2016 AAPM Annual Meeting
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Session Title: Advances and Innovations in Image Guided Brachytherapy
Question 1: Meta analysis has demonstrated cervical HDR brachytherapy versus LDR:
Reference:“Brachytherapy for cervix cancer: low-dose rate or high-dose rate brachytherapy – a meta-analysis of clinical trials”, Viani et al., Journal of Experimental & Clinical Cancer Research 2009, 28:47.
Choice A:Is still controversial in regards to its efficacy and safety and more data is needed.
Choice B:Offers same overall survival, local recurrence and late complications for clinical stages I, II and III.
Choice C:Is more complex and its use is not warranted.
Question 2: Per the 2012 ABS Consensus Guidelines for Cervical Cancer, what statement is true when 3D planning is performed:
Reference:References: 1) “ABS Consensus guidelines for locally advanced carcinoma of the cervix, Part I (General Principles)”, Viswanathan and Thomadsen, Brachytherapy 11 (2012) 33-46; 2) “ABS Consensus guidelines for locally advanced carcinoma of the cervix, Part II (General Principles)”, Viswanathan et al., Brachytherapy 11 (2012) 47-52.
Choice A:Target D90 should equal 100% of prescription.
Choice B:It is advisable to perform dosimetry calculations only for one fraction if fixed geometry applicators are used.
Choice C:Standard parameters to be reported include ICRU 38 bladder and rectum points.
Choice D:Point A should no longer be reported when 3D planning is performed.
Question 3: For cervical cancers, treatments performed with image guided HDR brachytherapy using hybrid (CT/MRI) vs. MRI alone have:
Reference:“Hybrid (CT/MRI based) vs. MRI only image-guided brachytherapy in cervical cancer: Dosimetry comparisons and clinical outcome”, Choong et al., Brachytherapy 15 (2016) 40-48.
Choice A:Comparable HR-CTV D90.
Choice B:Comparable D2cc for rectum and bowel, but worse D2cc for bladder and sigmoid.
Choice C:Good local control.
Choice D:All of the above.
Question 4: In MR-guided interstitial brachytherapy, what is the main hazard involved in the use of metallic, non-ferromagnetic materials:
Reference:Van den Bosch et al., Med Phys 2010 Feb; 37(2):814-21 Wang et al., Magn Reson Imaging Clin N Am 23 (2015) 579-589
Choice A:Due to unavoidable ferromagnetic traces during fabrication, all metallic equipment will be affected by the magnetic field and mechanically pulled towards the scanner.
Choice B:Metallic equipment will create distortion in the image that will result in errors in contouring and applicator reconstruction.
Choice C:Resonating electromagnetic radiofrequency waves along the metallic structures can cause heating.
Choice D:There are no hazards involved in the use of metallic equipment in an MR, as long as the equipment has been designated as MR-safe.
Question 5: 2D T2 FSE sequences are commonly used to contour the clinical target volume in gynecologic brachytherapy. How can these images be used during planning?
Reference:Damato et al, Magn Reson Imaging Clin N Am 23 (2015) 633-642 Hellebust et al, Radiother Oncol 2010 Aug; 96(2): 153-60 Berger et al., Radiother Oncol 2009 Nov;93(2):347-51
Choice A:The brachytherapy lumen in the applicator and in the needles can be always identified directly on the T2 images.
Choice B:Identification of the lumens can be performed directly on the T2 images if CuSO4 dummy markers are used during scanning.
Choice C:The applicator can be reconstructed on 2D T2 images using model based digitization; needles can be reconstructed if additional images (e.g.: paraxial 2D, parasagittal 2D, 3D SPACE, CT) are fused.
Choice D:A CT should be acquired for planning in all situations and fused with the T2 images.
Question 6: For vaginal disease, the use of needles is recommended when:
Reference:Beriwal et al., Brachytherapy 2012 11(1):68-75
Choice A:The extent of the disease exceeds 5mm past the vaginal wall.
Choice B:A multi-channel applicator is not available.
Choice C:Always, unless medically contraindicated.
Choice D:Never; the use of needles is limited to cervical cancer cases.
Question 7: In cervical cancer, what is the main reason that the use of MR during applicator/needle insertion is desirable compared to a pre-brachytherapy MR after external beam irradiation?
Reference:Kirisits et al., Int J Radiat Oncol Biol Phys 2006; 65:624-30 Jurgenliemk-Shulz et al., Radiother Oncol 2009;93:322-30
Choice A:The tumor response to external beam irradiation can vary greatly from patient to patient.
Choice B:Correct delineation of large, asymmetric tumors allow for the precise placement of interstitial needles and sculpting of the dose.
Choice C:Correct delineation of the organs-at-risk improve sparing and reduces toxicities.
Choice D:MR allows applicator reconstruction without irradiating the patient with a CT scan.
Question 8: Which of the following is the best marker agent for digitization of interstitial catheters on MRI is _______ 
Reference:Schindel J, Muruganandham M, Pigge FC, Anderson J, Kim Y.  Magnetic resonance imaging (MRI) markers for MRI-guided high-dose-rate brachytherapy: novel marker-flange for cervical cancer and marker catheters for prostate cancer.  Int J Radiat Oncol Biol Phys. 2013;86(2):387–393.
Choice A:1% agrose gel
Choice B:liquid Vitamin-E
Choice C:Saline
Choice D:Copper sulfate
Question 9: Which common sources of error in prostate HDR brachytherapy is NOT easily identified with electromagnetic tracking?
Reference:Antonio L. Damato,a)  Akila N. Viswanathan, Sarah M. Don, Jorgen L. Hansen, and Robert A. Cormack A system to use electromagnetic tracking for the quality assurance of brachytherapy catheter digitization Med. Phys. 41 (10), October 2014
Choice A:Catheter-transfer tube swap
Choice B:Catheter digitization mix
Choice C:Catheter-transfer tube length mis-measurement.
Choice D:Catheter shift error
Question 10: Which is NOT one of the four Robotics Institute of America classes of robots?
Reference:Poder et al.  AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy: Report of Task Group 192
Choice A:Devices that manipulate objects with manual control.
Choice B:Devices that pass the Turing test.
Choice C:Automated devices that manipulate objects with predetermined cycles.
Choice D:Programmable and servo-controlled robots with continuous point-to-point trajectories.
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