The document provides an introduction to radiation oncology nursing, describing the different types of radiation therapy including external beam radiation and brachytherapy, the goals and mechanisms of radiotherapy, nursing care of patients receiving radiation including symptom management, and side effects of radiation treatment. Radiation oncology nurses play an important role in caring for cancer patients undergoing radiotherapy by ensuring radiation safety, managing side effects, and providing education to patients.

1. INTRODUCTION TO
RADIATION ONCOLOGY
NURSING
MATHEW VARGHESE V
MSN(RAK),FHNP (CMC Vellore),CPEPC
Nursing officer
AIIMS Delhi
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2. Radiation Therapy
 Definition
 Sources of radiation.
 Goals of radiotherapy.
 Mechanism of action.
 Principles of radiation protection.
 Types of radiation therapy.
 Care of clients receiving radiation
therapy.
 Side effects & symptom management.
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3. RADIOTHERAPY
◦ One way to stop the cancer
from growing is to interfere
with the cancer cell’s ability to
multiply.
◦ Radiation at high dosages
causes changes in the cancer
cells that stops the cell’s
ability to multiply and
eventually kills the cancer cell.
◦ In some cases, it destroys
cancer cell, while in others, it
slows down the growth.
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4. Radiotherapy
 RADIOTHERAPY is the treatment of neoplastic
disease using high energy ionizing rays (x-rays or
gamma rays) to kill cancer cells.
 These may be generated by radioactive sources or
linear accelerators.
 THE HIGHER THE ENERGY OF THE PHOTON,
THE DEEPER IT CAN PENETRATE THE BODY
BEFORE LOSING ITS EFFECT.
 Radiation deters the proliferation of malignant cells
by decreasing the rate of mitosis or impairing DNA
synthesis.
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5. Sources of Radiation
 COLBALT 60
 CESIUM 137
 IODINE 131
 IRIDIUM 192
 RADIUM 226
 RADON 222
 STRONTIUM 90
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6. Gamma & X-rays
High Energy
Ionizing
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7. Goals of Radiotherapy
 Curative
 Control:
Adjuvant
Pre/Post Operative
Intraoperative
 Palliation
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8.  Radiation therapy may be in many types of
cancer if they are localized to one area of the body.
 It may also be used as a part of therapy,
e.g.. after performing surgery for removing a primary
malignant tumor, it can be used to prevent tumor
recurrence ( for example, early stages of breast
cancer). It is common to combine radiation therapy
with surgery, chemotherapy, hormone therapy and
immunotherapy.
 It is , and has been
used before, during and after chemotherapy in
susceptible cancers.
 It may also be used as treatment where
cure is not possible and the aim is for local disease
control or symptomatic relief.
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9.  Ionizing radiation works by damaging the DNA
of cancerous tissue leading to cellular death.
 To spare normal tissues, shaped radiation
beams are aimed from several angles of
exposure to intersect at the tumor, providing a
much larger absorbed dose there than in the
surrounding healthy tissues.
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10. Radiation Protection:
Principles
ALARA Principle The physical protection against
external radiation is based on the
following three principles:
-distance from the source of
radiation (distance),
-limitation of the time of irradiation
(time),
-absorption of radiation (shielding).
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11. Time
 Minimize time spent in close
proximity to the patient. Radiation
exposure is directly related to the
time spent within a specific distance
of radiation source. Care giver
should not exceed 1/2 to 1 hour
exposure per shift.
◦ Organize care, prior to entering room.
◦ Assemble all equipment, prior to room
entry
◦ In room, place supplies/equipment
within easy quick access.
◦ Post time guidelines on door. 11

12. Distance
 The amount of radiation decreases with
increase in distance.
 Doubling the distance from the radiation
source, Quarters the amount of radiation
received.
 If the exposure at 1 meter from the Radiation
Source is X, the exposure at 2m is ¼ of x, and
at 4m, one sixteenth.
Interventions:
 Teach patient self-care & rationale for isolation.
 Limit patient care by individual caregiver.
 Use communication devices outside room to
interact whenever possible.
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13. Shielding
 When used properly, lead shielding
can provide added protection from
radiation.
 In practice, nurses find lead shielding
apron cumbersome to work with.
 Nurses wear a film badge.
 NB: Pregnant nurses should not care
for radiation patients.
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14. Types of Radiation Therapy
 External Beam or Teletherapy
• most common type of radiation therapy using
machine (linear accelerator).
• patient is not radioactive.
 Internal radiation or Brachytherapy
• implant is placed inside patient
temporary/permanent.
• patient is radioactive.
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15. Teletherapy
 Delivering radiation from a source at a
distance from the target.
 Radiation department administers the
dose.
 Advantage: skin sparring effect, giving
max radiation to tumor not the skin.
 Patient is monitored via TV or intercom
 Treatment approx. 10 minutes.
 Not painful, though patient may feels
heat or tingling.
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16. EXTERNAL BEAM RADIATION
THERAPY
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17. Brachytherapy
 Delivers a high dose of radiation to a localized area.
 The specific radioisotope is chosen on the basis of
its half-life
Brachytherapy may be sealed or unsealed:
SEALED:
Interstitial
Intracavitary
UNSEALED:
Systemic (IV, oral)
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18. Brachytherapy
SEALED
 Emits low energy
continuously
 Interstitial &
intracavitary
implants
 Ex. Seeds,
APPLICATORS
 PATIENT EMITS
RADIATION but
NONE IN EXCRETA
UNSEALED
Injected, instilled or
oral.
Systemically
EX. I131
PATIENT AND
EXCRETA are
RADIOACTIVE
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19. Sealed Brachytherapy:
Intracavitary:
 Radioisotopes (cesium or radium) put inside
the applicator & placed in body cavity for a
specific amount of time (24-72hours)
 When treatment completed, applicator &
radioactive material removed
 treats cancer of uterus & cervix.
Interstitial:
 needles, beads, seeds, ribbons or catheters
are placed directly into tumor (breast,
prostrate)
 Radioisotopes: iridium, cesium, gold, radon
 Placement can be temporary or permanent
 Treats Prostrate, cervical, esophagus
cancer etc.
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20. BRACHYTHERAPY
APPLICATORS
Fletcher-Suit applicator
Radioactive seeds implanted in prostate 20

21. Nursing Care of the patient with
Sealed Implant
 Provide Private room with bathroom
 Radioactive material sign should be placed
outside
 Wear dosimeter
 No pregnant staff
 Visitors limited to 30 mins per day
 Visitors are restricted and must remain at 6 feet
distance
 All dressings & linens saved until implant
removed
 LEAD CONTAINER & LONG HANDLED
FORCEPS,LEAD GLOVES KEPT IN ROOM IN
EVENT OF DISLODGEMENT
 REMEMBER ALARA
TIME
DISTANCE
SHEILDING 21

22. Nursing Care of patient with
UNSEALED Implant
 Presents potential contamination hazard.
 All articles in room are considered
contaminated.
 After discharge, articles are discarded but
taken to protected area ‘till detectable
radioactivity decays’.
 Rubber gloves worn with direct care
 No pregnant staff
 Articles in room: phone, call light, floors
covered with plastic.
 Disposable plastic /paper should be used for
dietary trays & utensils.
 Flush toilet used by patient several times.
 Keep linen & gowns kept in separate isolation
bags 22

23. Loss of Radioactive Material
 Considered an emergency.
 Search should initiated by radiation
staff.
 Removes nothing from the room
while patient has radioactive
material in place.
 If radioactive material is found, use
long handled forceps & gloves.
 Notify Atomic Energy Center.
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24. RADIATION THERAPY : INJURY
Phases of Radiation Injury:
Early (acute) Phase: occurs within weeks and resolve
4-6 weeks post radiation. Usually temporary and
affect tissues with rapidly dividing cells (skin,
mucous membranes)
Late Phase: may occur months/years later and
usually result from damage to the micro-circulation.
Affect any/all tissues especially: lymph, thyroid,
pituitary, breast, brain, bone, cartilage, pancreas
and bile ducts.
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25. SIDE EFFECTS OF RADIATION
THERAPY
Factors influencing degree & occurrence of
side effects due to Radiotherapy
 Body site irradiated
 Dosage
 Extent of body area treated
 Method of radiation delivery
 Age of client
 General health of client
 Previous surgeries & chemotherapy
 Radiosensitivity of tissue/organ treated.
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26. Symptom Management in
Radiation Oncology
 Nausea & vomiting
 Diarrhea
 Xerostomia
 Ocular symptoms ( edema, dryness, photophobia)
 Oral mucositis
 Alopecia
 Hyperthermia
 Headache
 Cystitis
 Esophagitis
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27. Skin Reactions
 Acute: begin about 2 weeks after start
of treatment and resolve over next 3-4
weeks. Reactions include erythema,
dry desquamation, wet desquamation
 Chronic: may occur years later and
include atrophy, pigment changes,
fibrosis and telangiectasia.
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28. Dry desquamation
 Begins within 7-10 days of treatment
 Erythema that may progress to dry, itchy skin
 May be scaling, flaking, peeling
 Result of partial loss of the epidermal basal
cell layer.
Wet desquamation
 Result of complete destruction of the basal cell
layer
 Blister, vesicles, and serous oozing occur
 Pain may occur if nerve endings are exposed
 Occurs more often in areas of friction &
moisture (skin fold, groins)
 Increased risk of infection (may require break
in treatment)
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29. General Skin Care
 Wash daily with water or mild scent-free soap
 Use hand to wash the area.
 Rinse soap well.
 Pat skin dry.
 Don't use powders, creams unless ordered by
Oncologist.
 Wear soft clothing over radiation site (cotton).
 Avoid belts, straps & tight clothing.
 Avoid sun exposure.
 Shave with electric razor.
 Do not use tape over site.
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30. Alopecia
 May occur within the treatment field.
 Extent depends upon area of
treatment and dose of XRT.
 Often patchy in appearance.
 Usually begins 2 weeks after start of
XRT.
 Usually temporary, but may be
permanent.
 Regrowth usually begins 3-6months.
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31. Mucositis
 Inflammation of the mucosal lining of the G.I.
tract
• If oral cavity - stomatitis
• If esophagus – esophagitis
 Common in patients receiving RT to head & neck
 Severity depends on dose, size of field, and
fractionation schedule of RT
Symptoms include:
 Soreness or burning in mouth/ throat
 Difficulty swallowing
 Sensation of “having lump in throat”
 Redness, tenderness, or ulcerations
in the mouth
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32. Assessment of mucositis
 History
- Oral symptoms
- Food and fluid intake
- Difficulty swallowing
 Physical
- Assess oral cavity for redness, inflammation, ulcers, infection
 Investigations
-Take culture Swab of lesions if Candida or herpes suspected
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33. MUCOSITIS
INTERVENTION
Instruct patient/caregiver to:
 Gently brush all surfaces of teeth, gums, and tongue
with a soft nylon brush.
 Brush with a nonirritating dentifrice such as baking
soda.
 Remove and brush dentures thoroughly during and
after meals and as needed.
 Rinse the mouth thoroughly during and after brushing
 Avoid alcohol-containing mouthwashes.
 Use recommended mouth rinses:
o Hydrogen peroxide and saline or water (1:2 or 1:4).
o Baking soda and water (1 tsp in 500 ml).
o Salt (.5 tsp), baking soda (1 tsp), and water (100 ml).
 Keep lips moist.
 Avoid use of tobacco and alcohol.
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34. Xerostomia
 Dryness in the mouth caused by lack
of normal secretion of saliva
 Salivary glands very sensitive to RT
 Severity related to dose
 May be permanent with higher doses
 Lack of moisture to mucosa causes
irritation to the mucosa, fissures may
develop on the corners of the mouth
 Xerostomia promotes accumulation
of bacteria and plaque increasing
susceptibility to infection, dental
caries, and periodontal disease
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35. Xerostomia Interventions
 Good oral hygiene
 Frequent sips water, sugarless gum, avoid dry
foods, liquids with meals
 Avoid alcohol and smoking
 Humidifier
 Artificial saliva i.e. Moistir ac meals, hs, & prn
 Pilocarpine for radiation induced Xerostomia
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36. Diarrhea
 Passage of frequent (more than 3/24hrs), loose,
watery stool
 Can lead to dehydration, malabsorption, fatigue,
hemorrhoids, and perianal skin breakdown
 Caused by irritation/inflammation of the bowel
lining
 Risk for Diarrhea
 Higher in patients undergoing chemo or RT to
abdomen or pelvis
 With XRT usually develops 10-15 days into
treatment
 Lasts 2-3 weeks after treatment
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37. Assessment of Diarrhea
 History - onset, pattern, number of
B.M.’s/24 hrs.
 Physical – vital signs, assess
hydration status
 Psychological – anxiety, stress
 Investigations – serum electrolytes,
creatinine & urea, stool cultures &
stool for c. difficile
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38. Interventions
 Radiation induced diarrhea usually managed
initially with dietary changes
- Small freq. meals
- Drink 8-10 glasses of fluids
- Low fat, low fiber diet
- Avoid gas producing foods
- Avoid caffeinated beverages
 Loperamide – if patient has more than 3 watery
B.M.’s per day
 Protect peri-anal area form skin breakdown
- Keep area clean and dry
- Sitz bathes several times a day can ease
discomfort
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39. Other complications radiation
treatment
 Cystitis (usually occurs 1-2 weeks
post XRT and subsides 2 weeks after
XRT complete
 Lhermitte’s syndrome – after spinal
cord radiation
 Vaginal stenosis – after XRT to pelvis
 Radiation pneumonitis – after XRT to
lungs
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