose to personnel is kept to a minimum.
	Brachytherapy	radiation treatment of disease accomplished by inserting radioactive sources directly into the tumor site
	Interstitial Brachytherapy	Treatment technique that is characterized by the placement of radioactive sources directly into a tumor or tumor bed. Interstitial implants can be either permanent or temporary.
	Intracavitary Brachytherapy	Radioactive sources are placed within a body cavity for treatment. This type of brachytherapy has been the mainstay in treatment of cervical cancer for more than 50 years.
	Intraluminal Brachytherapy	Places sources of radiation within body tubes such as the esophagus, uterus, trachea, bronchus, and rectum. Many high dose rate applications are performed for intraluminal applications.
	Intravascular Brachytherapy	rapidly emerging treatment modality that introduces radioactive source(s) through vascular routes
	Ovoids	Also called colpostats, these applicators are oval-shaped and insert into the lateral fornices of the vagina. They can accommodate radioactive sources and shielding material and are used in the treatment of gynecologic tumors.
	Pulsed Dose Rate	in brachytherapy, a single source that can be positioned at different various times, known as stepping, is used to deliver a precise does to the treatment volume
	Tandem	Long narrow tube that inserts into the opening of the cervix (cervical os) into the uterus. They can hold radioactive sources and are used in the treatment of gynecologic tumors.
	Topcial Brachytherapy	Radioactive sources are placed on top of the area to be treated. Molds of the body part to be treated may be taken and prepared to place the sources in definite arrangements to deliver the prescribed dose.
	Film Badge	device for measuring dose
	Genetically Significant Dose (GSD)	dose equivalent to the gonads weighted for the age and sex distribution in those members of the irradiated population expected to have offspring; units are the REM or Sievert
	Natural Background Radiation	ionizing radiation from natural sources including cosmic rays from outer space and the sun, terrestrial radiation from radioactive materials in the earth, and internal radiation from radioactive materials normally present in the body
	Occupancy Factor (T)	fraction of time that an area adjacent to a source of radiation is occupied
	Pocket Ionization Chamber (Pocket Dosimeter)	Device for measuring exposure. It uses the phenomenon that, when air is irradiated, the ions formed partially discharge the static electricity on a fine filament, allowing it to move across a scale. Filament and scale can be visualized by holding the cylindrical device up to a light and looking through one end.
	Regulatory Agency	organization that may promulgate rules and regulations that have the force of law, license users, and provide inspection and enforcement actions
	Thermoluminescent Dosimeters (TLDs)	Device for measuring dose. It uses the phenomenon that some solid materials, when irradiated, will subsequently give off light when heated. Amount of light emitted is proportional to the dose delivered to the crystal.
	Use Factor (U)	fraction of time that the radiation beam is directed at a barrier; the use factor for scatter and leakage radiation is always
	Workload (W)	for superficial and orthovoltage units, the milliamperage (mA) used and beam on time per week; for high energy units, the Gy (RAD) per week at isocenter
	Most Common Histology Associated with the Oral Cavity	Squamous Cell Carcinoma
	Most Common Histology Associated with the Pharynx	Squamous Cell Carcinoma
	Most Common Histology Associated with the Lung	Squamous Cell Carcinoma
	Most Common Histology Associated with the Breast	Infiltrating Ductal Carcinoma
	Most Common Histology Associated with the Colon and Rectum	Adenocarcinoma
	Most Common Histology Associated with the Anus	Squamous Cell Carcinoma
	Most Common Histology Associated with the Cervix	Squamous Cell Carcinoma
	Most Common Histology Associated with the Endometrium	Adenocarcinoma
	Most Common Histology Associated with the Prostate	Adenocarcinoma
	Most Common Histology Associated with the Brain	Astrocytoma
	Common Metastatic Sites for Lung Cancer	Liver Adrenal Glands Bone Brain
	Common Metastatic Sites for Breast Cancer	Lungs Bone Brain
	Common Metastatic Sites for Stomach Cancer	Liver
	Common Metastatic Sites for Anus	Liver Lungs
	Common Metastatic Sites for Bladder	Lungs Bone Liver
	Common Metastatic Sites for Prostate	Bone Liver Lungs
	Common Metastatic Sites for Uterine Cervix	Lungs Bone Liver
	To give informed consent, the patient must be informed of the following:	1. The nature of the procedure, treatment, or disease 2. The expectations of the recommended treatment and the likelihood of success 3. Reasonable alternatives available and the probable outcome in the absence of treatment 4. The particular known risks that are material to the informed decision about whether to accept or reject medical recommendations.
	Characteristics of Benign Tumors	Slow growth rate Few Mitoses Normal nuclear chromatin Well differentiated Expansive local growth Encapsulated Little destruction of tissue No vessel invasion or metastases
	Characteristics of Malignant Tumors	Rapid growth rate Many Mitoses Increased nuclear chromatin Poorly differentiated Invasive local growth Not encapsulated Much destruction of tissue Frequent vessel invasion or metastases
	Dmax of 15 MV	3.0 cm
	Dmax of 20 MV	3.5 cm
	Dmax of 25 MV	5.0 cm
	Dmax of Superficial Therapy	0.0 cm
	Dmax of Orthovoltage	0.0 cm
	Dmax of Cesium-137	0.1 cm
	Dmax of radium-226	0.1 cm
	Dmax of Cobalt-60	0.5 cm
	Airborne Precautions are used with	Measles Varicella Tuberculosis
	Droplet Precautions are used with	Diptheria Pertussis Pneumonic Plague Mumps Rubella Influenza Severe acute respiratory syndrome (SARS) Avian Flu
	Contact Precautions are used with	Multidrug resistant bacteria in GI, respiratory, skin, or wound infections Enteric infections with a low infectious dose or prolonged evironmental survival including: escherichia coli, shigella, and hepatitis A Skin infections that are highly contagious or that may occur on dry skin including herpes simplex virus, impetigo, scabies, zoster Viral hemorrhagic infections such as ebola, lassa, and marburg
	Significant Weight change in 1 Week Severe Weight change in 1 Week	Significant: 1-2% Severe: >2%
	Significant Weight change in 1 Month Severe Weight change in 1 Month	Significant: 5% Severe: >5%
	Significant Weight change in 3 Months Severe Weight change in 3 Months	Significant: 7.5% Severe: >7.5%
	Significant Weight change in 6 Months Severe Weight change in 6 Months	Significant: 10% Severe: >10%
	The 7 Warning signs of Cancer	Change in bowel or bladder habits A sore throat that does not heal Unusual bleeding or discharge Thickening or lump in breast or any part of the body Indigestion or difficulty swallowing Obvious change in a wart or mole Nagging cough or hoarseness
	Biologic Tumor Volume	Biologically active part of the tumor (visible with PET)
	Gross Tumor Volume	Visible tumor
	Clinical Target Volume	GTV + margin to take into account microscopic disease
	Internal Target Volume	CTV + margin to take into account tumor movement
	Planned Target Volume	ITV + margin to take into account organ movement, patient movement, and inaccuracies in patient set up
	Tumors with High Radiosensitivity	Lymphoma Leukemia Seminoma Dysgerminoma
	Tumors with Fairly High Radiosensitivity	Squamous cell cancer of the oropharynx, glottis, bladder, skin, and cervical epithella Adenocarcimoma of the alimentary tract
	Tumors with Medium Radiosensitivity	Vascular and connective tissue elements of all tumors secondary neurovascularization Astrocytomas
	Tumors with Fairly Low Radiosensitivity	Salivary gland tumors Hepatomas Renal cancer Pancreatic cancer Chondrosarcoma Osteogenic sarcoma
	Tumors with Low Radiosensitivity	Rhabdomyosarcoma Leiomyosarcoma Ganglioneurofibrosarcoma
	TD 5/5 of kidney	2,300 cGy
	TD 5/5 of bladder	6,500 cGy
	TD 5/5 of Femoral heads	5,200 cGy
	TD 5/5 of TMJ joint	6,000 cGy
	TD 5/5 of rib cage	5,000 cGy
	TD 5/5 of 100 cm^2 of skin	5,500 cGy
	TD 5/5 of brain	4,500 cGy
	TD 5/5 of brain stem	5,000 cGy
	TD 5/5 of optic nerves	5,000 cGy
	TD 5/5 of chiasm	5,000 cGy
	TD 5/5 of 20 cm of spinal cord	4,700 cGy
	TD 5/5 of cauda equina	6,000 cGy
	TD 5/5 of brachial plexus	6,000 cGy
	TD 5/5 of lens of eye	1,000 cGy
	TD 5/5 of retina of eye	4,500 cGy
	TD 5/5 of mid/external ear	3,000 cGy (acute serous otitis) 5,500 cGy (chronic serous otitis)
	TD 5/5 of parotid gland	3,200 cGy
	TD 5/5 of larynx	4,500 cGy (edema) 7,000 cGy (cartilage necrosis)
	TD 5/5 of lung	1,750 cGy
	TD 5/5 of heart	4,000 cGy
	TD 5/5 of esophagus	5,500 cGy
	TD 5/5 of stomach	5,000 cGy
	TD 5/5 of small intestine	4,000 cGy
	TD 5/5 of colon	4,500 cGy
	TD 5/5 of rectum	6,000 cGy
	TD 5/5 of liver	3,000 cGy
	Law of Bergonie & Tribondeau	The radiosensitivity of cells is directly proportional to their reproductive activity and indirectly proportional to their degree of differentiation. Simplified: Cells with a higher mitotic activity are more susceptible to radiation. Whereas, cells that are highly specialized/well differentiated are not as susceptible to radiation. (So stem cells are highly radiosensitive, because they are undifferentiated.)
	Duality of Radiation	X-ray and gamma photons behave as waves when traveling through space (have properties of wavelength & frequency). When these photons encounter matter, they take on the characteristics of particles (have the ability to interact with atoms and atom components and can cause ionization). Photon: packets of energy that act like particles that have mass.
	Excitation	Energy transmitted results in a brief excitation of the atom, because the photon does not have enough energy to ionize. The energy raises the atom to an excited state, and to get rid of the energy the atom gives off another photon that is equal in energy to the original photon but which will most likely travel in a different direction (scatter radiation).
	Ionization	Produces an ion (atom that has charge) by removing an electron. This ion will have a positive charge. 2 Types of Ionization: Direct and Indirect
	Direct Ionization	The radiation involved directly interacts with an atom to cause ionization. A higher energy photon comes in, and it has the ability to knock out an electron.
	Indirect Ionization	The radiation involved interacts with an intermediate, usually water. The absorption of the radiation by water creates products that go on to ionize other atoms within cells.
	Coherent Scatter	When low energy photons (~10 keV) interact with atoms, they do not possess the energy necessary to eject an orbital electron. -Their energy is absorbed by the atom causing its electrons to vibrate in an excited state. -A secondary photon is then released having the same energy and wavelength as the incident photon but traveling in a different direction. -It is called scatter radiation, because energy that was directed in a particular direction to start with will be misdirected, or scattered off, in a different direction after it interacts with the atom. -Net energy gained by the atom is zero.
	Photoelectric Interaction	An incident photon with moderate energy enters an atom and gives up all of its energy to eject a bound inner shell orbital electron as a photoelectron. The incident photon may or may not be completely absorbed. It may only give up a portion of its energy depending on how tightly bound the electron was. The electron now possesses energy and may go on to effect another atom. The atom is now ionized and in an excited state. The atom may acquire a free electron or combining with another atom or molecule to return to neutral. An electron from a higher energy shell then fills the hole left by the photoelectron with resultant emission of a characteristic photon. This results in a characteristic cascade, because electrons from outer shells fall into successive holes in inner shells, so get several photons produced as a result of the electrons changing energy shells.
	Compton Interaction	A moderate energy incident photon ejects an outer shell electron giving up some of its energy. This causes the photon to change direction or ”scatter.” Therefore, Compton is scatter radiation. The ejected or recoil electron can then go fill a shell vacancy in another atom or ionize surrounding tissue if it has the necessary energy to eject an orbital electron. Scatter is not useful since it will not hit where it can be detected and just adds exposure. The potential for Compton Interaction vs. Photoelectric Interaction is mainly dependent on the energy of the photon. The higher the energy the more likely a Compton Interaction will occur. It also depends on the density of the tissue. Low density tissues (soft tissues like fat, muscle, connective tissues) are more likely to produce a Compton Interaction. Higher density tissues (like bone) are more likely to produce Photoelectric Interaction. With an x-ray, we want Photoelectric Interaction, so use 50 keV to 150 keV. Whereas, for radiation therapy use MeV, so Compton Interaction is more likely to occur.
	Pair Production	A high energy photon (at least 1.02 MeV) enters an atom, interacts with the nuclear force field, and the photon is converted to 2 charged particles, a negatron and a positron, each having an equal amount of energy. As each particle continues, it may encounter another particle of the opposite charge and produce 2 photons traveling in opposite directions and each having the same energy equaling half of the incident photon (511 keV if a 1.02 MeV photon). Negatron: highly charged electron which will seek out a positive charge. Positron: will seek out an electron. Once encounter compliment will combine and their energy will be deposited. PET (positron emission tomography) uses this interaction.
	Photodisintegration	A very high energy photon (at least 10 MeV) interacts directly with the nucleus (overcomes the nuclear force field) of an atom. The nucleus absorbs the energy from the photon, is raised to an excited state, and then emits a nucleon or other nuclear fragment. This is mainly seen with Radiation Therapy.
	High LET	neutrons, protons, a particles (have more mass and energy)
	Low LET	x and gamma rays, beta particles, electrons
	DNA Base Damage	Damage or elimination of a base This is the most easily fixed
	DNA Single Strand Breaks	One of the two strands of the helix is broken This is fairly easily repaired with accuracy
	DNA Double Strand Breaks	Have the potential to cause the most long lasting and permanent damage
	DNA Crosslinks	Elimination of complete sequences of DNA
	Clumping of Chromosomes	due to protein alteration If the DNA doesn’t unfold it cannot be transcribed.
	Inherited Radiosensitivity	Different types of cells have different degrees of radiosensitivity and radioresistance Radiosensitivity both high and low can be heritable Radioresistant mutations: progeny will have a higher resistance to radiation Radiosensitive mutations: progeny will have a higher sensitivity to radiation Ataxia telangiectasia Down’s syndrome
	4 R's of Radiobiology	1) Repair 2) Reassortment 3) Repopulation 4) Reoxygenation
	Oxygen Effect	Radiation damage is enhanced by exposure to oxygen. If there is oxygen present at the time of irradiation, there is an increase in the damaging effect that occurs as a result of that irradiation.
	Oxygen Enhancement Ratio (OER)	Ratio of doses administered under hypoxia to aerated (when oxygen is present) conditions needed to produce the same biological effect
	LD50/60	Dose will cause one half (50%) of the population to die within 60 days.
	4 Whole Body Syndrome Stage (Acute Exposure)	Prodromal Stage Latent Stage Manifest Stage Recovery or Death
	Prodromal Stage	Initial stage that occurs immediately after the exposure is over. Symptoms include Malaise Nausea Vomiting Fright (depending on if the individual is knowledgeable of exposure and radiation.) Nausea and vomiting are more for individuals who have received higher doses.
	Latent Stage	During the latent stage, the body seems to apparently recover from the effects of the exposure. Nothing is actively observed. The patient will not appear with any other symptoms. Depending on the level of exposure the latent stage may last from a few weeks to days and even hours. Length of latent stage is thought to be indirectly proportional to the dose. The higher the dose the faster the latent stage appears. It may even be absent in some cases.
	Manifest Stage	Signs and symptoms of the particular syndrome will be manifested. Progression of symptoms will occur. Symptoms are always particular to the specific syndrome but at higher levels of exposure the symptoms of more than one syndrome may be evident. Some syndromes can mask other syndromes. The higher dose syndromes may mask the lower dose syndromes.
	Recovery or Death related to Acute Exposure	Recovery or death is dependent on two things: total exposure in REM treatment availability The sooner treatment is available, the better the chances of recovery. If an individual has access to good medical facilities and treatment (clean environment, fluids, control of body systems), the potential for recovery increases quite a bit. You ultimately either recover or die.
	4 Syndromes from Acute Whole Body Exposure	Subclinical (or prodromal) Syndrome Hematopoietic Syndrome Gastrointestinal Syndrome Central Nervous Syndrome
	Subclinical (Prodromal) Syndrome	Occurs in ranges of 50-200 Rad (0.5 – 2 Gy). Only prodromal stage occurs with its associated symptoms. Do have damage/insult to body systems and body as a whole, but it is at a quantity that the body can tolerate and overcome. There may still be late effects. 20 - 100 Rad (0.5 Gy) effects will occur in the production of leukocytes (usually WBCs are eradicated at least initially). There will be recovery after the precursor cells mature. Less than 25 Rad there are not easily detectable effects. REMEMBER: THERE IS ALWAYS SOME EFFECT EVEN IF IT CANNOT BE DETECTED
	Hematopoietic Syndrome	Exposure ranges from 250-500 Rad (2-5 Gy). Potential for death 2-3 weeks or up to two months beyond the time of exposure. Prodromal Stage Can last 2 hours (higher exposure) - 2 days (lower exposure) Nausea Latent Stage Everything appears to improve. Bone marrow (probably including stem cells) and lymph nodes depleted of cells. Anemia occurs. This puts patient at higher risk for infection and death from infection. If can be treated through transfusion, the syndrome can be overcome. If reach manifest stage, patient is at much greater risk of death. Syndrome can be overcome with medical intervention. Manifest Stage Sore throat, fever, malaise, diarrhea. If reach this stage, the potential for someone to die is very real. With this syndrome, with good healthcare, patients have the ability to overcome this. LD50/60 is at the 400 Rad (4Gy) exposure level. Levels of 600 Rad will cause certain death. Although at least one person lived through an exposure that was thought to be higher than that.
	GI Syndrome	Whole body exposures from 600 - 1000 Rad Average survival is 6 days. Prodromal Stage Occurs within hours. It also includes the symptom of watery diarrhea. Latent Stage May or may not occur depending on quantity of exposure dose. Manifest Stage nausea, vomiting, prostration and elevated body temperature. Epithelium of the bowel lining flakes off and is removed. Bacteria are absorbed into the blood stream via the bowel. Increases the potential for infection. Death usually occurs within two weeks if no treatment is provided. Even if treatment is provided and recovery from GI effects occurs, death may still happen due to hematopoietic damage.
	CNS Syndrome	Occurs with very high exposures of 1000Rad+. Onset of nausea and vomiting within minutes. Convulsions, brain edema happen due to cell damage in the cerebellum. Severe vasculitis which can cause swelling in tissues (lymphadema). Death occurs within a few days. Only a few human subjects have been identified with this syndrome and have died very quickly. AKA cerebrovascular syndrome
	Deterministic Effects	Occur as a direct result of the quantity of dose given. Threshold is seen Threshold: level above or below which an effect will or will not be seen, respectively Increased dose increases severity of effect Example: Cataracts
	Stochastic Effects	Non-threshold Any dose regardless of how small will have an effect, but it is not a direct relationship instead it is a probability. Increased dose increases probability of effect Effects can appear to occur randomly within a population, because of differences in life style, individual health, etc. We will get differences within a population in the results. Ex: carcinogenesis
	Most Common Carcinogenic Effects	Leukemia Breast Cancer Thyroid Lung Bone Stomach
	Radiation Therapy Induced Carcinogenesis	Second malignancies produced from exposure from treatment Other factors may be more likely cause than actual treatment: Lifestyle Age
	Hereditary Effects of Radiation Therapy	Exposures to reproductive cells Genetic effects – exposure occurs to parent, biologic effects induced are passed along to progeny Germ cell DNA - chromosomes Linear non-threshold relationships. Each dose, no matter how small, will have an effect This doesn’t mean that it will carry on to be a genetic defect, but the potential is there if repair is not made
	Embryologic Syndrome- lethal effects	induced before or immediately after implantation; except for extremely high doses, there is little chance for lethal effects after implantation.
	Embryologic Syndrome- Congenital Malformations	specific to organ or tissue or system developing at the time of exposure. Are expressed after birth. This is because there is a lot of growth going on at this stage. These may or may not cause a lethal effect, but probably won’t. Sometimes the baby will die on birth because the congenital malformations may be too severe.
	Embryologic Syndrome- Growth Disturbances	may happen during or after gestation
	Pre-Implantation	Conception - 10 days Irradiation usually results in increased incidence of spontaneous abortion. Either will have a great effect or none at all. It is not likely that the individual will know that conception has occurred.
	Organogenesis	10 days - 6 weeks Stem cells for major organs are formed. Irradiation can result in newborn death or congenital abnormalities that may be significant. This is the most radiosensitive time in fetal development, because there is the most amount of mitosis occurring. At this point, it is better to find alternatives to medical radiation.
	Fetal Stage	6 weeks - delivery Irradiation during fetal stage will usually produce congenital abnormalities or NO effect. This is stochastic, so the probability of the effect occurring is increased. Late effects (1 year from the exposure); leukemia, mental impairment, growth retardation, genetic effects, may manifest later. However, you cannot say with any certainty that these effects were caused by the exposure.
	Teratogenic Effect	embryonic defects due to chemical (smoking and alcohol) or radiation exposure. Cancer Microcephaly Mental Impairment Spina Bifida IQ Reduction Growth Retardation
	Committed Equivalent Dose	internal sources
	Committed Effective Dose	committed equivalent dose with consideration of tissue weighting factors
	Collective Equivalent Dose	equivalent dose of a population Measured in person-sievert
	Collective Effective Dose	effective dose of a population
	Collective Committed Effective Dose	effective dose of internally deposited sources in a population
	Personnel Radiation Monitoring	Workers should be aware of the amount of dose they receive. Must be lightweight and easy to carry. Should be durable enough to tolerate daily use Must be able to detect small and large exposures Should not be affected by outside influences - heat, humidity, shock
	Film Badge	Not used anymore for the most part Film badge used to be most common and widely used - Consists of: -plastic holder- holds film (x-ray or photgraphic) and filters, also acts as a low energy x-ray filter - metal filters - usually Al & Cu - allow measurement of exposure energy (Copper requires the higher energy to penetrate) A densitometer is used to determine the density and an exposure value. - A control badge is also provided to determine if any exposure occurs during shipping. -The monitoring service prepares a report which includes amount and depth of exposure. - Each film can then be saved as a permanent legal record. - Film badge can discriminate whether exposure occurs as a result of x-rays, gamma, or beta radiation and the energy of each.
	Film Packet in Film Badge	- film packet - contains sensitive dosimetry film backed by lead foil to absorb backscatter - film detection range is 10 mrem to 500 rem -need something more sensitive - As exposure occurs the film becomes darkened with density recorded being proportional to exposure.
	Advantages and Disadvantages of Film Badges	Advantages - Cheap, lightweight, durable, not affected by outside influences, capable of discriminating between radiation types. - Disadvantages - Delayed reading time, limited accuracy, movement away from film Film is susceptible to light, heat, and radiation.
	Pocket Ionization Chamber	Pocket dosimeters - measures the amount of ionization of air within the chamber - The ionization chamber contains air, 2 electrodes and a quartz fiber. - Quartz fiber acts as part of the positive electrode and the indicator for reading the exposure on a printed scale. - The device must be “charged” prior to use to a predetermined voltage where the quartz fiber will be positioned at 0 on the scale. - As the air surrounding the positive electrode is ionized the quartz fiber acquires the released electrons and becomes more neutrally charged. - As the fiber becomes more neutral it moves further down the scale - These devices must be read the same day the exposure occurs because their charge can leak away, giving a false reading. - Mechanical shock can also cause a pocket dosimeter to discharge and give a false reading - Results must be logged daily for a permanent record to exist.
	Advantages and Disadvantages of Pocket Ionization Chambers	- Advantages - Convenient, easy to carry, more accurate and sensitive than film, immediate results. - Disadvantages - Expensive, must be read daily, no permanent legal record, must be handled carefully.
	Thermoluminescent Dosimeter	Upgrade from film badge and pocket dosimeters in being better able to accurately measure quantity of dose. TLD’s contain lithium fluoride chips which absorb radiation. - When irradiated electrons within the chips are excited to higher energy levels and trapped there. - When the chips are heated the electrons are released & return to their original energy levels, giving off the excess energy as light. - The amount of light given off by the crystals is measured by a TLD analyzer and is proportional to the exposure. - Can be worn up to 3 months. - Costs twice as much as film badge - Reusable but once heated no record of exposure remains. - The crystals interact with radiation much like human tissue does.
	Advantages and Disadvantages of Thermoluminescent Dosimeters	- Advantages – Accurate, sensitive, durable, reusable, can be worn up to 3 months, reacted more like human tissue. - Disadvantage - Cost, no permanent record, analyzer must be calibrated.
	Optically Stimulated Dosimeter	OSL is similar to TLD but a laser is used to stimulate release of energy as light Dose reading is obtained faster than with TLD Unaffected by normal temperature variations Has longer usable life than TLD – is depleted more slowly This is what we use. Also have the ring detector.
	Incidence	The number of individuals who have a new diagnosis of cancer in a specific period
	Prevalence	Number of individuals who have cancer at a specific time Usually includes individuals who have been diagnosed in the last 5 years.
	Mortality	The number of cancer deaths that occur in a specific period
	Lifetime Risk	Refers to the probability that an individual, over the course of a lifetime, will develop cancer or die from it.
	Relative Risk	Is a measure of the strength of the relationship between risk factors and the particular cancer Compares risk of developing cancer in persons with a certain exposure or trait to those without a certain exposure or trait
	Observed Survival Rate	the number of people who get cancer this year who will be alive 5 years after diagnosis
	Relative Survival Rates	Takes into account other causes of death other than the cancer itself.
	Cured	When the patient has no evidence of disease and has the same life expectancy as a person who never had cancer
	Cancer Causing Agents	Environmental Factors Genetic Factors Viral Factors Immune Factors Endocrine Factors Food
	Primary Prevention	aimed at measures to ensure that cancer never develops
	Secondary Prevention	prevent morbidity and mortality so early detection and prompt treatment are the activities emphasized.
	Tertiary Prevention	the care of established disease, with attempts made to restore to highest function, minimize the negative effects of disease, and prevent disease-related complications
	Sensitivity	probability that a test will detect cancer among all asymptomatic individuals that actually have the disease; it is true positives.
	Specificity	probability that a test will correctly identify healthy individuals as not having a disease; it is true negatives.
	Detection Methods	Radiology Hematology Cytology Histology Special studies
	Diagnosis	is the actual confirmation of a specific type of cancer and its location
	Sign	an objective finding as perceived by an examiner
	Symptom	subjective indication of disease or a change in condition as perceived by the patient
	Syndrome	set of signs and symptoms that arise from a common cause
	Premalignant Condition	physiologic characteristics or predisposing factors that may lead to malignancy.
	Paraneoplastic Syndrome	collection of symptoms that result from substances or hormones produced by the tumor, or that occur remotely from the tumor
	4 Components of the Physical Exam	Inspection Palpation Percussion Ausculation
	Physical Exam: Inspection	Use of sight to observe. There is a difference between seeing a patient and truly observing them. The physician will observe the patients skin, which may indicate signs of disease Examples: Dark Skin-Irritation Pale Skin-Anemia Flushed or Reddened-Hormone issues Yellow-Jaudice Cyanosis- Lack of Oxygen
	Physical Exam: Palpation	Palpation- the use of touch to acquire information about the patient. Doctor uses finger tips to feel for certain things. Light pressure for superficial tumors Deep pressure for deep seated lesions. Through palpation the physician tries to distinguish between: hard or soft, rough or smooth, warm and dry. Palpation can be used for: Vibrations in the chest(pneumoniae) Pulse Pain is present Lymph Node swelling (Lymphadenopathy) When palpating lymph nodes, the doctors typically check cervical, axillary, hips, etc. or
	Percussion	Percussion-act of striking or tapping the patient gently The purpose of percussion is to determine pain in underlying tissue or cause vibrations. Example-Making a fist and gently pounding the kidney area does not normally cause pain but if the kidneys are inflamed or infected it could produce pain
	Physical Exam: Auscultation	Auscultation-act of listening to sounds within the body. Use a stethoscope to listen for sounds in the: Lungs- can be altered due to the presence of air, fluid, or disease Heart- can be altered due to changes or abnormalities in structure or function Arteries Stomach Bowel
	Vital Signs	Temperature Pulse Pressure Respirations Blood Pressure
	Types of Surgery	Diagnostic Staging (exploratory) Definitive or primary surgery Adjuvant Preventative or prophylactic Reconstructive Palliative Supportive care Combination Second Look Procedures
	Brachytherapy	Refers to radiation therapy that involves placing radioactive material directly into or immediately adjacent to the tumor Brachy- means “short” Can be used for a number of malignancies Lung, esophagus, GYN, prostate, breast, etc. Major advantage: very high dose of radiation therapy delivered locally to a tumor in a short amount of time
	Brachytherapy Administration	Interstitial Intracavitary Intraluminal Intravascular Topical
	Low Dose Rate Brachytherapy	Involves implanting radiation sources that emit radiation at a rate of up to 2 Gy/h LDR brachytherapy is commonly used for cancers of the oral cavity, oropharynx, sarcomas, and prostate cancer
	High Dose Rate Brachytherapy	Rate of dose delivery exceeds 12 Gy/h Advantages Very low risk of radiation injury Can be given on a fractionated outpatient basis Actual source time can be can be in the range of 5-10 minutes More convenient and cheaper for the patient and the facility in terms of time Space requirements are a minimum Less expensive with similar outcomes
	Tandem and Oviods Point A and Point B	Point A: 2 cm lateral and 2 cm superior to external cervical canal and the plane of the uterus Point B: 3 cm lateral to point A and 1 cm lateral to the medial aspect of the pelvic wall
	Immunotherapy	Treatment that uses certain parts of the immune system to fight diseases including cancer
	Active Immunotherapy	Ex. Cancer Vaccines Stimulates own body’s immune system to attack the cancer cells
	Passive Immunotherapy	Ex. Monoclonal Antibodies A man-made immune response. A foreign monoclonal antibody with a specific protein for the immune system to attack is given, so that the immune system can remember for later and attack the cancer cells with that protein.
	Specific Immunotherapy	target one specific kind of cell or antigen
	Non-Specific Immunotherapy	Stimulate the immune system in general
	Naked Monoclonal Antibodies	MABs without drugs or radioactive material attached to them Most commonly used at this time They can act as a marker for the immune system destroy them: Rituxan Campath They can attach to specific antigens on cancer cells that aid in cancer cell growth and stop them from working When combined with radiation therapy, they work synergistically. Allows for more cell killing without the tumor repopulating. Referred to as targeted therapies FDA approved include: 1.Herceptin 3.Erbitux 2.Vectibix 4.Avastin
	Conjugated monoclonal antibodies	MABs that are attached to drugs, toxins, or radioactive substances: Chemolabeled: drugs Immunotoxins: toxin Radioimmunotherapy: radioactive Chemolabeled: Only being studied through clinical trials none are FDA approved
	Immunotoxins	MABs attached to bacterial toxins such as diptheria, psuedomonal exotoxin, or plant toxins such as ricin A or saporin. Shown promise in shrinking tumors especially those associated with lymphoma (because they are rapidly dividing) There is only one FDA approved: Gemtuzumab
	Radioimmunotherapy	Aside from treating cancer radiolabeled MABs are also used along with special cameras to help find areas of cancer mets (like SPECT imaging except using a MAB as the source) It can kill that cell along with the cells surrounding it. Two FDA approved: Zevalin & Bexxar
	Tumor Cell Vaccines	Made up of actual cancer cells that have been removed during surgery Doctors then add foreign substances to the cells often in forms of chemical or genes so that the immune system will recognize them as foreign The cells are then injected back into the patient or into another patient Two basic kinds of tumor cell vaccines include: Autologous Allogenic
	Autologous Tumor Cell Vaccine	Made from killed tumor cells taken from the same person in whom they will later be used Cells maybe re-injected shortly after surgery, may be grown in the lab, or frozen and given later, could also be made for residual disease
	Allogenic Tumor Cell Vaccine	Vaccines use cells of a particular cancer type that originally came from someone other than the patient being treated [or many people other than the patient in order to get more cell types to treat more mutations] Easier to make than autologous vaccines FDA hasn’t approved any Vaccines but are being studied for the following cancers: 1.Melanoma 4.Breast 7.Prostate 2.Kidney 5.Colorectal 8.Lymphoma 3.Ovarian 6.Lung 9.Leukemia
	Antigen Vaccines	Boost the immune by using only one antigen rather than whole tumor cells The antigens are usually proteins or pieces of proteins called peptides Cause an immune response only in patients with a certain kind of cancer Antigen vaccines are being studied to be used against these cancers: 1.Breast 4.Ovarian 7.Pancreatic 2.Prostate 5.Melanoma 8. Multiple Myeloma 3.Colorectal 6.Kidney
	Staging of Multiple Tumors in One Organ	The tumor with the highest T category is used for staging, but will also list how many tumors are in that organ
	Histologic Grade	Qualitative assessment of the differentiation of the tumor expressed as the extent to which a tumor resembles the normal tissue at that site. Is expressed in numeric grades of differentiation from most like the cells around it(1) to least similar to cells around it(4)
	Radiation Tolerance	the limit of radiation exposure a normal tissue can receive and still remain functional
	Radiation Tolerance Dose	concept that expresses the minimal and maximal injuries acceptable for different organs and the doses at which they occur
	Therapeutic Ratio	Probability of tumor control and normal tissue damage are dose dependent.
	Factors affecting radiosensitivity	Organ of origin Oxygenation Rate of proliferation Extent of differentiation Position of the cells in the cell cycle
	Fractionation	dividing a dose into a number of fractions spares normal tissues because of the repair of sublethal damage between dose fractions and cellular repopulation at the same time fractionation increases tumor damage because of reoxygenation and reassortment
	Acute Changes from Radiation Therapy	Inflammation Edema Hemorrhage Denudation of mucosal surfaces
	Acutely responding organs to radiation therapy	Radiosensitive to radioresistant Bone marrow Ovary - testes Lymph nodes Salivary gland Small bowel Stomach - colon Oral mucosa Larynx Esophagus Arterioles Skin Bladder Capillaries Vagina
	Subacutely responding organs to radiation therapy	Lung Liver Kidney Heart Spinal cord Brain
	Chronic Changes due to Radiation Therapy	Fibrosis Atrophy Ulceration Stricture Stenosis Obstruction
	Primary chronic effects of radiation therapy	Depletion of nonparenchymal cells Permanent, irreversible and mostly likely progressive Function of healing
	Secondary chronic effects of radiation therapy	Consequence of a severe acute effect Permanent, irreversible and mostly likely progressive Function of healing
	Radiation Effect on Bone Marrow	Primary effect of radiation on the bone marrow is a decrease the number of stem cells. High doses may cause severe or permanent depletion of stem cells Most radiosensitive: erythroblasts (precursors to red blood cells) recovery could take about a week Moderately radiosensitive: myeloblasts (precursors to white blood cells) 2-6 week recovery Least radiosensitive: megakaryocytes (precursors to platelets) 2-6 week recovery
	Radiation Effect on Circulating Blood	Cells in the circulating blood are resistant to radiation with the exception of the lymophocytes. Circulating blood reflects radiation damage in the bone marrow Blood tests are done to monitor All cells in the circulating blood have finite life spans ranging from 24 hours for granulocytes to 120 days for erythrocytes Most radiosensitive to least: Lymphocytes Neutrophils Platelets Erythrocytes
	Early Skin Changes due to Radiation Therapy	Inflammation Erythema Dry or moist desquamation
	Chronic Skin Changes due to Radiation Therapy	Atrophy Fibrosis Changes in Pigmentation Ulceration Necrosis
	Early GI Effects due to Radiation therapy	Mucositis Esophagitis
	Chronic GI Effects due to Radiation Therapy	Atrophy Ulceration Fibrosis Stricture
	Effects on SI due to Radiation Therapy	Most radiosensitive portion of the GI tract Lined with villi (made up of crypt cells which divide very rapidly), which absorb digested materials Radiation damage in the small intestine is the result of direct damage to crypt cells and the villi slough off to give a smooth inner small bowel, then nutrients can’t be absorbed as well
	Effects on Male Reproductive System due to Radiation Therapy	Primary effect of irradiation of the testes is damage and depopulation of spermatogonia (immature sperm cells; most radiosensitive cells in the body; 200 cGy may give temporary sterility; 500-600 cGy for permanent sterility). Chromosomal Abberations
	Effects on Female Reproductive System due to Radiation Therapy	The younger the patient the more radioresistant. The older the patient the more radiosensitive. Genetic effects are a major concern
	Radiation effect on the eye	Over 200 cGy (acute), a cataract will occur An acute dose of 700 cGy, will result in 100% incidence of cataracts
	Radiation Therapy effects on the cardiovascular system	Vessel occlusion (radiation damage to epithelial cells; small vessels are more sensitive; if large enough doses are given chronic effects may occur; damage is worsened by chemotherapy) Petechial hemorrhages Telangiectasia Vessel sclerosis
	Effects of Radiation Therapy on Bone and Cartilage	Mature bone and cartilage are radioresistant. Growing bone and cartilage are moderately radiosensitive due to their cell makeup (in kids) Effects on growing Bone: Cessation of bone growth Altered shape and sizes of bone Scoliosis
	Effects of Radiation Therapy on the Liver	Moderately sensitive to radiation Radiation injury to the liver is believed to be secondary to vascular changes TD 5/5 (whole organ) is 3000 cGy Parynchymal are more radiosensitive but do not divide
	Chronic Changes to the Liver due to Radiation Therapy	Radiation hepatitis Impaired liver function Liver failure and jaundice
	Early Changes of the lungs due to Radiation therapy	Inflammation Radiation pneumonitis These can happen at doses under 1000 cGy
	Chronic Changes of the lungs due to Radiation therapy	Chronic pulmonary fibrosis This can occur at 3000 cGy to both lungs
	Effects on the Kidney due to Radiation Therapy	The response of the kidneys to radiation is significant during irradiation of the abdominal cavity. This along with the small bowel are dose limiting structures in the abdomen. At least 2/3 of one kidney must be shielded if the other falls within the field Kidneys are late-responding and moderately radiosensitive to radiation
	Early Effects on the Kidney due to Radiation Therapy	Edema
	Chronic Effects on the Kidney due to Radiation Therapy	(Over 2500 cGy) Atrophy Fibrosis Hypertension Renal failure
	Early Effects on the CNS due to Radiation Therapy	Inflammation Edema In the brain, this is with doses over 1000 cGy
	Chronic Effects on the CNS due to Radiation Therapy	Fibrosis Necrosis In the brain, this is with doses over 5000 cGy and can occur years later
	Damage to muscle fibers due to radiation therapy	Pain, muscle spasms, decreased strength/ROM >55Gy fractionated or 10-20Gy single dose More common after treatment for H/N and soft tissue (Ewing’s) Treatment includes physical therapy, medications such as muscle relaxants, BOTOX
	Damage to nerves due to radiation therapy	60Gy or single dose of 28Gy (fairly radioresisitant) Pain months to years following XRT Treatment includes PT,OT, neuropathic meds, neurolytic procedures, and electrical stimulation May not occur exactly where the nerve damage is-it may happen to the area the nerve innervates. Affects quality of life after treatment
	Basis for late effects following radiation therapy	Alterations in the microcirculation The smaller the blood vessels, the more radiosensitive. Formation of fibroconnective tissue Disruption of parenchymal (functional) cells The tissues lose the ability to function properly Stromal hypoplasia With supportive tissue, occurs in slowly repopulating or non-repopulating tissues
	Symptoms of late side effects- neurologic system	Hard to distinguish between recurrence and radiation damage in the brain. Headaches, decreased intellectual performance, visual motor integration, attention span, and memory Brain atrophy – necrosis (progressive or fatal) Siezures Progressive demyelination and loss of parenchymal tissue function Late effects will 6 months or more after treatment
	Symptoms of late side effects- spinal cord	Present with paresthesias (paralysis), numbness, motor weakness and loss of sphincter control Transient myelopathy (2-4 months post-treatment; shock-like sensation down the spine; it can be healed) Irreversible myelopathy (can cause paralysis and sensory changes; 6-12 months post-treatment)
	Symptoms of late side effects- endocrine system	Primary or secondary hypothyroidism Growth retardation Delayed or aborted secondary sexual and reproductive development
	Symptoms of late side effects- cardiovascular system	Cardiotoxicity Cardiomyopathy w/wo CHF Conduction abnormalities (nerve issues; may need a pacemaker) Pericardial damage
	Symptoms of late side effects- immune system	Long-term alterations in immune function although function appears restored immediately after treatment No association with increased risk of infection Cell counts decrease during treatment
	Symptoms of late side effects- pulmonary system	Pneumonitis Presents with dyspnea, non-productive cough or chest pain, could also have fever and rails 6-16 weeks post-treatment Pulmonary fibrosis Usually asymptomatic May occur several months after treatment Usually preceded by pneumonitis Present with inability to breathe
	Symptoms of late side effects- GI system	Chronic enteritis Chronic partial bowel obstruction Hepatic fibrosis Cirrhosis of the liver Portal hypertension Diabetes mellitus Ostomy formation and altered elimination
	Symptoms of late side effects- renal system	Susceptibility to infection Chronic hemorrhagic cystitis Decrease in urinary capacity Frequency - urgency Chronic nephritis Loss of kidney Conduits, ostomies, and nephrostomy tubes
	Symptoms of late side effects- musculoskeletal system	More important in children, because these cells are actively dividing Delayed bone maturation Halt in bone growth and/or shortening of spine or extremities Scoliosis and kyphosis Osteoporosis Susceptibility to fractures and poor healing Facial asymmetry Osteoradionecrosis
	Symptoms of late side effects- Bone in children	Deformity of developing bone results from treatment to active bone growth centers Dose > 2000 cGy results in retardation Scoliosis: treatment of spinal, thoracic, or abdominal tumors Changes in growing bone, such as, irregular epiphyseal lines, contour of vertebra, hypodevelopment of bone, soft tissue, and skin
	Symptoms of late side effects- reproductive system	Temporary sterility with possible in males mutations are also possible if the spermatogonia is not killed Clam shells and sperm banking may be used Permanent sterility is possible in females Younger are more radioresistant, but also dose dependent May do a oophoropexy to bind ovaries to the abdominal wall in order to prevent treatment
	Symptoms of late side effects- bone marrow	Anemia Granulocytopenia Thrombocytopenia Permanent ablation of stem cells if dose is high enough Bone marrow depletion can occur at 400 cGy
	Symptoms of late side effects- eye	Cataract formation (can be occur at doses as small as 200 cGy) Retinopathy Optic neuropathy Lacrimal gland atrophy (no tears so eyes are not moist enough to close/blink) or duct stenosis Corneal vascularization and scarring
	Secondary malignancies related to radiation therapy	Ionizing radiation is closely linked with the development of a secondary malignancy Sarcomas of bone and soft tissue are the most common radiation therapy-related secondary malignancy Leukemia is also associated with previous radiation therapy
	Establishing a Therapeutic Relationship	The initial encounter with the patient is key to developing a positive relationship with the patient (block check day is the most important day in developing this relationship with patient) Patients come to the cancer center hoping that the health care providers will listen carefully and know the correct procedures and actions to help them
	10 Commonly used verbal responses	Minimal Response: yes, yeah’s, uh hu’s, etc. Patients will feel like this is not personal Reflecting: repeating what they say to answer the question or then answering the question Paraphrasing: rewording what they say and then asking a question Probing: patient gives a little information and have to ask questions to get more Clarifying: making sure you understand what the patient is saying Interpreting: give your interpretation on what the patient says Checking Out: zoning out Informing: answering by giving them information Confronting Summarizing
	Chemotherapy	cytoxic drugs used to treat cancer
	Antimetabolite drugs	Azacytidine Cladribine Cytarabine Decitabine Fluorouracil-5FU Floxuridine Fludarabine Gemcitabine Methotrexate Mercaptopurine Pemetrexed Pentostatin Thioguanine
	Alkylating Agent Drugs	Chlorambucil Cyclophosphamide Busulfan Ifosfamide Mechlorethamine Melphalan Thiotepa
	Anthracycline Antibiotic Drugs	Doxorubicin Daunorubicin Epirubicin Idarubicin
	Antitumor Antibiotic Drugs	Dactinomycin Mitomycin Mitoxantrone*
	Nitrosourea drugs	Carmustine Lomustine Streptozocin
	Miscellaneous Chemotherapy Drugs	Altretamine Carboplatin Cisplatin Dacarbazine Oxaliplatin Procarbazine
	S Phase Chemotherapy Drugs	Irinotecan Topotecan Antimetabolites
	M Phase Chemotherapy Drugs	Vinblastine Vincristine Vinorelbine Paclitaxel Docetaxel Ixabepilone
	G2 Phase Chemotherapy Drugs	Bleomycin* Etoposide
	Non-Cell Phase Specific Chemotherapy Drugs	Exert their cytotoxic effect throughout the cell cycle Cell kill is proportional to dose Alkylating agents (biggest class of non-cell phase) Antitumor antibiotics
	Cell Phase Specific Chemotherapy Drugs	Toxic to the proportion of cells in the part of the cell cycle in which the agent is active. These are schedule dependent, not dose dependent. Must be given more commonly. Antimetabolites Plant Alkaloids
	combination chemotherapy	Rationale Coverage of multiple cell lines Increase response rates Slow emergence of resistant strains Use drugs that target different phases Disadvantages Multiple toxicities Impact of dose effect (have to decrease dose) Complicated to administer
	Chemotherapy Dosing	Most Chemotherapy is Dosed Based on the Patient’s Body Surface Area (BSA) This tries to predict how much blood flow you have in your body and how well your heart, liver, and lung can handle the toxicities Dose expressed in milligrams per square meter of BSA (100 mg/m2) If have to hold chemotherapy due to the WBC, you have to do a dose delay and a 25% dose reduction. This is because the formula said your body could handle a certain amount but the laboratory values show that you cannot handle that dose.
	Patient Related Factors for Chemotherapy Administration	Laboratory values required prior to chemotherapy administration In general, chemotherapy is delayed or dose reduced when WBC < 4.0mm3, ANC < 1,000-1,500 and platelets < 100,000mm3 Renal and Hepatic Function Scr, BUN, Calculated CrCl, Alk Phos, ALT, AST, bilirubin Serum chemistries, pulmonary function tests, cardiac function (MUGA scan), neurologic exam
	Evaluation of Cancer Treatment	Complete Response (CR) Complete disappearance of all measurable disease Partial Response (PR) A greater than or equal to a 30% decrease in the sum of the LD Progression (PROG) Greater than or equal to a 20% increase in sum of the LD OR new lesions Stable Disease (STAB) Less than a 30% decrease or less than a 20% increase
	Rationale for combination chemotherapy	a. Overcome resistance b. Enhance anti-tumor effect (e.g. some agents can stimulate the tumor cells to divide and become more sensitive to a second agent) c. Rescue normal cells from cell death i. For example, leucovorin is added to methotrexate treatment
	Alkylating Agents	a. PCOL: These agents bind covalently to DNA. i. This binding to DNA inhibits DNA synthesis (directly) and stops cell growth. b. An important point is that alkylating agents attack ANY dividing cell in the body. (E.g., tumor cells, normal hair cells, normal gut cells, normal bone marrow cells because these are faster growing.) Tend to attack faster growing cells better. c. Derived from chemical warfare agents (mustard gas- this was the first chemotherapeutic agent) and first used to treat cancer during WWII d. EXAMPLES of commonly used alklyating agents: i. CYCLOPHOSPHAMIDE ii. CARMUSTINE
	Antimetabolites	a. PCOL: These agents block the biosynthesis or use of normal cellular metabolites. i. All the classes of antimetabolites we will discuss also inhibit DNA SYNTHESIS 1. Block synthesis (indirectly) by a. Removing critical proteins in DNA replication b. Being “false substrates for DNA synthetic enzymes” c. E.g., block folic acid, pyrimidines, purines b. The DIFFERENCE between antimetabolites and alkylating agents is that antimetabolites attack slower growing tumors better than alkylators c. EXAMPLES OF ANTIMETABOLITE DRUGS i. Methotrexate 1. Also used in rheumatoid arthritis to kill off immune cells since it is an autoimmune disease ii. 5-fluorouracil iii. gemcitabine iv. capecitabine
	Plant Alkaloids	These block cell division. a. EXAMPLES: i. VINCAS: vincristine, vinblastine, vinorelbine, vindesine 1. These are all isolated from vinca major from the periwinkle bush 2. PCOL: The vincas arrest cell division by preventing the formation of the mitotic spindle through disaggregation of microtubules. ii. TAXENES: paclitaxel, docetaxel 1. Isolated from the Yew bush 2. PCOL: The taxenes stabilize microtubules to inhibit mitotic spindle assembly to prevent cell division (the spindle forms but does not come apart)
	Kinase Inhibitors	a. EXAMPLES: sunitinib, sorafenib, erlotinib, lapatinib b. PCOL: These drugs block enzymes called kinases that put a phosphate group onto a protein, typically activating it. Examples of such kinases are EGF receptor, VEGF receptor, Abl kinase. Blocking these kinases, which are over-expressed in certain tumors, leads to decreased cell proliferation and ultimately cell death. c. Less adverse drug reactions
	THREE MAJOR TOXICITIES OF CHEMOTHERAPEUTIC AGENTS	myelosuppression dermatologic toxicities GI toxicities
	Myelosuppression due to chemotherapy	a. This is the MOST COMMON DOSE-LIMITING TOXICITY of chemotherapeutic agents and is both DOSE and AGENT related. b. This is the most life threatening side effect. c. The blood count usually bottoms out around day 14 and is back up around day 24 or 25. This is why chemotherapy is dosed every month. d. Why is this a problem? 1. Makes patient susceptible to infections and anemia 2. If you decrease RBCs you decrease oxygen to tissues. This leads to fatigue. 3. Decrease in platelets leads to decreased clotting. 4. If you kill of WBCs, you decrease immunity and, therefore, increase the chance of infection.
	Dermatologic toxicities due to chemotherapy	a. ALOPECIA (hair loss): i. Not life-threatening but HUGE quality of life issue ii. This is reversible. b. EXTRAVASATION NECROSIS i. DEFINITION: Localized tissue damage if drug is accidentally administered outside a vein
	GI toxicities due to chemotherapy	a. NAUSEA AND VOMITING i. Probably the most UPSETTING adverse effect to a patient ii. Can lead to dehydration, electrolyte disturbances, etc. if unchecked may be fatal iii. MOA: 1. direct irritation of GI membranes 2. stimulation of chemoreceptor trigger zone (CTZ) in brain 3. death of GI mucosal cells iv. TYPES OF N&V associated with chemotherapy: 1. Acute - within minutes of drug injection 2. Chronic - takes hours to days to occur 3. Anticipatory - triggered by smells, colors, places, etc.
	Computed Tomography	Computed tomography uses x-rays and computers to generate cross sectional and/or 3 dimensional images of the body for use in diagnostic analysis.
	CT- beam attenuation	Structures in a CT image are represented by varying shades of gray The creation of these shades of gray is based on basic radiation principles Certain shades of gray are produced depending on the transmission of photons: number of photons to reach the detector and the energy of the photons when they do so. The degree to which an x-ray beam is reduced by an object is referred to as attenuation How much attenuation occurs depends on tissue density. White indicates bone or other dense tissue. Black indicates air of tissue of lesser density. The range in between is various densities of tissue. The number of photons that interact depends on the object’s Thickness Density Atomic number
	CT- Hounsfield Units	Quantify the degree of beam attenuation Also referred to as CT numbers, or density values There are other extended Hounsfield scales that +/- 4,000 or +/-12,000 and are used in other industries besides the medical field 0 is assigned to the density of water –1,000 HU represents air 1,000 HU represents dense material such as bone Values higher than 2,000 represent very dense materials, such as metallic pacemakers Hence, there are 2,000 HU that represent naturally occurring structures Water attenuates radiation very well and is always 0 on the scale. Anything denser than water will be on the positive side of the scale and anything less dense than water will be on the negative side. Few things are less dense than water, like fat There are other gray scales that may not encompass the whole Hounsfield scale or have one larger. Tissues will usually have a certain HU associated with it; however, these tissues will have variances due to certain things. Different gray scales may be used that may not incorporate the whole scale.
	CT- Matrix	Made up of picture elements. Defined by the number of pixels Does not necessarily need to be a square matrix (may be rectangular) Pixels are not always square (may be rectangular) The number of pixels within a matrix can vary. CT will most often be made up of square matrix Matrix size refers to the number of pixels in the matrix. Common matrix size of CT monitors will display 256 X 256, 512 X 512, or 1024 x 1024 pixels. Matrix size vs. resolution The larger the matrix size, the higher the resolution. Pixel size vs. resolution The smaller the pixel size, the higher the resolution. Input and display resolution are 2 different things. We can have differing display and input resolutions. Pixel size is more important in display resolution. A 512x512 input matrix may be converted to higher resolution for display.
	CT Process	Data acquisition Image reconstruction Image display
	CT Collimation	One set of collimators is located inferior to the x-ray tube to shape the beam to cover only the thickness of the slice which the technologist has set. Sets size of the beam Reduces penumbra effects Penumbra- distortion of x-ray beam as it travels through space This is called pre-patient collimation. It is between the x-ray tube and the patient Not unusual to have more than one set of these. A second set of collimators can also be used above the detectors to reduce the amount of scatter radiation entering the detector This is called pre-detector or post patient collimation. Controls slice thickness of the attenuated beam Keeps the scatter that is produced from making it to the detectors.
	CT- Gas Ionization Detectors	The detector chamber contains charged metal plates. Some plates are charged positive and the opposite plate is charged negative X-ray photons hit the individual detector chambers. The x-ray photon ionizes the xenon by removing an electron from an orbital shell. The positive xenon ions migrate to the negative side of the chamber and the freed electrons to the positive plates. (opposites attract) As more photons hit the detector more ionization occurs which produces an electric signal The signal needs to be amplified after leaving the crystal.
	CT- Scintillation detectors	Ceramic crystal coupled to a photomultiplier tube [outdated](functions similar to an amplifier) or photodiode. An x-ray photon strikes the crystal and emits a flash of light (scintillation) The flashes of light are a response to ionization The photomultipler tube or photodiode increases intensity of light and converts it into an electric analog signal – electric current. The analog signal is then amplified, digitized and becomes part of the collection of raw data.
	Hardware	Parts of the computer that can be physically touched
	Software	Instructions that tell the computer what to do and when to do it
	Image reconstruction	The process of using raw data to create an image
	CT- Algorithms	a finite set of unambiguous steps performed in a prescribed sequence to solve a problem
	CT- Fourier Transform	an important image-processing tool that decomposes an image into components takes it to several places for processing then puts the output back together. This makes processing faster. AKA fast Fourier transform.
	CT- Interpolation	a mathematical method of estimating the value of an unknown function using the known value on either side of the unknown function. Allows us to take a low detector signal and make a very good guess as to what is there; therefore, allowing less patient dose.
	CT- Image Reconstruction Process	An attenuation profile is created for each view All of the attenuation profiles are overlaid in order to get a representative image. Information from all the profiles is projected onto a matrix
	CT- Filter Functions	They use different algorithms depending on which parts of the data must be enhanced or suppressed Some will “smooth” the data, reducing the difference between adjacent pixels Reduces artifacts but also reduces spatial resolution Filters are specific to specific exams Others enhance contrast by accentuating the difference between neighboring pixels Improves spatial resolution, but at the cost of low-contrast resolution (ability to differentiate tissue densities) Filter functions may be referred to as algorithms, convolution filters, or kernels Filter functions can only be applied to raw data
	CT- reconstruction algorithm	Changing the algorithm changes the way the raw data are manipulated to reconstruct the image
	Window Setting	This contrasts with changing the window setting, which merely changes the way the image is viewed. It is not an algorithm. Window setting is either window width (sometimes called center) or level.
	CT- Scan field of view	determines the area, within the gantry, from which the raw data are acquired (changed by changing width of fan beam) SFOV is in the isocenter of the gantry
	CT- Display field of view	determines how much of the collected raw data are used to create an image affects image quality is a type of zoom
	CT- Zoom	Improves the image size without degrading spatial resolution (does degrade it just slightly) The size of image can be constant with all images within a scan range Utilizes raw data Can apply a smoothing filter to make it look better
	CT- Magnification	Increases the image size but degrades spatial resolution and distorts the anatomical The size of image must be set each time. Utilizes image data Magnification will increase the pixel size.
	CT- Digital-to-Analog Converter	change the digital signal from the computer memory back to an analog format so that the image can be displayed on the monitor
	CT- Window Width	With over 4,000 shades of gray available on most modern CT scanners the window width tells us only the number of shades of gray used for the image we are viewing. Shades of gray
	CT- Window Level	Window level is the reference point of the center between the extremes of black and white in the window width. Represents the middle shade of gray. The middle of the shades of gray. Try to target the window level at a level of the tissue of interest.
	CT- Contiguous Slices	Slices that are exactly side by side. Where one slide ends, the other slice begins.
	CT- Non-Contiguous Slices	Slices leaves space in between each slice acquisition.
	CT- Helical Interpolation	To take the slant and blur out of the helical image Complex statistical methods result in images that closely resemble those acquired in a traditional axial mode
	CT- Pitch	describes the CT table movement during a helical scan acquisition relative to the tube rotation Most commonly defined as the travel distance of the CT scan table per 360° rotation of the x-ray tube, divided by the x-ray beam collimation width
	CT- Milliampere level (mA)	tube current; tied to mAs
	CT- Kilovolt-peak (kVp)	regulates the energy of the photons; usually use high kVp so that the photons transmit through sets the maximum x-ray energy controls the quality of x-rays Usually use 80-150 kVp
	CT- mAs (aka tube current)	a flow of electrons from cathode to anode over a period of time Controls the quantity of x-rays
	CT- Uncoupling Effect	the image quality is not directly linked to the dose, so even when an mA or kVp setting that is too high is used, a good image results
	CT- Automatic Tube Current Modulation	Software that automatically adjusts the mAs to fit the specific anatomic region (relative to tube position and thickness of tissue being exposed)
	CT- Spatial resolution	the ability to resolve (as separate objects) small, high-contrast objects
	CT- Contrast resolution	the ability to differentiate between objects with very similar densities as their background
	CT- Beam hardening artifact	Caused by the polychromatic nature of the x-ray beam used in CT As an x-ray beam passes through an object, lower-energy photons are preferentially absorbed, creating a “harder” beam that cannot be adjusted for by the system Minimized by filtration, calibration correction, and beam-hardening correction software Manifest as cupping artifacts [in the past, it would literally look like a cup relative to the brain](appearance of brain is different than it should be) or as dark bands or streaks between dense objects in the image
	CT- partial volume artifact	Occurs when more than one type of tissue is contained within a voxel; a lot of variation within one voxel This occurs because of volume averaging Results in a kind of ghosting (of borders) with 2 separate lines; one for a border more superior in the image and one for a border more inferior in the image. Best strategy to reduce these artifacts is the use of thin slices
	CT- Edge gradient artifact	Results in streak artifact or shading arising from irregularly shaped objects that have a pronounced difference in density from surrounding structures
	CT- Motion artifact	Artifacts from patient motion appear as shading, streaking, blurring, or ghosting Overt patient motion is reduced by adequately preparing the patient and making them comfortable and by giving them clear instructions during the scan Involuntary motion is reduced by using the shortest scan time possible. May use pharmacology (beta blockers or glucagon) to reduce involuntary motion.
	CT- Metallic artifact	Metal appears bright white Metal objects in the SFOV will create streak artifacts Best reduced by removing the metal Nonremovable objects can sometimes be avoided by angling the gantry
	CT- Out of field artifact	Caused by anatomy that extends outside of the selected SFOV but still inside the gantry Appear as streaks and shading on the image
	CT- Ring artifact	Caused by imperfect detector elements or possible an entire detector module Appear on the image as a ring or concentric rings because the detectors gather information from 360 degrees
	CT- Tube arcing	From electrical surges within the x-ray tube Electron stream goes from cathode to somewhere else in the x ray tube. This means the energy desired is not produced and tube damage may occur. Can be minor or major by destroying tube No specific pattern in their appearance Typically produce an error message
	CT- windmill artifact	Only on helical scans Attributable to the interpolation and reconstruction process Result in subtle inaccuracies in CT number and can be easily misinterpreted as disease
	CT- Reconstruction	When raw data are manipulated to create pixels that are then used to create an image These give better images because the data has not been changed
	CT- Reformation	When image data are assembled to produce images in different planes, or to produce 3D images These are any 3D images or images in a different plane than that plane that was used to acquire the images.
	CT- Retrospective reconstruction	These can be done at a later time only if raw data is available
	CT- Multiplanar reformation (MPR)	two-dimensional in nature Unlike 3D, 2D image displays always represent the original CT attenuation values Can be transverse, coronal, sagittal, or oblique planes
	CT- Curved planar reformation (CPR)	Created along the center line of tubular organs These may include many planes
	CT- 3D reformation	Seeks to represent the entire scan volume in only one image Unlike 2D, 3D techniques manipulate or combine CT values to display an image; the original CT value information is not included
	CT- Types of 3D reformation	Surface rendering Volume rendering Maximum intensity projection (MIP) Minimum intensity projection (MinIP) Endoluminal rendering
	CT- Surface Rendering	Also called shaded-surface display (SSD) Only voxels on the surface of the structure are used Largely replaced by volume rendering
	CT- Maximum-intensity projection (MIP)	Selects voxels with the highest value to display Volume rendering technique that uses 3D voxel information to produce a 2D image in whichever plane Displays voxels of highest density within a slab (volume)
	CT- Minimum intensity projection (MinIP)	Selects voxels with the lowest value to display Works good with respiratory tract
	CT- Volume rendering (VR)	3D semitransparent representation of the imaged structure Uses color or grayscale Provides depth to adjacent tissues by shading, coloring, lighting, etc. Excellent for demonstrating complex 3D anatomy
	CT- Endoluminal imaging	A form of Virtual Reformation Also called perspective volume rendering or virtual endoscopy Designed to look inside the lumen of a structure
	CT- Region-of-interest Editing	editing is done to remove obscuring structures from the 3D image 3D software allows this editing to be in a manual, automatic, or semiautomatic fashion
	CT- factors that degrade reformatted images	Segmentation errors Differences in anatomic position from 1 slice to the next usually due to motion Image noise Therefore increase mAs reasonably Artifact
	CT- informatics	The collection, classification, storage, retrieval, and dissemination of recorded information
	CT- Radiology information system (RIS)	These were developed before HIS systems were used. Now need to integrate well with the HIS systems Most often used for scheduling patients, storing reports, patient tracking, protocoling examinations, and billing
	CT- Picture archive and communication system (PACS)	Technologies necessary for the storage, retrieval, distribution, and display of images This is now integrated in the RIS
	CT- Network bandwidth	The amount of data that can be transmitted between two points in the network in a set period of time
	CT- image compression	Image data can be compressed to make transmission more efficient Compression schemes can be lossless or lossy Try to be aware of how much compression is used and try to use lossless
	CT- Digital Imaging and Communication in Medicine (DICOM)	Universally adopted standard for medical image interchange
	CT- Health Level Seven (HL7)	Organization that works to develop universal standards in healthcare data Also refers to the specific standards created by the organization
	CT- archiving	the process of saving image data from the originating modality to an electronic medium
	CT- Cone beam acquisition	Acquires a larger volume of information per gantry rotation Uses entire emitted cone of x-rays rather than a collimated fan beam Requires 3D back projection algorithm but still has accuracy issues especially towards the periphery of the detector
	CT- factors affecting dose	Slice width and spacing Pitch Scan field diameter Radiographic technique Patient size and thickness Repeat scans Collimation
	CT- special pediatric considerations	Increased sensitivity Higher effective dose
	CT- strategies for reducing dose	Adjust mAs to suit the individual patient When available, use automatic tube current modulation Avoid increasing kVp Increase pitch Limit the use of thin slices Limit repeat scans When available, use iterative reconstruction methods Verify the CT is clinically indicated Customize the CT examination when possible Shield patient
	CT- contrast agents	To improve the contrast between enhancing structures and nonenhancing structures Increases or decreases the tissue’s ability to attenuate the x-ray beam
	CT- properties of ideal contrast agents	Should enter the body and remain stable. Should require the least amount to enhance structures. Enhance only the desired structures. Remain in the body for the length of the examination Should minimally affect the physiological state Cost effective
	CT- Osmolality of contrast agents	The characteristic of a solution determined by the ionic concentration of the dissolved substances per unit of solvent. Number of dissolved particles per unit of solvent.
	CT- Osmotoxicity of contrast agents	Occurs when osmotic pressure within a vascular lumen increases, fluid from surrounding tissues is drawn inward in an attempt to dilute the osmotically active particles and to equalize the pressure on both sides of the membrane. This results in a loss of fluid from red blood cells, endothelium and extravascular space.
	CT- viscosity of contrast agents	A measure of resistance of fluid to flow. Viscosity is determined by the number of particle in the solution and the attraction between the particles.
	CT- Contrast reactions	Mostly due to chemotoxic and osmotoxic effects Iodinated contrast agents have potential for producing adverse reactions which range from mild to severe.
	CT- Minor Contrast Reactions	Nausea Vomiting Flushing Metallic taste Coughing (minor) Sweating Feeling of warmth (feeling like urinating)
	CT- Moderate Contrast Reactions	Urticaria Asthma attack (minor) Arrhythmia (mild; do not effect heart’s ability to pump blood by much) Rhinitis (Runny nose) Facial edema
	CT- Severe Contrast Reactions	Convulsions Cyanosis (Turning blue) Pulmonary edema Shock (Drop of blood pressure) Cardiac arrest Laryngospasm Respiratory arrest Death
	CT- Treatment of Adverse Contrast Reactions	Epinephrine Diphenhydramine (benedryl) Atropine (usually given after arrhythmia) Oxygen IV fluids
	CT- Factors associated with increased risk for adverse contrast reactions	Patient’s medical history Age and sex of the patient History of allergy Especially allergies to iodine such as shell fish and strawberries Asthma Previous reaction to contrast media and severity Amount of contrast medium administered Route of administration Osmolality and viscosity
	CT- Contraindications for Iodinated Contrast Media	History checklist Diabetic patients using glucophage or metformin for treatment- Can’t be used after administration of contrast Patients with renal failure (Will not be able to excrete the contrast) Elevated BUN and or creatinine (Indicates abnormal kidney function) Patients with sickle cell anemia Osmotoxic interaction with red blood cells would further damage their RBCs Patients with iodine sensitivity Previous rxn to iodine (even if external iodine caused rash) Hx of pheochromocytoma (Condition affects adrenal glands (and kidneys)) Patients with multiple myeloma Patients with hyperthyroid disease (Because iodine may interact with thyroid) Brain hemorrhage –active subarachnoid bleed
	CT- Blood Urea and Nitrogen (BUN)	Provides the necessary information about the kidney’s ability to remove impurities from the blood. Renal disease impairs the ability of the kidneys to remove impurities, and elevates the BUN levels BUN values range from 5 to 25 mg/dl
	CT- Creatinine	Creatinine is normally removed from the bloodstream by the kidneys Elevated creatinine levels may indicate impairment of the function of the kidneys. Normal levels are between 0.6 to 1.7 mg/dl.
	CT- tests for blood coagulability	Prothrombin time (PT) Partial thromboplastin time (PTT) Platelet count
	CT- Prothrombin time (PT)	Typical values for PT are 10 - 14 seconds
	CT- Partial thromboplastin time (PTT)	PTT values are 20 - 40 seconds
	CT- Platelet count	Platelet values are between 150,000 and 400,000 /mm3
	CT- Injection rates	Injection rates will range from between 1-8 ml/sec
	CT- Extravasation of contrast media	The injection should be stopped upon first sight of extravasation. Slight swelling and erythema may develop. Tissue necrosis has been reported as a result of contrast media extravasation. Application of local heat for the first 6 to 8 hours followed by the application of local cold for 6 to 8 hours may help speed the reduction of localized swelling and pain.
	CT- Iodinated contrast media	Contain iodine Injected into the venous system Ionic and nonionic (refers to the carrier molecule the iodine is attached to)
	CT- GI Contrast Media	Positive- adds tissue density Barium based- most commonly used Iodine based Negative- enhances ability to see fillable spaces; decreases tissue density Air (room air, carbon dioxide, or nitrongen) Neutral- bring tissue density closer to zero Water (soda may also be given)
	CT- Contraindications for Barium oral contrast media	Colon obstruction or perforation Tracheosophageal fistula (usually found in babies or very young children) Obstructing lesions of the small intestine Pyloric stenosis Hypersensitivity to barium sulfate
	CT- Adverse reactions to barium sulfate	Usually mild and include abdominal cramping colon impaction Barium appendicitis Intestinal perforation and peritonitis Pale, hard stools
	CT- Iodinated oral contrast media	Diluted solutions of iodinated contrast media. Alternative if contraindications to barium exist Most commonly known as gastrografin
	CT- Adverse reactions to iodinated oral contrast media	Typically mild Transient diarrhea Abdominal pain or flatulence Reactions to added artificial sweetener
	Chemotherapy spills	use PPE (gowns, gloves, goggles, and masks) dispose in an approved hazard bag
	Nutritional effects of cancer	anorexia-cachexia syndrome- progressive wasting and extensive loss of adipose tissue and skeletal muscle. Vitamin A, C, D, and B6 deficiencies Fluid and electrolyte imbalances Syndrome of inappropriate antidiuretic hormone secretion (SIADH) which also results in hypokalemia. Magnesium and potassium depletion from chemo
	Radiation therapy effects which may effect nutrition	Oral mucositis Taste changes xerostomia pain and difficulty swallowing dental caries esophagitis Dysphagia Long term strictures of the esophagus Vomiting Anorexia Diarrhea Gastric distension Chronic obstruction Malabsorption Fistula formation
	Chemotherapy effects which may effect nutrition	Anorexia Mucositis Taste alterations Nausea and vomiting Deficiencies of vitamins B1, B2, and K and of niacin, folic acid, and thiamine weight loss Hypoalbuminemia Taste alterations
	Surgical effects which may effect nutrition	alteration in ability to chew or swallow problems absorbing vitamin B12 and pernicious anemia dumping syndrome- causing nausea, cramping, and diarrhea Malabsorption of fat Decreased iron absorption- anemia
	Treatment of xerostomia and pain in mouth	saliva substitutes toptical anesthetics eating moist foods
	Treatment of dysphagia	topical anesthetics NSAIDs systemic analgesics histamine blockers soft, bland food and liquid supplements enteral feeding
	Treatment of vomiting	Antiemetics low reside and lactose free diet
	Treatment of taste alterations	cool foods with little aroma and bland foods
	Enteral or parenteral nutrition should be considered only for patients that demonstrate:	inability to eat for a long period of time weight loss from inability to eat rather than tumor induced metabolic changes availability of professional support to reduce complications of therapy cancer that can be expected to respond to treatment
	Enteral nutrition	tube feedings
	Parenteral nutrition	IV nutrition
	Common signs of hypersensitivity reaction	Agitation Urticaria Angioedema Upper airway edema Dyspnea Wheezing Flushing Dizziness Hypotension
	Half life of Ra-226	1,600 years
	Half life of Rn-222	3.83 days
	Half life of Co-60	5.26 years
	Half life of Cs-137	30.0 years
	Half life of Ir-192	73.8 days
	Half life of Au-198	2.7 days
	Half life of I-125	59.4 days
	Half life of Pd-103	17.0 days
	Photon energy of Ra-226	0.047-2.45 (0.83 avg) MeV
	Photon energy of Rn-222	0.047-2.45 (0.83 avg) MeV
	Photon energy of Co-60	1.17, 1.33 MeV
	Photon energy of Cs-137	0.662 MeV
	Photon energy of Ir-192	0.136-1.06 (0.38 avg) MeV
	Photon energy of Au-198	0.412 MeV
	Photon energy of I-125	0.028 avg
	Photon energy of Pd-103	0.021 avg
	Exposure rate constant of Ra-226	8.25 Rcm^2/mg-h
	Exposure rate constant of Rn-222	10.15 Rcm^2/mCi-h
	Exposure rate constant of Co-60	13.07 Rcm^2/mCi-h
	Exposure rate constant of Cs-137	3.26 Rcm^2/mCi-h
	Exposure rate constant of Ir-192	4.69 Rcm^2/mCi-h
	Exposure rate constant of Au-198	2.38 Rcm^2/mCi-h
	Exposure rate constant of I-125	1.46 Rcm^2/mCi-h
	Exposure rate constant of Pd-103	1.48 Rcm^2/mCi-h
	Grenz-ray therapy	very soft, low energyx -rays below potentials of 20 kV
	Contact therapy	operates at potentials of 40-50 kV very short SSD (2 cm or less)
	Superficial therapy	potentials of 50-150 kV 1-6 mm Al added to harden the beam HVL=1-8mm Al SSD between 15-20 cm
	Orthovoltage or deep therapy	150-500 kV SSD usually set at 50 cm limited for lesions deeper than 2-3 cm
	Supervoltage therapy	500-1,000 kV aka high voltage therapy
	Megavoltage therapy	energy of 1 MV or greater
	Van de Graaff generator	accelerates electrons to produce x-rays of 2-10 MV electrons move on a belt to create a potential
	linear accelerator	uses EM waves to accelerate charged particles
	Components of a linac	power supply modulator magnetron or klystron electron gun waveguide system accelerator tube beam transport system
	Magnetron	a device that produces microwaves high-power oscillator power low energy linacs (6 MV or less)
	Klystron	a microwave amplifier needs to be driven by a low power microwave oscillator bunching of electrons occur
	The linac x-ray beam	bremsstrahlung x-rays are produced when the electrons are incident on a target of a high Z material The average photon energy of the beam is approximately one third of the maximum energy
	Treatment head contains	shielding x-ray target scattering foil flattening filter ion chamber collimation light localizer system
	Fixed primary collimator	located immediately beyond the x-ray target and before the flattening filter
	Light localizing system	a combination of a mirror and a light source located in the space between the chambers and the jaws projects a light beam as if emitting from the x-ray focal spot it is congruent with the radiation field
	Betatron	the accelerating tube is shaped like a hollow doughnut and is placed between the poles of an alternating current magnet 6 MeV-40 MeV
	Microtron	an electron accelerator that combines the principles of the linac and the cyclotron 2-22 MeV
	Cyclotron	a charged particle accelerator cylinder shape an alternating potential is applied between two Ds up to 30 MeV
	Free air ionization chamber	used in the measurement of the roentgen calibrates secondary instruments designed for field use corrections for air attenuation, recombination of ions, effects of temperature, pressure, and humidity, and ionization produced by scattered photons
	Percentage depth dose is effected by	beam quality or energy fields size field shape source to surface distance beam collimation
	Tissue air ratio (TAR)	removes the SSD dependence of percent depth dose varies with energy, depth, and field size
	Backscatter factor	the TAR at the depth of maximum dose
	Scatter air ratio (SAR)	depends on beam energy, depth, and field size difference between the TAR for the given field and the TAR for the 0x0 field size
	Obliquity in electron beam therapy	can cause cold spots
	Tissue inhomogeniety in electron beam therapy	can cause hot and cold spots
	Adjacent fields in electron beam therapy	can cause overdosing (hot spots)
	Brachytherapy radium source configurations	uniform indian club dumbell tube
	Dosimetry of I-125 brachytherapy	anisotropic two circles with constriction toward the center
	Dosimetry of Pd-103 brachytherapy	oval with points out of the center portion
	Dosimetry of tandem and ovioids	pear shaped
	Paterson-Parker system	deliver uniform dose (within +/- 10%) to a plane or volume with nonuniform source distribution
	The Quimby System	nonuniform dose distribution with uniform source distribution resulting in higher central dose
	The Memorial System	an extension of the Quimby system complete dose distributions around lattices of point sources of uniform strength spaced 1cm apart
	The Paris System	wider spacing for longer sources or larger treatment volumes sources implanted in parallel lines
	Brachytherapy techniques	surface molds interstitial therapy intracavitary interstitial
	REM to mSv	1 Rem= 10 mSv
	Annual occupational exposure: effective dose-equivalent limit (stochastic effects)	50 mSv
	Annual occupational exposure: dose-equivalent limit (nonstochastic effects) lens of the eye	150 mSv
	Annual occupational exposure: dose-equivalent limit (nonstochastic effects) all other organs (e.g., red bone marrow, breast, lung, gonads, skin, and extremities)	500 mSv
	Annual occupational exposure: dose-equivalent limit (nonstochastic effects) cumulative exposure	10 mSv x age
	Annual public exposure effective dose-equivalent limit, continuous or frequent exposure	1 mSv
	Annual public exposure effective dose-equivalent limit, infrequent exposure	5 mSv
	Annual public exposure Remedial action recommended when: effective dose equivalent	>5 mSv
	Annual public exposure Remedial action recommended when: exposure to radon and its decay products	>0.007 Jhm^-3
	Annual public exposure Education and training exposure: effective dose equivalent	1 mSv
	Annual public exposure Education and training exposure: dose-equivalent limit for lens of eye, skin, and extremities	50 mSv
	Embryo-fetus exposure total equivalent-dose limit	5 mSv
	Embryo-fetus exposure dose equivalent limit in a month	0.5 mSv
	Negligible individual risk level annual effective dose equivalent per source or practice	0.01 mSv
	Structural shielding design factors	Workload Use factor Occupancy factor (T) Distance
	Workload	weekly dose delivered 1 m from the source in rad/week
	Use factor	fraction of the operating time during which the radiation under consideration is directed toward a particular barrier
	Occupancy factor	fraction of the operating time during which the area of interest is occupied by the individual
	Distance	in meters from the radiation source to the area to be protected
	Typical Use factor for the floor	1
	Typical Use factor for the walls	1/4
	Typical Use factor for the ceiling	1/4-1/2 depending on the equipment and techniques
	Typical full occupancy factor and areas	T=1 work areas, offices, nurses' stations
	Typical partial occupancy factor and areas	T=1/4 corridors, restrooms, elevators with operators
	Typical occasional occupancy factor and areas	T=1/8-1/4 waiting rooms, restrooms, stairways, unattended elevators, outside areas used only for pedestrian or vehicular traffic
	Bragg peak	the sharp increase or peak in dose deposition at the end of proton particle range
	Spread out Bragg peak	the Bragg peak can be spread out by superposition of several beams of different energies to get a beam that is wide enough to treat target volumes

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