3. • Checks and practices ensure SAFE,
ACCURATE and EFFECTIVE treatment
• chính xác, an tòan và hi u q aệ ủ
• Once treatment and dose is given, it cannot
be reversed
• không thay đ i l i đ cổ ạ ượ
RTT role on treatment
4. RTT role on treatment cont…
• Basic understanding of dosimetry
recommended by IAEA
• Importance to be aware of practices &
recognise possible errors
• Monitoring and side-effect
6. RTTs working in pairs (Hai người)
• International standard to work in pairs
• Positioning is easier & more efficient
• Checking each other to minimise errors
• I SET YOU CHECK!!
• “Tôi làm , b n ki m tra”ạ ể
• Learn from mistakes
7. Correct patient (đúng bệnh nhân)
• Full name (tên đ y đầ ủ)
• Date of birth (ngày tháng năm sinh)
• Correct treatment site
(chính xác đi u trề ị)
8. Positioning the patient (Định vị trí tư thế)
• Always take patient file with you in the room
• Replicate Simulation Position (tái tạo lại vị trí)
• Ensures dose (Liều lượng) delivered safely,
accurately & effectively to the correct area
9. Straightening (Cố định thẳng)
• Palpate midline landmarks
• Midline anterior tattoo
• Adjust patient & align with lasers
• Straight throughout entire body
• Especially treatment area
10. Levelling (bằng)
• Rotate (Cố định hai bên) patient
• Match tattoos/marks with lasers
• Visually check or use spirit level
11. Reference point
• Locate reference point
• Measurements to anatomical landmarks
(Xác định điểm chuẩn) confirms reference point
TATTOO
12. Iso-centre (Xác định trọng tâm)
• Move to iso-centre
• Bed (giường) moved
– Lt/Rt (bên trái - bên Phai)
– Sup/Inf (Mặt trên - Mặt dưới)
– Ant/Post (Mặt trước - Mặt sau)
• Both RTTs check moves
14. Accessories & final checks
Kiểm tra trước khi rời phòng
• Accessories? – wedge, bolus, shielding blocks
• Correct patient? (Date of Birth, Name)
• Final stage before turning on radiation
• Routine checks minimise errors
15. Head and neck set up
• Straighten – mid Forehead, mid Nose, SSN.
• Align ATN’s (anterior
Tragal notch)
• Set VBL and HBL
(reference marks)
• Move to iso-centre
• Check SSD
16. Breast set up
• Straighten – SSN and JOR
• Check rotation using lateral
tattoo
• Set SSD for depth
• Move to iso-centre position
• Check SSD, ME/PE and
overshoot at gantry angle.
• Place bolus if required.
17. Treating with Electrons
• SSD - distance from machine to patients’ skin
• Skin Apposition
– Applicator flat with treatment area
– Even dose
19. Before beaming on
Have Treatment file in front of you for checking
Phiếu điều trị phải đựơc kiểm tra ngay bàn điều khiển
• Does it make Sense?
– Prescription (Rad/Pall) / Y lệnh
– Site / disease / vùng điều trị
– Correct side (Left/Right?) Trái/phải
– Mu’s / Điều lựơng xạ
• Beam parameters & accessories
Các chùmm thông số và thiết bị phụ
If in doubt, question. Because if you don’t,
no one will!!
21. Are you happy to turn the Radiation Beam on?
Bạn có thật sự hài lòng để nhấn máy?
22. Beaming on
• Monitor the patient (movement) / có di động
• Monitor machine head (collision) / có va chạm
• Monitor beam parameters (MLC, EDW, dose given etc.)
những thiết bị khác
If something is not right
STOP TREATMENT!!
Có điều gì không ổn,
phài ngừng ngay
Record the & verify dose (MU)
when delivered.
• Writing signing and dating
23. Remember, checking is an important part
of an RTTs role
To ensure Accurate, Safe and Effective Radiation
treatment delivery
24. Patient care / Chăm sóc bệnh nhân)
• RTTs monitor & anticipate side effects (tác dụng phụ)
• Advise on patient care / chỉ dẩn chăm sóc vùng điểu trị
• Refer to Dr or nurse / giới thiệu tới y tá và bác sỹ
The role of an RTT on treatment is extremely important. The checks and practices are crucial to ensuring the patient receives the correct dose to the correct area. It is also important to remember that once the beam is turned on, the radiation dose delivered cannot be reversed.
In Vietnam, RTT’s have limited autonomy however need to understand the RO treatment prescription and Physicists work plan to be able to recognise any possible errors. Patient care and support through their course of treatment is also an important role as RTT’s on treatment need to monitor and anticipate treatment related effects to ensure referrals are made to the appropriate health discipline.
Setting up patients ready for radiation treatment delivery plays an important role in the delivery of accurate, safe, and effective radiotherapy treatment.
As one of the guidelines set by the international standards, working in pairs is highly recommended.
This makes the process inside the treatment unit more easier and efficient. One of the main positive outcomes working in pairs, is the ability to double check each other to reduce any chance of error, thus building a culture around the concept of “ I set you check”
When checking and detecting errors, it is essential to adopt a ‘no blame’ culture, where staff are encouraged to develop and ultimately learn for their mistakes.
It is necessary to ensure that the intended procedure is performed on the correct patient at the correct site to minimise any miss treatment to the incorrect patient and site.
This can be done by asking them to confirm their full name, DOB and the site / side to be treated prior to the commencement of each treatment.
The aim for daily patient set up is to replicate the exact same position as in simulation. As in simulation the same principles of comfort, reproducibly and stability apply to ensure the dose is delivered safely, accurately and effectively to the correct treatment area.
Using the laser inside the room, the first set is to straighten the patient. Palpable midline landmarks and reference points are used to achieve this. The anatomical diagram on the right represents two common palpable landmarks (SSN and Xiphy) used to straighten patients particularly for patients who are getting treated in the chest area.
Ensure the patient is levelled and not rotated. The best way to achieve this is to match the lateral tattoos with the laser or alternatively, visually check or use a spirit level.
Reference points are determined based on measurements from anatomical landmarks. It is commonly used to move to the iso-centre.
These points should always be checked.
Once the patient is lying is the correct position and reference points have been determined, the next step is to move to the planned iso-centre position.
Ensure the iso-centre position is moved in all three planes. Lt/rt sup/inf and Ant /post as recorded in the treatment file.
SSD is the distance from the target to the patients skin. This should be checked and recorded on a daily basis and is used to identify changes in patient contour over the course of treatment.
If there is a consistent change in this measurement (5 day average), this may indicate the need to alter the dose delivered to account for this change.
it is important to ensure that all planned treatment accessories eg. Wedges, bolus or shielding are used as for indicated in the treatment file.
The entire procedure from the initial identification checking process, through the time-out process and to completion of the scan or treatment session must be completed by the same two Radiation Therapy staff who conduct the treatment.
All staff involved in the patient set-up must confirm:
correct patient identity by verifying that the patient’s paper treatment sheet matches the downloaded information and the correct patient has been set-up.
correct tattoo position
agreement on the intended RT procedure
correct isocentre position
any necessary field parameters
correct equipment
Prior to placing the mask on the patient it is crucial to straighten the patient using mid Forehead, mid Nose, SSN.
Align ATN’s to help assist with head rotation.
Once the mask is fitted, It is important to assess the for any gaps in the mask and double check any additional landmarks such as Ear marks to assist with this.
This will immediately allow us to recognise changes in patient contour.
Set to your VBL/HBL reference marks and from there move to planned iso-centre.
SSD measurements need to be recorded daily in the treatment file to track any external changes.
Skin apposition is the principle which refers to making sure that the head of the applicator on all edges are as flat as possible to the treatment skin creating an even dose distribution to the treatment area.
Before turning on the radiation treatment beam, review the treatment parameters, prescriptions and monitor units, making sure that they make sense.
Verification and recoding of dose is important, especially for systems with no record and verify set in place.
As an RTT on treatment you are seeing the patient everyday, this enables you to monitor and anticipate treatment related side-effects. RTT’s play an important role in advising of patient care and referrals to other clinical health professionals including a nurse or doctor.
BASIC SKIN CARE (wound care more in depth):
Avoid extreme temperatures at treatment site
Use sorbolene cream
Avoid sun exposure to treatment site
Do not use perfume or deodorant IN THE TREATMENT AREA
If starts to get itchy, use hydrocortisone cream.
Pelvis patients: avoid spicy food, if gets sore, salt water baths
