Procedures: Treatments (19%)

ARRT-T · 57 questions

• A post-mastectomy patient receives a 6 MV field to a superficial chest wall target that reaches the skin, and the plan's MLC leaves already match the target outline. In vivo measurements put the surface dose well below prescription while the reading at 1 cm depth is on target. Which beam modifier should be used to bring the skin dose up to prescription?
• A patient with head-and-neck cancer is simulated for a course covering the cervical nodes that will repeat daily for several weeks. The patient cannot keep both arms raised for more than a few minutes and reports neck pain whenever the head turns to the side. Which immobilization setup should be chosen for reproducible daily positioning?
• A 70-year-old with a localized 3 cm lung tumor and severe COPD is judged unfit for surgery, and staging shows no nodal or distant spread. Which treatment approach best matches this patient's localized, inoperable disease?
• On the fourth fraction of a chest plan, record-and-verify confirms that monitor units, beam energy and gantry angles match the approved plan for every field, and earlier daily images aligned well. The current image registered to the planning CT shows the target about one cm superior to its planned position, with the beam still off. Which verification step should complete this setup before the fraction is delivered?
• A patient with a small peripheral lung lesion that moves with breathing is scheduled for a short high-dose course. The plan must shape dose tightly around the target, account for respiratory motion, and include a volumetric image check every treatment day. Which treatment and imaging combination satisfies all three requirements?
• A patient receiving pelvic radiotherapy lines up on the tattoos and wall lasers, yet daily cone beam CTs show a different 5 to 8 mm error with each therapist. The knee sling, foot plate, and table index are set by eye each morning rather than locked to recorded positions. Which correction will most reliably restore this patient's setup reproducibility?
• A patient is positioned for a lateral head-and-neck field, and the tabletop edge would clip the beam at the planned gantry angle. The therapist plans to adjust the couch before the first fraction without disturbing the tattooed setup. Which couch adjustment keeps the beam clear while the patient stays at isocenter?
• You are at the console monitoring a treatment fraction when the patient on the couch grows pale and clammy and tells you over the intercom that the room is spinning. Within a minute her replies turn slow and groggy, and the camera view is partly blocked so you cannot tell whether she is still responding. Which immediate response should the therapists take to manage her decreasing alertness during treatment?
• A pancreatic tumor shows about 2 cm of craniocaudal motion on fluoroscopy, and the patient cannot sustain a breath hold because of chronic lung disease. The plan must keep motion small and tie beam delivery to a reproducible respiratory phase. Which motion-management approach meets the motion and phase requirements?
• A therapist covering three rooms reads a conditioning treatment before a stem cell transplant, an electron treatment across the entire skin surface, and a photon course to a lung primary. Which pairing of technique with clinical purpose is accurate?
• While a postoperative chest wall field is being delivered, the linear accelerator stops mid-fraction and the console shows an unfamiliar error code. The record system indicates that part of the planned monitor units has been given and the patient is still immobilized on the couch. Which steps and record entries follow this equipment malfunction?
• A patient receiving pelvic treatments has a knee that stays bent and a pelvis that keeps sliding toward the foot of the table during each fraction. Which combination of positioning aids should the therapist set up to support the knee and limit pelvic movement?
• A patient with a superficial chest wall lesion is planned for photon treatment, and the physician wants the dose at the skin surface to reach the prescription level instead of falling in the build-up region. Which beam modifier should be added to the treatment set-up for each fraction?
• Halfway through an upper abdomen fraction, the patient on the couch, drowsy from premedication, suddenly begins to retch and vomit while the beam is running and you are alone at the console. Which immediate response best protects a patient who vomits during treatment?
• A patient with a small, localized stage I non-small-cell lung cancer that has grown on recent imaging is medically inoperable because of cardiopulmonary disease. Which management approach best fits this patient's tumor and medical fitness?
• A daily CBCT is acquired for a pelvic treatment, and the automatic match proposes a large longitudinal shift. The sagittal view alone looks convincing, but the axial slices show the femoral heads rotating out of alignment. Which verification confirms that the registration is valid before the beam is delivered?
• A patient is being set up for a posterior oblique chest field, and the plan calls for the couch top rotated 30° so the rails clear the beam at a 315° gantry angle. The collimator must stay at 0°, and the isocenter has to remain at the same point in the patient after the rotation. Department protocol requires image guidance, not surface imaging alone, to verify internal position after couch rotation. Which couch and console checks confirm the setup before the beam is delivered?
• A patient receiving daily pelvic radiation is set up on a four-field plan whose approved record places the treatment isocenter 1.5 cm anterior to the skin mark. Today's orthogonal images show the target 0.5 cm lateral to that planned point, and a couch shift is applied. Which verification step confirms that the corrected setup now treats the planned isocenter?
• A patient is being set up for chest wall irradiation after a mastectomy. The physician requires that the dose at the skin surface match the prescribed depth dose, and the scar lies over a curved, uneven contour that the beam must follow. Which accessory best satisfies both the surface dose requirement and the contour requirement?
• Midway through an afternoon fraction the linear accelerator drops the beam and shows an interlock that does not clear when it is reset. The patient is unharmed and still positioned on the couch, and department policy requires that the cause be established before treatments continue on that unit. Which action satisfies the required response to this equipment malfunction?
• During orientation, a student reads four course descriptions from the schedule: a larynx photon plan, a total skin electron course for cutaneous lymphoma, a total body irradiation conditioning plan, and a temporary implant left in a cavity overnight. Which statement correctly matches each technique to its treated volume and where its source sits?
• A patient begins chest wall treatment with a field reaching toward the axilla. Both arms must be raised out of the beam and placed the same way each day, and tight hamstrings keep the patient from lying with straight legs. Which combination of positioning aids best satisfies these requirements?
• A patient returns for a boost fraction after the plan was revised earlier in the week, yet the record-and-verify system still has the original plan loaded for today's slot, while the printed summary in the chart shows the revised dose and new isocenter coordinates. Which verification step should be completed before the beam is enabled?
• A patient with a peripheral lung lesion that moves with breathing is being set up for stereotactic treatment on a linac. The team wants a volumetric check of the tumor's soft-tissue position immediately before beam-on every fraction, with imaging dose kept as low as reasonably achievable. Which imaging modality best meets that daily localization requirement?
• At simulation, a patient having treatment to the chest wall can hold both arms overhead only briefly, and with the arms at the sides the upper arms fall inside the planned beam paths. The setup must reproduce the same shoulder angle every day for the whole course. Which arm-positioning approach best fits these requirements?
• A boost plan is approved for a patient whose machine, immobilization device, and prescription are unchanged from the original course. The approved plan calls for a posterior isocenter shift of 1.5 cm, while the treatment record still shows a shift value of 0.0 cm. Which setup parameter must be entered and verified against the approved plan before the first boost fraction?
• Midway through a chest fraction, the patient on the table turns pale, sweats heavily, and reports feeling faint; the physician is down the hall and the emergency cart is outside the vault. Which immediate response best manages the deteriorating patient while help is on the way?
• A woman with a 3 cm, biopsy-proven, node-negative invasive breast carcinoma wants to keep her breast, and the surgeon confirms the lesion can be removed with clear margins. The tumor board also wants the lowest achievable local recurrence while the breast is preserved. Which treatment plan best delivers breast conservation, clear margins, and the lowest local recurrence?
• During a fraction a service error stops the linear accelerator partway through an arc, leaving the patient positioned on the couch while the console shows the fault message. Policy allows the beam to restart only after the physicist clears the unit, and the treatment record must show what actually delivered. Which response completes the equipment malfunction procedure?
• A liver SBRT patient has target motion larger than the 5 mm setup margin, breath-holds run out before the beam time ends, and the abdominal compression plate is painful over the treatment site. Respiratory gating with an external breathing surrogate is available. Which motion-management method best matches this patient's stated limits?
• On a busy day the schedule includes a pre-transplant whole-body treatment, a skin-wide electron treatment for a widespread superficial condition, a temporary cavity implant, and a conventional localized external beam. The team briefly disagrees about which description belongs to the skin-wide treatment. Which description correctly identifies total skin electron irradiation?
• Midway through a thoracic fraction, an elderly patient suddenly becomes short of breath, reports sharp chest pain with each breath, and the oxygen saturation starts falling. Which immediate response to this acute breathing emergency should the treatment team take?
• For a lung patient, the plan's registration instructions specify matching the tumor's soft-tissue edge on each daily image, but the automated match this morning locks onto the spine. Which check best validates the registration before the beams are treated?
• During setup for a supine spine field, the image shows the jaw edges running about ten degrees off the patient's spine, while the isocenter sits on the target and the beam must enter from the planned direction. Which single control change lines the field edge up with the spine?
• During fraction 14 of a lung boost course, the record-and-verify screen still shows the original 200 cGy dose and the old isocenter even though yesterday's revised plan was approved at 180 cGy with a shifted isocenter, and on-treatment imaging matches the new target. Which step confirms the plan version, isocenter, and dose before the beam is released?
• A tumor board reviews a 61-year-old with a 2.4 cm, node-negative, hormone-responsive breast tumor who hopes to keep the breast, and the team weighs surgery, radiation and systemic therapy. Which comparison of these options best supports recommending breast-conserving therapy for this patient?
• A patient with a lung tumor that shifts with breathing completed a 4D CT simulation, and fiducial markers are unavailable. Each day the team must confirm the soft-tissue position of the moving target before treatment. Which imaging approach best satisfies this daily localization requirement?
• During an arc treatment, the beam shuts off and the console shows a delivery fault before the planned monitor units are reached. The patient remains immobilized on the couch while the therapists decide how to respond. Which response correctly handles and documents this equipment malfunction?
• A patient in a thermoplastic mask is set up for a head-and-neck fraction, but a comfort adjustment leaves the skin marks misaligned with the room lasers. The console parameters match the treatment chart, and policy requires the isocenter to be confirmed against the simulated position before beam-on. Which verification step should the therapist complete first to confirm the isocenter?
• A plan-review worksheet lists three courses: course A gives electron treatments across the whole skin surface, course B gives fractionated irradiation to the whole body, including the lungs, liver and marrow, as transplant conditioning, and course C places an internal source in a surgical cavity. Which course should be labeled total body irradiation?
• A post-mastectomy patient is treated on a 6 MV linac with tangential fields at a fixed 100 cm SSD. Planning shows an even profile across the chest wall, but the buildup region leaves the dose at 3 mm depth well below the prescription, and the physician wants that superficial layer covered from the medial edge to the lateral margin. Which beam modifier should be added to bring the prescribed dose to the superficial chest wall layer?
• A patient receiving abdominal SBRT uses an abdominal compression plate because free-breathing motion was 14 mm at simulation. Marks, couch index, and isocenter were all set with compression at the recorded plate setting. At fraction one, the therapist aligned the tattoos to the lasers before applying compression, and the pre-treatment image showed the target 6 mm off. Policy requires imaging to serve only as confirmation of the setup. Which change to the abdominal compression setup sequence should be made first?
• A patient with a lung lesion is scheduled for stereotactic treatment in three fractions, and the lesion moves noticeably with breathing near the chest wall. The department offers kV cone-beam CT, MV portal imaging, kV orthogonal pairs, and surface-guided optical tracking. Which imaging method best confirms that this patient's lesion sits in the planned position before each fraction?
• A 52-year-old with a 3 cm biopsy-proven tumor confined to the primary site and regional nodes meets the surgeon, radiation oncologist, and medical oncologist at a multidisciplinary clinic, and each recommends a different approach. Which statement correctly describes the reach of surgery, radiation, and systemic therapy for this disease?
• During an afternoon fraction the treatment couch stops mid-travel and stays stuck, so the setup is finished manually and the beam is delivered. The physicist resets the machine and asks for a record of the event before the next patient is treated. Under the department's procedure, which requires documenting such events in both the treatment record and equipment log before the next patient, which entry most completely documents this equipment malfunction for the session?
• A patient with limited shoulder motion is scheduled for a chest treatment that was planned with both arms raised above the head. The therapist must keep the treatment volume aligned with the plan while the patient lies still for fifteen minutes. Which immobilization and positioning setup should be selected for the daily treatment?
• During setup for an anterior neck field, the light-field edge falls 1 cm short of the skin mark in the side-to-side direction even though the jaw-defined field size and collimator angle match the plan. Which machine control should the therapist adjust first to place that edge on the mark?
• A patient treated for an upper abdominal tumor shows more day-to-day shift in the anterior-posterior direction than expected even though the skin marks match the lasers. The department has indexed couch positions, surface-guided cameras, respiratory gating and an abdominal compressor. Which setup aid should you standardize and document first to reduce this variation?
• A patient with high-risk leukemia is scheduled for allogeneic stem cell transplantation. The prescription lists whole-body photon treatment delivered in two fractions per day with lung blocks, to be finished the day before the stem cells are infused. Which treatment technique does this prescription describe?
• A spine patient's plan calls for a couch shift of 1.0 cm superior and 0.5 cm toward the patient's right after verification imaging, and the record lists beam energy, field size, and monitor units for each beam. The patient is already aligned with the immobilization device and skin marks. Which pre-treatment verification covers every item stated for this fraction?
• A patient with a localized tumor asks the radiation therapist during setup how radiation differs from the surgery the oncologist mentioned and the systemic therapy other patients receive. The therapist keeps the answer accurate and general, centered on how each treatment reaches the tumor and the rest of the body. Which comparison correctly describes how each option acts on the disease?
• On the third fraction of a prostate treatment, today's image shows the same small offset of the target from the reference image that appeared on fractions one and two. The therapist is ready to treat and wants to keep the session moving. Which image-guidance check must be completed before beam-on for this fraction?
• During a lung treatment the patient signals through the intercom that they are suddenly very short of breath, and when you enter the room you find them coughing hard, pale, and slightly blue around the lips with about half of the fraction delivered. You are trained in basic life support. Which immediate response should the therapist take when breathing distress appears mid-fraction?
• A patient with widespread cutaneous T-cell lymphoma has plaques covering the trunk, arms, legs and scalp, and the oncologist wants a radiation option that treats the whole skin surface while keeping the dose shallow so deeper organs are spared. Which treatment option best fits that description?
• During plan review, an oblique photon field to a patient's sloped shoulder shows a hot spot on the crest and a cold band below it, with the isodose lines running diagonally across the target. Which beam modifier can correct this dose distribution?
• Daily imaging on a pelvic plan shows the target sitting superior to the planned isocenter. The physician approves a superior correction, and the shift is documented on the setup note while the patient stays on the couch. Which console operation should you perform to deliver this approved correction?
• A patient with a lung lesion that moves with breathing is set up for stereotactic treatment. The department offers daily orthogonal kV imaging, MV portal images of the treatment fields, and CBCT, and the lesion sits away from any fixed bony landmark. Which imaging strategy best verifies the target position for each fraction?