| Question 1: Which of the following techniques does NOT reduce the volume of irradiated normal tissue during treatment of a target subject to respiratory motion? |
| Reference: | Keall PJ, et al., “The management of respiratory motion in radiation oncology: Report of AAPM Task Group 76,” Med Phys 33, 3874-3900 (2006). |
| Choice A: | 4DCT to determine ITV |
| Choice B: | Respiratory gating |
| Choice C: | Breath hold |
| Choice D: | Real-time tumor tracking |
| Question 2: When using respiratory motion management techniques for treatment, which of the following should be considered when determining PTV margins: |
| Reference: | Keall PJ, et al., “The management of respiratory motion in radiation oncology: Report of AAPM Task Group 76,” Med Phys 33, 3874-3900 (2006). |
| Choice A: | Uncertainty in correlation between positions of tumor and surrogate |
| Choice B: | Variability in breath-hold position |
| Choice C: | Residual motion |
| Choice D: | All of the above |
| Question 3: Optical imaging systems: |
| Reference: | Willoughby T, et al., “Quality assurance for nonradiographic radiotherapy localization and positioning systems: Report of Task Group 147,” Med Phys 39, 1728-1747 (2012). |
| Choice A: | are a source of radiation dose for patients. |
| Choice B: | require that the imaged surface be sufficiently reflective. |
| Choice C: | track the position of external reflectors placed on the patient surface. |
| Choice D: | provide information about patient displacement (i.e., motion), but not patient position. |
| Question 4: Which of the following is NOT a necessary component of a clinical MLC tracking program for respiratory motion affected treatments? |
| Reference: | Keall, P. J., Sawant, A., Berbeco, R. I., Booth, J. T., Cho, B., Cerviño, L. I., ... & Stathakis, S. (2020). AAPM Task Group 264: The safe clinical implementation of MLC tracking in radiotherapy. Medical physics |
| Choice A: | A real-time motion monitoring system with a QA program separate to the MLC tracking integration |
| Choice B: | 4D treatment planning which can account for anatomic changes of the target and
OAR(s) across all breathing phases |
| Choice C: | A motion phantom that can represent target motion and onto which dosimeters can be placed to measure dose in the target’s frame of reference. |
| Choice D: | Patient specific pretreatment QA tests including end-to-end dosimetry of the treatment plan |
| Question 5: A failure mode and effect analysis (FMEA)-based quality assurance program for MLC tracking should: |
| Reference: | Keall, P. J., Sawant, A., Berbeco, R. I., Booth, J. T., Cho, B., Cerviño, L. I., ... & Stathakis, S. (2020). AAPM Task Group 264: The safe clinical implementation of MLC tracking in radiotherapy. Medical physics
Sawant, A., Dieterich, S., Svatos, M., & Keall, P. (2010). Failure mode and effect analysis‐based quality assurance for dynamic MLC tracking systems. Medical physics, 37(12), 6466-6479 |
| Choice A: | be overseen by a Qualified Medical Physicist (QMP) |
| Choice B: | include tests for overall system latency |
| Choice C: | be revised on an ongoing basis as new failure modes are detected or new information on existing modes becomes available |
| Choice D: | All of the above |
| Question 6: Which of the following x-ray image-based methods does NOT yield 3-dimensional information of target position? |
| Reference: | Bertholet J, et al. “Real-time intrafraction motion monitoring in external beam radiotherapy”, Phys Med Biol 64 (2019) 15TR01. DOI: 10.1088/1361-6560/ab2ba8 |
| Choice A: | Using individual planar images from a single kV imaging or MV imaging system |
| Choice B: | Using two or more orthogonal kV imaging systems |
| Choice C: | Using a combination of kV imaging and MV imaging systems |
| Choice D: | Using a single kV imaging system together with a 3D probability model of target position |
| Question 7: Which of the following procedures does NOT test an x-ray imaging system’s ability to detect fiducial marker motion? |
| Reference: | 1) Ng J, et al. “Quality assurance for the clinical implementation of kilovoltage intrafraction monitoring for prostate cancer VMAT:. Med Phys 41 (2014) 111712. DOI: 10.1118/1.4898119
2) Hunt M, et al. “Simultaneous MV-kV imaging for intrafractional motion management during volumetric-modulated arc therapy delivery”. J Appl Clin Med Phys 17 (2016) 473-486. DOI: 10.1120/jacmp.v17i2.5836
3) Fontenot J, et al. “AAPM Medical Physics Practice Guideline 2.a: Commissioning and quality assurance of x-ray-based image-guided radiotherapy systems”. J Appl Clin Med Phys 15 (2014) 3-13. DOI: 10.1120/jacmp.v15i1.4528 |
| Choice A: | Marker-embedded phantom in combination with motion platform |
| Choice B: | Marker-embedded phantom manually placed at different treatment couch positions |
| Choice C: | Marker-embedded phantom measurement of imaging-treatment isocenter coincidence |
| Choice D: | Retrospective imaging processing of patient treatments with imbedded markers |
| Question 8: Which of the following statements is true in using Synchrony motion tracking technology during helical delivery? |
| Reference: | Chen GP, Tai A, Keiper TD, Lim S, Li XA. Technical Note: Comprehensive performance tests of the first clinical real-time motion tracking and compensation system using MLC and jaws. Med Phys. 2020 Jul;47(7): |
| Choice A: | Real time target motion is detected by sequential kV radiographs during helical delivery. |
| Choice B: | Dynamic jaws are used to compensate for the target motion in superior-inferior (longitudinal) direction. |
| Choice C: | Binary MLC are used to account for the target motion in left-right (lateral) direction. |
| Choice D: | All of above |
| Question 9: A major purpose of using motion tracking and compensation during radiation therapy delivery is to reduce: |
| Reference: | Chen GP, Tai A, Keiper TD, Lim S, Li XA. Technical Note: Comprehensive performance tests of the first clinical real-time motion tracking and compensation system using MLC and jaws. Med Phys. 2020 Jul;47(7) |
| Choice A: | CTV |
| Choice B: | GTV |
| Choice C: | ITV |
| Choice D: | PRV |
| Question 10: A major reason for using implanted fiducials to monitor intra-fraction prostate motion is the: |
| Reference: | Chen GP, Tai A, Keiper TD, Lim S, Li XA. Technical Note: Comprehensive performance tests of the first clinical real-time motion tracking and compensation system using MLC and jaws. Med Phys. 2020 Jul;47(7) |
| Choice A: | difficulty in distinguishing the prostate in the real time images. |
| Choice B: | daily irregularity of the prostate motion. |
| Choice C: | magnitude of the motion with respect to size of prostate. |
| Choice D: | day to day variability in rectal filling. |
