| Question 1: For a device-independent patient who is treated for prostate cancer with 18 MV photons:
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| Reference: | 1. D. Gelblum, H. Amols, “Implanted cardiac defibrillator care in radiation oncology patient population” IJROBP 73, 1525-1531 (2009).
2. H. Hashii, T. Hashimoto, et al., “Comparison of the effects of high-energy photon beam irradiation (10MV and 18MV) on two type of implantable cardioverter-defibrillators” IJROBP 85, 840-845 (2013).
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| Choice A: | The cardiac device is safe due to the large distance from the treatment area. |
| Choice B: | The cardiac device is safe as long as no IMRT is used for his treatment. |
| Choice C: | The patient needs to be managed independently to what cumulative dose the device receives. |
| Choice D: | The cardiac device will be affected by secondary neutrons only after the 2Gy dose level is reached. |
| Choice E: | The cardiac device will be affected by leakage photon radiation. |
| Question 2: The effects of CT scanning on a CIED are/do:
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| Reference: | 1. C. H. McCollough, J. Zhang, A. N. Primak, W. J. Clement and J. R. Buysman, "Effects of CT irradiation on implantable cardiac rhythm management devices," Radiology 243, 766-774 (2007).
2. M. Hirose, K. Tachikawa, M. Ozaki, et al., “X-ray Radiation Causes Electromagnetic Interference in Implantable Cardiac Pacemakers” PACE 33, 1174-1181 (2010).
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| Choice A: | Device over-sensing and are transient in nature. |
| Choice B: | More severe for defibrillators. |
| Choice C: | Require shielding of the device before scanning. |
| Choice D: | Damaging to the device so, no irradiation is allowed. |
| Choice E: | Independent of the irradiation parameters and scanning protocol. |
| Question 3: Neutron production is most abundant for which modality?
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| Reference: | AAPM TG 158: Measurement and calculation of doses outside the treated volume from external-beam radiation therapy.
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| Choice A: | 10 MV VMAT. |
| Choice B: | 10 MV FFF. |
| Choice C: | 20 MeV electron therapy. |
| Choice D: | 200 MeV proton therapy. |
| Choice E: | 6 MV 3D CRT. |
| Question 4: Which of the following is NOT part of a comprehensive measurement approach for the dose to the CIED?
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| Reference: | •Edwards CR and Mountford PJ (2004) Near surface photon energy spectra outside a 6 MV field edge. Phys Med Biol 49 N293-N301.
•Kry, S. F., U. Titt, F. Ponisch, D. Followill, O. N. Vassiliev, R. A. White, R. Mohan and M. Salehpour (2006). "A Monte Carlo model for calculating out-of-field dose from a varian 6 MV beam." Med Phys 33(11): 4405-4413.
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| Choice A: | Measure the dose to the part of the CIED closest to the radiation field. |
| Choice B: | Account for the lower-energy radiation outside the treatment field. |
| Choice C: | Cover the detector with bolus. |
| Choice D: | Include passive leads in the dose assessment. |
| Question 5: A pace-dependent patient with an ICED device receiving a dose < 2 Gy should be managed as: |
| Reference: | 1.) Dimitris Mihailidis, Moyed Miften, Stephen F. Kry, et al, “Management of Radiotherapy Patients with Implanted Cardiac Pacemakers and Defibrillators: A Report of the AAPM TG-203”.
2.) C. W. Hurkmans, J. L. Knegjens, B. S. Oei, A. J. Maas, G. Uiterwaal, A. J. van der Borden, M. M. Ploegmakers and L. van Erven, "Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands," Radiation Oncology 7, 198 (2012).
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| Choice A: | Low-risk patient . |
| Choice B: | Medium-risk patient. |
| Choice C: | High-risk patient. |
| Choice D: | Low-risk unless neutrons are present . |
| Choice E: | None of the above. |
| Question 6: When should the dose to the CIED be physically measured?
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| Reference: | 1. R. M. Howell, S. B. Scarboro, S. F. Kry and D. Z. Yaldo, "Accuracy of out-of-field dose calculations by a commercial treatment planning system," Phys Med Biol 55, 6999-7008 (2010).
2. AAPM TG 158: Measurement and calculation of doses outside the treated volume from external-beam radiation therapy.
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| Choice A: | Any patient with a CIED. |
| Choice B: | Any device-dependent patient. |
| Choice C: | When the device is between 3 and 10 cm of the treatment field. |
| Choice D: | When the device is beyond 5 cm from the treatment field. |
| Choice E: | Physical measurements are never needed. |
