2016 AAPM Annual Meeting
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Session Title: Planning and Delivering HDR APBI Treatments
Question 1: Which of the following devices will not involve a balloon?
Reference:1. Dosimetric comparison of three brachytherapy applicators for partial breast irradiation. Salin Gurdali, Robert Kuske, ABS 2008. 2. New data presented at San Antonio Breast Cancer Symposium confirms efficacy of Cianna Medical’s Savi Scout surgical guidance system in localizing breast lesions, San Antonio 2015
Choice A:ML Mammosite
Choice B:Contura
Choice C:Savi
Question 2: Accelerated Partial Breast irradiation (APBI) is a technique in which?
Reference:1. Swnson TA, Vicini FA, Overview of accelerated partial breast irradiation, Curr. Oncol Rep, 2008 2. Arthur DW, Vicini FA, Accelerated partial Breast irradiation as part of breast conservation therapy. J. Clin. Oncol., 2005 3. Antonucci JV, Wallace M, M Goldstein NS, et al. Differences in patterns of failure in patients treated with accelerated partial irradiation versus whole-breast irradiation: a matched-pair analysis with 10 year follow-up, Int. J. Radiat. Oncol. Biol. Phys. 2009
Choice A:A portion of the breast at the highest risk of recurrence receives a shortened course of high radiation therapy.
Choice B:The tissue surrounding the lumpectomy cavity receives radiation therapy via high dose rate brachytherapy as a sole from of radiation therapy.
Choice C:A multichannel device is placed in the lumpectomy via a single insertion and high dose rate accelerated radiation therapy is delivered.
Choice D:All of the above
Question 3: What is the recommended dose limit to the uninvolved normal breast, subtracting the balloon/cavity, when treating a patient with APBI?
Reference:NSABP Protocol B-39 RTOG Protocol 0413, 2004 and update 2005
Choice A:< 60% of the whole breast should receive should receive ≥ 50% of the prescribed dose.
Choice B:< 50% of the whole breast should receive ≥ 60% of the prescribed dose.
Choice C:< 100% of the whole breast should receive ≥ 50% of the prescribed dose.
Question 4: When planning for an accelerated partial breast irradiation in 3D what is it that we should not do?
Reference:1. Quality management for breast brachytherapy, D. Tudor, New England AAPM Chapter 2012 2. Dosimetric characteristics of the Mammosite RTS, a new brachytherapy applicator. Edmundson CK, Vicini FA, Chen PY, Mitchell C. Martinez AA, Int. J. Radiat. Oncol. Biol. Phys. 2002. Mar.
Choice A:Create appropriate planning and optimization structures.
Choice B:Using an inverse DVH-based optimization imposing adequate constraints.
Choice C:Use the manual dose shaping tools.
Question 5: What is considered an acceptable dose distribution based on DVH analysis for APBI HDR?
Reference:NSABP Protocol B-39 RTOG Protocol 0413, 2004 and update 2005
Choice A:At least 95% of the PTV-Eval receives 100% of the prescribed dose.
Choice B:At least 95% of the prescribed dose covers 90% of the PTV-Eval.
Choice C:At least 80% of the prescribed dose covers 95% of the PTV-Eval.
Question 6: A robust QA program for the APBI applicators prior to the first scan and each treatment time should include:
Reference:1. SU-E-T-254 Comprehensive Quality assurance for Accelerated Partial Breast Irradiation Using the SAVI HDR Applicator, J. Cui, J. Mayadev, R. Stern, UC Davis Medical Center 2.SU-T-596 High Dose Brachytherapy Planning of a left breast cancer patient with in situ pacemaker, D. Jacob, H. Chen, L. Simpson, AAPM 2011.
Choice A:Record the applicator’s location in relation to the patient’s anatomy by marking the skin by a chosen channel aligned with the mark.
Choice B:A device work sheet to be used to denote the key measurements during the simulation QA.
Choice C:After the plan was reviewed by the physician, the physicist will check the delineation of each catheter and dose distributions using a pre-plan check sheet as a guide.
Choice D:All of the above.
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