2017 AAPM Annual Meeting
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Session Title: Recent Advances in Brachytherapy
Question 1: Which of the following statement is correct regarding the use of electromagnetic tracking (EMT) for seed drop detection in LDR prostate brachytherapy:
Reference:Racine E, Hautvast G, Binnekamp D, Beaulieu L. Real-time electromagnetic seed drop detection for permanent implants brachytherapy: Technology overview and performance assessment. Medical physics. 2016;43(12):6217.
Choice A:EMT cannot be used for this application due to the presence of ferromagnetic material near the implantation site;
Choice B:EMT can be used as an alternative to ultrasound;
Choice C:EMT requires the presence of an MRI scanner to provide the required electromagnetic field, and it is therefore not suitable for TRUS applications;
Choice D:Phantom studies have shown the potential of EMT for the seed drop detection.
Question 2: Which of the following tracking system natively provide brachyterhapy catheters positions in the coordinate system of the images without need for registration:
Reference:Wang W, Viswanathan AN, Damato AL, et al. Evaluation of an active magnetic resonance tracking system for interstitial brachytherapy. Medical physics. 2015;42(12):7114-7121.
Choice A:Electromagnetic tracking
Choice B:Active MRI tracking
Choice C:Optical tracking
Choice D:Fiber Bragg Grating
Question 3: Electromagnetic tracking has been investigated for quality assurance of brachytherapy treatments. What are possible applications of this technology to brachytherapy QA?
Reference:Kellermeier M, Herbolzheimer J, Kreppner S, Lotter M, Strnad V, Bert C. Electromagnetic tracking (EMT) technology for improved treatment quality assurance in interstitial brachytherapy. Journal of applied clinical medical physics. 2017;18(1):211-222. Damato AL, Viswanathan AN, Don SM, Hansen JL, Cormack RA. A system to use electromagnetic tracking for the quality assurance of brachytherapy catheter digitization. Medical physics. 2014;41(10):101702. Racine E, Hautvast G, Binnekamp D, Beaulieu L. Real-time electromagnetic seed drop detection for permanent implants brachytherapy: Technology overview and performance assessment. Medical physics. 2016;43(12):6217.
Choice A:Catheter digitization QA.
Choice B:Pre-treatment analysis of implant displacement/deformation in HDR brachytherapy.
Choice C:Real time verification of seed deposition in LDR TRUS prostate brachytherapy.
Choice D:A and B only.
Choice E:A and B and C.
Question 4: Which of the following is NOT an example of IMBT:
Reference:Adams Q.E., J. Xu, E.K.Breitbach, X. Li, S.A. Enger, W.R. Rockey, Y. Kim, X. Wu, and R.T. Flynn. 2014. “Interstitial rotating shield brachytherapy for prostate cancer.” Medical Physics 41: 051703. doi:10.1118/1.4870441. Han D.Y., H. Safigholi, A. Soliman, A. Ravi, E. Leung, D.J. Scanderbeg, Z. Liu, A. Owrangi, and W.Y. Song. 2016. “Direction modulated brachytherapy for treatment of cervical cancer. II: Comparative planning study with intracavitary and intracavitary–interstitial techniques.” International Journal of Radiation Oncology Biology Physics 96: 440-448.doi: 10.1016/j.ijrobp.2016.06.015. Lin L., R.R. Patel, B.R. Thomadsen, and D.L. Henderson. 2008. “The use of directional interstitial sources to improve dosimetry in breast brachytherapy.”Medical Physics 35: 240-247. doi: 10.1118/1.2815623.
Choice A:Applicators containing shields that rotate during treatment to direct radiation away from critical structures.
Choice B:Applicators containing fixed shields in one direction for use with a conventional HDR 192Ir source.
Choice C:Sources containing two radionuclides (e.g., 125I and 192Ir) with dramatically different photon energies and half-lives.
Choice D:125I seeds containing an internal shield of gold on one side.
Question 5: Which material can provide the highest shielding for an IMBT 192Ir source?
Reference:Heredia A.Y. “Developing a directional high-dose rate (d-HDR) brachytherapy source.” In: Medical physics. Madison WI: University of Wisconsin; 2013.
Choice A:Aluminum.
Choice B:Iron.
Choice C:Silver.
Choice D:Tungsten.
Question 6: Using a conventional brachytherapy treatment planning system based on the TG-43 formalism, dose can be calculated only for:
Reference:An approach to using conventional brachytherapy software for clinical treatment planning of complex, Monte Carlo-based brachytherapy dose distributions. MJ Rivard, CS Melhus, D Granero, J Perez-Calatayud, and F Ballester. Med Phys, Vol. 36, pp. 1968-1675 (2009).
Choice A:Applicators with time-dependent dose distributions utilizing rotating shields.
Choice B:Sources and applicators with cylindrically-symmetric dose distributions.
Choice C:Sources with photon emissions above a strict energy threshold.
Choice D:Absorbed dose to water (not any other medium).
Question 7: Intensity modulated brachytherapy utilizes the following variables in optimizing plans:
Reference:Webster MJ, Devic S, Vuong T, et al. Dynamic modulated brachytherapy (DMBT) for rectal cancer. Med Phys 2013;40(1):011718.
Choice A:Radiation beam direction (i.e., directional radiation source).
Choice B:Radiation energy.
Choice C:Geometry of anatomy (i.e., dwell positions).
Choice D:Dynamic motion of applicator during treatment delivery.
Question 8: Which of the following algorithms cannot incorporate dosimetric effects of metal shielding directly into treatment planning dose calculations?
Reference:Beaulieu L, Tedgren AC, Carrier JF, et al. Report of the Task Group 186 on model-based dose calculation methods in brachytherapy beyond the TG-43 formalism: Current status and recommendations for clinical implementation. Med Phys 2012;39(10):6208-6236.
Choice A:Monte Carlo.
Choice B:Collapsed cone convolution.
Choice C:Grid-based Bolzmann solver (GBBS).
Choice D:TG43 formalism.
Question 9: Due to limitations in the bronchoscope size, optical bronchoscopic navigation in general cannot be used beyond the following structure(s):
Reference:Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images: the first human study, Yehuda Schwarz, MD, Joel Greif, MD, Heinrich D. Becker, MD, Armin Ernst, MD, Atul Mehta, MD, Chest, Volume 129, Issue 4, April 2006, Pages 988–994
Choice A:Carina.
Choice B:Trachea.
Choice C:Primary Bronchi.
Choice D:Tertiary Bronchi.
Question 10: In comparison to SABR/SBRT treatments of lung lesion via external beam delivery, for targets with volumes less than 20 cc, the dosimetry of ablative brachytherapy implants is generally characterized by: 
Reference:Evaluation of Electromagnetically Guided High-Dose Rate Brachytherapy for Ablative Treatment of Lung Metastases, Daniel Pinkham, PhD, David Shultz , MD, PhD, Billy Loo , MD, PhD, Arthur Sung ,MD, PhD, Maximilian Diehn, MD, PhD, Benjamin Fahimian, PhD, Med. Phys., Volume 42, Issue 6, June 2015, Page 3595
Choice A:Enhanced dose homogeneity in the PTV, and steeper gradients in the normal tissue.
Choice B:Increased heterogeneity in the PTV, and steeper gradients in the normal tissue.
Choice C:Reduced V100%/V50% ratios.
Choice D:Reduced Dmax/DPrescription ratios.
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