2022 AAPM 64th Annual Meeting
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Session Title: Interventional Imaging
Question 1: What is (are) the fundamental difference(s) between photon counting detectors (PCDs) and energy-integrating detectors (EIDs)?
Reference:Reference: G. Knoll, “Radiation Detection and Measurement (4th edition).” Wiley press (2010)
Choice A:Spatial resolution
Choice B:Capability of spectral imaging
Choice C:Response linearity and uniformity
Choice D:Detection mode (pulse vs. charge integration)
Question 2: What is (are) the major benefit(s) of using direction-conversion, spectral-resolving PCDs in interventional imaging
Reference:Reference: X Ji, M Feng, K Treb, R Zhang, S Schafer, K Li, “Development of an integrated C-arm interventional imaging system with a strip photon counting detector and a flat panel detector.” IEEE Transactions on Medical Imaging 40:3674 (2021)
Choice A:Improved low-contrast detectability
Choice B:Higher confidence in material differentiation
Choice C:Improved visualization of vessels and interventional devices
Choice D:All of the above
Question 3: True or false: Bringing photon counting detectors to the interventional room retires the existing energy-integrating flat panel detectors?
Reference:Reference: K. Treb, X. Ji, S. Periyasamy, M. Feng, R. Zhang, D. Bushe, P. Laeseke, K. Li, “A dagger photon counting detector system for both 2D and 3D interventional imaging.” Proc. SPIE, 12031: 120310G (2022)
Choice A:True
Choice B:False
Question 4: What is the primary motivation for intraoperative imaging during tumor resection?
Reference:Albert FK, Forsting M, Sartor K, Adams HP, Kunze S. Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery. 1994 Jan;34(1):45-60; discussion 60-1. doi: 10.1097/00006123-199401000-00008. PMID: 8121569.
Choice A:Ability to charge for another MR study
Choice B:Ability to assess tumor resection completeness
Choice C:Avoids the need to use a surgical microscope
Choice D:Avoids the need for pre-operative imaging
Question 5: Which is NOT a benefit for MR guided DBS procedures?
Reference:Larson PS, Starr PA, Martin AJ. Deep Brain Stimulation: Interventional and Intraoperative MRI Approaches. Prog Neurol Surg. 2018;33:187-197. doi: 10.1159/000481103. Epub 2018 Jan 12. PMID: 29332083.
Choice A:Patients can be awake and free to move during surgery
Choice B:Surgical duration can be substantially shortened
Choice C:High targeting accuracy minimizes the number of brain penetrations
Choice D:Intra-operative brain shift can be accounted for
Question 6: Which statement about stroke therapy in a combined X-ray angiography and MRI suite is correct?
Reference:Narsinh KH, Kilbride BF, Mueller K, Murph D, Copelan A, Massachi J, Vitt J, Sun CH, Bhat H, Amans MR, Dowd CF, Halbach VV, Higashida RT, Moore T, Wilson MW, Cooke DL, Hetts SW. Combined Use of X-ray Angiography and Intraprocedural MRI Enables Tissue-based Decision Making Regarding Revascularization during Acute Ischemic Stroke Intervention. Radiology. 2021 Apr;299(1):167-176. doi: 10.1148/radiol.2021202750. Epub 2021 Feb 9. PMID: 33560189; PMCID: PMC7997614.
Choice A:MRI is best used for real time device guidance while x-ray angiography effectively measures tissue perfusion
Choice B:Stroke treatment via mechanical thrombectomy does not benefit from tissue-based assessments
Choice C:Conventional endovascular devices can safely be left in place throughout both x-ray and MR imaging
Choice D:The combination permits efficient feedback on whether or not to continue mechanical thrombectomy
Question 7: True or False: Cone Beam CT has been used to generate patient-matched 3D-printed drill guides?
Reference:A. Kanawati, A. Constantinidis, Z. Williams, R. O’Brien, and T. Reynolds. Generating patient-matched 3D-printed pedicle screw and laminectomy drill guides from Cone Beam CT images: studies in ovine and porcine cadavers. Medical Physics 2022 https://doi.org/10.1002/mp.15681
Choice A:True
Choice B:False
Question 8: What is the most widely used FDA cleared indication for fluorescence guided surgery today?
Reference:Pogue BW, Rosenthal EL. Review of successful pathways for regulatory approvals in open-field fluorescence-guided surgery. J Biomed Opt. 2021 Mar;26(3):030901. doi: 10.1117/1.JBO.26.3.030901. BW Pogue, EL Rosenthal, S Achilefu, GM van Dam, Perspective review of what is needed for molecular-specific fluorescence-guided surgery, J. of Biomedical Optics, 23(10), 100601 (2018). https://doi.org/10.1117/1.JBO.23.10.100601
Choice A:Tissue perfusion imaging
Choice B:Oncologic resection guidance
Choice C:Lymph node detection and removal
Choice D:Vascular reconstruction
Question 9: Which wavelengths are optimal for imaging with fluorescence in vivo?
Reference:BM Dijkstra, H-RJR Jeltema, S Kruijff, RJM Groen, The application of fluorescence techniques in meningioma surgery-a review, Neurosurg Rev. 2019 Dec;42(4):799-809. doi: 10.1007/s10143-018-01062-4.
Choice A:Only red wavelengths are used because the penetrate the best in tissue.
Choice B:Only near infrared can be used effectively.
Choice C:Ultraviolet is optimal because it excites the most molecules.
Choice D:All visible and near infrared wavelengths can be used, depending upon the tracer used.
Question 10: True or false: A receptor-specific fluorescent tracer is now approved by the FDA for human use in surgical oncology.
Choice A:True
Choice B:False
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