Test Bank for Principles and Practice of Radiation Therapy, 4th Edition Charles M.

Washingt

Test Bank for Principles and Practice of Radiation Therapy, 4th

Edition Charles M. Washington Dennis T. Leaver
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Unit I: Introduction
1. Cancer: An Overview
2. The Ethics and Legal Considerations of Cancer Management
3. Principles of Pathology
4. Overview of Radiobiology
5. Detection and Diagnosis
6. Medical Imaging
7. Treatment Delivery Equipment
8. Treatment Procedures
9. Infection Control in Radiation Oncology Facilities
10. Patient Assessment
11. Pharmacology and Drug Administration
Unit II: Physics, Simulation and Treatment Planning
12. Applied Mathematics Review
13. Introduction to Radiation Therapy Physics
14. Aspects of Brachytherapy
15. Special Procedures
16. Particle Therapy
17. Radiation Safety and Protection
18. Patient Safety in Radiation Oncology
19. Quality Improvement in Radiation Oncology
20. Surface and Sectional Anatomy
21. Simulator Design
22. Computed Tomography Simulation
23. Photon Dosimetry Concepts and Calculations
24. Photon Dose Distributions
25. Electron Beams in Radiation Therapy
26. Electronic Charting and Image Management
Unit III: Practical Applications
27. Bone, Cartilage and Soft Tissue Sarcomas
28. Lymphoreticular System Tumors
29. Endocrine System Tumors
30. Respiratory System Tumors
31. Head and Neck Cancers
32. Central Nervous System Tumors
33. Digestive System Tumors
34. Gynecological Tumors
35. Male Reproductive and Genitourinary Tumors
36. Breast Cancer
37. Pediatric Solid Tumors
38. Skin Cancers and Melanoma
Glossary
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 The exercises selected must be such as will strengthen these particular
groups of muscles, and, while taking the exercises, the entire attention must
be concentrated on the part being exercised.
Any lack of symmetry in the chest, spinal curvature, or actual weakness
of the lungs will necessitate the prescribing of special and carefully selected
exercises.
As to the exercises themselves, they should be so arranged as to bring
into play in a methodic manner all the muscles. All special and corrective
work must be supplemented by general work, which will increase the
organic vigor of the heart, lungs, and chest necessary to meet the vital
demands of the whole system. Games are, of course, most useful for this
purpose, but the games should not be too violent.
In most free exercises the limbs are used for weights of resistance. In a
man weighing one hundred and fifty pounds the arms usually weigh about
ten pounds each and the legs twenty pounds.
The Causes of Round Shoulders.—The general conditions are those that
produce muscular or constitutional weakness, as rapid growth, overwork,
the impure air of ill-ventilated rooms, acute illness, near-sightedness
uncorrected by glasses, lack of proper exercise, and the wearing of clothing
supported by suspenders bearing on the points of the shoulders, tending to
pull them downward and forward, or even to produce a painful deformity of
the scapula.
It is the rule rather than the exception to find, with round shoulders, some
inequality in the height. The right shoulder is apt to be the lower, owing to
the carrying of burdens on the right arm. Habitual standing with the weight
on the right leg contributes to a good many cases. Games in which the right
arm is almost exclusively used is another cause.
The Causes of Spinal Curvature.—The spinal column forms the central
support of the body, and, for grace and suppleness of motion, its thirty-four
joints should be constantly exercised, as well as the muscles which hold it
erect and support the head upon it, as well as attach the shoulders, hips, and
legs more or less closely to it. In brief, all the muscles of the back need
varied and regular exercise to maintain the erect position of the body, and
 from early childhood especial attention should be given to
develop and strengthen this region of the body.
The normal movements of the spinal column are
flexion, extension, side bending, and torsion. Flexion and
extension take place, for the most part, in the lumbar and
cervical regions.
Gould believes that astigmatism is a prominent factor
in the causation of spinal curvature; the curvature is
affected by the tilting of the head to one side in reading or
writing.
But a faulty postural habit is probably the most frequent
cause both in standing and at the desk. When the weight is
supported by the right leg, the left being used merely as a
prop; there is a marked C-shaped curve produced, with a
lowering of the right shoulder and prominence of the right
hip. This position is assumed by school children for long
periods of time, and there is a consequent overstretching
of the ligaments of the spine and hip. These cases are
generally accompanied by round shoulders and flat chest,
Fig. 29.—The protrusion of the abdomen, and rotation of the vertebræ.
spinal column
(Church and A muscle can be developed only by the active
Peterson). contraction and relaxation of its fibers. Continuous
tension quickly tires and lowers its tone, so that exercises
given for increasing muscular power should be comparatively quick and
frequently repeated, while those that aim at the stretching of muscles and
ligaments should be slow and long maintained.
In all cases where corrective treatment is needed the first thing to be
attended to is the general condition, and the best hygienic conditions must
be provided, the general health inquired into and attended to. In all cases the
eyes should be examined by a competent oculist.
All exercises and stretching movements should be given daily, with a
period of rest after three or four movements, and they should be so
alternated and combined that no two, employing the same muscles in the
same way, should follow one another, and so cause excessive fatigue.
 The Muscles of the Abdomen.—These muscles are most important for
breathing and therefore for health, for the retention in their normal position
of the various abdominal viscera, for good digestion and regularity of the
evacuation of the bowels. Sluggish digestion and constipation are among
the commonest evils in life, and they are generally connected with relaxed
abdominal walls and flabbiness of the abdominal muscles. Active pressure
of the abdominal muscles on the viscera massages the liver and presses
onward the contents of the intestines.
The protuberant abdomen may either be due to a faulty position in
standing or an excess of fat in the great omentum, a membrane intended to
protect the bowels. This excess of fat may be in turn due to lack of exercise
or an excess of sweets and starchy foods, and the reduction of this
superfluous fat by suitable exercises, properly taken, together with the
attention to the diet, not starvation, is the only common sense and safe way
for a woman to reduce her size.
The abdominal muscles are used in bending, in stooping forward, in
raising up from the recumbent position, somewhat in climbing, and in many
other movements. Trunk bending forward and backward; lateral flexions of
the trunk; bending of the knees down to a squatting position, together with
torsions, and all exercises derived from these types, bring into play and
exercise the abdominal muscles.

EXERCISES FOR DEVELOPING THE VARIOUS REGIONS

OF THE BODY

The following list of free exercises has been selected primarily for
developing the lungs and chest and correcting deformities, such as round
shoulders, stooping attitude, and beginning spinal curvature, when due only
to muscular weakness and faulty attitude in standing, sitting, and walking.
Fig. 28.—Correct attitude in
standing.
Fig. 30.—Correct attitude in
walking. First position.
Fig. 31.—Correct attitude in
walking. Second position.
Fig. 32.—Shoulder-blade exercise.
First position.
 Fig. 33.—Shoulder-blade exercise. Second position.

While each exercise calls into play many other muscles than the ones for
whose development the exercise is given, the exercise is classed under the
group for the region which it is especially designed to benefit.
Shoulder-blade Exercises (Fig. 32).—First Position.—Stand erect, with
the feet nearly together, and the palms of the hands brought together above
the head in the manner shown in the figure.
Second Position (Fig. 33).—Throw hands and forearms backward,
keeping the arms on a line with the shoulders, the elbows bent, and turn the
palms forward, as represented in the second position of the figure. Return to
the first position, and repeat ten times. These exercises strengthen
particularly the muscles between the shoulder-blades, whose function it is
to hold the shoulders back.
The first point in taking each exercise is to learn the correct attitude
before a mirror; after this has been mastered, the exercises should be taken
with a considerable amount of rapidity and force, but not so forcibly that
the collar-bone projects at its junction with the breast-bone. In throwing the
hands and forearms back, the force of the motion should come at the
elbows, not at the hands, and the shoulders should be carried as far back as
possible.
Shoulder-blade Exercises, Number 2 (Fig. 34).—Stand erect, with the
feet nearly together, and with the hands clasped behind the neck, as seen in
the figure. Then force the head and elbows strongly back. Relax, letting the
elbows come forward. Repeat ten times.
It will be readily seen that these shoulder-blade movements are exercises
for the arms and chest as well. The object being to raise and broaden the
chest.
Respiratory Exercises (Figs. 35, 36, 37).—First Position.—Stand with
the feet nearly together, the chin down, the arms extended downward, with
the backs of the hands touching, as shown in the figure.
Second Position.—The chin should be raised with the arms, so that in
the second position the head is held erect.
Third Position.—The movements of the hands are carried upward still
further and separated as shown in the figure. From this position the hands
should be brought downward in the large sweep of a circle to the original
position.
When these various movements have been accurately acquired, forcible
respiratory movements should be added. Begin to inhale forcibly as the
hands are raised, and hold the breath as long as possible while the hands are
held above the head, and exhale forcibly while the arms are being brought
down. These exercises bring into play the muscles of natural and forced
respiration.
Exercises for Forward Projection of the Chest and Retraction of the
Abdomen (Figs. 38, 39).—First Position.—Stand erect, with the arms
behind the back, the hands resting in the small of the back, the fingers
interlocked, and the palms facing backward.
Second Position.—Straighten the arms, turn the palms inward and then
downward, and lastly out, all the while keeping the fingers interlocked. Roll
the shoulders and arms into supination, and extend the neck, as in the
attitude of the second position of the figure. Retain this position for a
moment, then reverse slowly back into the first position.
When the fingers cannot be held in this position, start by holding a loop
of cord in the hands, instead of interlocking the fingers.
This exercise is particularly valuable for projecting the chest forward,
stretching the shortened ligaments, and drawing in the abdomen. Care
should be taken to have the chin pressed backward when the arms are
brought downward and turned outward.
Shoulder and Back Exercises (Figs. 40, 41).—First Position.—Stand
erect, with the feet together, and both arms extended on a plane with the
shoulders, so that in the first position the left arm is extended directly in
front of the body and the right arm on the same plane directly behind the
body. The arms must be held rigidly on the same plane.

Fig. 34.—Shoulder-blade exercise. Number 2.

Fig. 35.—Respiratory exercise. First
position.
Fig. 36.—Respiratory exercise. Second
position.
Fig. 37.—Respiratory exercise. Third
position.
Fig. 38.—Exercise for forward projection of
chest and retraction of abdomen. First
position.
 Fig. 39.—Exercise for forward
projection of chest and retraction of
abdomen. Second position.
Fig. 40.—Shoulder and back exercises. First
position.
Fig. 41.—Shoulder and back exercises. Second position.
Fig. 42.—Leg exercises. First position.
Fig. 43.—Leg exercises. Second
position.
 Fig. 44.—Squatting exercises for muscles of spine
and abdomen.

Second Position.—By a circular movement, the position of the left arm is

assumed by the right, and vice versa. During the entire movement the feet
must be kept firmly planted on the floor, pivoting at the hips only, while
making the continuous circular movement of the arms.
These movements consist in a torsion of the body around the axis of the
spinal column, and to these can be added deep inspirations from left to
right, with expirations from right to left. In addition to the effect on the
circulation, the respiratory movements keep up the nutrition and efficiency
of the lungs, which in old age undergo a kind of atrophy, and also maintain
the elasticity of the chest-walls, which are apt to become stiff through
disuse, and so interfere with the movements of the lungs and pleura.
Leg Exercises (Figs. 42, 43).—First Position.—Stand erect, with the
hands resting on the hips and the legs crossed at the knees, with the right
foot in front, as shown in the figure.