2019 AAPM Annual Meeting
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Session Title: Intrafraction Motion Management in Radiotherapy - State of the Art and Future Roadmap
Question 1: Soft tissue contrast is higher in
Reference:Hugo, Geoffrey D., and Mihaela Rosu. "Advances in 4D radiation therapy for managing respiration: Part I–4D imaging." Zeitschrift für Medizinische Physik 22.4 (2012): 258-271
Choice A:4DCBCT
Choice B:Fluoroscopy
Choice C:Dynamic MRI
Choice D:3D CBCT
Question 2: Treatment precision of image-guided liver SBRT using fiducial markers depends on marker-tumor distance
Reference:Seppenwoolde, Yvette, et al. "Treatment precision of image-guided liver SBRT using implanted fiducial markers depends on marker-tumour distance." Physics in medicine and biology56.17 (2011): 5445.
Choice A:True
Choice B:False
Question 3: Which inter-cycle breathing variations are least accurately captured in respiratory-correlated 4DCT?
Reference:Steiner, E., et al. "Both four-dimensional computed tomography and four-dimensional cone beam computed tomography under-predict lung target motion during radiotherapy." Radiotherapy and Oncology 135: (2019); 65-73.
Choice A:variations in superior-inferior amplitude
Choice B:variations in anterior-posterior amplitude
Choice C:variations in period per respiratory cycle
Choice D:baseline shifts
Question 4: The main limitation of in-room real-time monitoring of a single point (tumor centroid) is that
Reference:Sawant et al., "Investigating the Feasibility of Rapid MRI for Image-Guided Motion Management in Lung Cancer Radiotherapy," BioMed Research International, vol. 2014, Article ID 485067, 6 pages, 2014. https://doi.org/10.1155/2014/485067
Choice A:Cycle-to-cycle variations of tumor position are not captured
Choice B:Baseline shifts are not captured
Choice C:Baseline shifts are not captured
Choice D:current real-time systems do not have a sufficiently high update rate to capture breathing motion
Question 5: Which of the following is correct for the correlation between external surrogate and internal motion?
Reference:Minn, A. Yuriko, et al. "Pancreatic tumor motion on a single planning 4D-CT does not correlate with intrafraction tumor motion during treatment." American journal of clinical oncology32.4 (2009): 364-368.
Choice A:The correlation stays constant throughout treatment
Choice B:The correlation might fluctuate for a very small percentage of patients
Choice C:About 50% of patients were shown to have major fluctuations between simulation and treatment
Question 6: Which of the following are direct tumor localization techniques?
Reference:Kitamura, Kei, et al. "Registration accuracy and possible migration of internal fiducial gold marker implanted in prostate and liver treated with real-time tumor-tracking radiation therapy (RTRT)." Radiotherapy and oncology 62.3 (2002): 275-281. Green, O., et al. "PO-0891: Clinical implementation and experience with real-time anatomy tracking and gating during MR-IGRT." Radiotherapy and Oncology 119 (2016): S428-S429. Shah, Amish P., et al. "An evaluation of intrafraction motion of the prostate in the prone and supine positions using electromagnetic tracking." Radiotherapy and Oncology 99.1 (2011): 37-43.
Choice A:MR linac
Choice B:Electromagnetic fiducal tracking
Choice C:Fluoroscopy
Choice D:All of the above
Question 7: The AAPM Task Group 76 report recommends that respiratory management techniques be considered when
Reference:Keall P, Mageras G, Balter J et al. AAPM Task Group 76: The management of respiratory motion in radiation oncology. Medical Physics. 2006
Choice A:Greater than 5 mm range of motion is observed in any direction
Choice B:Significant normal tissue sparing can be gained through the use of a respiration management technique
Choice C:A or B
Choice D:A and B
Question 8: Real-time 3D image guided radiation therapy has been clinically implemented on:
Reference:Uchinami Y, Katoh N, Abo D, et al. An Organ Motion and Acute Toxicity Study of Image-Guided Spot-Scanning Proton Beam Therapy With An Internal Fiducial Marker for Pancreatic Cancers. International Journal of Radiation Oncology• Biology• Physics 2017;99:E194. & Keall P, Nguyen D, O’Brien R, et al. A Review of Real-Time 3D IGRT on Standard-Equipped Cancer Radiotherapy Systems: Are We at the Tipping Point for the Era of Real-Time Radiotherapy? International Journal of Radiation Oncology• Biology• Physics 2018.
Choice A:CyberKnife and Vero systems
Choice B:Standard-equipped linear accelerators
Choice C:Particle therapy systems
Choice D:All of the above
Question 9: Which statement is incorrect?
Reference:(1) Rietzel, Eike, and Christoph Bert. "Respiratory motion management in particle therapy." Medical physics 37, no. 2 (2010): 449-460. (2) Knopf, Antje, Christoph Bert, Emily Heath, Simeon Nill, Kim Kraus, Daniel Richter, Eugen Hug et al. "Special report: Workshop on 4D‐treatment planning in actively scanned particle therapy—Recommendations, technical challenges, and future research directions." Medical physics 37, no. 9 (2010): 4608-4614.
Choice A:Beam angle selection is important to minimize tissue variations in the beam path
Choice B:Passive scattered proton therapy does not have motion management issues
Choice C:A large beam spot in pencil beam scanning would minimize the impact of motion
Choice D:Repainting the treatment volume multiple times would reduce the impact of motion
Question 10: What is the 4D dynamic dose calculation?
Reference:Richter, Daniel, Nami Saito, Naved Chaudhri, Martin Härtig, Malte Ellerbrock, Oliver Jäkel, Stephanie E. Combs et al. "Four-dimensional patient dose reconstruction for scanned ion beam therapy of moving liver tumors." International Journal of Radiation Oncology* Biology* Physics 89, no. 1 (2014): 175-181.
Choice A:It is a method to estimate the final dose distribution after a dynamic treatment delivery
Choice B:It incorporates patient’s breathing model from 4DCT imaging
Choice C:It incorporates the timing of pencil beam delivery from the machine log file
Choice D:It uses deformable image registration to track dose delivered to various organs
Choice E:All of the above
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