| Question 1: 1. What is a difficulty encountered with the extreme hypofractionation regimens used for SBRT? |
| Reference: | Seminars in Radiation Oncology, 2016: Volume 26, Issue 2 – especially “Dose Tolerance for Stereotactic Body Radiation Therapyâ€, J. Grimm; “Dose-Response Model for Chest Wall Tolerance of Stereotactic Body Radiation Therapyâ€, F Kimsey et al (pp 129-134); “Esophageal Dose Tolerance in Patients Treated with Stereotactic Body Radiation Therapyâ€, J J Nuyttens et al (pp 120-128); and “Stereotactic body radiation therapy: The report of AAPM Task Group 101†(2010) Medical Physics 37 (2010), pp 4078-4101. |
| Choice A: | TCP is often worse than expected |
| Choice B: | Normal tissue complications are observed that are rare at conventional fractionation |
| Choice C: | Such hypofractionation cannot be used for prostate or lung treatments |
| Choice D: | The therapeutic ratio is usually lower than for conventional fractionation |
| Question 2: 2. Why is the Linear Quadratic (LQ) model most often used to compare effectiveness of SBRT regimens? |
| Reference: | “The Linear-Quadratic Model is an Appropriate Methodology for Determining Isoeffective Doses at Large Doses per Fractionâ€, D J Brenner, Seminars in Radiation Oncology (2008) Volume 18, Issue 4 (pp 234-239); “The Linear-Quadratic Model is inappropriate to Model Huigh Dose per Fraction Effects in Radiosurgeryâ€, J P Kirkpatrick et al, Seminars in Radiation Oncology (2008) Volume 18, Issue 4 (pp 240-243); and “The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved?â€, Brown JM, et al. Int J Radiat Oncol Biol Phys. 2014;88(2):254-262. |
| Choice A: | It is very accurate for the doses per fraction typical of SBRT |
| Choice B: | It has the correct volume dependence for SBRT |
| Choice C: | It is mathematically simpler than competing models |
| Choice D: | It is the only model available |
| Question 3: The objective of the WECARE Study is to examine the interaction of radiation exposure and genetic susceptibility in the etiology of second primary cancer. What is the global hypothesis being tested across all WECARE work? |
| Reference: | Reference: Bernstein JL, et al. Designing and implementing quality control for multi-center screening of mutations in the ATM gene among women with breast cancer. Hum Mutat 2003; 21:542-500. |
| Choice A: | Contralateral breasts will always develop cancer |
| Choice B: | Women who are carriers of certain genetic mutations will be more susceptible to radiation-induced breast cancer than are non-carriers |
| Choice C: | Genetic susceptibility plays no role in the development of second cancers |
| Choice D: | Conformal doses reduce overall risk of radiation-induced breast cancer |
| Question 4: While tamoxifen treatment greatly reduces a woman’s risk of developing a second primary breast cancer, certain phenotypes do contribute to differences in risk impact. |
| Reference: | Brooks JD, et al. CYP2D6 phenotype, tamoxifen, and risk of contralateral breast cancer in the WECARE Study. Breast Cancer Res. 2018; 20(1):149. |
| Choice A: | True |
| Choice B: | False |
| Question 5: A process QA must be established for each new process as part of QM program. Which of the following is true? |
| Reference: | “Safety is No Accidentâ€. American Society for Radiation Oncology. Safety is No Accident, 2019. Page 28. |
| Choice A: | The Joint Commission requires hospitals to select one high-risk process and conduct a proactive risk assessment at least every 6 months |
| Choice B: | FMEA is being adapted for process and quality improvement in health care |
| Choice C: | AAPM Task Group 142 outlines safety and quality standards for the handling of hazard analysis |
| Choice D: | Training and documentation should be updated each time new staff is hired |
| Question 6: AAPM introduced the safety profile assessment (SPA) in July 2013. Which of the following is true? |
| Reference: | Dunscombe P, et al. Safety Profile Assessment: An online tool to gauge safety-critical performance in radiation oncology. Pract Radiat Oncol. 2015;5:127-134 |
| Choice A: | SPA is developed with input from associated professional organizations including manufacturers |
| Choice B: | SPA is qualified by the ABR as meeting the criteria for practice quality improvement of its Maintenance of Certification program |
| Choice C: | SPA is comprised of enforced survey questions for the physics plan review |
| Choice D: | SPA survey questions are incorporated by 5 sections with 129 questions |
