Methodology Midterm Exam Study Guide

inter-fractional uncertainty - have to do with variations in set up that exist between each setup. Ex: weight loss, bloating, tumor changes, or setup errors intra fraction motion - the change in target position during treatment delivery as might occur in the thorax with respirations. surface guided radiation therapy (SGRT) - Technology that uses an optical surface scanning system to track a patient's 3-D surface in real-time adaptive radiation therapy - online or offline planning during treatment linac cbct acquisition - - 5 frames/second - 2 min/ rotation - 600 projections - typical exposure is 120kvp, 100ma, 10-20ms For head and neck if laterals do not align you should - split the diff for supine pelvis if laterals do not align with asu set to - - set to whatever one is more stable for prone rectum if laterals do not align with psu set to - - set to psudepth tolerance for H&N ----- for everything else ------SRS brain ----- SBRT - head and neck = +/- 0.5cm total 1cm everything else = +/- 1cm total 2cm SRS = 1mm halo, 2mm mouth bite SBRT = 0.5cm clinical tolerance for rotation in general ------ at Michener head and neck ------ below head and neck ----- - 2-5 degrees head neck = 3 degrees below= 5 degrees genitourinary cancers 2 general ----- 3 male ------ - general = kidney, bladder male= penile, testes, prostate pelvic lymph nodes - - paraaortic nodes - presacral nodes - common iliac; split into external and internal - inguinal nodes; deep and superficial - femoral nodes ASIS (anterior superior iliac spine) - - bifurcation of common iliac, origin o fIVC, ovaries - L5/S1 Upper border of the symphysis pubis ------ and lower border------ - upper - cervix, prostate- greater trochanter, top of coccyx lower - pelvic floor - ischial tuberosities 3 types of kidney tumours - 1- wilms (nephroblastoma) 2- renal cell adenocarcinoma (majority) 3- transitional cell carcinoma of the renal pelvis (7% of renal cancers, 1% of GU cancers) RCC originates from ------ ratio is ----- - epithelial cells of proximal renal tubules - medulla and cortex mainly - 2:1 male to female Transitional cell carcinoma ----- ratio is ----- - found within the renal pelvis + ureters - transitional cell = 90% - squamous cell 7-8% worst prognosis - Adeno is rare - 3:1 male to female von Hippel-Lindau disease risk factor for - RCC 5 routes of spread for RCC - 1- Local infiltration from capsule into perinephric fat 2- direct extension into renal vein or IVC3- retrograde venous extension to testes 4- LNs= renal hilar, paraaortic, paracaval 5- hematogenous; lung, liver, bone, CNS, 3 routes of spread for transitional pelvic + ureter - 1- direct invasion 2- LN 3- hematogenous T1/T2 localized disease RCC- 3 treatment options - 1- radical nephrectomy; include perinephreic fat, LN, adrenal gland (4cm can do partial nephrectomy) 2- chemo; marginally effective; also use immuno, antiangiogenics, targeted 3- radiation; limited due to abdominal organs. largly reserved for palliation and as neoadjuvent advanced RCC tx- 2 - 1- debunking nephrectomy 2- radiation for palliation RT volume for RCC ----- borders ----- - - entire kidney and renal bed - renal hilar and paraaortic LNs adjuvently