2022 AAPM 64th Annual Meeting
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Session Title: Managing Implanted Devices
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 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
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