2022 AAPM 64th Annual Meeting
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Session Title: State of the Art of Adaptive Radiotherapy
Question 1: Potential benefits of adaptive radiation therapy include:
Reference:• Brock et al. Adaptive Radiotherapy: Moving Into the Future. Semin Radiat Oncol. 2019 July ; 29(3): 181–184. doi:10.1016/j.semradonc.2019.02.011. • Rudra et al . Using adaptive magnetic resonance image-guided radiation therapy for treatment of inoperable pancreatic cancer. Cancer Med. 2019 May;8(5):2123-2132. doi: 10.1002/cam4.2100. Epub 2019 Apr 1. PMID: 30932367; PMCID: PMC6536981. • Kong et al. NRG-RTOG 1106/ACRIN 6697: A phase IIR trial of standard versus adaptive (mid-treatment PET-based) chemoradiotherapy for stage III NSCLC—Results and comparison to NRG-RTOG 0617 (non-personalized RT dose escalation). Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021) 8548-8548. DOI: 10.1200/JCO.2021.39.15_suppl.8548 • Schwartz DL, Garden AS, Thomas J, et al. Adaptive radiotherapy for head-and-neck cancer: initial clinical outcomes from a prospective trial. Int J Radiat Oncol Biol Phys. 2012;83(3):986-993.
Choice A:Dose escalation
Choice B:Adjustment of dose based on metabolic/biologic response
Choice C:Accounting for dosimetric changes over a treatment course (e.g. due to weight loss)
Choice D:Reducing toxicity risk for tumors adjacent to highly mobile organs
Choice E:All of the above
Question 2: What are some key barriers to translating the potential benefits of adaptive radiation therapy from theory to clinical practice?
Reference:• Brock et al. Semin Radiat Oncol. 2019 July ; 29(3): 181–184. doi:10.1016/j.semradonc.2019.02.011. • Glide-Hurst et al. Adaptiv Adaptive Radiation Ther e Radiation Therapy (ART) Strategies and Technical Considerations: A State of the ART Review From NRG Oncology. Int J Radiation Oncol Biol Phys, 2021; 109(4):1054-1075 • Hall et al. Magnetic resonance linear accelerator technology and adaptive radiation therapy: An overview for clinicians. CA Cancer J. Clin. 2022; 72:34–56.
Choice A:Training personnel to perform new tasks and adequate staffing for the added work of replanning
Choice B:Consistent clinical criteria on when adaptation is needed
Choice C:Accurate representation of dose accumulation
Choice D:All of the above
Question 3: Linac-integrated kV CBCT imaging systems are the most readily available systems for in-room imaging in the treatment position. What are some of the considerations in using kV CBCT for online adaptive radiotherapy?
Reference:Sonke JJ, Aznar M, Rasch C. Adaptive Radiotherapy for Anatomical Changes. Semin Radiat Oncol. 2019 Jul;29(3):245-257. PMID: 31027642
Choice A:Limited field of view
Choice B:Reduced soft-tissue contrast compared to CT for organ delineation
Choice C:Lower HU accuracy compared to CT for dose calculation
Choice D:All of the above
Question 4: What type of adaptive radiotherapy could be feasible using standard kV CBCT imaging?
Reference:Glide-Hurst CK, Lee P, Yock AD, et al. Adaptive Radiation Therapy (ART) Strategies and Technical Considerations: A State of the ART Review From NRG Oncology. Int J Radiat Oncol Biol Phys. 2021 Mar 15;109(4):1054-1075. PMID: 33470210
Choice A:Functional adaptation
Choice B:Biological adaptation
Choice C:Geometric/anatomic adaptation
Question 5: Compared to the standard IMRT process, which of the following failure modes is most likely to cause a treatment error in an online adaptive process?
Reference:Noel CE, Santanam L, Parikh PJ, et al. Process-based quality management for clinical implementation of adaptive radiotherapy. Med Phys. 2014 Aug;41(8):081717. PMID: 25086527
Choice A:Errors in contouring
Choice B:Isocenter and alignment error
Choice C:Errors in electron density
Choice D:Plan QA and delivery errors
Question 6: What is the main concern of intrafraction gastrointestinal (GI) peristalsis during ablative delivery of MR-guided adaptive radiotherapy in the abdomen?
Reference:Mostafaei, Farshad et al. “Variations of MRI-assessed peristaltic motions during radiation therapy.” PloS one vol. 13,10 e0205917. 25 Oct. 2018
Choice A:Motion artifacts in the real-time MR cine
Choice B:Electron density changing
Choice C:Overdose of GI organs from high doses
Choice D:Reduction in gadolinium-based contrast agents
Question 7: Which of the following best describes “robustness” of MR-guided online adaptive plans:
Reference:Bohoudi O, Bruynzeel AME, Senan S, et al. Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer. Radiother Oncol. 2017;125(3):439-444.
Choice A:Segmentation quality on the MR of the day
Choice B:CT to MR deformation quality on the MR of the day
Choice C:ART plan quality of initial plan objectives re-optimized on anatomy of the day
Choice D:Time efficiency of MR-guided adaptive workflow
Question 8: 18F-FDG-PET is able to achieve an accurate and precise definition of ______ boundaries during RT planning:
Reference:ELEONORA FARINA, MARTINA FERIOLI, PAOLO CASTELLUCCI, ARIANNA FARINA, GIUSEPPE ZANIRATO RAMBALDI, SAVINO CILLA, SILVIA CAMMELLI, STEFANO FANTI and ALESSIO G. MORGANTI. 18F-Fdg-PET-guided Planning and Re-Planning (Adaptive) Radiotherapy in Head and Neck Cancer: Current State of Art. Anticancer Research December 2017, 37 (12) 6523-6532
Choice A:GTV
Choice B:CTV
Choice C:ITV
Choice D:PTV
Question 9: Which of the following statement for PET imaging is NOT correct?
Reference:Glide-Hurst, C. K., Lee, P., Yock, A. D., Olsen, J. R., Cao, M., Siddiqui, F., ... & Wuthrick, E. (2021). Adaptive radiation therapy (ART) strategies and technical considerations: a state of the ART review from NRG oncology. International Journal of Radiation Oncology* Biology* Physics, 109(4), 1054-1075.
Choice A:Provide quantitative functional information
Choice B:Very long scan times, prone to blurring from motion
Choice C:Subject to intra-fraction images variations due to metabolic uptake changes
Choice D:Provide excellent soft tissue contrast
Question 10: What kind of delivery tracking is unique to PET-guided BgRT?
Reference:Shirvani SM, Huntzinger CJ, Melcher T, Olcott PD, Voronenko Y, Bartlett-Roberto J, Mazin S. Biology-guided radiotherapy: redefining the role of radiotherapy in metastatic cancer. Br J Radiol. 2021 Jan 1;94(1117):20200873. doi: 10.1259/bjr.20200873. Epub 2020 Oct 30. PMID: 33112685; PMCID: PMC7774706
Choice A:Respiratory gating motion management
Choice B:Real-time PET-based biologically tracking
Choice C:During treatment kV-image monitoring
Choice D:Surface motion monitoring
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