2018 AAPM Annual Meeting
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Session Title: In Memoriam of Lynn Verhey: Clinical Physicists Must Know and Be Involved in Treatment Planning
Question 1: A key aspect of effectively using new technologies / techniques is to:
Reference:Meyer, J; Verhey, L;, Xia, P; and Wong, J: New Technologies in the Radiotherapy Clinic, in IMRT, IGRT, SBRT – Advances in the Treatment Planning and Delivery of Radiotherapy, eds. Meyer, JL: Kavanaugh, BD; Purdy, JA; Timmerman, R. Karger AG, Basel, 2007. Verhey, LJ; Goitein, M;, McNulty, P;, Munzenrider, JE;, and Suit, HD: Precise Positioning of Patients for Radiation Therapy. Int J Radiat Oncol Biol Phys 8(2):289-94, 1982.
Choice A:Institute new practices rapidly so that patients can benefit as early as possible.
Choice B:Using a team approach to integrate new practices into the clinic.
Choice C:Recognize that new technologies may not benefit all patients; the best techniques may be the simplest.
Choice D:B and C.
Choice E:All of the above.
Question 2: Good Practices in Medical Physics, as recommended by Medical Physics 3.0, include all of the following except:
Reference:https://www.aapm.org/MedPhys30/articles/GoodPractices.asp, accessed 4/18/2018.
Choice A:Never forget that each patient is a person and that contributing to each patient’s care is our primary purpose.
Choice B:Embrace accountability by taking ownership of your work including your errors and omissions.
Choice C:Establish a regular physical presence in the practice, and do not rely exclusively on electronic communications.
Choice D:Maximize the value of your contributions by critically examining the work of others.
Question 3: Which statement below summaries common features of advanced planning tools of knowledge-based planning, multiple criteria optimization, and auto-planning?
Reference:Krayenbuehl et. al. Evaluation of an automated knowledge based treatment planning system for head and neck, radiation oncology, 2015 10:226. Philips manual in Pinnacle treatment planning RayStation User’s Manual
Choice A:Only knowledge-based planning propagates knowledge from experts’ planning .
Choice B:There is no common feature between the three methods.
Choice C:Multiple criteria optimization can find the optimal solution.
Choice D:Auto-planning is the same as the conventional IMRT planning.
Choice E:These three methods can improve plan quality, consistency, and efficiency.
Question 4: Treatment planning knowledge based models are
Reference:Lian et al, Modeling the dosimetry of organ-at-risk in head and neck IMRT planning: An inter-technique and inter-institutional study, Medical Physics 2013, 40(12) Yuan et al, Quantitative analysis of the factors which affect the inter-patient organ-at-risk dose sparing variation in IMRT plans, Medical Physics 2012, 39(11)-
Choice A:Confined to a single institution.
Choice B:Applicable to multiple modalities.
Choice C:Useful for only IMRT.
Choice D:Physician Specific.
Choice E:Useable only with Monte Carlo-based dose calculation algorithms.
Question 5: Based on RTOG 0813, if an institution does not use active breath hold or tracking (i.e. Cyberknife Synchorny) during treatment, and uses 4DCT to obtain the ITV, what kind of margin is needed for PTV for lung SBRT?
Reference:https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0813 https://www.ncbi.nlm.nih.gov/pubmed/25735283
Choice A:0.5 cm in all directions.
Choice B:0.5 cm axial and lateral, 0.8 cm S/I direction.
Choice C:No need to margin.
Choice D:0.5 cm in the axial plane and 1.0 cm in the longitudinal plane.
Choice E:Institutional margins.
Question 6: What CT image derived from 4D CT is frequently used for lung SBRT treatment planning (no active breath control), and in what scenario this CT may introduce dosimetry error?
Reference:Wunderle K, et. al. Chapter 13 in “Physics in Radiation Oncology Self-Assessment Guide”, Andrew Godley and Ping Xia (editors), Demos Medical Publishing LLC (2016). Ohira Shingo, et. al. Journal of Radiation Research, Vol. 57, No. 1, 2016, pp. 91–97
Choice A:MIP CT, tumor is located in the upper lobe of the lung
Choice B:AIP CT, tumor is located in the upper lobe of the lung
Choice C:MIP CT, tumor is located near the diaphragm with a motion greater than 2 cm
Choice D:AIP CT, tumor is located near the diaphragm with a motion greater than 2 cm
Choice E:AIP CT, tumor is located in the middle of the lung
Question 7: The PTV concept does not translate well to proton planning because:
Reference:Langen K and Zhu M. Concepts of PTV and Robustness in Passively Scattered and Pencil Beam Scanning Proton Therapy. Seminars in Radiation Oncology (in Press), 2018.
Choice A:Tange uncertainties are beam specific and require beam specific PTVs.
Choice B:Setup uncertainties are minimal in proton therapy and can be ignored.
Choice C:Planning to the CTV is sufficient since protons are very precise.
Choice D:Beam specific uncertainties are taken into account in the design of the proton beam.
Choice E:A and D.
Question 8: In proton planning the plan robustness of a plan is evaluated as a quality metric. It describes:
Reference:Langen K and Zhu M. Concepts of PTV and Robustness in Passively Scattered and Pencil Beam Scanning Proton Therapy. Seminars in Radiation Oncology (in Press), 2018.
Choice A:The interplay effect between a moving target and dynamic beam delivery
Choice B:How reproducible the patient setup is
Choice C:How reproducible the proton machine can deliver the proton plan
Choice D:How reproducible the dose distribution is when range and setup uncertainties are taken into account
Question 9: Magnetic Resonance Imaging (MRI) may be prone to system and patient-level distortions. Which system-level distortion is the largest contributor to the total distortion?
Reference:Baldwin, L.N., Wachowicz, K., Thomas, S.D., Rivest, R. and Fallone, B.G., 2007. Characterization, prediction, and correction of geometric distortion in 3T MR images. Medical Physics, 34(2), pp.388-399.
Choice A:Gradient nonlinearity.
Choice B:Chemical shift.
Choice C:Radiofrequency noise.
Choice D:All of the above.
Question 10: The largest dose calculation differences for photon-based MR-only treatment planning compared to CT-based planning arises from which of the following effects?
Reference:Kim, J., Garbarino, K., Schultz, L., Levin, K., Movsas, B., Siddiqui, M.S., Chetty, I.J. and Glide-Hurst, C., 2015. Dosimetric evaluation of synthetic CT relative to bulk density assignment-based magnetic resonance-only approaches for prostate radiotherapy. Radiation Oncology, 10(1), p.239.
Choice A:Distortions in the MRI data.
Choice B:Inaccurate Hounsfield Unit assignment.
Choice C:Large volumes of air that are not taken into account.
Choice D:Metal artifacts.
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