Protraction- deliver the dose lower however continuous

Fractionation- in between

Straight field – single field

100 percent of prescribed dose
No need to divide

Two field technique – parallel or opposing field

- AP and right lat.

Multi-field
-360 degrees
- large size tumor; pelvic region

2 parallel opposed field – lessen rad’n dose of organ @ risk

Head and neck – lat, thyroid gland

Split field technique – right and left lateral

Wedges- irregular body contour: shielding port of treatment head: homogeneous (thinner –
thicker) uniform dose
- Compensate nasopharynx
- Types: manual – placed in the treatment tray (hard wedges) , Motorized – commonly
used by Elekta company where remove it in and out remotely : angled @ 60degrees ,
Dynamic – automated wedges can be controlled by computer system used by variant
company. : moved the wedges by the Jaw.
Weighted field – unequal: 1 field could receive higher dose
equal: receive the same dose as the other field.

Treatment time – cGy/m

LINAC- cGy/
Criteria of a good treatment
- Homogeneous dose if needed - Intensity modulated
- Absence of hot - areas receives overlapping dose, cold – areas receive lesser dose of what
is required.
- Minimum dose- normal tissues suppose not to be irradiated
- Radiosensitive organs : gonads and thyroid glands
ALARA

Px pos’n
-ease: make sure px in comfort pos’n
-contour: irregular body contours check to appropriate blocks
- displacement: applied in organ : nephron :

Coordinate system
X-axis – superior and inferior
Y-axis-focus on the left or right side of the body
Z-axis- anterior and posterior

Sagittal- y-axis
Transverse,axial or horizontal – x-axis
Coronal – Z-axis

Accessories
A tray – commonly found on treatment head shield window
-attach other accessories
- lucite – graphite like but not as much like lead
Wedge – homogenous dose to deliver in irregular body contour
Multileaf collimator - shape
EPID –
Verification film- images obtained with the use of treatment beam
(main goal treatment not diagnose) assess while deliver accurate appropriate dose based on the
image

Lead blocks- accessories

Bolus- increase skin dose, compensate skin tissue: increase attenuation and absorption: wet
tissue: disposable / towel (much better)
Paraffin wax, flour and rice, and cellophane: skin irradiation
Compensator / filter: placed in the shielding
-intensity modulated – automated

Positioning moulds
Alpha cradle- upper body
Vac- lok – all body or upper
Aqua Plast – head, face and neck irradiation
Total plaster shell – cast

Immobilizers
- Head – applies sandbags
- Stereotactic – small lesions in the head
- Breast pos’n – angulated breast
- Belly borad – prone pos’n if the main interest is the spine to not irradiated organs in the
abdomen.
Stimulator- build the blocks
- Follow px’s contour

360 degrees – first expo by 80 – prone – lateral - supine

Sandwich – combination 2 treatment : time frame main concern is the recurrence followed by
surgery and post operative : not to expose the same area
- stage 3 and 4 metastasis
- Shrink the tumor -
- Expose area with possible recurrence
- Secondary cancer to much radiation to the cell within the time frame

Boosting field – scar boost

- Additional dose to the area
- Breast irradiation commonly applied

Shrinking field technique – field size

Larger – small lessen field size

Weighted : equal – deliver same dose to different field

Unequal

Mantle field- treatment of hangken’s lymphoma - letter M irradiate lymph nodes in neck located
in the chest – underarm

Inverted Y- irradiate lymph nodes, in the abdomen , inguinal areas, spleen,

Whole body – multi field technique 360 degrees

- Also known as total body irrad
- Bone marrow
- Focus to skin distance
- 360 degrees
- Supine, lat, prone rotate
- Upper and thorax – sitting pos’n
Half body – either upper or lower extremities: management of pain , primarily palliative
treatment
Total skin – main interest is the skin
Total electron – shallow tumors
AP-PA-LAT
prone-supine

Periodic evaluation
-every after treatment
- supportive care
-hemoglobin count
- 1 laboratory procedure
- recommend- dietary

Complete remission – removal

Partial –

Stable disease – palliative care

Causes of error
Judgement – oncologist malpractice
Omission – does not disclose the risk , complications, and side effects
Commission- negligence