Slackers radiation oncology fact stack
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Slackers Radiation Oncology Fact Stack. Mike Ori. Disclaimer. These represent my understanding of the subject and have not been vetted or reviewed by faculty. Use at your own peril. I can’t type so below are common missing letters you may need to supply e r l

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Slackers Radiation Oncology Fact Stack

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Slackers Radiation Oncology Fact Stack

Mike Ori


  • These represent my understanding of the subject and have not been vetted or reviewed by faculty. Use at your own peril.

  • I can’t type so below are common missing letters you may need to supply

  • e r l

  • I didn’t use greek letters because they are a pain to cut and paste in.

  • What are the five stages of cancer diagnosis and therapy

  • Screening

  • Diagnosis

  • Staging

  • Therapy

  • Follow-up

  • What is the most successful use of radiology for screening

  • Mammography

  • What is one area where radiology techniques have not been successful in screening

  • Ultrasound screening of the prostate

  • Explain the role of contrast kinetics in MRI

  • Wash-in and wash-out times help differentiate benign and malignant

  • Normal tissue tends to have slower wash-in and wash-out kinetics than tumor.

  • What is a sestamibi scan

  • Use of 99mTc-sestamibi to identify areas of angiogenesis and tumor.

  • Compare sestamibi scans to MRI

  • Uses ionizing radiation

  • Not as available as MR

  • Faster

  • Cheaper

  • What is octreotide scanning

  • A somatostatin-like compound that can interact wit somatostatin receptors on the surface of cells. Some types of cancer (neuro-endocrine mostly) are notable for such receptors.

  • Compare octreotide scanning to MRI/CT

  • Sometimes shows mets when other modalities don’t

  • Poorer anatomic localization than other modalities

  • Can be used to indicate treatment with yttrium 90-octrotide

  • What is MRI spectroscopy

  • The use of the MRI machine to perform spectroscopic analysis of tissue to look for marker compounds that indicate growth or abnormal metabolism.

  • Rarely used capability due to reimbursement

  • What radiographic techniques can be used to stage cancer

  • CT

    • The workhorse

  • PET

    • Especially when combine with CT

  • MRI

    • Increasing in use. Dominant in some areas

  • Radionucleotide bone scans

    • For skeletal mets

  • Ultrasound

    • Rarely

  • How does PET scanning work

  • Fluoro-D-Glucose is injected into the body. Hot spots appear in any tissue actively metabolizing glucose. This includes tumors but also inflammed and regnerating areas.

  • For what cancers is PET scanning approved

  • Non-small cell lung cancer

  • Colorectal cancer

  • Melanoma

  • Lymphoma

  • Head and neck cancer (not thyroid or CNS)

  • Esophageal

  • Cervical

  • Breast monitoring and restaging

  • Thyroid restaging

  • Explain radionucleotide bone scans

  • 99mTC-methylene diphosphonate is injected into the body and incorporated into hydroxyapatite in the bone by osteoblasts. Thus areas of bone growth are visible.

  • Needs follow-up anatomic imaging

  • What is the role of radioactive iodine in the treatment of thyroid neoplasia

  • RAI is used post surgery to destroy remaining thyroid tissue.

  • What is image guided therapy

  • The use of radiology techniques in the performance of treatment

  • Intra arterial chemo catheter

  • Embolization

    • Simple

    • Chemo

  • Alcohol ablation/cryotherapy

  • RF ablation

  • Focused ultrasound

  • What is RECIST

  • Response evaluation criteria in solid tumors is an heuristic used to quantify the change in a solid tumor over time.

    • CR = complete response

    • PR = partial response, 30% decrease

    • PD = progressive disease, 20% increase

    • SD = stable disease

  • What type of radiation is used in radiotherapy

  • Ionizing radiation such as x-rays, gamma rays, electrons, protons

  • What device produces the radiation used most predominantly in the US

  • The linear accelerator or linac

  • How many linacs can fit on the head of a pin?

  • None.

  • Differentiate teletherapy from brachytherapy

  • Teletherapy uses a radiation beam generated by source remote to the patient. This is your classic sci-fi death ray.

  • Brachytherapy places an intrinsically radioactive substance in close approximation to the target tissue.

  • What is linear energy transfer

  • The amount of energy transferred per unit length of track

  • What is the bragg peak

  • The point of maximum energy release along a track.

  • Differentiate directly ionizing from indirectly ionizing radiation

  • Directly ionizing radiation has sufficient energy to directly disrupt the atomic structure of DNA. Protons.

  • Indirectly ionizing radiation creates free radicals that damage DNA. X-rays.

  • What is the primary method of cell killing caused by radiation

  • Double stand DNA breaks that are improperly repaired.

  • Why are oxygenated cells more susceptible to radiation than are hypoxic cells

  • The ionizing process generates free electrons which are taken up by oxygen to generate oxygen radicals which attack DNA. In hypoxic conditions, less oxygen is available to generate free radicals.

  • Which phase of the cell cycle is sensitive to radiation? Which is resistant?

  • G1/M are sensitive

  • S is resistant

  • What factors influence the survival of a radiated cell?

  • Position in the mitotic cycle

  • Molecular checkpoint activation

  • Hypoxia

  • Repopulation

  • Describe how a 50Gy dose of radiation is delivered to patients

  • The dose is usually fractionated into multiple doses of ~2Gy. These are then delivered over the course of many days until the total prescription is delivered.

  • Describe image modulated radiation therapy

  • IMRT uses a multi-leaf collimator shape a radiation beam to limit exposure of adjacent structures.

  • List several benign diseases for which radiotherapy can be prescribed

  • Omas of the CNS

    • Schwanoma

    • Chordoma

    • Meningioma

    • Pituitary adenoma

  • AVM

  • Trigeminal neuralgia

  • Pterygium

  • Heterotopic ossification

  • Trigeminal neuralgia

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