Because immobilization can be the weakest link in the chain of events leading to the cure for the pediatric patient, the purpose of this module is to acquaint the learner with an overview of methods used when simulating a pediatric patient using a dedicated CT scanner. The module includes: immobilization techniques used with and without the complication of anesthesia, the need for creativity in immobilization when prone or supine, and the necessity of a team approach when dealing with family members.

This activity is approved for credit by the ASRT. Course Approval Expiration/End Date: November 1, 2011 Category A Credits

This activity may be available in multiple formats or from different sponsors. The ARRT does not allow CE activities such as internet courses, home study programs or directed readings to be repeated for CE credit in the same or any subsequent biennium.

After studying the information provided, the learner will be able to:

1. Explain why it is often more difficult psychologically to simulate a pediatric patient.
   
2. List the radiation treatment procedures used before bone marrow transplantation.
   
3. List the team members involved in a pediatric simulation.
   
4. Discuss the importance of advance preparation by the radiation therapist.
   
5. Explain why a current BUN and Creatinine is necessary if IV contrast is to be given.
   
6. Explain why it is important the primary oncologist be in the department the day of the simulation.
   
7. Explain the reason why a child's port should be flushed before and after the contrast has been administered.
   
8. Compare the difference in room preparation for a patient who needs anesthesia to one who does not.
   
9. Explain why it is important to perform appropriate quality assurance before the patient is simulated.
   
10. Explain why age-appropriate communication is so important when describing medical procedures to a child.
    
11. Discuss the importance of establishing trust with the parents and family.
    
12. Explain why voluntary motion is a primary concern when simulating children.
    
13. List five examples of immobilization tools used in simulation.
    
14. Explain why set up marks must be placed on the immobilization tool as well as the patient.
    
15. Name the immobilization tool that, when used, would not require set up marks be also placed on the skin.
    
16. Evaluate when a chin should be extended and when the chin should not be extended.
    
17. Discuss three immobilization techniques between a set up on a child with anesthesia and one without anesthesia.
    
18. Explain how to prevent plastic tubing from fusing to the facemask.
    
19. Give four examples of gliomas and why they are best treated in th eprone position.
    
20. Discuss how to program the CT scanner for a small vs. a large child.
    
21. Explain why the brain must always be scanned with the thinner slice thickness.
    
22. Discuss the parameters used when setting up the CT scanner to scan the prone CSI patient.
    
23. Name the two locations in which tumors present that would require a supine set-up.
    
24. List two examples of tumors that would fall into the chest or abdomen category.
    
25. Explain how the correct amount of contrast is determined for a pediatric patient and the administration routes.
    
26. Give an example of a nonionic, iodinated water-soluble contrast medium.
    

Biobiolography
Bentel GC. Patient positioning and immobilization in radiation oncology. New York: McGraw-Hill; 1998.

Chao KS, Perez CA, Brady LW, eds. 2nd ed. Radiation oncology management decisions. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2001.

Dasher B, Wiggers N, Vann AM. Portal design in radiation therapy. 2nd ed. Houston, TX: D W V Enterprises; 2006.

Rubin P, ed. Clinical oncology: a multidisciplinary approach for physicians and students. 8th ed. Philadelphia, Pa.: WB Saunders & Co.; 2001.

Washington CM, Leaver DT, eds. Principles and practice of radiation therapy: practical applications. St. Louis: Mosby; 2003.

Webliography
CIVCO, Inc.: http://www.civco.com/oncology/vaclok/index.html Accessed October 1, 2009.

WFR/Aquaplast Corporation: http://www.wfr-aquaplast.com/ Accessed October 1, 2009.

Harpell Associates, Inc.: http://www.harpell.ca/radiation-therapy/ Accessed October 1, 2009.