| Question 1: For patients undergoing stereotactic radiosurgery (SRS) for the treatment of 2-3 brain metastases, which of the following is true |
| Reference: | Speaker: Michael Milano
Rationale: Slide 18 summarizes the literature on SRS alone vs. SRS plus whole brain radiation. SRS alone is associated with a greater likelihood of local and distant brain metastases, but overall survival is not compromised because salvage therapy is effe |
| Choice A: | The omission of whole brain radiotherapy (WBRT) leads to a lower survival rate (as compared to those who undergo WBRT and SRS). |
| Choice B: | The omission of whole brain radiotherapy leads to a greater likelihood for developing new brain metastases after SRS. |
| Choice C: | Salvage options (i.e. treatment for new or progressing brain metastases) are limited for those patients who SRS alone. |
| Choice D: | SRS alone (i.e. no whole brain radiotherapy) should not be considered as an accepted treatment approach outside of experimental protocols. |
| Question 2: For stereotactic radiosurgery (SRS) alone (i.e. no whole brain radiotherapy) for the treatment of multiple brain metastases, which of the following is true |
| Reference: | Speaker: Michael Milano
Rationale: The number of lesions, among those with multiple (>1 to 10) brain metastases, does not appear to impact survival outcomes, based on retrospective and prospective (non-randomized) studies (slide 29). With >10 brain metastases, there appears to b |
| Choice A: | The bulk (i.e. volume) of brain metastases does NOT appear to be a significant factor for survival outcomes. |
| Choice B: | The rates of survival and of distant (i.e. new) brain metastases among those with >10 metastases is similar to that observed after SRS alone in patients with 1 brain metastasis. |
| Choice C: | The number of metastatic lesions (among those with 10 or fewer metastases) is NOT a strong predictor of survival. |
| Choice D: | Neuro-cognitive outcomes are not relevant in treatment decision making. |
| Question 3: For single isocenter treatment of multiple metastases, targets that are 10cm away from the isocenter should be planned with the following PTV margins: |
| Reference: | Speaker: Nzhde Agazaryan
Summarized in my presentation, as well as, the following article:
Jenghwa Chang, Incorporating the rotational setup uncertainty into the planning target volume margin expansion for the single isocenter for multiple targets technique, Practical Radiation O |
| Choice A: | 0 mm |
| Choice B: | 1-2 mm |
| Choice C: | 5 mm |
| Choice D: | 10 mm |
| Question 4: When using 2mm margin vs. 0mm margin for PTV creation, the resulting PTV volumes, V5Gy volumes, V10Gy volumes, and V12Gy volumes: |
| Reference: | Speaker: Nzhde Agazaryan
Jenghwa Chang, “Incorporating the rotational setup uncertainty into the planning target volume margin expansion for the single isocenter for multiple targets technique†Practical Radiation Oncology, Volume 8, Issue 6, 2018, Pages 475-483. |
| Choice A: | remain unchanged |
| Choice B: | significantly increase, more than doubling for targets smaller than 1.5cm in diameter |
| Choice C: | PTV volumes change; however, V5Gy volumes, V10Gy volume, and V12Gy volumes stay the same |
| Choice D: | PTV volumes change; however, V5Gy volumes, V10Gy volume, and V12Gy decrease |
| Question 5: According to TG-142, the tolerance for imaging isocenter and treatment isocenter coincidence for SRS is |
| Reference: | Speaker: Grace Kim
Reference: E.E. Klein, et al., Task Group 142 report: Quality assurance of medical accelerators, Med. Phys. 35, 4197-4212 (2009). |
| Choice A: | 0.1 mm |
| Choice B: | 0.5 mm |
| Choice C: | 1.0 mm |
| Choice D: | 2.0 mm |
| Question 6: Which of the following features is NOT utilized in HyperArc? |
| Reference: | Speaker: Grace Kim
Ruggieri et al., Linac-based VMAT radiosurgery for multiple brain lesions: comparison between a conventional multi-isocenter approach and a new dedicated mono-isocenter technique, Radiation Oncology (2018) 13:38 |
| Choice A: | Automatic isocenter placement |
| Choice B: | Collimator angle optimizer |
| Choice C: | SRS normal tissue objectives |
| Choice D: | Automatic target delineation. |
