Part 5 - Case Scenarios

The four case scenarios found in this section will help you examine your clinical skills and knowledge. Consider how you might approach each case as a practising Canadian radiation therapist.

Once you have considered how you would approach each case, click “Things to consider...” under each scenario to view the questions you should be asking for each case.

Case Scenario 1: Breast

Mrs. Michelle Lambert, an obese 42-year old female, has been diagnosed recently with breast cancer. She will receive 6 cycles of chemotherapy. Then, she will receive external beam radiation therapy to the breast only, with a boost to the lumpectomy cavity.

Things to consider...
  • Can you explain why combined modalities or treatments are used to treat breast cancer?
  • Do you understand the legal and ethical implications of informed patient consent?
  • Do you know about privacy and confidentiality within the healthcare setting?
  • What set-up issues should you consider for proper treatment?
  • What are the standard field borders?
  • What documentation is required?
  • What factors must you consider to make sure the treatment plan is suitable for the patient’s disease?
  • Using portal imaging, can you describe a proper set-up? What difficulties or complications might occur and how would you correct these?
  • Can you identify a situation where a treatment recalculation may be required?

Case Scenario 2: Gynecological

Ms. Raleigh Smith, a 29-year old female, has been diagnosed recently with Stage IIB cancer of the cervix. She will receive external beam radiation therapy and chemotherapy. In addition, Ms. Smith will have three high-dose-rate (HDR) brachytherapy insertions. Ms. Smith and her husband have arrived for the education and CT-Simulation planning session.

Things to consider...
  • What information will you give the patient about the external beam and HDR brachytherapy treatments?
  • How will you position this patient for her CT-Simulation?
  • What scan limits will you apply during the CT-Simulation?
  • What critical organs will you contour within the treatment volume?
  • Do you understand the role of brachytherapy in the treatment of this cancer?
  • What dose of radiation would you expect this patient to receive by the external beam and by brachytherapy?
  • What side effects would the patient expect from the radiation therapy treatment? When might these side effects occur?
  • Should this patient be referred to see another health care professional? If so, whom?
  • What effect will this treatment have on the long-term health and well-being of this patient? Consider survival, sexuality and fertility.

Case Scenario 3: Head and Neck

Mr. Paul Rossetti, a widowed 77-year old man, has oral cancer. He will receive 7 weeks of radiation therapy treatment using an IMRT technique. Mr. Rossetti has agreed to participate in a clinical trial and has signed the appropriate patient consent forms.

Things to consider...
  • What positioning devices would you expect this patient to have for the treatment? How would you correct any problems with these devices?
  • What does IMRT stand for? Do you understand the differences between conventional, 3D conformal and IMRT techniques?
  • Can you identify the acceptable dose/fractionation regimes for this particular site?
  • Can you apply your knowledge of cross-sectional anatomy to oral cancer?
  • Are you familiar with the emerging imaging technologies that could be used to ensure accurate IMRT treatment for this patient?
  • Do you understand the reactions to radiation therapy this patient is likely to have? When they will occur?
  • Do you know the radiation therapists’ role in assessing the patient’s side effects? What other professionals should be involved in this patient’s care?
  • What other difficulties might Mr. Rossetti experience? Consider medical, nutritional and psychosocial needs.
  • Can you identify situations where a calculation modification may be required? Can you take the appropriate action to make those changes?
  • Do you know the clinical trial in which this patient is enrolled? Do you know what is the role of the radiation treatment in this trial?

Case Scenario 4: Prostate

Mr. Harvey Jacobs is a 75 year old man recently diagnosed with a T4, high grade cancer of the prostate. The treatment plan for Mr. Jacobs includes large field radiation therapy to the pelvis, followed by a boost to the prostate.

Things to consider...
  • Do you know the importance of PSA or prostate-specific antigen in the detection and monitoring of prostate cancer?
  • Can you describe the role of radiation therapy treatment in the pathology and staging of prostate cancer?
  • Why should a patient have a full bladder and empty rectum for this treatment?
  • What are acceptable dose/fractionation regimes for this treatment plan?
  • Do you understand the role of fiducial markers or reference points to determine accurate field placement?
  • Using portal imaging, what factors determine the correct set-up? What are the possible difficulties or complications? What would you change to achieve acceptable set-up?
  • Can you apply your knowledge of cross-sectional anatomy and landmarks of the pelvis to treat the whole pelvis or provide a boost to the prostate?
  • What chronic reactions may this patient experience as a result of this treatment?