| Question 1: Advantages of using MRI in radiation treatment planning include: |
| Reference: | Tzikas, et al. Investigating the Clinical Aspects of Using CT vs. CT-MRI Images during Organ Delineation and Treatment Planning in Prostate Cancer Radiotherapy. Technology in Cancer Research & Treatment. Vol 10, Issue 3, pp. 231 – 242. doi: 10.7785/tcrt.2012.500198 |
| Choice A: | Improved target delineation |
| Choice B: | Improved spatial resolution |
| Choice C: | Accurate electron density |
| Choice D: | Geometric accuracy |
| Choice E: | High signal intensity of bone |
| Question 2: What is the adaptive radiation therapy? |
| Reference: | XA Li, ed. Adaptive Radiation Therapy. Phys. Taylor & Francis, 2011. |
| Choice A: | creating a boost plan |
| Choice B: | modifying patient contours mid-treatment |
| Choice C: | modifying radiation plans during treatment to account for patient anatomy changes |
| Choice D: | adapting imaging procedures to improve anatomical visualization |
| Choice E: | all of the above |
| Question 3: What are the major differences between low- and high-field MRI? |
| Reference: | Scarabino, et al. 3.0T MRI Diagnostic Features: Comparison with Lower Magnetic Fields. High Field Brain MRI: Use in Clinical Practice. Springer, Feb 27, 2017. |
| Choice A: | lower signal to noise ratio as field strength increases |
| Choice B: | flow/motion artifacts are often more apparent on images from lower field scanners |
| Choice C: | similar spatial and temporal resolution in low and high fields |
| Choice D: | improved functional images with high field MRI |
| Choice E: | shorter T1 relaxation time for high-field MRI |
| Question 4: The 5-Gauss line is: |
| Reference: | E Kanal, JP Borgstede, AJ Barkovich, C Bell, WG. Bradley, JP Felmlee, JW Froelich, EM Kaminski, EK Keeler, JW Lester, EA Scoumis, LA Zaremba and MD Zinninge, American College of Radiology White Paper on MR Safety, American Journal of Roentgenology. 2002;178: 1335-1347. doi:10.2214/ajr.178.6.1781335 |
| Choice A: | A pixel line in the matrix |
| Choice B: | The magnetic field line territory within which the magnetic field can become harmful |
| Choice C: | A catheter inserted into the femoral artery |
| Choice D: | A geometric theorem |
| Question 5: How do you perform machine acceptance tests for hybrid MRI radiotherapy systems? |
| Reference: | Beam characterization of the 1.5 T MRI-linac, Woodings et al. (Phys Med Biol 2018 Apr 19 63(8) 085015). |
| Choice A: | Perform as you would for normal linacs, but do use non-magnetic detectors and team up with radiology for QA on the MRI. |
| Choice B: | Rely on manufacturer setting to work results and check with end-to-end chain test. |
| Choice C: | Set up a dedicated QA program to account for B field, new system functionality and layout. |
| Choice D: | Perform acceptance procedure as for any interventional radiology system, added with regular linac QA |
| Question 6: What is the hurdle for reliable dose accumulation? |
| Reference: | Anatomically plausible models and quality assurance criteria for online mono- and multi-modal medical image registration, Zachiu et al. (Phys Med Biol, 2018, Aug 1;63(15):155016) |
| Choice A: | Image quality is too poor for stitching images to a reference data set. |
| Choice B: | Certainty about the physiologically plausibility of non-rigid registration for stitching images to a reference data set |
| Choice C: | MRI only provides 2D data, so no volumetric image registration is possible |
| Choice D: | Non-rigid registration is an ill-defined problem, so you will always have multiple solutions which makes it clinically impossible to use |
| Question 7: Is real-time adaptive radiotherapy even conceivable? |
| Reference: | 1. Development of patient-controlled respiratory gating system based on visual guidance for magnetic-resonance image-guided radiation therapy, Kim et al. Med Phys. 2017 Sep 44(9) 4838-4846;
2. Towards fast online intrafraction replanning for free |
| Choice A: | No, MRI is too slow for real-time anatomical updates |
| Choice B: | No, even daily full re-planning cannot be done with MRI as an input and therefore approximative plan adaptation is done for hybrid MRI radiotherapy systems |
| Choice C: | No, re-planning for these systems need to account for the magnetic field via Monte Carlo dose calculations in the inverse optimization and this is simply too computationally intensive |
| Choice D: | Yes, gating is already a form of real-time intervention, more sophisticated adaption workflows will follow for sure. |
| Question 8: Which of the following are the advantages of MRgRT system? |
| Reference: | P Kupelian P, J-J Sonke, Magnetic Resonance–Guided Adaptive Radiotherapy: A Solution to the Future. Semin Radiat Oncol. 2014;24(3):227-232. doi:10.1016/j.semradonc.2014.02.01 |
| Choice A: | Improved soft tissue contrast |
| Choice B: | Soft tissue based gated treatment |
| Choice C: | Effective online adaptive therapy |
| Choice D: | On-board functional imaging capability |
| Choice E: | All of the above |
| Question 9: Which of the following is not challenges for using conventional DWI in Viewray RTgRT system: |
| Reference: | Y. Gao, F. Han, Z. Zhou, M. Cao, T. Kaprealian, M. Kamrava, M. Wang, J. Neylon, D. Low, Y. Yang, P. Hu, “Distortion-Free Diffusion MRI using an MRI-Guided Tri-Cobalt 60 Radiotherapy System: Sequence Validation and Preliminary Clinical Experienceâ€, Med |
| Choice A: | Biological changes, such as ADC change, often happen earlier than morphological change |
| Choice B: | Optimal timing of acquiring DWI |
| Choice C: | Low spatial resolution |
| Choice D: | Large geometric distortion |
| Choice E: | SNR loss causing inaccurate DWI with high b values |
| Question 10: Which of the following can cause geometric distortion on MRI image? |
| Reference: | Walker, A., Liney, G. P., Metcalfe, P. E. & Holloway, L. C. (2014). MRI distortion: considerations for MRI based radiotherapy treatment planning. Australasian Physical & Engineering Sciences in Medicine, 37 (1), 103-113. |
| Choice A: | Chemical shifts |
| Choice B: | Inhomogeneity in magnetic field |
| Choice C: | Gradient non-linearity |
| Choice D: | All of the above |
| Choice E: | None of the above |
