| Question 1: The prescription dose of 25Gy/1 fraction for noninvasive cardiac radioablation was derived from: |
| Reference: | Zei PC, Wong D, Gardner E, et al. Safety and efficacy of stereotactic radioablation targeting pulmonary vein tissues in an experimental model. Heart Rhythm 2018: 15(9): 1420-1427.
Lehmann HI, Richter D, Prokesch H, et al. Atrioventricular node ablation in Langendorff-perfused porcine hearts using carbon ion particle therapy: methods and an in vivo feasibility investigation for catheter-free ablation of cardiac arrhythmias. Circ Arrhythm Electrophysiol. 2015 Apr;8(2):429-38. |
| Choice A: | Pre-clinical myocyte cell culture studies that demonstrated fibrosis at 25Gy/1 fraction |
| Choice B: | Pre-clinical animal models that demonstrated electrical conduction block at a minimum dose of 25Gy/1 fraction |
| Choice C: | Phase I institutional data for cardiac sarcoma SBRT showing conduction blocks with BED >100Gy |
| Choice D: | Phase II institutional data for ultra-central lung tumor SBRT showing conduction blocks with BED >100Gy |
| Question 2: Documented Grade 2-5 adverse events during long-term follow up from ENCORE-VT have included which of the following: |
| Reference: | Robinson CR, et al. Longer Term Results from a Phase I/II Study of EP-guided Noninvasive Cardiac Radioablation for Treatment of Ventricular Tachycardia (ENCORE-VT). Presented at the ASTRO Annual Meeting, September 16, 2019, Chicago, IL. |
| Choice A: | Pericarditis requiring pericardectomy |
| Choice B: | Ventricular wall aneurysm |
| Choice C: | Gastropericardial fistula requiring surgery |
| Choice D: | Atrioventricular (AV) block |
| Choice E: | Esophagitis |
| Question 3: For late gadolinium enhancement (LGE) cardiac MR, the hyperintensity image artifacts caused by the ICD and pacemaker can be eliminated by: |
| Reference: | Rashid S, Rapacchi S, Vaseghi M, Tung R, Shivkumar K, Finn JP, et al. Improved Late Gadolinium Enhancement MR Imaging for Patients with Implanted Cardiac Devices. Radiology. 2014 Jan; 270(1):269–74. |
| Choice A: | wide-bandwidth RF inversion |
| Choice B: | increasing number of excitations |
| Choice C: | shorter echo spacing |
| Choice D: | short tau inversion recovery |
| Question 4: Which of the following cardiac VT substrate mapping methods is considered as invasive? |
| Reference: | Mahida Saagar, Sacher Frédéric, Dubois Rémi, Sermesant Maxime, Bogun Frank, Haïssaguerre Michel, et al. Cardiac Imaging in Patients With Ventricular Tachycardia. Circulation. 2017 Dec 19; 136(25):2491–507 |
| Choice A: | Late gadolinium enhanced MRI |
| Choice B: | Electrocardiographic Imaging (ECGI) |
| Choice C: | Electroanatomic Mapping (EAM) |
| Choice D: | 12-lead ECG |
| Question 5: Recent sub-analysis for evaluating dose escalation for locally advanced non-small cell lung cancer, Radiation Therapy Oncology Group 0617, revealed which of the following cardiac endpoints was strongly associated with clinically meaningful decline in quality of life? |
| Reference: | Movsas, Benjamin, Chen Hu, Jeffrey Sloan, Jeffrey Bradley, Ritsuko Komaki, Gregory Masters, Vivek Kavadi et al. "Quality of life analysis of a radiation dose–escalation study of patients with non–small-cell lung cancer: a secondary analysis of the radiation therapy oncology group 0617 randomized clinical trial." JAMA oncology 2, no. 3 (2016): 359-367. |
| Choice A: | Mean heart dose |
| Choice B: | Heart V5 (the percentage of the heart receiving >5 Gy) |
| Choice C: | Dose to 0.03 CC of the heart as a surrogate for maximum dose |
| Choice D: | Volume of the left ventricle receiving 5 Gy (LV-V5) |
| Question 6: Following ICRU 62 guidelines, to derive an ideal planning organ at risk (PRV) margin for cardiac substructure sparing, which of the following uncertainties should be considered? |
| Reference: | International Commission on Radiation Units and Measurements, 1999. ICRU Report 62. Prescribing, Recording and Reporting Photon Beam Therapy (Supplement to ICRU 50). |
| Choice A: | Inter-fraction setup error |
| Choice B: | Intra-fraction respiratory motion |
| Choice C: | Intra-fraction cardiac motion |
| Choice D: | All of the above |
