| Question 1: What is the recommendation of GEC-ESTRO with respect to MR imaging? |
| Reference: | Reference: Dimopoulos JCA, Petrow P, Tanderup K et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): Basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiother Oncol 2012; 103: 113-122. |
| Choice A: | Use MR at the time of diagnosis |
| Choice B: | Use MR at the time of Brachytherapy |
| Choice C: | Use T2 weighted pulse sequences |
| Choice D: | All the above |
| Question 2: All of the following were addressed within the GYN GEC ESTRO working group reports EXCEPT: |
| Reference: | C. Haie-Meder et al., “Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV,” Radiotherapy and Oncology, 74, 235-45 (2005).
R. Potter et al., “Recommendations form gynaecological (GYN) GEC ESTRO working group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy – 3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology,” Radiotherapy and Oncology,78, 67-77 (2006). |
| Choice A: | a. Reconstruction of both plastic and titanium applicators |
| Choice B: | b. Recommendation of image sequences for 1.5 – 3 T MR scanners |
| Choice C: | c. Definition and guidance in the contouring of clinical target volumes |
| Choice D: | d. Recommended target and organ at risk dose volume parameters |
| Question 3: 1. Gradient nonlinearity (GNL)-induced distortions are expected to be small for MRI-based BT for prostate and cervical cancers because: |
| Reference: | Paulson ES, Erickson B, Schultz C, et al. Comprehensive MRI simulation methodology using a dedicated MRI scanner in radiation oncology for external beam radiation treatment planning. Med Phys. 2015;42(1):28-39 |
| Choice A: | a. Target volumes are near the MRI scanner isocenter. |
| Choice B: | b. Turning off the vendor-provided 3D gradient distortion correction should be applied prior to using the images for treatment planning |
| Choice C: | c. All the above |
| Question 4: 2. All of the following terms are currently used by vendors based on the recommendations of the MR Task Group of the American Society for Testing Materials (ASTM) International when labeling a brachytherapy applicator, except: |
| Reference: | F.G. Shellock and A. Spinazzi, “Review. MRI safety update 2008: Part 2, Screening patients for MRI,” American Journal of Roentgenology, 191, 1140 -1149 (2008).
T.O. Woods, “Standards for medical devices in MRI: present and future,” Journal of Magnetic Resonance Imaging, 26, 1186 – 1189 (2007).
American Society for Testing and Materials (ASTM) International. Standard practice for marking medical devices and other items for safety in the magnetic resonance environment. West Conshohocken, PA: ASTM International, 2005; designation: F2503-05 |
| Choice A: | a. MR safe |
| Choice B: | b. MR compatible |
| Choice C: | c. MR conditional |
| Question 5: MRI based prostate HDR brachytherapy, where MRI is use for treatment planning after needle insertion, is the most common method for incorporating MRI in the procedure with hospitals implementing this approach not having access to an in-suite MRI scanner. The addition of the MRI study with this approach improves visualization of the prostate gland and OARs, but: |
| Reference: | S Buus, S Rylander, S Hokland et al; Learning curve of MRI-based planning for high-dose-rate brachytherapy for prostate cancer, Brachytherapy 15 (2016) 426-434. |
| Choice A: | a. Adds no significant time to the procedure compared to US based implants |
| Choice B: | b. Adds at least 1 hour to the overall procedure time compared to US based implants |
| Choice C: | c. Adds some time to the procedure when initially implemented, but that time is largely eliminated as staff gain experience with the procedure. |
| Choice D: | d. Added time to the procedure renders it impractical for routine clinical use. |
| Question 6: Treatment planning for MR based prostate HDR requires digitization of the needles in MRI. However, visualization of the needle in MRI can be challenging. All the following statements are correct, EXCEPT: |
| Reference: | S Rylander, S Buus, EM Pedersen et al; Dosimetric impact of contouring and needle reconstruction uncertainties in US-, CT- and MRI-based high-dose-rate prostate brachytherapy treatment planning. Radiotherapy and Oncology 123 (2017) 125-132.
S Haack, SK Nielsen, JC Lindegaard, et al; Applicator reconstruction in MRI 3D image-based dose planning of brachytherapy for cervical cancer. Radiotherapy and Oncology 91 (2009) 187–193. |
| Choice A: | a. Careful characterization of the needles artifacts during commissioning enables correct digitization of the needles on MRI images directly |
| Choice B: | b. Because it may be challenging to visualize the needles directly on MRI, registration of the MRI with a planning CT or CBCT can be used to assist with the digitization task |
| Choice C: | c. Uncertainties in needles reconstruction may affect target coverage. |
| Choice D: | d. MR sequence optimization at time of commissioning will eliminate applicator and needles artifacts |
