| Question 1: In addition to the gross tumor volume, the tumor vessel interface has a high chance of: |
| Reference: | Dholakia AS, Kumar R, Raman SP, et al. Mapping patterns of local recurrence after pancreaticoduodenectomy for pancreatic adenocarcinoma: A new approach to adjuvant radiation field design. Int. J. Radiat. Oncol. Biol. Phys. 87:1007-1015 (2013). |
| Choice A: | Normal tissue toxicity |
| Choice B: | Recurrence |
| Choice C: | Lower proliferative activity |
| Choice D: | Reduced cancer metabolism |
| Question 2: Assuming a tumor alpha/beta ratio of 10, which of the following fractionation schedules would provide the highest biologically effective dose (BED)? |
| Reference: | Krishnan S, Chadha AS, Suh Y, et al. Focal radiation therapy dose escalation improves overall survival in locally advanced pancreatic cancer patients receiving induction chemotherapy and consolidative chemoradiation. Int. J. Radiat. Oncol. Biol. Phys. 94:755-765 (2016). |
| Choice A: | 50 Gy in 25 fractions |
| Choice B: | 25 Gy in 1 fraction |
| Choice C: | 46 Gy in 5 fractions |
| Choice D: | 60 Gy in 15 fractions |
| Question 3: For upper abdominal GI cancers, which of the following are suitable image guidance modalities? |
| Reference: | Reyngold M, Parikh P, Crane CH. Ablative radiation therapy for locally advanced pancreatic cancer: Techniques and results. Radiat Oncol. 14:1-8 (2019). |
| Choice A: | MRI |
| Choice B: | CBCT |
| Choice C: | CT-on-rails |
| Choice D: | Ultrasound |
| Choice E: | A-C |
| Question 4: The major limitation of intrafraction gastrointestinal (GI) peristalsis during the ablative delivery of MR-guided adaptive radiotherapy to the abdomen is: |
| Reference: | Farshad Mostafaei, An Tai, Eenas Omari, Yingqiu Song, James Christian, Eric Paulson, William Hall, Beth Erickson, X. Allen Li. Variations of MRI-assessed peristaltic motions during radiation therapy. PloS one 13:e0205917 (2018). |
| Choice A: | Motion artifacts in the real-time MR cine during delivery |
| Choice B: | Electron density becoming out of date during delivery |
| Choice C: | Overdose of GI luminal organs from high dose gradient during delivery |
| Choice D: | Reduction in gadolinium-based contrast agents during delivery |
| Question 5: Which of the following best describes “robustness” of online adaptive plans: |
| Reference: | O. Bohoudi, A.M.E. Bruynzeel, S. Senan, J.P. Cuijpers, B.J. Slotman, F.J. Lagerwaard, M.A. Palacios. Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer. Radiother. Oncol. 125:439-444 (2017). |
| Choice A: | Adaptive plan quality with interfractional changes |
| Choice B: | Adaptive segmentation quality with interfractional changes |
| Choice C: | Adaptive CT to MR deformation quality with interfractional changes |
| Choice D: | Adaptive IMRT QA accuracy with interfractional changes |
| Question 6: Online adaptive radiotherapy offers opportunities to more accurately determine the maximum tolerated dose to gastrointestinal luminal anatomy. |
| Reference: | Witt JS, Rosenberg SA, Bassetti MF. MRI-guided adaptive radiotherapy for liver tumours: visualising the future. Lancet Oncol. 21:e74-e82 (2020). |
| Choice A: | True |
| Choice B: | False |
