| Question 1: Ultrasound is the only imaging modality presently clinically available for real-time guidance in radiation therapy which:
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| Reference: | O'Shea T et al., “Review of ultrasound image guidance in external beam radiotherapy part II: intra-fraction motion management and novel applications.” Phys Med Biol. 2016 Apr 21;61(8):R90-137 |
| Choice A: | Is non invasive. |
| Choice B: | Provides volumetric information. |
| Choice C: | Does not deliver extra dose to the patient. |
| Choice D: | Does not show aberrations. |
| Question 2: Ultrasound imaging alone cannot be used for radiation therapy planning because:
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| Reference: | van der Meer S et al., “Simulation of pseudo-CT images based on deformable image registration of ultrasound images: A proof of concept for transabdominal ultrasound imaging of the prostate during radiotherapy.” Med Phys. 2016 Apr;43(4):1913.
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| Choice A: | a. it does not provide physical density information |
| Choice B: | a. it cannot be used to contour structures |
| Choice C: | a. it cannot be imported in the treatment planning system |
| Choice D: | a. it is not a quantitative imaging modality |
| Question 3: With free-hand ultrasound guidance systems target localization uncertainty is introduced by:
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| Reference: | I. Artignan X, Smitsmans MH, Lebesque JV, Jaffray DA, van Her M, Bartelink H., Online ultrasound image guidance for radiotherapy of prostate cancer: impact of image acquisition on prostate displacement. Int J Radiat Oncol Biol Phys. 2004.
II. Dobler B, Mai S, Ross C, Wolff D, Wertz H, Lohr F, Wenz F. Evaluation of possible prostate displacement induced by pressure applied during transabdominal ultrasound image acquisition. Strahlenther Onkol. 2006 Apr;182(4):240-6.
III. Fontanarosa D, van der Meer S, Harris E, Verhaegen F. A CT based correction method for speed of sound aberration for ultrasound based image guided radiotherapy. Med Phys. 2011 May;38(5):2665-73
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| Choice A: | Operator induced systematic target displacements between imaging and treatment. |
| Choice B: | Unknown speed of sound variation in tissue. |
| Choice C: | Inter-user variability in image acquisition and interpretation. |
| Choice D: | All of the above. |
| Question 4: Substituting free-hand pre-treatment ultrasound acquisition with continuous robot/arm assisted imaging eliminates which of the following sources of localization uncertainties:
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| Reference: | I. Schlosser J, Gong RH, Bruder R, Schweikard A, Jang S, Henrie J, Kamaya A, Koong A, Chang DT, Hristov D. Robotic intrafractional US guidance for liver SABR: System design, beam avoidance, and clinical imaging. Med Phys. 2016 Nov;43(11):5951.
II. Schlosser J, Salisbury K, Hristov D. Online image-based monitoring of soft-tissue displacements for radiation therapy of the prostate. Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1633-40. doi: 10.1016/j.ijrobp.2011.10.049.
III. Schlosser J, Salisbury K, Hristov D. Telerobotic system concept for real-time soft-tissue imaging during radiotherapy beam delivery. Med Phys. 2010
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| Choice A: | Operator induced systematic target displacements between imaging and treatment. |
| Choice B: | Unknown speed of sound variation in tissue. |
| Choice C: | Inter-user variability in image acquisition and interpretation. |
| Choice D: | All of the above. |
| Question 5: The advantage of ultrasound imaging for managing intrafraction monitoring is:
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| Reference: | Sen H, Bell ML, Zhang Y, Ding K, Boctor E, Wong J, Iordachita I and Kazanzides P. System Integration and In-Vivo Testing of a Robot for Ultrasound Guidance and Monitoring during Radiotherapy. IEEE Transactions on Biomedical Engineering 2016;PP:1-11.
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| Choice A: | Does not need contact with the patient. |
| Choice B: | Can use any diagnostic ultrasound unit. |
| Choice C: | Does not depend on the operator for image quality. |
| Choice D: | Is non-ionizing, non-invasive and real-time. |
| Question 6: The primary function of an infrared camera for ultrasound imaging in the room is to: |
| Reference: | Sen H, Bell ML, Zhang Y, Ding K, Boctor E, Wong J, Iordachita I and Kazanzides P. System Integration and In-Vivo Testing of a Robot for Ultrasound Guidance and Monitoring during Radiotherapy. IEEE Transactions on Biomedical Engineering 2016;PP:1-11. |
| Choice A: | Track probe position. |
| Choice B: | Monitor patient surface motion. |
| Choice C: | Monitor gantry collision. |
| Choice D: | Monitor beam delivery. |
| Question 7: Ultrasound image quality for tracking the target does not depend on: |
| Reference: | Sen H, Bell ML, Zhang Y, Ding K, Boctor E, Wong J, Iordachita I and Kazanzides P. System Integration and In-Vivo Testing of a Robot for Ultrasound Guidance and Monitoring during Radiotherapy. IEEE Transactions on Biomedical Engineering 2016;PP:1-11.
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| Choice A: | Probe position. |
| Choice B: | Probe pressure. |
| Choice C: | Probe orientation. |
| Choice D: | All of the above. |
| Question 8: While most IGRT techniques may add non-trivial total radiation dose delivered to the patient, and alternative IGRT approach that does not use ionizing radiation is to use electromagnetic (EM) tracking of implanted transponders, however:
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| Reference: | 1. Kupelian P, Willoughby T, Hahadevan A, et al. Multi-institutional clinical experience with the calypso system in localization and
continuous, real-time monitoring of the prostate gland during external radiotherapy. Int J Radiat Oncol Biol Phys. 2007: 61088-61098.
2. Willoughby TR, Kupelian PA, Pouilot J, et al. Target localization and real-time tracking using the Calypso 4D localization system in patients with localized prostate cancer. Int J Radiat Oncol Biol Phys. 2006;65:528-534.
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| Choice A: | Their use may suffer from the requirement of invasive implantation of the transponders, and associated comorbidities (such as infection and bleeding). |
| Choice B: | Contraindications (such as obese patients, or patients with hip prostheses, which disrupt the EM field) may prevent their usage. |
| Choice C: | Potential for migration of the implanted marker may create errors in patient set-up. |
| Choice D: | All of the above. |
| Question 9: US-based localization techniques can offer potentially unique advantages for interfractional IGRT, including: |
| Reference: | Salter BJ, Szegedi M, Boehm C, Sarkar V, Rassiah-Szegedi P, Wang B, Zhao H, Huang J, Huang L, Kokeny K, Tward JD. Comparison of 2 transabdominal ultrasound image guidance techniques for prostate and prostatic fossa radiation therapy. Pract Radiat Oncol. 2017 Mar - Apr;7(2):e99-e107.
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| Choice A: | The US process is noninvasive. |
| Choice B: | The US process does not administer radiation dose. |
| Choice C: | The US process affords soft-tissue visualization superior to typical x-ray–based image guidance techniques. |
| Choice D: | All of the Above. |
| Question 10: For cancer radiotherapy, ultrasound imaging technology has been used in the following area except: |
| Reference: | 1. Kuban D A, Dong L, Cheung R, Strom E and De Crevoisier R 2005 Ultrasound-based localization Semin. Radiat. Oncol. 15 180–91.
2. Fenster A, Surry K, Smith W, Gill J and Downey D B 2002 3D ultrasound imaging: applications in image-guided therapy and biopsy Comput. Graphics 26 557–68.
3. Fontanarosa D, Van Der Meer S, Bamber J, Harris E, O’Shea T and Verhaegen F 2015 Review of ultrasound image guidance in external beam radiotherapy: I. Treatment planning and inter-fraction motion management Phys. Med. Biol. 60 R77–114.
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| Choice A: | Patient positioning. |
| Choice B: | Prostate delineation. |
| Choice C: | Lung tumor visualization. |
| Choice D: | Real-time HDR needle guidance. |
