| Question 1: Which statement is True about the use of CBCT in proton therapy?
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| Reference: | Y-K-Park et al, Med Phys 42 4449 (2015), C Veiga et al, IJROBP 95 549 (2016). |
| Choice A: | Photon scatter affects the image quality of CBCT images but have minimal impact on the accuracy of proton dose calculation. |
| Choice B: | Deformable image registration alone between simulation CT and CBCT can model all complex anatomical change. |
| Choice C: | The accuracy of Hounsfield units in CBCT is not affected by beam hardening. |
| Choice D: | CBCT can be used for the qualitative assessment of anatomical change. |
| Question 2: Range uncertainty of a proton beam:
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| Reference: | Moyers MF, et.al. : Med Dosim. 2010 Autumn;35(3):179-94. doi: 10.1016/j.meddos.2009.05.004.
Yang M, et.al : Phys Med Biol. 2012 Jul 7;57(13):4095-115. doi: 10.1088/0031-9155/57/13/4095.
Paganetti, H : Phys Med Biol. 2012 Jun 7;57(11):R99-117. doi: 10.1088/0031-9155/57/11/R99.
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| Choice A: | Will produce less normal tissue complications. |
| Choice B: | Will lead to greater tumor control rates for proton patients when compared to photons. |
| Choice C: | Can be addressed by using a beam specific margins in the distal and proximal directions. |
| Choice D: | Eliminate the benefits of decreased integral dose given to the patient. |
| Choice E: | Has been poorly researched and is not quantifiable. |
| Question 3: Which statement concerning image guidance for proton therapy is NOT true?
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| Reference: | 1. Chen G et al. A review of image-guided radiotherapy. Radiol Phys Technol. 2:1-12, 2009.
2. Dong L. Image guidance to reduce setup error. 2011 AAPM summer school. https://www.aapm.org/education/VL/vl.asp?id=2158
3. Seco J and Spadea MF. Imaging in particle therapy: state of the art and future perspective. Acta Oncologica. 54:1254-1258, 2015.
4. Poludniowski G et al. Proton radiography and tomography with application to proton therapy. Br J Radiol. 88:20150134, 2015.
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| Choice A: | Currently the majority of proton centers rely on 2D X-ray imaging with or without fiducials to verify patient position. |
| Choice B: | Registering 2D X-ray images to 3D planning CT dataset in 2D-3D mode may allow determining the required set up correction in translation and rotation. |
| Choice C: | KV CBCT has become commercially available and has been installed in several proton centers worldwide. |
| Choice D: | Volumetric image guidance can be accomplished with gantry mounted CBCT, robotic C-arm CBCT, or CT-on rail. |
| Choice E: | The major barrier to clinical use of proton CT in treatment planning and verification is the unduly high dose to patient. |
| Question 4: Which statement is True about cyclotron and synchrotron?
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| Reference: | Godfrey D, Das S. K., Wolbarst A. B., Advances in Medical Physics, Medical Physics Publication, Vol. 5, 2014 |
| Choice A: | In cyclotron, as the proton energy is increased, the magnetic field is also increased. |
| Choice B: | Proton energy increases by increasing the magnetic fields in synchrotron. |
| Choice C: | As the energy increases, the proton radius increases in synchrotron. |
| Choice D: | Magnetic field strength and energy are increased simultaneously to keep protons in the same orbits in synchrotron. |
| Question 5: Which is true for different delivery systems?
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| Reference: | Paganetti H, Proton therapy physics. CRC press N.Y. 2012 |
| Choice A: | Double scattering uses energy stacking to produce spread out Bragg peak. |
| Choice B: | Uniform scanning uses modulation wheels to produce spread out Bragg peak. |
| Choice C: | To produce spread out Bragg peaks, energy of protons needs to be changed. |
| Choice D: | Scanning delivery systems do not produce spread out Bragg peaks. |
| Question 6: Regarding proton beams characteristics:
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| Reference: | Principles and Practice of Proton Beam Therapy, I. Das, H. Paganetti, AAPM summer school 2015. |
| Choice A: | 250 MeV proton beams spread laterally more than 70 MeV proton Beams. |
| Choice B: | 70 MeV proton beams suffer higher straggling than 250 MeV proton beams. |
| Choice C: | Proton beams provides a finite range and sparing of distally organ at risk to the target. |
| Choice D: | Have lower linear energy transfer (LET). |
