| Question 1: Which of the following is true about lymphocyte counts following high dose rate radiation? |
| Reference: | Venkatesulu BP, Sharma A, Pollard-Larkin JM, Sadagopan R, Symons J, Neri S, Singh PK, Tailor R, Lin SH, Krishnan S. Ultra high dose rate (35 Gy/sec) radiation does not spare the normal tissue in cardiac and splenic models of lymphopenia and gastrointestinal syndrome. Sci Rep. 2019 Nov 20;9(1):17180.
Q. Zhang, E. Cascio, C. Li, Q. Yang, L.E. Gerweck, P. Huang, B. Gottschalk, J. Flanz, J.P. Schuemann. Differences in Lymphocyte Count after Abdominal Flash or Conventional Proton Irradiation. Int J Radiat Oncol Biol Phys 2020; 108(3), S157-S158 |
| Choice A: | Splenic high dose rate radiation causes less lymphopenia than splenic convention dose rate radiation |
| Choice B: | Cardiac high dose rate radiation causes less lymphopenia than cardiac convention dose rate radiation |
| Choice C: | Abdominal high dose rate radiation causes less lymphopenia than abdominal convention dose rate radiation |
| Choice D: | Abdominal high dose rate radiation causes more lymphopenia than abdominal convention dose rate radiation |
| Question 2: Which of the following is true regarding abdominal radiation with high dose rate radiation? |
| Reference: | Smyth LML, Donoghue JF, Ventura JA, Livingstone J, Bailey T, Day LRJ, Crosbie JC, Rogers PAW. Comparative toxicity of synchrotron and conventional radiation therapy based on total and partial body irradiation in a murine model. Sci Rep. 2018 Aug 13;8(1):12044. doi: 10.1038/s41598-018-30543-1.
Diffenderfer ES, Verginadis II, Kim MM, Shoniyozov K, Velalopoulou A, Goia D, Putt M, Hagan S, Avery S, Teo K, Zou W, Lin A, Swisher-McClure S, Koch C, Kennedy AR, Minn A, Maity A, Busch TM, Dong L, Koumenis C, Metz J, Cengel KA. Design, Implementation, and in Vivo Validation of a Novel Proton FLASH Radiation Therapy System. Int J Radiat Oncol Biol Phys. 2020 Feb 1;106(2):440-448.
Venkatesulu BP, Sharma A, Pollard-Larkin JM, Sadagopan R, Symons J, Neri S, Singh PK, Tailor R, Lin SH, Krishnan S. Ultra high dose rate (35 Gy/sec) radiation does not spare the normal tissue in cardiac and splenic models of lymphopenia and gastrointestinal syndrome. Sci Rep. 2019 Nov 20;9(1):17180. |
| Choice A: | All published manuscripts suggest that high dose rate radiation causes less denudation of villi and the gastrointestinal syndrome to improve survival of mice. |
| Choice B: | Conflicting results on the GI sparing effects of high dose rate radiation have been published so far. |
| Choice C: | Intestinal crypt proliferation is increased after high dose rate radiation compared to standard dose rate. |
| Choice D: | Intestinal fibrosis is increased after high dose rate radiation compared to standard dose rate. |
| Question 3: A single dose of 8 Gy delivered with FLASH-RT to the whole brain of juvenile mice was found to: |
| Reference: | Alaghband Y, Cheeks SN, Allen BD, et al. Neuroprotection of radiosensitive juvenile mice by ultra-high dose rate flash irradiation. Cancers (Basel). 2020;12(6):1-21. doi:10.3390/cancers12061671 |
| Choice A: | preserve the cognitive function 2- and 4-months post exposure . |
| Choice B: | induce an irreversible neuroinflammatory response. |
| Choice C: | preserve the cognitive function but deplete the pool of neural stem cells. |
| Choice D: | does not preserve the plasmatic levels of growth hormone in the irradiated animals. |
| Question 4: Preclinical studies on murine glioblastoma treatment with FLASH-RT show that: |
| Reference: | Montay-Gruel P, Acharya MM, Gonçalves Jorge P, et al. Hypo-fractionated FLASH-RT as an effective treatment against glioblastoma that reduces neurocognitive side effects in mice. Clin Cancer Res. 2020:clincanres.0894.2020. doi:10.1158/1078-0432.ccr-20-0894 |
| Choice A: | FLASH-RT does not induce cognitive deficits in tumor-bearing animals even when delivered with a single dose > 14 Gy. |
| Choice B: | hypo-fractionated regimen of FLASH-RT are less efficacious than conventional dose rate RT to treat murine glioblastoma. |
| Choice C: | difference in normal tissue toxicity between FLASH and conventional dose rate RT is observed when the dose per fraction is < 5 Gy. |
| Choice D: | hypo-fractionated regimen with doses per fraction > 5 Gy seem to be optimal to observe the FLASH effect. |
| Question 5: Proton FLASH is advantageous for targeting deep-seated targets due to the proton’s |
| Reference: | Esplen, N., Mendonca, M.S. and Bazalova-Carter, M., 2020. Physics and biology of ultrahigh dose-rate (FLASH) radiotherapy: a topical review. Physics in Medicine & Biology, 65(23), p.23TR03. |
| Choice A: | Range straggling |
| Choice B: | Bragg peak |
| Choice C: | Increased lateral penumbra |
| Choice D: | Increased surface dose |
| Question 6: What is one method to create a uniform proton field at the target from a Gaussian field shape? |
| Reference: | Diffenderfer, E.S., Verginadis, I.I., Kim, M.M., Shoniyozov, K., Velalopoulou, A., Goia, D., Putt, M., Hagan, S., Avery, S., Teo, K. and Zou, W., 2020. Design, implementation, and in vivo validation of a novel proton FLASH radiation therapy system. International Journal of Radiation Oncology* Biology* Physics, 106(2), pp.440-448. |
| Choice A: | Energy stacking |
| Choice B: | Range shifting |
| Choice C: | Double scattering |
| Choice D: | Filtering |
| Question 7: VHEE refer to electrons in the energy range: |
| Reference: | DesRosiers, Moskvin, Bielajew, Papiez, 150-250 MeV electron beams in radiation therapy, Phys Med Biol, 45(2000) 1781-1805 |
| Choice A: | 30 – 50 MeV |
| Choice B: | 50 – 100 MeV |
| Choice C: | 150 MeV – 250 MeV |
| Choice D: | 250 MeV – 500 MeV |
| Question 8: FLASH potential favorability for VHEE is supported by: |
| Reference: | Esplen, Mendonca, Bazalova-Carter. Physics and biology of ultrahigh dose-rate (FLASH) radiotherapy: a topical review, Phys. Med Biol (2020) Dec 4;65(23):23TR03.doi: 10.1088/1361-6560/abaa28.
DesRosiers, Moskvin, Bielajew, Papiez, 150-250 MeV electron beams in radiation therapy, Phys Med Biol, 45(2000) 1781-1805 |
| Choice A: | High dose rates with electrons are more easily achievable than with photons. |
| Choice B: | The FLASH effect has been more consistently demonstrated with electrons as compared with photons. |
| Choice C: | VHEE can treat a broader range of diseases than clinically available electron beams. |
| Choice D: | All of the above are true. |
| Question 9: A review of recent scientific publications estimates the dose modifying factors for FLASH dose rates in normal tissues as: |
| Reference: | Vozenin et al. “Biological benefits of ultra-high dose rate FLASH radiotherapy: Sleeping Beauty awoken.” Clin Oncol (R Coll Radiol). 2019 Jul;31(7):407-415. doi: 10.1016/j.clon.2019.04.001. |
| Choice A: | 0.3-0.8 |
| Choice B: | 1.1-1.8 |
| Choice C: | 3.0-5.0 |
| Choice D: | 10.0+ |
| Question 10: According to FAST-01 clinical protocol, the following is NOT a primary or secondary end point: |
| Reference: | https://www.clinicaltrials.gov/ct2/show/NCT04592887 |
| Choice A: | Workflow feasibility, as measured by patient time on the treatment table. |
| Choice B: | Workflow feasibility, as measured by no significant treatment delays due to the investigational device. |
| Choice C: | Assessment of toxicities, as measured by toxicities possibly, probably or definitely related to FLASH. |
| Choice D: | Efficacy, as indicated by FLASH tumor control below, above or equal to conventional tumor control. |
| Choice E: | Pain relief, as indicated by pain relief at periodic follow-up intervals. |
| Choice F: | Pain relief, as indicated by pain relief by following pain medication usage. |
