1. Mostafa El-Haddad MD., FRCR., HMD. Tips and Tricks ™ By

2. Category 1 Priority; SCC of the head and neck region. SCC cervix. Non-small cell carcinoma of lung. Guidelines for the Management of the Unscheduled Interruption or Prolongation of a Radical Course of Radiotherapy (2nd Edition. 2002).

3. MD Anderson series showed that completed combined treatment (Surgery + Radiotherapy) in 11 weeks is better than 11 to 13 weeks and more than 13 weeks is the worst.

4. Why Head And Neck Is Special Very Complicated anatomy. Many risk organ in a very narrow space. Needs high precision. Patients in very bad shape. RCR report for priority.

5. General

7. Positioning

8. Head Rest Trick!

9. A comfortable head support is one that tightly fits to the posterior surface of the head and neck and help the patient to maintain the position without straining. The neck is rested but not the head, this open room for a movement

10. Supine Position. Lateral position Open neck position.

11. Lateral or Open Neck

12. Extension is it Necessary?

14. Brain inclusion with more extension. Neck to be included or not.

17. Neutral Chin Position

18. Neutral Position

19. Maxillary Sinus

21. Another Method Gantry

23. Head supports Hyperextension can be achieved by elevating the chest without make a strain on the head.

24. When Extension is Not Necessary?

25. Oral Cavity

26. Pushing The lip forward in Tongue cancer But avoid tissue equivalent material

27. Tongue depressor may be different Spot the difference?

28. Tongue Bite Or Mouth Opener

29. Shielding Stents

31. Open Mouth or Closed when and why?

32. Hypopharynx

33. With Tongue Bite

34. Without Tongue Bite

35. Energy Used

36. Ipsilateral neck failure as first event (13%) than patients treated by 60C0 and 4 MV (9%). This difference was not statistically significant.

37. Beam Spoiler

38. Larynx

39. 1- Identify the anatomy and orientation. 2-Which is an indirect (mirror) laryngoscopy view and which is a flexible nasolaryngoscopy view ?

40. Under Wedging in Cancer Larynx

41. 120%

42. Will You Block The Arytenoids after 60Gy

43. Three Field Technique

45. Preferential 2:1

46. Stoma Story Where do you Prescribe?

48. SupraGlottic Larynx

49. Skull Base or Not

50. R NECK CTV GTV CTV LT NECK CTV L3 LT ANGLE DOWN (LLO)

51. When angle down technique we have to Increase the length of the field

52. Angle Down RLO LLO Target Sup Inf

53. Angle Down Sup Inf

55. Anterior Skin lesion

56. Clothes Clamp

58. Clothes Clamp Another use?

59. Less Oral Mucosa

60. LOOK HERE CAREFULLY (Waldron et al 2003) GTV How to Solve this problem.

62. How Can You Determine the Energy for Electron beam Separation=12cm Spinal Cord Take care for neck asymmetry

63. Spinal Cord Spinal Cord

64. Tonsil? What’s the difference between a Lymph node and the tonsils? From where coming the Squamous cell carcinoma if its only lymphoid tissue. Anterior and posterior pillars? palatoglossus and palatopharyngeus muscles?