| Question 1: Which of the following describes the difference between dose-LET volume histogram (DLVH) and conventional dose volume histogram (DVH) |
| Reference: | Yang Y, Vargas CE, Bhangoo RS, Wong WW, Schild SE, Daniels TB, Keole SR, Rwigema JCM, Glass JL, Shen J, DeWees TA, Liu T, Bues M, Fatyga M, Liu W. Exploratory Investigation of Dose-Linear Energy Transfer (LET) Volume Histogram (DLVH) for Adverse Events Study in Intensity-Modulated Proton Therapy, accepted by Int J Radiat Oncol Biol Phys. 2021. |
| Choice A: | DLVH includes LET information as another independent parameter for volume histogram |
| Choice B: | DLVH does not have DVH information |
| Choice C: | DLVH is only designed for normal organs, while DVH can be used for both normal tissue and tumor target. |
| Question 2: If a point on the DL20% line is located at the intersection of dose 50 Gy and LET 2 keV/um in dose-LET volume histogram (DLVH), which of the following descriptions is correct |
| Reference: | Yang Y, Vargas CE, Bhangoo RS, Wong WW, Schild SE, Daniels TB, Keole SR, Rwigema JCM, Glass JL, Shen J, DeWees TA, Liu T, Bues M, Fatyga M, Liu W. Exploratory Investigation of Dose-Linear Energy Transfer (LET) Volume Histogram (DLVH) for Adverse Events Study in Intensity-Modulated Proton Therapy, accepted by Int J Radiat Oncol Biol Phys. 2021. |
| Choice A: | 20% of the volume of that organ receives a dose of exactly 50Gy and an LET of exactly 2 keV/um |
| Choice B: | 20% of the volume of that organ receives a dose at least 50Gy and an LET at least 2 keV/um |
| Choice C: | 20% of the volume of that organ receives a dose at most 50Gy and an LET at most 2 keV/um |
| Choice D: | 80% of the volume of that organ receives a dose at least 50Gy and an LET at least 2 keV/um |
| Question 3: According to the current literature, what is the main trigger for treatment adaptations in the treatment of thoracic indications with scanned proton therapy? |
| Reference: | Meijers A, Knopf AC, Crijns APG, Ubbels JF, Niezink AGH, Langendijk JA, Wijsman R, Both S. Evaluation of interplay and organ motion effects by means of 4D dose reconstruction and accumulation. Radiother Oncol. 2020 Sep; 150:268-274. doi: 10.1016/j.radonc.2020.07.055. Epub 2020 Aug 5. PMID: 32768509. |
| Choice A: | Dose degradation due to the interplay effect |
| Choice B: | Target underdosage due to respiratory motion |
| Choice C: | Anatomical changes |
| Choice D: | Organ at risk overdosage due to respiratory motion |
| Question 4: What is NOT essential for the treatment quality when treating thoracic indications with scanned proton therapy? |
| Reference: | Ribeiro CO, Visser S, Korevaar EW, Sijtsema NM, Anakotta RM, Dieters M, Both S, Langendijk JA, Wijsman R, Muijs CT, Meijers A, Knopf A. Towards the clinical implementation of intensity-modulated proton therapy for thoracic indications with moderate motion: Robust optimised plan evaluation by means of patient and machine specific information. Radiother Oncol. 2021 Feb 3;157:210-218. doi: 10.1016/j.radonc.2021.01.014. Epub ahead of print. PMID: 33545257. |
| Choice A: | Accurate positioning |
| Choice B: | 4D optimization |
| Choice C: | Recurrent volumetric imaging to monitor anatomical changes |
| Choice D: | A realistic motion assessment |
| Question 5: Model-based selection can be applied to indentify patients that are expected to benefit most from proton therapy with regard to: |
| Reference: | Langendijk JA, Boersma LJ, Rasch CRN, van Vulpen M, Reitsma JB, van der Schaaf A, Schuit E. Clinical Trial Strategies to Compare Protons With Photons. Semin Radiat Oncol. 2018 Apr;28(2):79-87. |
| Choice A: | Prevention of late toxicities, but not for prevention of acute toxicities |
| Choice B: | Prevention of acute and late toxicities |
| Choice C: | Prevention of induction of secondary tumors |
| Choice D: | Prevention of locoregional recurrences |
| Question 6: In a model-based clinical evaluation study the added value of new radiation technologies is tested by: |
| Reference: | Langendijk JA, Boersma LJ, Rasch CRN, van Vulpen M, Reitsma JB, van der Schaaf A, Schuit E. Clinical Trial Strategies to Compare Protons With Photons. Semin Radiat Oncol. 2018 Apr;28(2):79-87. |
| Choice A: | Comparing the toxicity rates observed after protons versus those observed after photons |
| Choice B: | Comparing the toxicity rates observed after protons versus those observed after photons after randomization |
| Choice C: | Comparing the toxicity rates observed after protons with an historical group treated with photons using propensity scores |
| Choice D: | Comparing the toxicity rates observed after protons with the expected toxicity rates based on the back up photon plans. |
| Question 7: What is NOT a rationale for integrating a fixed proton beamline into a conventional photon treatment room? |
| Reference: | Fabiano S, Balermpas P, Guckenberger M, Unkelbach J. Combined proton–photon treatments - A new approach to proton therapy without a gantry, Radiotherapy and Oncology 145, 81-87, 2020 |
| Choice A: | To reduce normal tissue dose compared to IMRT or VMAT treatments |
| Choice B: | To achieve improved dose distributions compared to gantry-based IMPT by adding photon beams. |
| Choice C: | To allow installation of proton therapy systems in existing departments designed for photon therapy |
| Question 8: What is NOT an advantage of delivering some fractions with protons and others with photons |
| Reference: | S C M ten Eikelder et al. Optimal combined proton–photon therapy schemes based on the standard BED model. Phys. Med. Biol. 64 065011, 2019 |
| Choice A: | Protons and photons may have complementary advantages regarding different plan quality indicators so that a combined treatment may improve on single-modality treatments. |
| Choice B: | Combined treatments may better exploit a limited number of proton fractions in the context of limited proton therapy availability |
| Choice C: | Combined treatments are Pareto-optimal and minimize integral dose to normal tissues. |
| Question 9: What is the purpose of developing proton therapy system without a gantry? |
| Reference: | T. Bortfeld, M. Viana, S. Yan, "The societal impact of ion beam therapy", Zeitschrift fur medizinische Physik, July 2020 |
| Choice A: | To be able to use cone beam CT |
| Choice B: | To use pencil beam scanning technique |
| Choice C: | To reduce the cost and size of the proton system |
| Choice D: | To provide more beam angles than a gantry system |
| Question 10: What are the proposed treatment positions for the compact gantry-less therapy system? |
| Reference: | S. Yan, H. Lu, PhD, J. Flanz, J. Adams, A. Trofimov, T. Bortfeld, “Reassessment of the necessity of the proton gantry: analysis of beam orientations from 4332 treatments at the Massachusetts General Hospital (MGH) proton center over the past 10 years”, International Journal of Radiation Oncology Biology Physics, Sept. 2015 |
| Choice A: | Supine position |
| Choice B: | Sitting, reclined and lying |
| Choice C: | Sitting only |
| Choice D: | Prone position |
