| Question 1: What was the beam delivery technique used by the three first linac-based SRS techniques developed in the 80’s? |
| Reference: | Betti O, Derechinsky V, Hyperselective Encephalic Irradiation with Linear Accelerator. Acta Neurochir 1984; Suppl 33:385-390
Colombo F, Benedetti A, Pozza F, et al, External Stereotactic Irradiation by Linear Accelerator, Neurosurgery, Volume 16, Issue 2, February 1985, Pages 154–160,
Hartmann G, Schlegel W, Sturm V, et al. Cerebral radiation surgery using moving field irradiation at a linear accelerator facility. IJROBP 1985;2: 1185–92 |
| Choice A: | Multiple non-coplanar static beams |
| Choice B: | Multiple coplanar arcs |
| Choice C: | Multiple non-coplanar arcs |
| Choice D: | Multiple coplanar static beams |
| Question 2: What QC test method was developed specifically for linac-based SRS and that is now widely used for regular linac QC? |
| Reference: | Lutz W, Winston KR, Maleki N. A system for stereotactic radiosurgery with a linear accelerator. IJROBP. 1988;14(2):373‐381. doi:10.1016/0360-3016(88)90446-4 |
| Choice A: | PDD measurements for cones |
| Choice B: | Mechanical and radiation axes alignment using fiducial marker and 2D imaging |
| Choice C: | SRS Localization apparatus alignment |
| Choice D: | Couch longitudinal motion accuracy |
| Question 3: What is the magnitude of translational positioning errors as a result of intrafractional angular uncertainties when treating 50 mm from the radiation isocenter (1 sigma spread)? |
| Reference: | B. Winey & M. Bussiére “Geometric and dosimetric uncertainties in intracranial stereotatctic treatments for multiple nonisocentric lesions.” 2014 JACMP 15(3): 122-132. |
| Choice A: | 0.5 mm |
| Choice B: | 1 mm |
| Choice C: | 2 mm |
| Choice D: | 4 mm |
| Choice E: | 6 mm |
| Question 4: What is the V12 threshold for >10% risk of radiation necrosis when treating a single brain metastasis? |
| Reference: | M.H. Soike, R.T. Hughes, M. Farris, E.R. McTyre, C.K. Cramer, J.D. Bourland, M.D. Chan, Does Stereotactic Radiosurgery “Have a Role in the Management of Patients Presenting With 4 or More Brain Metastases?” 2019 Neurosurgery, 84(3): 558–566. |
| Choice A: | 1 cc |
| Choice B: | 2 cc |
| Choice C: | 4 cc |
| Choice D: | 8 cc |
| Choice E: | 12 cc |
| Question 5: With appropriate planning technique, the RTOG conformity index of single isocenter VMAT is: |
| Reference: | Thomas EM, Popple RA, Wu X, Clark GM, Markert JM, Guthrie BL, Yuan Y, Dobelbower MC, Spencer SA, Fiveash JB. Comparison of plan quality and delivery time between volumetric arc therapy (RapidArc) and Gamma Knife radiosurgery for multiple cranial metastases. Neurosurgery. 2014 Oct;75(4):409-17; discussion 417-8. doi: 10.1227/NEU.0000000000000448. PMID: 24871143; PMCID: PMC4203364. |
| Choice A: | Favorable compared to Gamma Knife |
| Choice B: | Inferior to Gamma Knife |
| Choice C: | Similar to Gamma Knife |
| Choice D: | Not relevant for evaluation of single isocenter treatment plans |
| Choice E: | Always 1.0 |
| Question 6: The most effective method of minimizing dose to normal brain for single isocenter VMAT radiosurgery is: |
| Reference: | Yuan Y, Thomas EM, Clark GA, Markert JM, Fiveash JB, Popple RA. Evaluation of multiple factors affecting normal brain dose in single-isocenter multiple target radiosurgery. J Radiosurg SBRT. 2018;5(2):131-144. PMID: 29657894; PMCID: PMC5893454. |
| Choice A: | Choosing the collimator angles to minimize MLC leaf sharing |
| Choice B: | Choosing the table angles to minimize MLC leaf sharing |
| Choice C: | Using jaw tracking |
| Choice D: | Including a constraint on the normal brain dose in the optimization objective function |
| Choice E: | Turning off the display of the normal brain DVH |
