| Question 1: Which of the following best characterizes the precision of biomarker results when measurements are obtained by two different operators and at times separated by a month? |
| Reference: | Sullivan DC, Obuchowski NA, Kessler LG, et al. Metrology standards for quantitative imaging biomarkers. Radiology 2015; 277(3):813-25. |
| Choice A: | Reproducibility coefficient. |
| Choice B: | Repeatability coefficient. |
| Choice C: | Root mean square. |
| Choice D: | Linearity. |
| Question 2: Which of the following characterizes the technical validation of a biomarker?
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| Reference: | Wagner JA, Williams SA, Webster CJ. Biomarkers and surrogate endpoints for fit-for-purpose development and regulatory evaluations of new drugs. Clinical Pharmacology & Therapeutics 2007; 81(1):104-7.
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| Choice A: | A fit-for-purpose evidentiary process linking a biomarker with biological processes and clinical end points. |
| Choice B: | Demonstration that the biomarker can substitute for a clinical endpoint in regulatory approvals. |
| Choice C: | The determination of the range of conditions under which the measurement will produce accurate and reproducible results. |
| Question 3: Which of the following is true for FDG-PET during the course of fractionated radiotherapy?
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| Reference: | 1) Kong FM, Frey KA, Quint LE, Ten Haken RK, Hayman JA, Kessler M, Chetty IJ, Normolle D, Eisbruch A, Lawrence TS. A pilot study of [18F]fluorodeoxyglucose positron emission tomography scans during and after radiation-based therapy in patients with non small-cell lung cancer. J Clin Oncol. 2007 Jul 20;25(21):3116-23. PubMed PMID: 17634490.
2) Feng M, Kong FM, Gross M, Fernando S, Hayman JA, Ten Haken RK. Using fluorodeoxyglucose positron emission tomography to assess tumor volume during radiotherapy for non-small-cell lung cancer and its potential impact on adaptive dose escalation and normal tissue sparing. Int J Radiat Oncol Biol Phys. 2009 Mar15;73(4):1228-34. doi: 10.1016/j.ijrobp.2008.10.054. PubMed PMID: 19251094;PubMed Central PMCID: PMC3381895.
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| Choice A: | Should not be performed as there will be radiation inflammation to cause confounding effects. |
| Choice B: | Can be performed during the course of RT, but with significant noise from normal lung. |
| Choice C: | Has limited role on adaptive treatment. |
| Choice D: | Can guide adaptive treatment to escalate RT dose without increasing doses to normal tissue. |
| Question 4: V/Q SPECT can be used to map lung function during the course of fractionated radiation therapy.
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| Reference: | 1. Meng X, Frey K, Matuszak M, Paul S, Ten Haken R, Yu J, Kong FM. Changes in functional lung regions during the course of radiation therapy and their potential impact on lung dosimetry for non-small cell lung cancer. Int J RadiatOncol Biol Phys. 2014 May 1;89(1):145-51. doi: 10.1016/j.ijrobp.2014.01.044. PubMed PMID: 24725697; PubMed Central PMCID: PMC4400732.
2: Yuan ST, Frey KA, Gross MD, Hayman JA, Arenberg D, Cai XW, Ramnath N, Hassan K, Moran J, Eisbruch A, Ten Haken RK, Kong FM. Changes in global function and regional ventilation and perfusion on SPECT during the course of radiotherapy in patients with non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2012 Mar 15;82(4):e631-8. doi: 10.1016/j.ijrobp.2011.07.044. Epub 2011 Dec 22. PubMed PMID: 22197235; PubMed Central PMCID: PMC3381888
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| Choice A: | Can be easily registered retrospectively without a CT scan. |
| Choice B: | Changes little during the course of fractionated RT in vast majority of patients. |
| Choice C: | Changes on V/Q SPECT during the course of radiation may have significant impact on functional dosimetry. |
| Choice D: | V/Q SPECT has not been done clinically during the course of radiation therapy, the changes are unknown to radiation oncology community. |
| Question 5: What are the benefits of MR-Image Guided Radiation Therapy?
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| Reference: | Lagendijk JJW, Raaymakers BW, van Vulpen M. The Magnetic Resonance Imaging–Linac System. Semin Radiat Oncol. 2014 Jul;24(3):207–9.
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| Choice A: | Imaging can be performed during treatment. |
| Choice B: | Better soft tissue contrast than diagnostic CT. |
| Choice C: | Able to stop motion better than CBCT imaging. |
| Choice D: | Images can be manipulated to provide density data for heterogeneity corrections. |
| Choice E: | All of the above. |
| Question 6: Which of the following dosimetry systems and conditions is likely to be most affected by the Electron Return Effect in an MR-Linac?
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| Reference: | O'Brien DJ, Roberts DA, Ibbott GS, Sawakuchi GO. Reference dosimetry in magnetic fields: formalism and ionization chamber correction factors. Med Phys. American Association of Physicists in Medicine; 2016 Aug;43(8):4915–27
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| Choice A: | Polymer gel dosimeter immersed in a water phantom |
| Choice B: | Diode detector embedded in plastic matrix |
| Choice C: | Optically-stimulated luminescence detector (OSLD) sandwiched in bolus material |
| Choice D: | Ionization chamber in water-equivalent plastic phantom |
| Question 7: Which of the following affect the reproducibility of radiomics features extracted from CT images?
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| Reference: | Hunter et al, High quality machine-robust image features: Identification in nonsmall cell lung cancer computed tomography images, Med Phys 40, 121916 (2013)
Mackin et al, Measuring Computed Tomography Scanner Variability of Radiomics Features, Investigative Radiology 50 (2015)
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| Choice A: | Pixel size. |
| Choice B: | Scanner manufacturer. |
| Choice C: | Reconstruction technique. |
| Choice D: | Thresholding level used to delineate lung tumors. |
| Choice E: | All of the above. |
| Question 8: Which of the following technical approaches have been used for acquiring dual energy data?
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| Reference: | McCollough, C. H., S. Leng, L. Yu and J. G. Fletcher (2015). "Dual-and multi-energy CT: principles, technical approaches, and clinical applications." Radiology 276(3): 637-653.
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| Choice A: | Sequential acquisition of two different scans . |
| Choice B: | Rapid tube potential switching . |
| Choice C: | Multilayer detectors. |
| Choice D: | Dual x-ray sources. |
| Choice E: | All of the above. |
| Question 9: One of the critical technical issues associated with the utilization of PET/MR is the difficulties of obtaining accurate MR-based attenuation correction maps. This is due to the fact that..
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| Reference: | Su et al, J Nucl Med, 2016:57:913-917 |
| Choice A: | MR images are acquired separately from PET images. |
| Choice B: | The MR signal is originated from protons not photos. |
| Choice C: | MR need radio frequency excitation pulses to obtain signal. |
| Choice D: | MR imaging sessions are typically much longer than that of PET/CT. |
| Question 10: It has been demonstrated that the hybrid PET/MR may improve our ability to characterize tumor heterogeneities. Which factor does not contribute to this observed improvement?
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| Reference: | Brooks et al, Clinical Cancer Res 2016, 22:2950-2959 . |
| Choice A: | MR provides excellent soft tissue contrast and high spatial resolution. |
| Choice B: | MR offer multi-parametric contrast images. |
| Choice C: | MR is completely non-invasive, radiation free, and widely available clinically. |
| Choice D: | Hybrid PET/MR offers simultaneously acquired PET and MR images. |
