| Question 1: Retrospective data shows that PTV elimination (in the presence of dose monitoring and ART) may have more impact on the reduction of normal tissue toxicity in head and neck than dose de-escalation. |
| Reference: | Methods for Reducing Normal Tissue Complication Probabilities in Oropharyngeal Cancer: Dose Reduction or Planning Target Volume Elimination.
Samuels SE, Eisbruch A, Vineberg K, Lee J, Lee C, Matuszak MM, Ten Haken RK, Brock KK. Int J Radiat Oncol Biol Phys. 2016 Nov 1;96(3):645-52. doi: 10.1016/j.ijrobp.2016.06.2456. |
| Choice A: | True |
| Choice B: | False |
| Question 2: A study on 81 patients treated with stereotactic body radiotherapy (SBRT) for liver metastases shows that minimum accumulated dose to the gross tumor volume is: |
| Reference: | Accumulated Delivered Dose Response of Stereotactic Body Radiation Therapy for Liver Metastases. Swaminath A, Massey C, Brierley JD, Dinniwell R, Wong R, Kim JJ, Velec M, Brock KK, Dawson LA. Int J Radiat Oncol Biol Phys. 2015 Nov 1;93(3):639-48. doi: 10.1016/j.ijrobp.2015.07.2273. Epub 2015 Jul 26.
PMID: 26461006 |
| Choice A: | Meaningless |
| Choice B: | A poor predictor of overall survival |
| Choice C: | A better predictor of total time to local progression than the minimum dose to the planning target volume |
| Choice D: | A worse predictor of total time to local progression than the minimum dose to the planning target volume |
| Choice E: | A worse predictor of total time to local progression than the maximum dose to the planning target volume |
| Question 3: A simulation study of normal tissue toxicity demonstrated that the standard, planned-dose normal tissue toxicity model: |
| Reference: | A simulation study to assess the potential impact of developing normal tissue complication probability models with accumulated dose.
McCulloch MM, Muenz DG, Schipper MJ, Velec M, Dawson LA, Brock KK.
Adv Radiat Oncol. 2018 May 16;3(4):662-672. doi: 10.101 |
| Choice A: | overestimates toxicity risk for both the duodenal and stomach models at doses that are below approximately 20 Gy 6 fractions and underestimates toxicity risk for doses above approximately 20 Gy 6 fractions, compared to accumulated dose |
| Choice B: | underestimates toxicity risk for both the duodenal and stomach models at doses that are below approximately 20 Gy 6 fractions and overestimates toxicity risk for doses above approximately 20 Gy 6 fractions, compared to accumulated dose |
| Choice C: | shows no difference from accumulated dose models |
| Choice D: | should be reduced by 50% to avoid a 50% risk in toxicity |
| Choice E: | is completely flawed and should never be used |
| Question 4: A midtreatment threshold deviation was determined to predict the need to replan for the submandibular glands by fraction 15 of 30 to 35 total fractions of RT. |
| Reference: | Predictive Models to Determine Clinically Relevant Deviations in Delivered Dose for Head and Neck Cancer.
McCulloch MM, Lee C, Rosen BS, Kamp JD, Lockhart CM, Lee JY, Polan DF, Hawkins PG, Anderson CJR, Heukelom J, Sonke JJ, Fuller CD, Balter JM, Ten Haken RK, Eisbruch A, Brock KK.
Pract Radiat Oncol. 2019 Mar 2. pii: S1879-8500(19)30068-2. doi: 10.1016/j.prro.2019.02.014.
PMID: 30836190 |
| Choice A: | True |
| Choice B: | False |
| Question 5: Deformable image registration (DIR) is an integral part of adaptive radiation therapy. According to AAPM TG-132, which of the following methods is an acceptable form of quantitative evaluation of DIR performance? |
| Reference: | Brock KK, Mutic S, McNutt TR, et al. Use of Image Registration and Fusion Algorithms and Techniques in Radiotherapy: Report of the AAPM Radiation Therapy Committee Task Group No. 132. Med Phys 2017;44:e43-e76. |
| Choice A: | Visual inspection of registration |
| Choice B: | Dice similarity coefficient of propagated contours |
| Choice C: | Overlaying images for qualitative review |
| Choice D: | Review of images with checkerboard patterns |
| Question 6: Which of the following tasks is currently the most time consuming in an online adaptive radiation therapy workflow? |
| Reference: | Henke, L., Kashani, R., Robinson, C., Curcuru, A., DeWees, T., Bradley, J., Green, O., Michalski, J., Mutic, S., Parikh, P. and Olsen, J., 2018. Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen. Radiotherapy and Oncology, 126(3), pp.519-526. |
| Choice A: | Acquisition of daily setup image |
| Choice B: | Physics check of the daily adapted plan |
| Choice C: | Plan re-optimization |
| Choice D: | Daily delineation of planning structures |
| Question 7: To facilitate online ART, rapid contouring must be performed while the patient is on the treatment table. Which of the following strategies have been shown to be effective for expediting contouring? |
| Reference: | Bohoudi, O., A. M. E. Bruynzeel, S. Senan, J. P. Cuijpers, B. J. Slotman, F. J. Lagerwaard, and M. A. Palacios. "Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer." Radiotherapy and Oncology 125, no. 3 (2017): 439-444. |
| Choice A: | Contouring organs within a limited region around the target |
| Choice B: | Deformable propagation of the contours from the initial dataset |
| Choice C: | Rigidly copying contours from the initial dataset |
| Choice D: | All of the above |
| Question 8: In which year was the first patient treated with real-time adaptation using a commercial linac? |
| Reference: | B. The first patient treatment with real-time adaptation occurred in 2004 using the Cyberknife with kV and surface tracking. That is 15 years ago The first real-time adaptive treatments with MLC tracking occurred in 2013 prostate and 2016 lung.
Re |
| Choice A: | 2004 |
| Choice B: | 2013 |
| Choice C: | 2016 |
| Choice D: | Not yet possible |
| Question 9: Which of the following is an uncertainty specific to real-time adaptation? |
| Reference: | Booth, J.T., Caillet, V., Hardcastle, N., O’Brien, R., Szymura, K., Crasta, C., Harris, B., Haddad, C., Eade, T. and Keall, P.J., 2016. The first patient treatment of electromagnetic-guided real time adaptive radiotherapy using MLC tracking for lung SAB |
| Choice A: | Target localization |
| Choice B: | Motion prediction errors |
| Choice C: | Accuracy of surrogate |
| Choice D: | All of the above. |
| Question 10: The application of real-time adaptive radiotherapy to lung SABR has shown reductions in planning target volume compared to an internal target volume (ITV)-based planning technique in the range: |
| Reference: | Caillet, V., Keall, P.J., Colvill, E., Hardcastle, N., O'Brien, R., Szymura, K. and Booth, J.T., 2017. MLC tracking for lung SABR reduces planning target volumes and dose to organs at risk. Radiotherapy and Oncology, 124(1), pp.18-24. |
| Choice A: | No PTV changes with real-time targeting |
| Choice B: | Up to 10% reduction in PTV |
| Choice C: | Up to 40% reduction in PTV |
| Choice D: | Greater than 40% reduction in PTV |
