2016 AAPM Annual Meeting
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Session Title: Practical Implementation of Deep Inspiration Breath Hold Techniques for Breast Radiation Therapy
Question 1: What is the main dosimetric advantage of using the Active Breathing Coordinator (Elekta) during the radiation treatment of left breast?
Reference:Latty D, Stuart KE, Wang W, Ahern V. Review of deep inspiration breath-hold techniques for the treatment of breast cancer. Journal of Medical Radiation Sciences. 2015;62(1):74-81. doi:10.1002/jmrs.96.
Choice A:Decreased dose to the heart.
Choice B:Decreased dose to the left lung.
Choice C:Decreased dose to the contralateral breast.
Choice D:All of the above.
Question 2: The Active Breathing Coordinator (Elekta) can only be used in radiation treatments of the left breast.
Reference:Judit Boda-Heggemann, Antje-Christin Knopf, Anna Simeonova-Chergou, Hansjörg Wertz, Florian Stieler, Anika Jahnke, Lennart Jahnke, Jens Fleckenstein, Lena Vogel, Anna Arns, Manuel Blessing, Frederik Wenz, Frank Lohr, Deep Inspiration Breath Hold—Based Radiation Therapy: A Clinical Review, International Journal of Radiation Oncology*Biology*Physics, Volume 94, Issue 3, 1 March 2016, Pages 478-492, ISSN 0360-3016, http://dx.doi.org/10.1016/j.ijrobp.2015.11.049.
Choice A:False.
Choice B:True.
Question 3: During self-held breath hold with respiratory monitoring for breast radiation therapy-
Reference:The management of respiratory motion in radiation oncology report of AAPM Task Group 76 (Keall, et al. Med. Phys. 33(10), 3874-3900: 2006.
Choice A:Patient respiration is continuously monitored.
Choice B:Patient respiration is intermittently monitored.
Choice C:Patient respiration is self-monitored.
Choice D:Patient respiration is robotically monitored.
Question 4: Which of the following are true of the RPM system?
Reference:Deep Inspiration Breath Hold and Respiratory Gating Strategies for Reducing Organ Motion in Radiation Treatment Mageras and Yorke Seminars in Radiation Oncology. 14(1), 65-75: 2004.
Choice A:Some simulation CT scanners can be triggered directly by the RPM to acquire the scan.
Choice B:No simulation CT scanner can be triggered directly by the RPM to acquire the scan.
Choice C:Some simulation CT scanners can be triggered manually while monitoring the patient respiration waveform.
Choice D:A & C.
Choice E:None of the above.
Question 5: During deep inspiration, the heart position shifts (compared to free breathing)?
Reference:AAPM Task Group 76 - The Management of Respiratory Motion in Radiation Oncology. Section 6.C. Breath Hold Methods (2006)
Choice A:Posterior, inferior, and to the right.
Choice B:Posterior, inferior, and to the left.
Choice C:Anterior, superior, and to the right.
Choice D:Anterior, inferior, and to the right.
Question 6: The expected change in the lung V20Gy for a patient whose CT scan was acquired in DIBH mode is expected to be _________ (compared to a scan acquired during FB mode)?
Reference:Remouchamps, V.M., et al., Significant reductions in heart and lung doses using deep inspiration breath hold with active breathing control and intensity-modulated radiation therapy for patients treated with locoregional breast irradiation. Int J Radiat Oncol Biol Phys, 2003. 55(2): p. 392-406.
Choice A:Higher dose.
Choice B:Lower dose.
Choice C:Negligible difference.
Question 7: If the DIBH setup were based on surface imaging, and the decision threshold was set to 3mm, what are the expected random uncertainties of the cardiac sparing between the port film and DRR? i.e. what are the uncertainties of the distance between the heart and the field edge?
Reference:Reference: Clinical experience with 3-dimensional surface matching-based deep inspiration breath hold for left-sided breast cancer radiation therapy, X Tang, TM Zagar, E Bair, EL Jones, D Fried, L Zhang, G Tracton, Z Xu, T Leach, S Chang, and LB Marks, Practical Radiation Oncology, Vol 4(3), e151-8, 2013
Choice A:4 mm
Choice B:3 mm
Choice C:2 mm
Choice D:1 mm
Question 8: Which ones of the following items do not need to be done during clinical commissioning for the surface based image guided system?
Reference:[1] Adaptive radiation therapy, XA Li, 2011, Taylor & Francis Group, LLC, 240. [2] AAPM Task Group 142 report: quality assurance of medical accelerators, EE Klein, J Hanley, J Bayouth, F Yin, W Simon, S Dresser, C Serago, F Aguirre, L Ma, B Arjomandy, and C Liu, Medical Physics, Vol 36(9), 4197-212, 2009.
Choice A:Stability and consistency
Choice B:Alignment accuracy respect to laser
Choice C:Gating ability
Choice D:Beam output constancy
Choice E:DICOM transfer accuracy
Question 9: According to the paper by Giraud the heart volume is reduced under deep inspiration breath hold due to compression by the inflated lungs.
Reference:Giraud P, Djadi-Prat J, Morelle M, et al. Contribution of Respiratory Gating Techniques for Optimization of Breast Cancer Radiotherapy. Cancer Invest. 2012;30(4):323–330. doi:10.3109/07357907.2012.657818.
Choice A:True
Choice B:False
Question 10: According to the paper by Giraud DIBH had the following impact on max dose to contralateral breast...
Reference:Giraud P, Djadi-Prat J, Morelle M, et al. Contribution of Respiratory Gating Techniques for Optimization of Breast Cancer Radiotherapy. Cancer Invest. 2012;30(4):323–330. doi:10.3109/07357907.2012.657818.
Choice A:Increased
Choice B:Decreased
Choice C:No Change.
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