Methods and Techniques in Radiotherapy II

Base Knowledge

The student should have knowledge of methods and techniques in radiotherapy.

Teaching Methodologies

Teaching is supervised by teachers or professionals in practice who collaborate with ESTeSC in the Degree in Medical Imaging and Radiotherapy.

It is up to the holder of the UC to define the objectives and forms of evaluation of the UC in coordination with the service’s employees.

Students will be encouraged to apply the theoretical and technical-scientific knowledge acquired during the course, using scientific terminology properly, in a simulated clinical environment (use of phantoms).

All topics in the area of intervention should be addressed using planning CT, in order to root technical-scientific attitudes that will be developed in a real context in the UC of Clinical Internship.

Learning Results

The student must acquire knowledge about:

The areas of intervention of radiographer, in the area of Radiotherapy (RT); The methodologies related to the performance of immobilization/ pre-planning image acquisition at RT; More appropriate professional attitudes versus patient constraints.

 

The student must acquire skills in:

Follow, according to the technical indications, the methodology required to prepare the patient for an immobilization procedure/pre-planning image acquisition in RT; About the procedures performed in the clinical context, understanding the objective and specificity of each one in the application in different oncological pathologies.

 

The student must acquire skills in:

Relational in the sense of recognizing the fragility of the patient and openness to the need for empathy in the approach to the same; Contribute to the physical, psychological and social well-being of the patient; Good conduct in the relationship with the patient in accordance with presuppositions of professional ethics.

Program

In a clinical context (or alternatively in a school environment), under the direct supervision of an advisor, students will be encouraged to simulate attitudes and techniques of radiotherapy treatment in phantoms and, when possible, among peers.

Subjects:

Apply radiological protection standards in relation to the patient and himself;

Identify the data in the registration and verification system; Identify the most used techniques and treatment modalities depending on the location of the tumor;

Distinguish the different steps of the process: diagnosis, planning and treatment;

Make contact with equipment and other specific materials;

Position and execute immobilization techniques with rigor;

Perform with skill and rigor all procedures related to planning in Tc;

Quality Assurance and Control.

 

Diffrent modules:

Module 1 – Positioning and Immobilization Techniques

Immobilization devices (masks, bases/supports/support systems, protective mattresses, among others, reusable whenever possible), based on sustainability, involve reducing waste and pollution; Laser marking and alignment; Specific positions: head, thoracic region, abdominal-pelvic region, and limbs versus pathology; Accurate positioning and immobilization techniques.

Module 2 – Simulation and Image Acquisition

Acquisition of simulated 3D (phantom) and 4D planning CT scans; Anatomical recognition and referencing; Data transfer to the planning system.

Module 3 – Safety, Communication, and Humanization

Distinguish the different steps of the process: diagnosis, planning, and treatment; Notions of practical radiation protection for the patient and oneself; Simulation, reception, and communication, emphasizing clear and accessible explanations of the treatment steps, side effects, and necessary care; Active listening to understand the patient’s questions, fears, and expectations, using simple language and avoiding excessive technical terms; Individualization of care, respecting cultural and social values; Care during the procedure based on humanization in patient immobilization, explaining each step to reduce discomfort, respecting privacy (use of sheets, explanations before body exposure); Teamwork and technical record-keeping (positioning notes).

Module 4 – Verification and Correction (IGRT)

Verification methods (CBCT, portals, kV/MV) – offline review; Assessment of deviations and corrections in a simulated environment; Assessment of verification effectiveness and impact on dose

Module 5 – Learning with a Linear Accelerator (in a simulated environment)

Control interface: dose parameters, exposure time, energies, and fields; Treatment preparation sequence: checklist, plan verification, patient identity confirmation (simulated); Safety procedures: tolerances, interlocks, emergency stop; Individual or paired practical tasks: Treatment preparation and patient alignment; Application of safety measures; Communication between the technical team during treatment execution (simulated).

Curricular Unit Teachers

Maria João Taborda Serrano Gomes da Cunha Cura Mariano

Internship(s)

NAO

Bibliography

Boustani, Grapin, Laurent, Apetoh, & Mirjolet. (2019). The 6th R of Radiobiology: Reactivation of Anti-Tumor Immune Response. Cancers, 11(6), 860. https://doi.org/10.3390/cancers11060860

Faithfull, S. & Wells, M. (2003). Supportive Care in Radiotherapy. London: Churchill Livingstone.
Hoskin, P. (2006). Radiotherapy in Practice: External Beam Therapy. Oxford: Oxford University Press.

Heinzerling, J. H., Hampton, C. J., Robinson, M., Bright, M., Moeller, B. J., Ruiz, J., Prabhu, R., Burri, S. H., & Foster, R. D. (2020). Use of surface‐guided radiation therapy in combination with IGRT for setup and intrafraction motion monitoring during stereotactic body radiation therapy treatments of the lung and abdomen. Journal of Applied Clinical Medical Physics, 21(5), 48–55. https://doi.org/10.1002/acm2.12852

International Atomic Energy Agency (IAEA). (n.d.). Radiotherapy. Human Health Campus. Retrieved July 26, 2023, from https://humanhealth.iaea.org/HHW/MedicalPhysics/Radiotherapy/

Lahmi, L., Mamzer, M.-F., Burgun, A., Durdux, C., & Bibault, J.-E. (2022). Ethical Aspects of Artificial Intelligence in Radiation Oncology. Seminars in Radiation Oncology, 32(4), 442–448. https://doi.org/10.1016/j.semradonc.2022.06.013

Leech, M., Coffey, M., Mast, M., Moura, F., Osztavics, A., Pasini, D., & Vaandering, A. (2017). ESTRO ACROP guidelines for positioning, immobilisation and position verification of head and neck patients for radiation therapists. Technical Innovations & Patient Support in Radiation Oncology, 1, 1–7. https://doi.org/10.1016/j.tipsro.2016.12.001

Mast, M., & Perryck, S. (2022). Introduction to: Surface Guided Radiotherapy (SGRT). Technical Innovations & Patient Support in Radiation Oncology, 22, 37–38. https://doi.org/10.1016/j.tipsro.2022.04.004

Moore, K., Agur, A. M. R., & Dalley, A. F. (2014). Anatomia Orientada para a Clínica (N. GUANABARA, Ed.; 7a). NOVA GUANABARA.

Perez & Brady’s Principles and Practice of Radiation Oncology (Perez and Bradys Principles and Practice of Radiation Oncology) 7ª Edição (2018)

Khan, FM (2020). The Physics of Radiation Therapy. 6a ED., Lippincott Williams & Wilkins.

Zhao, W., Shen, L., Islam, M. T., Qin, W., Zhang, Z., Liang, X., Zhang, G., Xu, S., & Li, X. (2021). Artificial intelligence in image-guided radiotherapy: a review of treatment target localization. Quantitative Imaging in Medicine and Surgery, 11(12), 4881–4894. https://doi.org/10.21037/qims-21-199 Edinburgh: Churchill Livingstone.