| Question 1: Why do CO2-based tissue expanders cause dosimetric challenges to postmastectomy radiation therapy? |
| Reference: | Moni J, Saleeby J, Bannon E, et al. Dosimetric impact of the AeroForm tissue expander in postmastectomy radiation therapy: an ex vivo analysis. Pract Radiat Oncol. 2015;5(1):e1-8. doi: 10.1016/j.prro.2014.04.001. |
| Choice A: | This type of expander is made with tissue-equivalent material |
| Choice B: | This type of expander is made with high Z material resulting in high uncertainty in transmission factors |
| Choice C: | Analytical Anisotropic Algorithm (AAA) does not fully account for the inhomogeneity |
| Choice D: | Both B and C |
| Choice E: | All of the above |
| Question 2: Which of the following strategies will reduce the chest wall dosimetric uncertainty of CO2-based tissue expanders? |
| Reference: | Lim SB, Kuo LC, Li G, et al. A dosimetry study of post-mastectomy radiation therapy with AeroForm tissue expander. J Appl Clin Med Phys. 2020; 21(9):33-38. doi: 10.1002/acm2.12962. |
| Choice A: | Do not use inhomogeneity correction |
| Choice B: | Adding AP field in a lateral beam arrangement |
| Choice C: | Use lateral beam arrangement only |
| Choice D: | Assigning appropriate electron and mass density for the high Z material in the CT |
| Choice E: | Both C and D |
| Question 3: Which condition represents a high-risk scenario for a patient with a CIED? |
| Reference: | High-risk therapy includes either: a dose to the device of >5Gy or the presence of neutrons. 15 MV x-rays are neutron producing (and the only neutron producing therapy). Miften M, Mihailidis D, Kry SF, et al. Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A report of the AAPM TG-203. Med Phys. 2019; 46(12):e757-e788. doi: 10.1002/mp.13838. |
| Choice A: | Treatment at 6 MV, dose to the device is 0.5 Gy |
| Choice B: | Treatment at 15 MV, dose to the device is 0.5 Gy |
| Choice C: | Treatment at 6 MV, dose to the device is 3 Gy |
| Choice D: | Treatment at 18 MeV, dose to the device is 2 Gy |
| Question 4: What can the maximum percentage range of dosimetry effect be if the spinal metal is uncorrected for proton therapy planning? |
| Reference: | Giantsoudi D, De Man B, Verburg J, et al. Metal artifacts in computed tomography for radiation therapy planning: dosimetric effects and impact of metal artifact reduction. Phys Med Biol. 2017; 62(8):R49-R80. doi:10.1088/1361-6560/aa5293. |
| Choice A: | 0-5% |
| Choice B: | 6-10% |
| Choice C: | 11-15% |
| Choice D: | 16-20% |
| Choice E: | 21-25% |
| Question 5: Which of the following implanted spine screw type is closer to the normal spine considering the dosimetry effect for proton treatment planning? |
| Reference: | Poel R, Belosi F, Albertini F, et al. Assessing the advantages of CFR-PEEK over titanium spinal stabilization implants in proton therapy-a phantom study. Phys Med Biol. 2020;65(24):245031. doi: 10.1088/1361-6560/ab8ba0 |
| Choice A: | Titanium |
| Choice B: | Hybrid CFR-PEEK |
| Choice C: | CFR-PEEK |
| Choice D: | All of them |
| Question 6: Which of the following implanted device does not have a recommended radiation dose limit? |
| Reference: | MF Chan, C. Young, D. Gelblum, et al. A review and analysis of managing commonly seen implanted devices for patients undergoing radiation therapy. Advances Rad Oncol, 2021; 6, 100732. Table 1. Doi: 10.1016/j.adro.2021.100732 |
| Choice A: | Pacemaker |
| Choice B: | Programmable Hepatic Pump |
| Choice C: | Cerebral Shunt |
| Choice D: | Neurostimulator |
