2022 AAPM 64th Annual Meeting
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Session Title: Current Challenges and Prospects in Motion Management for Radiotherapy
Question 1: All of the following CT scan techniques are typically used to estimate target motion, EXCEPT for which technique?
Reference:Keall, P.J., Mageras, G.S., Balter, J.M., Emery, R.S., Forster, K.M., Jiang, S.B., Kapatoes, J.M., Low, D.A., Murphy, M.J., Murray, B.R., Ramsey, C.R., Van Herk, M.B., Vedam, S.S., Wong, J.W. and Yorke, E. (2006), The management of respiratory motion in radiation oncology report of AAPM Task Group 76a). Med. Phys., 33: 3874-3900. https://doi.org/10.1118/1.2349696.
Choice A:Slow scan
Choice B:Single fast scan
Choice C:Multiple fast scans
Choice D:4D scan
Choice E:Breath-hold scans
Question 2: Which of the following statements is most accurate?
Reference:Hoisak JD, Sixel KE, Tirona R, Cheung PC, Pignol JP. Correlation of lung tumor motion with external surrogate indicators of respiration. Int J Radiat Oncol Biol Phys. 2004 Nov 15;60(4):1298-306. doi: 10.1016/j.ijrobp.2004.07.681. PMID: 15519803; Giraud, Philippe, and Annie Houle. “Respiratory Gating for Radiotherapy: Main Technical Aspects and Clinical Benefits.” ISRN Pulmonology 2013 (March 19, 2013): e519602. https://doi.org/10.1155/2013/519602; Michalski D., Huq M.S. (2013) Four-Dimensional (4D) Treatment Planning/Respiratory Gating. In: Brady L.W., Yaeger T.E. (eds) Encyclopedia of Radiation Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85516-3_29.
Choice A:The external surrogate signal in respiratory-gated CT always has a perfect correlation with the target motion
Choice B:Respiratory-gated CT typically uses an external surrogate signal to reconstruct the acquired projection data into spatiotemporal bins of the motion
Choice C:In helical 4D-CT, using the highest gantry rotation speed always results in best image quality due to improved temporal resolution
Choice D:Once a CT scan is started, the patient’s free-breathing respiratory pattern does not change anymore
Question 3: Which of the following devices is NOT commonly used for respiratory-gated CT?
Reference:Reference: Philippe Giraud, Annie Houle, "Respiratory Gating for Radiotherapy: Main Technical Aspects and Clinical Benefits", International Scholarly Research Notices, vol. 2013, Article ID 519602, 2013. https://doi.org/10.1155/2013/519602
Choice A:Infrared light reflected from a marker box placed on the patient’s chest or abdomen
Choice B:Strain gauges that convert mechanical motion into an electrical signal
Choice C:Spirometers that measure air flow or volume displacements
Choice D:Microphones that record the patient’s breathing noise
Question 4: The mid-position approach to manage respiratory motion:
Reference:Dhont J, et al.Image-guided Radiotherapy to Manage Respiratory Motion: Lung and Liver. Clinical Oncology 32 (2020) 792-804
Choice A:Is an active motion management technique
Choice B:Requires similar margins to the internal target volume (also called motion encompassing) approach
Choice C:Is based on a representation of the time-weighted average anatomy
Choice D:Ensures the target is hit 100% of the time in most patients
Question 5: MLC tracking by real-time realignment of the target and the beam:
Reference:Keall P, et al. AAPM Task Group 264: The safe clinical implementation of MLC tracking in radiotherapy. Medical Physics (2021) e44-e64, 48(5)
Choice A:Requires real-time position monitoring with frequency of about 1Hz when applied to adapt to respiratory motion
Choice B:May be combined with a temporal prediction algorithm to reduce the latency of target position monitoring
Choice C:Can only address translational target motion
Choice D:Can adapt equally well to motion in any direction (perpendicular or parallel to leaf travel direction)
Question 6: Active real-time respiratory motion management in clinical practice (external photon beam radiotherapy):
Reference:Anastasi G, et al. Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part I: Intra-fraction breathing motion management. Radiotherapy and Oncology (2020) 79-87, 153.
Choice A:Is already widely implemented, mostly for abdominal targets
Choice B:Is generally combined with accurate internal target position monitoring on conventional linacs
Choice C:Is likely to be implemented for lung cancer radiotherapy in less than half the radiation therapy centers in high-income countries in the 2020s
Choice D:Is mainly limited by human and financial resources
Question 7: Which of the following statements is true regarding the interplay effect:
Reference:Grassberger C, et al. Motion mitigation for lung cancer patients treated with active scanning proton therapy. Med. Phys. (2015) May 42 (5), 2462-2469.
Choice A:The interplay effect can be simulated by calculating the dose on a breathhold CT
Choice B:Using fewer beams can reduce the interplay effect
Choice C:Smaller spot size can reduce the interplay effect compared to larger spot sizes in a non-robustly optimized plan
Choice D:Larger spot size can reduce the interplay effect compared to smaller spot sizes in a non-robustly optimized plan
Question 8: Which of the following techniques is not currently used for motion mitigation in proton therapy:
Reference:Li H, et al. AAPM Task Group Report 290: Respiratory motion management for particle therapy. Med Phys. 2022;49:e50–e81.
Choice A:Abdominal compression
Choice B:Active tracking with real time adaptation of spot position and energy
Choice C:Volumetric rescanning
Choice D:Layer rescanning
Question 9: Which of the following statements is NOT correct?
Reference:Colvill E, et al. DMLC tracking and gating can improve dose coverage for prostate VMAT. Medical Physics (2014) 41: 091705-1-10. De Roover R et al. Dosimetric impact of intrafraction prostate rotation and accuracy of gating, multi-leaf collimator tracking and couch tracking to manage rotation: an end-to-end validation using volumetric film measurements. Radiother Oncol (2021) 156: 10-18.
Choice A:MLC tracking provides faster treatment delivery than gating
Choice B:MLC tracking has capability to adapt to more complex motion than gating
Choice C:MLC tracking is generally better than gating in securing correct dose delivery in the presence of motion
Choice D:For MLC tracking, internal motion monitoring is more crucial than for gating
Question 10: Which of the following tracking techniques has not been applied clinically (as of 2022):
Reference:Keall P, et al. AAPM Task Group 264: The safe clinical implementation of MLC tracking in radiotherapy. Medical Physics (2021) 48: e44-e64, 48(5)
Choice A:Robotic tracking
Choice B:MLC tracking
Choice C:Couch tracking
Choice D:Gimbal tracking
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