Effects of Radiation Therapy on Abdomen and Pelvis Imaging

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.75
Procedures: 1.75
Abdomen and Pelvis: 1.75

Magnetic Resonance Imaging: 1.75
Procedures: 1.75
Body: 1.75

Nuclear Medicine Technology: 1.25
Procedures: 1.25
Endocrine and Oncology Procedures: 1.25

Registered Radiologist Assistant: 3.25
Procedures: 3.25
Abdominal Section: 3.25

Sonography: 1.75
Procedures: 1.75
Abdomen: 1.50
Gynecology: 0.25

Radiation Therapy: 3.50
Safety: 0.25
Radiation Protection, Equipment Operation, and Quality Assurance: 0.25
Procedures: 3.25
Treatments: 3.25

Outline

1. Introduction
2. Radiation Biology: A Refresher
3. External Radiation Delivery Techniques
   1. Traditional External-Beam Radiation Therapy
   2. Conformal Radiation Therapy
      1. Intensity-modulated Radiation Therapy
      2. Stereotactic Body Radiation Therapy
   3. Proton Beam Therapy
4. Internal Radiation Delivery Techniques
   1. Brachytherapy
   2. Radioembolization
5. Posttherapeutic Imaging Findings
   1. Liver
      1. Findings after External-Beam Radiation Therapy
      2. Findings after Radioembolization
   2. Spleen
   3. Pancreas
   4. Bowel
   5. Kidneys and Ureters
   6. Bladder
   7. Female Pelvic Organs
   8. Male Pelvic Organs
   9. Blood Vessels
   10. Bones and Marrow
   11. Secondary Malignancies
6. Conclusion

Objectives

Upon completion of this course, students will:

1. differentiate the various radiation delivery techniques
2. define innocent bystander tissue
3. know the primary reason for cell death
4. understand the rationale for fractionating the dose
5. differentiate between conditional and inherent radiation sensitivity
6. define cellular sensitivity
7. know the most common acute effect in epithelial tissue
8. know the effect of radiation on stromal parts of organs
9. know which was the first cancer to be treated with radiation after 1895
10. understand the rationale for using frontal and lateral radiographs for treatment planning
11. define the date of progress
12. understand dynamic moving leaves for collimation
13. understand the significance of “beams eye view” for sparing of normal tissue
14. know the relationship between radiosensitivity and cellular regeneration
15. be familiar with IMRT
16. describe how IMRT is modeled
17. differentiate the high and low dose region in relation to IMRT
18. understand the differences between SBRT and IMRT
19. understand the objectives of fractionation in radiation therapy
20. describe the physical properties of a proton beam when traversing tissues
21. know the major advantages of proton beam therapy
22. describe the methods for delivering radiation in brachytherapy
23. state the radionuclide used for prostate cancer brachytherapy
24. state the method of brachytherapy for gynecologic cancer
25. know the type of hepatic malignancies treated by radioembolization
26. understand the radioactive source used for radioembolization
27. know the factors that affect the likelihood of recurrence of disease after radiation
28. be familiar with the radiation dose ranges at which imaging changes occur
29. describe the histologic changes in the liver after radiation therapy starts
30. recognize the radiation changes in liver parenchyma as seen on CT images
31. recognize that using SBRT or IMRT will change the shape of the treated zone
32. understand the timeline in which veno-occlusive disease manifests
33. recognize how regeneration of the liver manifests
34. recognize the tumor changes after radioembolization
35. state the dose at which the spleen exhibits damage
36. know the relationship between cell turnover and radiosensitivity in the small bowel
37. recognize the chronic effects of radiation exposure in the small bowel
38. understand the difficulty differentiating between similar radiation effects and surgical effects
39. recognize imaging changes due to partial exposure of the kidney to radiation for treatment of adjacent structures
40. recognize the acute effects of radiation on the bladder
41. know the terminology associated with ovarian preservation
42. recognize the chronic effects of radiation in the larger blood vessels
43. state the one tissue where radiation-induced effects are unique
44. know which type of radiation-induced tumor is aggressive
45. understand the basis of radiosensitivity and the resulting effects of radiation-induced injury