2017 AAPM Annual Meeting
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Session Title: Overview of Imaging's Role in Clinical Trial (Session 1 of the Certificate Course Series)
Question 1: Imaging biomarkers could potentially play a critical role in oncology clinical trials. What are some of the challenges in development of imaging biomarkers in clinical trials?
Reference:Liu Y, deSouza NM, Shankar LK, et. al., Lancet Oncol 16:2622-28, 2015.
Choice A:Complexity of functional or quantitative imaging technologies, including data acquisition, reconstruction, and post-processing.
Choice B:Safety issues related to imaging contrast agents.
Choice C:Standardization of imaging acquisition across multiple vendor platforms.
Choice D:Harmonization of imaging interpretation.
Choice E:All of the above.
Question 2: Which of the following services are provided by the the Imaging and Radiation Oncology Core (IROC) within the NCI National Clinical Trials Network (NTCN)?
Reference:FitzGerald TJ, Bishop-Jodoin M, Followill DS, et. al., Int J Radiation Oncol Biol Phys, Vol. 94(2); 404-411, 2016
Choice A:Siting of imaging and RT modalities.
Choice B:Imaging and RT guidelines and QA requirements.
Choice C:Statistics support.
Choice D:Site qualification and credentialing for imaging and RT.
Choice E:Guidelines for imaging and RT data acquisition and interpretation.
Choice F:B, D and E.
Question 3: Geometric distortion in MRI are mainly caused by:
Reference:Weygand J, Fuller CD, Ibbott GS, Mohamed AS, Ding Y, Yang J, Hwang KP, Wang J. Spatial Precision in Magnetic Resonance Imaging-Guided Radiation Therapy: The Role of Geometric Distortion. Int J Radiat Oncol Biol Phys 95(4):1304-16, 7/2016
Choice A:Gradient non-linearities.
Choice B:B0 non-uniformities.
Choice C:Tissue susceptibility differences.
Choice D:All of the above.
Question 4: Which of the following statements is not true?
Reference:1). Kurland BF et al, Promise and pitfalls of quantitative imaging in oncology clinical trials, MRM 30(2012) 2). O’Connor J et al, Imaging biomarker roadmap for cancer studies, Nature Review, (2016)
Choice A:All functional/molecular MRI techniques are quantitative.
Choice B:All functional/molecular MRI requires some post-processing.
Choice C:Quality control and quality assurance are required for MR imaging in clinical trials.
Choice D:Functional/molecular MRI are typically more noisy.
Question 5: What are the main challenges for MRI-only treatment planning in today’s radiation therapy?
Reference:Karotki A, Mah K, Meijer G, Meltsner M. Comparison of bulk electron density and voxel-based electron density treatment planning. J Appl Clin Med Phys. 2011 Nov 15;12(4):3522. doi:10.1120/jacmp.v12i4.3522.
Choice A:Geometric distortion in MRI.
Choice B:Lack of electron density information for TPS.
Choice C:Interference of magnetic field on secondary electrons.
Choice D:RF interference of MRI to radiation therapy.
Choice E:A and B.
Question 6: A major advantage of PET is the ability to quantify radiotracer accumulation. The most common parameter used to measure tracer accumulation in PET studies is the standardized uptake value (SUV). Which of the following factors influence the accuracy of SUV measurements:
Reference:Adams MC1, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol. 2010 Aug;195(2):310-20. doi: 10.2214/AJR.10.4923.
Choice A:Scanner technology (detector material, crystal dimensions).
Choice B:Reconstruction parameters (matrix size, Field of View).
Choice C:Patient size including weight composition (fat vs. muscle).
Choice D:Calibration error between scanner and dose calibrator.
Choice E:ROI placement by observer.
Choice F:All of the above.
Question 7: When using SUV as an endpoint in a clinical trial, which of the following are recommended to obtain accurate and consistent values:
Reference:Adams MC1, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol. 2010 Aug;195(2):310-20. doi: 10.2214/AJR.10.4923.
Choice A:Use scanners from different manufacturers on baseline and follow up exams
Choice B:Use scanners from the same manufacturer, but use different scanner models on baseline and followup exams.
Choice C:Use scanners of the same manufacturer and model, but use different field of view settings on baseline and follow up exams.
Choice D:Use scanners of the same manufacturer and model with the same field of view settings on baseline and all follow up exams.
Question 8: Why should an insightful PI consider including Medical Physics support in a clinical trial that includes CT imaging in some form?
Reference:Cagnon C.H., Cody DD, McNitt-Gray, MF, Seibert J.A., Judy P.F. Aberle D.R. Description and implementation of a quality control program in an imaging based clinical trial. Academ Radiol 13(11):1431-1441, 2006. PMID: 17111584.
Choice A:Looks good to reviewers.
Choice B:Provides quality and consistency in pooled data sets.
Choice C:Fun colleagues to party with after day-long meetings.
Choice D:Tomographic sections require physics input.
Question 9: You are faced with designing CT acquisition parameters for a large multi-center trial for many academic sites. Based on the NLST experience, you might approach it this way:
Reference:Cagnon C.H., Cody DD, McNitt-Gray, MF, Seibert J.A., Judy P.F. Aberle D.R. Description and implementation of a quality control program in an imaging based clinical trial. Academ Radiol 13(11):1431-1441, 2006. PMID: 17111584
Choice A:Granular: list parameters (or ranges) for each individual scanner model to contribute images for this trial.
Choice B:Medium: list parameters (or ranges) for each individual manufacturer whose scanners will contribute images to this trial.
Choice C:Large scales: provide overall ranges of parameters for all scanners which will contribute images to this trial.
Choice D:Allow sites to use their own routine protocol sets and select their own parameters for acquisition.
Question 10: Radiation Dose is a consistent concern when CT is used in clinical trials, even in a low dose lung cancer screening context. When estimating radiation dose to participants, the approach that is widely accepted is to:
Reference:Larke FJ, Kruger RL, Cagnon CH, Flynn MJ, McNitt-Gray MM, Wu X, Judy PF, Cody DD. Estimated radiation dose associated with low-dose chest CT of average-size participants in the National Lung Screening Trial. AJR Am J Roentgenol. 2011 Nov;197(5):1165-9. doi: 10.2214/AJR.11.6533. PMID: 22021510
Choice A:Report CTDIvol for each scanner.
Choice B:Report DLP for each scanner.
Choice C:Report both CTDIvol and DLP for each scanner.
Choice D:Use existing tools to estimate effective dose to a reference participant (standard sized male or female).
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