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CME Test Questions: May 2017
CME TEST QUESTIONS: MAY 2017
Examination available at http://learn.sirweb.org/. To take the online JVIR CME tests, please log into the SIR Learning Center with your SIR user name and password. Nonmembers: If you do not already have an SIR username and password, please click on “Create an Account” to gain access to the SIR Learning Center. Once in the Learning Center, click on the “Publication” activity type for a listing of all available JVIR CME tests. Each test will be available online for 3 years from the month/date of publication. The CME questions in this issue are derived from the article “Correlation of Technetium-99m Macroaggregated Albumin and Yttrium-90 Glass Microsphere Biodistribution in Hepatocellular Carcinoma: A Retrospective Review of Pretreatment Single Photon Emission CT and Posttreatment Positron Emission Tomography/CT” by Haste et al. In this article the authors investigate the distribution of 99mTc Macro-Aggregated Albumin (MAA) performed prior to Y-90 administration for hepatocellular carcinoma (HCC). 1. Which of the following statements regarding the current Y-90 treatment algorithm using glass microspheres is incorrect? a. Planar imaging following 99mTc MAA is primarily used to identify any non-target extra-hepatic distribution, including ling shunt fraction. b. The algorithm includes the routine use of 99mTc MAA SPECT to accurately identify and predict the distribution of Y-90. c. It uses the desired absorbed dose to the intended treatment volume to calculate the administered activity. d. It does not take into account the tumor characteristics in order to maximize the likelihood of tumor response while minimizing injury to the liver. 2. Based on the comparisons conducted by the authors between 99mTc MAA-SPECT and Y-90 PET/CT, which of the following statements is incorrect? a. The reproducibility coefficient (RDC) is higher in tumor than in whole liver normal tissue. b. The dosimetry approach is more reproducible in whole liver normal tissue than in tumors. c. The variability in the calculated absorbed dose for the tumor with Y-90 PET/CT is identical to that of 99mTc MAA-SPECT.
d. The inter-reviewer variability for absorbed dose was acceptable for for whole liver normal tissue, but not for the tumor itself. 3. True or False? Complete subjective agreement scores between 99mTc MAA and Y-90 distribution in tumors translated into better absorbed dose agreement between the two imaging modalities, and conversely, poor subjective agreement corresponded to larger absorbed dose differences. a. True b. False 4. Based on the authors’ analyses for tumor response, which one of the following statements is correct? a. A threshold for absorbed dose that predicted tumor response from Y-90 PET/CT was not identified. b. Using mRECIST criteria, objective response was achieved in 60% of the tumors. c. The mean tumor absorbed dose for objective response was identical in responders and non-responders. d. For tumors that met the mRECIST criteria for objective response (responders), the mean tumor absorbed dose was approximately 200Gy.
Examination available at http://learn.sirweb.org/. To take the online JVIR CME tests, please log into the SIR Learning Center with your SIR user name and password. Nonmembers: If you do not already have an SIR username and password, please click on “Create an Account” to gain access to the SIR Learning Center. Once in the Learning Center, click on the “Publication” activity type for a listing of all available JVIR CME tests. Each test will be available online for 3 years from the month/date of publication. The CME questions in this issue are derived from the article “Correlation of Technetium-99m Macroaggregated Albumin and Yttrium-90 Glass Microsphere Biodistribution in Hepatocellular Carcinoma: A Retrospective Review of Pretreatment Single Photon Emission CT and Posttreatment Positron Emission Tomography/CT” by Haste et al. In this article the authors investigate the distribution of 99mTc Macro-Aggregated Albumin (MAA) performed prior to Y-90 administration for hepatocellular carcinoma (HCC). 1. Which of the following statements regarding the current Y-90 treatment algorithm using glass microspheres is incorrect? a. Planar imaging following 99mTc MAA is primarily used to identify any non-target extra-hepatic distribution, including ling shunt fraction. b. The algorithm includes the routine use of 99mTc MAA SPECT to accurately identify and predict the distribution of Y-90. c. It uses the desired absorbed dose to the intended treatment volume to calculate the administered activity. d. It does not take into account the tumor characteristics in order to maximize the likelihood of tumor response while minimizing injury to the liver. 2. Based on the comparisons conducted by the authors between 99mTc MAA-SPECT and Y-90 PET/CT, which of the following statements is incorrect? a. The reproducibility coefficient (RDC) is higher in tumor than in whole liver normal tissue. b. The dosimetry approach is more reproducible in whole liver normal tissue than in tumors. c. The variability in the calculated absorbed dose for the tumor with Y-90 PET/CT is identical to that of 99mTc MAA-SPECT.
d. The inter-reviewer variability for absorbed dose was acceptable for for whole liver normal tissue, but not for the tumor itself. 3. True or False? Complete subjective agreement scores between 99mTc MAA and Y-90 distribution in tumors translated into better absorbed dose agreement between the two imaging modalities, and conversely, poor subjective agreement corresponded to larger absorbed dose differences. a. True b. False 4. Based on the authors’ analyses for tumor response, which one of the following statements is correct? a. A threshold for absorbed dose that predicted tumor response from Y-90 PET/CT was not identified. b. Using mRECIST criteria, objective response was achieved in 60% of the tumors. c. The mean tumor absorbed dose for objective response was identical in responders and non-responders. d. For tumors that met the mRECIST criteria for objective response (responders), the mean tumor absorbed dose was approximately 200Gy.