| Question 1: Which of the following are the advantages of MRgRT systems? |
| Reference: | P Kupelian P, J-J Sonke, Magnetic Resonance–Guided Adaptive Radiotherapy: A Solution to the Future. Semin Radiat Oncol. 2014;24(3):227-232. doi:10.1016/j.semradonc.2014.02.01 |
| Choice A: | Improved soft tissue contrast |
| Choice B: | Soft tissue based gated treatment |
| Choice C: | Effective online adaptive therapy |
| Choice D: | Onboard functional imaging capability |
| Choice E: | All of the above |
| Question 2: Which of the following are not challenges for using conventional DWI on an MRgRT system: |
| Reference: | Y. Gao, F. Han, Z. Zhou, M. Cao, T. Kaprealian, M. Kamrava, M. Wang, J. Neylon, D. Low, Y. Yang, P. Hu, “Distortion-Free Diffusion MRI using an MRI-Guided Tri-Cobalt 60 Radiotherapy System: Sequence Validation and Preliminary Clinical Experience”, Med Phys. 2017 Oct;44(10):5357-5366 |
| Choice A: | Biological changes, such as ADC change, often happen earlier than morphological change |
| Choice B: | Optimal timing of acquiring DWI |
| Choice C: | Low spatial resolution |
| Choice D: | Large geometric distortion |
| Choice E: | SNR loss causing inaccurate DWI with high b values |
| Question 3: Which of the following can cause geometric distortion on MRI images? |
| Reference: | Walker, A., Liney, G. P., Metcalfe, P. E. & Holloway, L. C. (2014). MRI distortion: considerations for MRI based radiotherapy treatment planning. Australasian Physical & Engineering Sciences in Medicine, 37 (1), 103-113. |
| Choice A: | Chemical shifts |
| Choice B: | Inhomogeneity in magnetic field |
| Choice C: | Gradient non-linearity |
| Choice D: | All of the above |
| Question 4: The Unity couch can move to apply shifts determined from co-registration of daily MRI to reference images. True or False? |
| Reference: | Paulson ES, Ahunbay E, Chen X, Mickevicius NJ, Chen GP, Schultz C, Erickson B, Straza M, Hall WA, Li XA. 4D-MRI driven MR-guided online adaptive radiotherapy for abdominal stereotactic body radiation therapy on a high field MR-Linac: Implementation and initial clinical experience. Clin Transl Radiat Oncol. 2020 May 15;23:72-79. doi: 10.1016/j.ctro.2020.05.002. eCollection 2020 Jul. |
| Choice A: | True |
| Choice B: | False |
| Question 5: Synthetic CT images are used to calculate adaptive plans in which of the following Unity workflows: |
| Reference: | Winkel D, Bol GH, Kroon PS, van Asselen B, Hackett SS, Werensteijn-Honingh AM, Intven MPW, Eppinga WSC, Tijssen RHN, Kerkmeijer LGW, de Boer HCJ, Mook S, Meijer GJ, Hes J, Willemsen-Bosman M, de Groot-van Breugel EN, Jürgenliemk-Schulz IM, Raaymakers BW. Adaptive radiotherapy: The Elekta Unity MR-linac concept. Clin Transl Radiat Oncol. 2019 Apr 2;18:54-59. doi: 10.1016/j.ctro.2019.04.001. eCollection 2019 Sep. |
| Choice A: | Adapt-to-Position |
| Choice B: | Adapt-to-Shape |
| Choice C: | Both Adapt-to-Position and Adapt-to-Shape |
| Choice D: | None of the above |
| Question 6: Compared to the Adapt-to-Position workflow, in the Adapt-to-Shape workflows: |
| Reference: | Winkel D, Bol GH, Kroon PS, van Asselen B, Hackett SS, Werensteijn-Honingh AM, Intven MPW, Eppinga WSC, Tijssen RHN, Kerkmeijer LGW, de Boer HCJ, Mook S, Meijer GJ, Hes J, Willemsen-Bosman M, de Groot-van Breugel EN, Jürgenliemk-Schulz IM, Raaymakers BW. Adaptive radiotherapy: The Elekta Unity MR-linac concept. Clin Transl Radiat Oncol. 2019 Apr 2;18:54-59. doi: 10.1016/j.ctro.2019.04.001. eCollection 2019 Sep. |
| Choice A: | Contour editing is performed on daily MR images |
| Choice B: | Synthetic CT images are used for dose calculation |
| Choice C: | Shifts from co-registration of daily to reference images are not applied during adaptive planning |
| Choice D: | All of the above |
| Question 7: Compared to the Adapt-to-Shape workflow, the number of possible adaptive modes in the Adapt-to-Position workflow is: |
| Reference: | Winkel D, Bol GH, Kroon PS, van Asselen B, Hackett SS, Werensteijn-Honingh AM, Intven MPW, Eppinga WSC, Tijssen RHN, Kerkmeijer LGW, de Boer HCJ, Mook S, Meijer GJ, Hes J, Willemsen-Bosman M, de Groot-van Breugel EN, Jürgenliemk-Schulz IM, Raaymakers BW. Adaptive radiotherapy: The Elekta Unity MR-linac concept. Clin Transl Radiat Oncol. 2019 Apr 2;18:54-59. doi: 10.1016/j.ctro.2019.04.001. eCollection 2019 Sep. |
| Choice A: | Fewer |
| Choice B: | Equal |
| Choice C: | Greater |
| Choice D: | None of the above |
| Question 8: Which of the following is a contraindication for MRgRT treatments: |
| Reference: | Gach HM, Green OL, Cuculich PS, Wittland EJ, Marko A, Luchtefeld ME, Entwistle JM, Yang D, Wilber DJ, Mutic S, Robinson CG. Lessons learned from the first human low-field MRI guided radiation therapy of the heart in the presence of an implantable cardiac defibrillator. Practical radiation oncology. 2019 Jul 1;9(4):274-9. |
| Choice A: | Presence of a chemotherapy port |
| Choice B: | Presence of an implanted cardiac device |
| Choice C: | Presence of tattoos |
| Choice D: | Presence of leads from a removed cardiac device |
| Question 9: In an online adaptation workflow, which of the following contributes the most to patient time on table for a 0.35-T system? |
| Reference: | Boldrini L, Cusumano D, Cellini F, Azario L, Mattiucci GC, Valentini V. Online adaptive magnetic resonance guided radiotherapy for pancreatic cancer: state of the art, pearls and pitfalls. Radiation Oncology. 2019 Dec;14(1):1-6. |
| Choice A: | Initial volumetric scan |
| Choice B: | Treatment plan reoptimization |
| Choice C: | Contour evaluation and editing |
| Choice D: | Gating parameter set up |
| Question 10: For upper-abdominal GI tumors (e.g., pancreas), it is necessary to contour: |
| Reference: | Bohoudi O, Bruynzeel AM, Senan S, Cuijpers JP, Slotman BJ, Lagerwaard FJ, Palacios MA. Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer. Radiotherapy and Oncology. 2017 Dec 1;125(3):439-44. |
| Choice A: | The entire transverse slice as bounded by the external body contour |
| Choice B: | Within a 3 mm area around the GTV |
| Choice C: | Between the liver and stomach only |
| Choice D: | Within a 3 cm area around the PTV |
