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. |