| Question 1: The purpose of regional lung function avoidance is to: |
| Reference: | Vinogradskiy, Yevgeniy, et al. "Use of 4-dimensional computed tomography-based ventilation imaging to correlate lung dose and function with clinical outcomes." International Journal of Radiation Oncology* Biology* Physics 86.2 (2013): 366-371. |
| Choice A: | Reduce the probability that patients develop radiation pneumonitis |
| Choice B: | Provide improved target delineation |
| Choice C: | Provide better tumor control |
| Choice D: | Decrease complexity of treatment planning |
| Question 2: What is the evidence that regional lung function avoidance reduces rates of radiation pneumonitis? |
| Reference: | Faught, Austin M., et al. "Evaluating which dose-function metrics are most critical for functional-guided radiation therapy." International Journal of Radiation Oncology* Biology* Physics 99.1 (2017): 202-209 |
| Choice A: | Regional lung function avoidance plans are highly complex |
| Choice B: | Lung cancer patients that are good candidates for regional lung function avoidance have poor pre-treatment lung function |
| Choice C: | Modeling studies showing that metrics that combine dose and functional lung imaging better predict for radiation pneumonitis than dose metrics alone |
| Choice D: | Multiple prospective clinical trials |
| Question 3: As dose to highly functional lung regions is reduced, the following is most likely to occur |
| Reference: | Vinogradskiy, Yevgeniy, et al. "Interim analysis of a two-institution, prospective clinical trial of 4DCT-ventilation-based functional avoidance radiation therapy." International Journal of Radiation Oncology* Biology* Physics 102.4 (2018): 1357-1365 |
| Choice A: | Target coverage improves |
| Choice B: | Mean heart doses decrease |
| Choice C: | Conformity index improves |
| Choice D: | Spinal cord max doses increase |
| Question 4: The following factors are the most direct determinants of radiation-induced airway injury |
| Reference: | Kazemzadeh N, Modiri A, Samanta S, Yan Y, Bland R, Rozario T, Wibowo H, Iyengar P, Ahn C, Timmerman R, Sawant A. Virtual Bronchoscopy-Guided Treatment Planning to Map and Mitigate Radiation-Induced Airway Injury in Lung SAbR. Int J Radiat Oncol Biol Phys. 2018 Sep 1;102(1):210-218. doi: 10.1016/j.ijrobp.2018.04.060. Epub 2018 May 2. PMID: 29891202; PMCID: PMC6089651. |
| Choice A: | airway diameter |
| Choice B: | prior history of smoking |
| Choice C: | maximum point dose to an airway segment |
| Choice D: | mean lung dose |
| Choice E: | a and c |
| Choice F: | b and d |
| Question 5: A possible limitation of functional avoidance RT planning based on regional ventilation mapping is |
| Reference: | Vicente E, Modiri A, Kipritidis J, et al. Functionally weighted airway sparing (FWAS): a functional avoidance method for preserving post-treatment ventilation in lung radiotherapy. Physics in Medicine and Biology. 2020 Aug;65(16):165010. DOI: 10.1088/1361-6560/ab9f5d. |
| Choice A: | dose to heart can increase |
| Choice B: | optimization algorithm may not converge due to too many criteria |
| Choice C: | redirecting beams through poorly-ventilated regions may inadvertently damage bronchial segments that supply air to well-ventilated regions |
| Choice D: | ventilation maps may change from fraction to fraction |
| Question 6: True or False: Function guided planning can only be applied to normal tissue avoidance |
| Reference: | Beaton, L., Bandula, S., Gaze, M.N. et al. How rapid advances in imaging are defining the future of precision radiation oncology. Br J Cancer 120, 779–790 (2019). https://doi.org/10.1038/s41416-019-0412-y |
| Choice A: | True |
| Choice B: | False |
| Question 7: Which of the following best describes a function guided planning approach? |
| Reference: | Reference: Matuszak MM, Kashani R, Green M, Lee C, Cao Y, Owen D, Jolly S, Mierzwa M. Functional Adaptation in Radiation Therapy. Semin Radiat Oncol. 2019 Jul;29(3):236-244. doi: 10.1016/j.semradonc.2019.02.006 |
| Choice A: | Minimizing mean liver dose in liver SBRT |
| Choice B: | Changing a prostate plan mid-treatment due to rectal filling |
| Choice C: | Spatially adjusting a lung treatment plan based on V/Q SPECT imaging |
| Choice D: | Using CBCT for pre-treatment alignment in lung |
| Question 8: Which of the following techniques may be considered biology-guided radiation therapy |
| Reference: | Beaton, L., Bandula, S., Gaze, M.N. et al. How rapid advances in imaging are defining the future of precision radiation oncology. Br J Cancer 120, 779–790 (2019) |
| Choice A: | PET image guidance |
| Choice B: | CT simulation for treatment planning |
| Choice C: | Ultrasound image guidance |
| Choice D: | kV image guidance for patient set-up verification |
| Question 9: Which factors should be considered in the creation of the total margin when using the PET-based biology tracking? |
| Reference: | N/A |
| Choice A: | PET tracking margin (latency) |
| Choice B: | PET and planning CT alignment uncertainty |
| Choice C: | Target motion |
| Choice D: | All of the above |
| Question 10: What kind of delivery tracking is unique to PET-guided BgRT? |
| Reference: | Shirvani SM, Huntzinger CJ, Melcher T, Olcott PD, Voronenko Y, Bartlett-Roberto J, Mazin S. Biology-guided radiotherapy: redefining the role of radiotherapy in metastatic cancer. Br J Radiol. 2021 Jan 1;94(1117):20200873. doi: 10.1259/bjr.20200873. Epub 2020 Oct 30. PMID: 33112685; PMCID: PMC7774706 |
| Choice A: | Respiratory gating motion management |
| Choice B: | Real-time tracking of metastatic lesions |
| Choice C: | Real-time tumor motion tracking |
