| 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 |
