| Question 1: 1. A metastatic tumor at T8 on MRI is seen involving the right posterior vertebral body and right pedicle. What should be included as part of the CTV? |
| Reference: | Cox et al. International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):e597-605. |
| Choice A: | The vertebral body only. |
| Choice B: | The vertebral body and the right pedicle. |
| Choice C: | The vertebral body and bilateral pedicles. |
| Choice D: | The vertebral body and the right pedicle, transverse process, and lamina. |
| Choice E: | The vertebral body and bilateral pedicles, transverse processes, and laminae. |
| Question 2: The predicted point max absolute dose to the thecal sac for 2-fraction SBRT that results in a 5% probability of radiation myelopathy is: |
| Reference: | Sahgal et al. Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice. Int J Radiat Oncol Biol Phys. 2013 Feb 1;85(2):341-7. |
| Choice A: | 12.4 Gy |
| Choice B: | 14.6 Gy |
| Choice C: | 17.0 Gy |
| Choice D: | 23.0 Gy |
| Choice E: | 25.3 Gy |
| Question 3: The most common pattern of failure after spine SBRT is: |
| Reference: | Thibault et al. Salvage Stereotactic Body Radiotherapy (SBRT) Following In-Field Failure of Initial SBRT for Spinal Metastases. Int J Radiat Oncol Biol Phys. 2015 Oct 1;93(2):353-60.
Al-Omair et al. Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy. Neuro Oncol. 2013 Oct;15(10):1413-9.
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| Choice A: | Progression within the vertebral body. |
| Choice B: | Progression within the epidural space. |
| Choice C: | Progression within the posterior elements of the vertebral segment when not included in the CTV. |
| Choice D: | Progression in the para-spinal extra-osseous soft tissues. |
| Question 4: Dose to modiolus is closely related to which of the cochlear dose? |
| Reference: | Pract Radiat Oncol. January 2017 doi: 10.1016/j.prro.2016.08.005. Inherent functional dependence among cochlear dose surrogates for stereotactic radiosurgery of vestibular schwannomas. |
| Choice A: | Mean Dose. |
| Choice B: | Maximum Dose. |
| Choice C: | Median Dose. |
| Choice D: | Minimum Dose. |
| Choice E: | Modal Dose. |
| Question 5: According to TG101 recommendations, the maximum dose calculation grid size for a spine SBRT treatment should be... |
| Reference: | Stereotactic body radiation therapy: The report of TG101, Med Phys 2010: pg 4078, DOI: 10.1118/1.3438081 |
| Choice A: | 2mm. |
| Choice B: | 3 mm. |
| Choice C: | 4 mm. |
| Choice D: | 5 mm. |
| Question 6: In the measurement of very small fields (< 1x1 cm), typical variation in output factors caused by wrong detector and/or incorrect setup is... |
| Reference: | Das et al, Task Group 106, Med Phys 35, 4186 (2008).
Benedict et al, Task Group 101, Med Phys 37, 4078 (2010
|
| Choice A: | <2%. |
| Choice B: | 2 - 5%. |
| Choice C: | 5 -10%. |
| Choice D: | 10%. |
| Question 7: For lung SBRT of small targets, independent checks of TPS calculated monitor units (MUs).. |
| Reference: | Das et al, Task Group 106, Med Phys 35, 4186 (2008).
Benedict et al, Task Group 101, Med Phys 37, 4078 (2010)
|
| Choice A: | Should never be done because they never agree with TPS. |
| Choice B: | Will always produce same MUs as TPS because both account for heterogeneity corrections. |
| Choice C: | Will produce lower MUs than TPS because independent calculations fail to account for reduced scatter conditions in TPS. |
| Choice D: | Will produce higher MUs because scatter is missing in independent calculations. |
| Choice E: | Will produce higher MUs because independent calculations are 2D and TPS is 3D. |
| Question 8: Which of the following QA tests must be an integral part of SRS/SBRT commissioning since it validates all three systems: imaging, treatment planning and image guidance: |
| Reference: | Das et al, Task Group 106, Med Phys 35, 4186 (2008).
Benedict et al, Task Group 101, Med Phys 37, 4078 (2010)
|
| Choice A: | Fusion QA. |
| Choice B: | Dose Output QA. |
| Choice C: | IMRT QA. |
| Choice D: | MLC Picket fence QA. |
| Choice E: | End to End QA. |
| Question 9: Detector size impacts all of the following SRS commissioning measurements except: |
| Reference: | Das et al, Task Group 106, Med Phys 35, 4186 (2008).
Benedict et al, Task Group 101, Med Phys 37, 4078 (2010)
|
| Choice A: | Output factors. |
| Choice B: | Penumbra. |
| Choice C: | PDD. |
| Choice D: | Beam Profile. |
| Choice E: | FWHM. |
| Question 10: Good practice recommendation to ensure accuracy of small field output factors measured in your clinic is to use... |
| Reference: | Das et al, Task Group 106, Med Phys 35, 4186 (2008).
Benedict et al, Task Group 101, Med Phys 37, 4078 (2010)
|
| Choice A: | One Ion Chamber. |
| Choice B: | Any one ion chamber + one diode. |
| Choice C: | Two ion chambers + one diode. |
| Choice D: | One ion chamber + two diodes. |
| Choice E: | Trust your instincts! |
