2019 AAPM Annual Meeting
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Session Title: Advances in Ultrasound Guidance and Planning for Brachytherapy
Question 1: According to the literature, the accuracy of catheter reconstruction in interstitial HDR brachytherapy is:
Reference:Batchelar, Deidre, Miren Gaztañaga, Matt Schmid, Cynthia Araujo, François Bachand, and Juanita Crook. Validation Study of Ultrasound-Based High-Dose-Rate Prostate Brachytherapy Planning Compared with CT-Based Planning. Brachytherapy 13, (2014) 75
Choice A:Perfect
Choice B:Between 1 and 3 mm
Choice C:About 5 mm
Choice D:Worse than 5 mm
Question 2: When using EM tracking, what is the overall catheter reconstruction accuracy?
Reference:Poulin, E, E Racine, D Binnekamp, and L. Beaulieu. Fast, Automatic, and Accurate Catheter Reconstruction in HDR Brachytherapy Using an Electromagnetic 3D Tracking System. Medical Physics 42 (2015) 1227. Bharat, Shyam, Cynthia Kung, Ehsan Dehg
Choice A:10 s/catheter with accuracy of < 1 mm
Choice B:10 s/catheter with accuracy between 1-3 mm
Choice C:60 s/catheter with accuracy of about 1 mm
Choice D:120 s/catheter with accuracy of about 5 mm
Question 3: The use of electromagnetic tracking has been described in ultrasound-based brachytherapy needle insertion to assist with: 1. Catheter digitization quality assurance 2. Digitization of catheter trajectory in HDR brachytherapy 3. Identification of seed deposition in LDR brachytherapy 4. Real-time feedback in MRI-guided brachytherapy insertions
Reference:Damato, A. L., A. N. Viswanathan, S. M. Don, J. L. Hansen, and R. A. Cormack. (2014). A system to use electromagnetic tracking for the quality assurance of brachytherapy catheter digitization. Med. Phys. 41(10). ; Poulin et al, Med. Phys.
Choice A:1 and 2 only
Choice B:3 and 4 only
Choice C:1, 2, and 3
Choice D:All 4.
Question 4: What are the limitations of 2D ultrasound imaging?
Reference:Tong S, Cardinal HN, McLoughlin RF, Downey DB, Fenster A. Intra-and Inter-Observer Variability and Reliability of Prostate Volume Measurement Via 2D and 3D Ultrasound Imaging. Ultrasound in Medicine and Biology 24(5): 673-681, 1998.
Choice A:It is difficult to reproduce the same 2D ultrasound image plane at two different imaging sessions.
Choice B:Estimation of tumor volume with 2D ultrasound imaging is inaccurate and variable.
Choice C:It is not possible to view the anatomy in a plane parallel to the skin (C-mode).
Choice D:All the above.
Choice E:None of the above.
Question 5: What is the approximate time for generation of a 3D ultrasound image for prostate, breast and gynecologic brachytherapy using a mechanical scanning method?
Reference:Fenster A, Downey D, Cardinal N. Three Dimensional Ultrasound Imaging. Physics in Medicine and Biology 46(5): R67-R99, 2001.
Choice A:Less than 1 second
Choice B:5 to 20 seconds
Choice C:30 to 60 seconds
Choice D:Longer than 60 seconds
Question 6: Possible 3D ultrasound mechanical scan geometries for use in prostate and gynecologic brachytherapy are:
Reference:Hrinivich T, Hoover DA, Surry K, Edirisinghe C, Velker V, Bauman G, D'Souza D, Fenster A, Wong E. Accuracy and variability of high-dose-rate prostate brachytherapy needle tip localization using live two-dimensional and sagittally-reconstructed three-dimensional ultrasound. Brachytherapy, 16(5) 1035-1043 Sep.-Oct. 2017, DOI: 10.1016/j.brachy.2017.06.008. PMID 28764882 Rodgers J, Bax J, Surry K, Velker V, Leung E, D’Souza D, Fenster A. Intraoperative 360-deg three-dimensional transvaginal ultrasound during needle insertions for high-dose-rate transperineal interstitial gynecologic brachytherapy of vaginal tumors. Journal of Medical Imaging. 6(2), 025001; 1-12. DOI: 10.1117/1.JMI.6.2.025001. Apr. 2019.
Choice A:Pull-back method of the ultrasound probe
Choice B:Rotational method with a side firing ultrasound probe
Choice C:Rotational method with an end-firing ultrasound probe
Choice D:(a) and (b) only
Choice E:All the above
Question 7: 1. What are two reasons for adding interstitial needles to a ring and tandem implant for cervical cancer? (1) Increased coverage of the CTV (2) Decreased dose to bladder and rectum (3) Decreased dose to femoral heads (4) Assist in long term stability of the implant
Reference:Sethi, R., Kuo, Y., Edraki, B., et al., Real-time Doppler ultrasound to identify vessels and guide needle placement for gynecologic interstitial brachytherapy. Brachytherapy. 2018; 17: 742-746
Choice A:(1) and (4)
Choice B:(2) and (3)
Choice C:(1) and (2)
Choice D:(3) and (4)
Question 8: As reported in the literature, how frequently are blood vessels punctured during while inserting needles during cervical brachytherapy?
Reference:Nomden, C.N., de Leeuw, A.A., Moerland, M.A. et al. Clinical use of the Utrecht applicator for combined intracavitary/interstitial brachytherapy treatment in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys. 2012; 82: 1424–1430 Fokdal, L., Tanderup, K., Hokland, S.B. et al. Clinical feasibility of combined intracavitary/interstitial brachytherapy in locally advanced cervical cancer employing MRI with a tandem/ring applicator in situ and virtual preplanning of the interstitial component. Radiother Oncol. 2013; 107: 63–68
Choice A:>30%
Choice B:20-25%
Choice C:15-20%
Choice D:0-4%
Question 9: The number of blood vessels located in the (inferior or superior cervix, pick one) correlate well with the (tumor size or FIGO stage, pick one).
Reference:Sethi, R., Kuo, Y., Edraki, B., et al., Real-time Doppler ultrasound to identify vessels and guide needle placement for gynecologic interstitial brachytherapy. Brachytherapy. 2018; 17: 742-746
Choice A:Inferior cervix, FIGO stage
Choice B:Inferior cervix, tumor size
Choice C:Superior cervix, FIGO stage
Choice D:Superior cervix, tumor size
Question 10: According to AAPM practice guidelines, how should a trans-rectal ultrasound probes used for brachytherapy procedures be calibrated?
Reference:Pfeiffer et al. AAPM Task Group 128: Quality assurance tests for prostate brachytherapy ultrasound systems.Med. Phys. 35(12), December 2008
Choice A:Only air is necessary, no water or tissue equivalent phantom required.
Choice B:Water is sufficient, but tissue equivalent phantom is better.
Choice C:Tissue equivalent phantom is the only acceptable medium.
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