| 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 4Dâ€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 |
