2022 AAPM 64th Annual Meeting
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Session Title: Emerging and Re-Emerging Brachytherapy Treatments
Question 1: A biokinetic model has been used to calculate the maximum theoretical size of a tumor to be effectively treated with DaRT to account for:
Reference:Arazi et al, The treatment of solid tumors by alpha emitters released from 224Ra-loaded sources—internal dosimetry analysis Phys. Med. Biol. 55 (2010) 1203–1218
Choice A:Changes in the diffusion coefficient over large tumors
Choice B:Hypoxic effects correlated to tumor size
Choice C:Dose to distant organs from accumulation of radioactive elements that entered the bloodstream
Choice D:Bystander effects of the tumor C-cells
Question 2: In Popovtzery et al., DaRT use in humans was first described. The technique used involved:
Reference:Popovtzeri et al, Initial Safety and Tumor Control Results From a “First-in-Human” Multicenter Prospective Trial Evaluating a Novel Alpha-Emitting Radionuclide for the Treatment of Locally Advanced Recurrent Squamous Cell Carcinomas of the Skin and Head and Neck, Int. J. Radiat. Oncol. Biol. Phys. 106.3 (2020): 571-578
Choice A:DaRT of 2 mCi strength per wire implanted at 5-mm intervals
Choice B:DaRT injected in an artery accessing the tumor
Choice C:A single DaRT implanted at the tumor centroid
Choice D:DaRT mounted on a linac gantry to take advantage of the linac imaging capabilities
Question 3: The effective diameter (region receiving > 10Gy) of a recoil-short lived alpha emitting device:
Reference:Arazi et al, Diffusing alpha-emitters radiation therapy: approximate modeling of the macroscopic alpha particle dose of a point source, Phys. Med. Biol. 65 (2020) 015015 (24pp)
Choice A:Increases linearly with the activity of the device.
Choice B:Is smaller for tissues with higher diffusion coefficient.
Choice C:Is expected to be between 5 and 8 mm for sources of 2 mCi.
Choice D:Is always < 50 mm due to the short range of the alpha particles.
Question 4: What is the major side effect of coronary brachytherapy?
Reference:Popma JJ, Suntharalingam M, Lansky AJ, et al.; Stents And Radiation Therapy (START) Investigators. Randomized trial of 90Sr/90Y beta-radiation versus placebo control for treatment of in-stent restenosis. Circulation. 2002;106(9):1090–1096
Choice A:Lymphopenia and risk for viral infections
Choice B:Secondary Cancers
Choice C:Thrombosis of the irradiated blood vessel
Choice D:Perforation of the vessel wall
Question 5: Intravascular brachytherapy must meet the licensing requirements under which subpart of Code of Federal Regulations (CFR)?
Choice A:10 CFR 35.300
Choice B:10 CFR 35.400
Choice C:10 CFR 35.600
Choice D:10 CFR 35.1000
Question 6: Intravascular brachytherapy prescriptions are based on all of the following parameters EXCEPT:
Reference:Beta-Cath 3.5F System User’s manual, http://www.bestvascular.com/assets/D03745D%20Beta%20Cath%20System%20Users%20Manual.pdf
Choice A:Reference vessel diameter
Choice B:Stented length
Choice C:Source train length
Choice D:Distal and/or proximal margin
Question 7: During an IVBT treatment, who is responsible for sending and returning 90Sr sources?
Choice A:The Cardiologist
Choice B:The Radiation Oncologist (authorized physician user)
Choice C:The Physicist
Choice D:Nurses
Question 8: To prepare for emergency source recovery during an IVBT procedure, all of the following items are required EXCEPT:
Reference:Beta-Cath 3.5F System User’s manual, http://www.bestvascular.com/assets/D03745D%20Beta%20Cath%20System%20Users%20Manual.pdf
Choice A:An acrylic temporary storage container
Choice B:Reverse action tweezer (or magnetic source recovery probe)
Choice C:A lead container
Choice D:Water-soaked gauze sponges (4 or more)
Question 9: What advantages has Cs-131 exhibits in comparison to I-125 for brain brachytherapy?
Reference:Mahase SS, Navrazhina K, Schwartz TH, Parashar B, Wernicke AG. Intraoperative brachytherapy for resected brain metastases. Brachytherapy. 2019 May-Jun;18(3):258-270.
Choice A:Higher dose rate
Choice B:Higher mean energy
Choice C:Shorter half life
Choice D:All the above
Question 10: Cavity shrinkage after surgical resection is correlated with an increased risk of radiation necrosis of the surrounding tissue for patients treated with SRS.
Reference:Wernicke AG, Lazow SP, Taube S, Yondorf MZ, Kovanlikaya I, Nori D, Christos P, Boockvar JA, Pannullo S, Stieg PE, Schwartz TH. Surgical Technique and Clinically Relevant Resection Cavity Dynamics Following Implantation of Cesium-131 (Cs-131) Brachytherapy in Patients With Brain Metastases. Oper Neurosurg (Hagerstown). 2016 Mar;12(1):49-60
Choice A:True
Choice B:False
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