2. Treatment Chart Record of patients radiation therapy history. Must contain: History and diagnosis Rationale for treatment Treatment plan Consent Documentation of treatment Follow up notes

3. Treatment Record Patient identification Signed prescription Treatment planning data Treatment field identifiers Daily treatment record Verification images

4. Prescription Dose Fractionation Treatment technique Special Immobilization (if necessary) Beam modifiers Must be dated and signed by physician

5. Treatment Plan Isodose distributions Monitor unit calculations Checked and signed by at least two people Checked on treatment machine by physicist for accuracy

6. Treatment Field Identifiers Positioning and immobilization Surface landmarks (Pictures) Each field is assigned a letter or number Each field is described Size, angle, beam direction

7. Daily Treatment Record Treatment number Elapsed days Date Daily and total dose Procedures such as portal imaging MU given Dose to critical structures

8. Verification Images Documents that the correct area is treated. i.e. Port Films

9. Treatment Preparation Treatment room Treatment unit Patient preparation and communication Patient transfers Patient position Isocenter and field placement Beam direction and shaping Verification imaging

10. Beam Modifying Devices Bolus Compensators Wedges Electron cones Internal shielding Electron shields

11. Treatment Delivery Console settings Record and verify systems Beam on and beam off Patient monitoring

12. Treatment Techniques AP/PA POP Tangential Four field box Boost Arc therapy

13. Treatment Room Maintenance Radiation therapist must inspect: Treatment unit Treatment accessories Supplies Cleanliness Orderliness Unsafe conditions Lights

14. TREATMENT DELIVERY PROCEDURES

15. Modern Machines Initially, treatment machines were only used for treatment Modern machines not only treat cancers but control: 1. MLCs 2. Portal imaging (MeV) 3. kV imaging 4. Gated therapy treatments

16. Effectiveness Radiation is being used more effectively and targets are becoming more focused by using CT, MRI and PET scans. Radiation is also more effective since there are more imaging modalities in the treatment room.

17. Image Guided Radiation Therapy (IGRT) An image from different resources is used to determine if treatment setup is correct.

18. Ultrasound Imaging Beta Acquisition Tomography (BAT) Localizes the prostate using 2D images. Obtain axial and sagittal images and compare to a control image determined by dosimetry. Patient is then be moved in order to match control image.

19. Electronic Portal Imaging Digital images are widely used because they can be viewed from multiple locations

20. On Board Imaging (OBI) Varian and Elekta X-ray unit and image receptor system 90 o from x ray beam and portal imaging system. DRRs are uploaded into the treatment system so the current image can be compared and shifts can be made.

21. On Board Imaging

22. Respiratory Gating Treatment of lung, breast, and upper abdominal sites. Gating allows you to correlate where the tumor is in relation to the patients respiratory cycle. The system measures the patients respiratory pattern and range of motion and displays them as a waveform. The gating thresholds are set when the tumor is in the desired portion of the respiratory cycle. These thresholds determine when the gating system turns the treatment beam on and off.

23. Respiratory Gating

24. Cyberknife CyberKnife delivers as many as 1,400 highly pinpointed beams of radiation to control or destroy the tumor. Image-guided cameras locate the tumor's position and remain locked on the target throughout the procedure. Treatments typically last about two hours each spread out during a two-week period. Used for treatment of the brain, neck or spine.

25. Cyberknife

26. Gamma Knife A gamma knife is used to treat brain tumors with a high dose of radiation therapy in one day. Contains 201 cobalt-60 sources placed in a heavily shielded assembly. The device aims gamma radiation through a target point in the patient's brain. A dose of radiation is sent through the tumor in one treatment session, while surrounding brain tissues are relatively spared.

27. Gamma Knife