| Question 1: With respect to the harmful reactions of skin irradiation: |
| Reference: | International Commission on Radiological Protection. “ICRP Statement on Tissue Reactions / Early and Late Effects of Radiation in Normal Tissues and Organs – Threshold Doses for Tissue Reactions in a Radiation Protection Context”. ICRP Publication 118. Ann. ICRP 41(1-2), (2012) |
| Choice A: | They have random character |
| Choice B: | Tissue tolerance to radiation decreases due to cell repair |
| Choice C: | Erythema may appear from the first to the fourth week after irradiation |
| Choice D: | Neither dry nor moist desquamation are reversible |
| Choice E: | The skin is more radiosensitive than the bone marrow |
| Question 2: Mental retardation as a consequence of an in utero irradiation: |
| Reference: | National Council on Radiation Protection and Measurements. “Preconception and Prenatal Radiation Exposure: Health Effects and Protective Guidance”. NCRP Report No. 174, NCRP, Bethesda, Maryland (2013) |
| Choice A: | Has been detected at fetal doses of 5 mGy |
| Choice B: | Has been demonstrated only in mice |
| Choice C: | Is more prevalent in the first five weeks of pregnancy |
| Choice D: | Disappears after the twentieth week of gestation |
| Choice E: | May result in a reduction of up to 30 IQ units per Gy |
| Question 3: Compared to a course of conventional fractionation of 60 Gy at 2 Gy/fraction, a course of accelerated hyperfractionation _____ |
| Reference: | M.Q.F..Hatton and J.E.Martin, “Continuous Hyperfractionated Accelerated Radiotherapy (CHART) and Non-conventionally Fractionated Radiotherapy in the Treatment of Non-small Cell Lung Cancer: a Review and Consideration of Future Directions”, Clinical Oncology
Volume 22, Issue 5, June 2010, Pages 356-36. |
| Choice A: | Uses a higher dose/fraction |
| Choice B: | Is completed in far fewer total days |
| Choice C: | Is completed in slightly fewer days |
| Choice D: | Uses a higher total dose |
| Choice E: | Is more cost-effective |
| Question 4: The main reason why radiotherapy treatments have traditionally been fractionated is _____ |
| Reference: | C.G. Orton, “Fractionation: Radiobiologic Principles and Clinical Practice”, in Khan, Gibbons, and Sperduto (Eds.), Khan's Treatment Planning in Radiation Oncology, 4th Edition, Wolters Kluwer, The Netherlands, 2016, p. 342.. |
| Choice A: | Because cancer cells do not repair damage at low doses as well as do late-reacting normal tissue cells |
| Choice B: | Because cancer cells do not repair damage at low doses as well as do acutely-reacting normal tissue cells |
| Choice C: | To allow time for late-reacting normal tissue cells to repopulate |
| Choice D: | To take advantage of repair of acutely-reacting normal tissue cells at low doses |
| Choice E: | Because this is the most cost-effective way to treat cancers |
| Question 5: The oxygen enhancement ratio (OER) |
| Reference: | E Scifoni 1, W Tinganelli, W K Weyrather, M Durante, A Maier, M Krämer, Including oxygen enhancement ratio in ion beam treatment planning: model implementation and experimental verification, Phys Med Biol. 2013 Jun 7;58(11):3871-95. doi: 10.1088/0031-9155/58/11/3871. |
| Choice A: | Describes the clinically observed transient increase of hypoxia upon ion irradiation |
| Choice B: | Refers to the ratio of dose required to generate the same biological effect in absence and in presence of oxygen, respectively, for a given radiation quality |
| Choice C: | Refers to the ratio of dose required to generate the same biological effect in absence of oxygen for ions with respect to reference photon radiation |
| Choice D: | Increases for increasing ion charge and decreasing ion energy |
| Question 6: RBE modeling in treatment planning: |
| Reference: | Robert D Stewart, David J Carlson, Michael P Butkus, Roland Hawkins, Thomas Friedrich, Michael Scholz, A comparison of mechanism-inspired models for particle relative biological effectiveness (RBE), Med Phys. 2018 Nov;45(11):e925-e952. doi: 10.1002/mp.13207. |
| Choice A: | Approximates RBE to 1.1 for all clinically available ion species due to the negligible variations with respect to the large uncertainties of available in-vivo data. |
| Choice B: | Is based on pre-treatment QA measurements in patient-specific cell lines. |
| Choice C: | Typically resorts to mechanistic models like LEM (local effect model) or microdosimetric kinetic model (MKM) for light ion therapy. |
| Choice D: | Is currently only possible in specialized research treatment planning systems of the few operating carbon ion therapy facilities. |
| Question 7: In an experiment measuring oxygen consumption in water in a closed container by a radiation dose of 30 Gy, the researchers may observe: _______________. |
| Reference: | Jansen et al. “Does FLASH deplete Oxygen? Experimental Evaluation for 1
Photons, Protons and Carbon Ions.” Published in arXiv.org, arXiv:2102.12762, accepted for publications in Medical physics |
| Choice A: | No oxygen consumption for both FLASH radiation and conventional-dose-rate radiation. |
| Choice B: | The oxygen consumption is the same for FLASH radiation and conventional-dose-rate radiation. |
| Choice C: | The oxygen consumption is higher in FLASH radiation than in conventional-dose-rate radiation. |
| Choice D: | The oxygen consumption is lower in FLASH radiation than in conventional-dose-rate radiation. |
| Question 8: In animal experiments, researchers have reported FLASH radiation spared normal tissue and had at least the same effect in tumor killing in comparison to conventional-dose-rate radiation. This reported FLASH effect is most probably caused by __________. |
| Reference: | Jansen et al. “Does FLASH deplete Oxygen? Experimental Evaluation for 1
Photons, Protons and Carbon Ions.” Published in arXiv.org, arXiv:2102.12762, accepted for publications in Medical physics.
Jin JY et al. “Ultra-high dose rate effect on circulating immune cells: A potential mechanism for FLASH effect?” Radiother Oncol. 2020 Aug;149:55-62. |
| Choice A: | The oxygen depletion induced transient hypoxia status in cells. |
| Choice B: | A combination of recombination theory and immune sparing theory. |
| Choice C: | A combination of oxygen depletion theory and immune sparing theory. |
| Choice D: | A combination of oxygen depletion theory and recombination theory |
| Question 9: Models of the risk of acute toxicity can be said to: |
| Reference: | Von Reibnitz D, Yorke ED, Oh JH, Apte AP, Yang J, Pham H, Thor M, Wu AJ, Fleisher M, Gelb E, Deasy JO. Predictive modeling of thoracic radiotherapy toxicity and the potential role of serum alpha-2-macroglobulin. Frontiers in oncology. 2020 Aug 6;10:1395. |
| Choice A: | Depend on the overall dose but not the dose per fraction. |
| Choice B: | Depend on the overall treatment duration (days) independently of the overall dose. |
| Choice C: | Depend on the overall dose independently of the dose per fraction. |
| Question 10: Reduced dose (cold spots) volumes in the non-GTV portion of the CTV volume, compared to reduced dose volumes in the GTV, are: |
| Reference: | Deasy JO, Jeong J. Radiobiological principles for adaptive radiotherapy. Adaptive radiation therapy. Boca Raton, FL: CRC Press, Taylor & Francis Group. 2011:3-18 |
| Choice A: | More dangerous regarding the impact on local control. |
| Choice B: | Similarly dangerous regarding the impact on local control. |
| Choice C: | Less dangerous regarding the impact on local control. |
