| Question 1: How does a dosimetrist know if they have found the global minimum of the inverse planning search space? |
| Reference: | J Tepper, R. Mackie (Editors) " Radiation Therapy Treatment Optimization," Seminars in Radiation Oncology Vol. 9 No 1 January 1999 Entire Journal has 8 manuscripts.
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| Choice A: | The objective value stops improving from one iteration to the next. |
| Choice B: | They never really know. |
| Choice C: | They can only know if they use multi-criteria optimization. |
| Choice D: | The system has reached the maximum number of iterations. |
| Question 2: The promise of predicting organ specific dose goals from prior patient plans is: |
| Reference: | Binbin Wu, Francesco Ricchetti, Giuseppe Sanguineti, Misha Kazhdan, Patricio Simari, Ming Chuang, Russell Taylor, Robert Jacques, Todd McNutt, "Patient Geometry-Driven Information Retrieval for IMRT Treatment Plan Quality Control", Medical Physics, 2009 Dec;36(12):5497-505
- Wu, B., Ricchetti, F., Sanguineti, G., Kazhdan, M., Simari, P., Jacques, R., Taylor, R., McNutt, T.: "Data-driven approach to generating achievable dose-volume histogram objectives in intensity modulated radiotherapy planning". International Journal of Radiation Oncology, Biology, Physics 2011 Mar 15;79(4):1241-7. Epub 2010 Aug
- Steven F. Petit, Binbin Wu, Michael Kazhdan , André Dekker, Patricio Simari, Rachit Kumar, Russel Taylor, Joseph M. Herman, Todd McNutt," Increased organ sparing using shape-based treatment plan optimization for intensity modulated radiation therapy of pancreatic adenocarcinoma", Radiotherapy and Oncology, 102 (2012) 38-44.
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| Choice A: | To insure high quality plans are created for all patients. |
| Choice B: | To automate the planning process. |
| Choice C: | To highlight where clinical trade-offs may be needed for a specific patient. |
| Choice D: | All of the above. |
| Question 3: The concept of varying the dose rate and field shape as a function of gantry angle over an arc to obtain improved dose distributions... |
| Reference: | Mantel, Perry, Weinkam, "Automatic variation of field size and dose rate in rotation therapy," Int'l J. of Rad. Onc. Biol. Phys. 1977, Vol 2 pp. 697-704 |
| Choice A: | Was first enabled with digital control of linear accelerators. |
| Choice B: | Was introduced as early as 1977. |
| Choice C: | Was widely enabled with improved inverse planning performance. |
| Choice D: | B and C only. |
| Choice E: | A and C only. |
| Question 4: According to the IAEA's DIRAC database, there are currently 10,774 medical linear accelerators worldwide. How many of them are IGRT-enabled with cone-beam CT?
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| Reference: | IAEA Directory of Radiation Centres (DIRAC) Production Year>2010 |
| Choice A: | <1000 |
| Choice B: | 1000-2000 |
| Choice C: | 2000-3000 |
| Choice D: | >3000 |
| Question 5: Typical uncorrected CBCT Hounsfield Units are within +/-100 HU of a calibrated planning CT. How much does this effect a typical dose calculation? |
| Reference: | Held, M., Cremers, F., Sneed, P. K., Braunstein, S., Fogh, S. E., Nakamura, J., Barani, I., Perez-Andujar, A., Pouliot, J. and Morin, O. (2016), Assessment of image quality and dose calculation accuracy on kV CBCT, MV CBCT, and MV CT images for urgent palliative radiotherapy treatments. Journal of Applied Clinical Medical Physics, 17: 279–290. doi:10.1120/jacmp.v17i2.6040
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| Choice A: | <1%. |
| Choice B: | 1-5%. |
| Choice C: | 5-10%. |
| Choice D: | >10%. |
| Question 6: Accuracy in deformable image registration is important for anatomical-based adaptive radiotherapy as reductions in uncertainties of 1.6 mm have been shown to have a potentially clinically significant impact on the decision making metrics used.
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| Reference: | Samavati N, Velec M, Brock KK, ‘Effect of deformable registration uncertainty on lung SBRT dose accumulation’, Med Phys. 2016 Jan;43(1):233. doi: 10.1118/1.4938412.
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| Choice A: | True. |
| Choice B: | False. |
| Question 7: When irradiated in a standard fractionation schedule, lung tumors...
|
| Reference: | Sonke JJ, Belderbos J, ‘Adaptive radiotherapy for lung cancer’, Semin Radiat Oncol. 2010 Apr;20(2):94-106. doi: 10.1016/j.semradonc.2009.11.003
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| Choice A: | Never respond to radiation during the treatment, response isn’t seen for 2 months post-completion. |
| Choice B: | Have been shown to respond anatomically in different ways, some regressing and pulling the normal tissue with them and some eroding, potentially leaving microscopic disease. |
| Choice C: | Respond at a rate of radius_reduction=Fraction_number/MU_per_fraction. |
| Choice D: | Increase in size for the first half of treatment then rapidly dissolve. |
| Choice E: | May respond in function, but never in anatomical size. |
| Question 8: A prospective dose escalation trial for locally advanced non-small cell lung cancer showed that using 4DPET/4DCT scans acquired before and during a course of chemoradiotherapy...
|
| Reference: | Yap ML, Sun A, Higgins J, Clarke K, Marshall A, Becker N, Le LW3, Vines DC, Bezjak A, Bissonnette JP, ‘Adaptive Dose Escalation using Serial Four-dimensional Positron Emission Tomography/Computed Tomography Scans during Radiotherapy for Locally Advanced Non-small Cell Lung Cancer’, Clin Oncol (R Coll Radiol). 2016 Dec;28(12):e199-e205. doi: 10.1016/j.clon.2016.08.011
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| Choice A: | It is feasible to dose escalate both primary and nodal disease in most patients. |
| Choice B: | 4DPET provides no benefit to patients. |
| Choice C: | Only a minority of patients could receive a successful boost to their treatment. |
| Choice D: | Acute toxicity was so high that the study was cancelled. |
| Choice E: | 6DPET is required to make an reasonable assessment of the patient. |
| Question 9: Spatial resolution is an important image quality metric in Cone-Beam CT. Which one of the following system elements does NOT affect spatial resolution....
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| Reference: | Image dose - Jaffray, D. A. and Siewerdsen, J. H. (2000), Cone-beam computed tomography with a flat-panel imager: Initial performance characterization. Med. Phys., 27: 1311–1323. doi:10.1118/1.599009
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| Choice A: | kV Tube Focal spot size. |
| Choice B: | Geometric calibration. |
| Choice C: | Detector pixel pitch. |
| Choice D: | Image dose. |
| Choice E: | Reconstruction voxel size. |
| Question 10: A prospective adaptive radiotherapy pilot trial for patients with locally advanced oropharyngeal cancer suggests that.....
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| Reference: | Schwartz DL, Garden AS, Shah SJ, Chronowski G, Sejpal S, Rosenthal DI, Chen Y, Zhang Y, Zhang L, Wong PF, Garcia JA, Kian Ang K, Dong L, ‘Adaptive radiotherapy for head and neck cancer--dosimetric results from a prospective clinical trial’, Radiother Oncol. 2013 Jan;106(1):80-4. doi: 10.1016/j.radonc.2012.10.010.
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| Choice A: | Adaptive RT leads to local failures. |
| Choice B: | Adaptive RT leads to a significant increase in toxicities. |
| Choice C: | Adaptive RT shows no potential to improve local control or reduce toxicity. |
| Choice D: | Adaptive RT dosimetrically outperforms IMRT. |
| Choice E: | Adaptive RT will result in 100% local control and eliminate toxicity. |
