Longitudinal Remote SBRT/SRS Training in Latin America: A Prospective Cohort Study

Background Continuing medical education in stereotactic technology are scarcely accessible in developing countries. We report the results of upscaling a longitudinal telehealth training course on stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), after successfully developing a pilot course in Latin America. Methods Longitudinal training on SBRT and SRS was provided to radiation oncology practitioners in Peru and Colombia at no cost. The program included sixteen weekly 1-hour live conferencing sessions with interactive didactics and a cloud-based platform for case-based learning. Participant-reported confidence was measured in 16 SBRT/SRS practical domains, based on a 1-to-5 Likert scale. Pre- and post-curriculum exams were required for participation credit. Knowledge-baseline, pre- and post-curriculum surveys, overall and single professional-group confidence changes, and exam results were assessed. Results One hundred and seventy-three radiotherapy professionals participated. An average of 56 (SD ±18) attendees per session were registered. Fifty (29.7%) participants completed the pre- and post-curriculum surveys, of which 30% were radiation oncologists (RO), 26% radiation therapists (RTT), 20% residents, 18% medical physicists and 6% neurosurgeons. Significant improvements were found across all 16 domains with overall mean +0.55 (SD ±0.17, p<0.001) Likert-scale points. Significant improvements in individual competences were most common among medical physicists, RTT and residents. Pre- and post-curriculum exams yielded a mean 16.15/30 (53.8 ± 20.3%) and 23.6/30 (78.7 ± 19.3%) correct answers (p<0.001). Conclusion Longitudinal telehealth training is an effective method for improving confidence and knowledge on SBRT/SRS amongst professionals. Remote continuing medical education should be widely adopted in lower-middle income countries.


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SBRT/SRS 2.0 Pre-Curriculum Assessment
Welcome to the Rayos Contra Cancer SBRT/SRS 2.0 Curriculum. Please complete this form for enrollment.

4.
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Reassortment of cells in the cell cycle can explain the response of cancer cells to radiation
Repopulation of cells can explain the response of cancer cells to radiation exposures typical of hypofractionation.
Reoxygenation can explain the response of cancer cells to a single high dose of radiation.
Repair of DNA damage between fractions can explain, at least in part, the response of cancer cells to multiple hypofractionated doses of radiation.

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Name/Nombre Completo * Institution/Institución * Considering the "Rs" of radiobiology, choose the one CORRECT response.

5.
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Tumor vessels are more sensitive to high dose radiation than low dose radiation Chronic anoxia occurs days after high dose radiation Immunological priming elicits an immune reaction after high dose radiation Reoxygenation is rapid and complete after high dose radiation 6.

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MRI must be acquired before the CT CT scan must be acquired before MRI Assuring the Planning Framed CT scan and MRI are dimensionally correct and CO-registered appropriately.
Ensuring the image resolution is the lowest in each imaging modality.
Choose the one INCORRECT hypothesis put forth to explain how SRS can be so effective considering that 1) tumor hypoxia is a problem limiting the effectiveness of radiotherapy and 2) some metastatic brain tumors such as those arising from radioresistant primary cancers (melanoma, renal cell carcinoma, anaplastic thyroid cancer, etc.), respond as well to radiotherapy as radiosensitive cancers.
For Cone Based or Gamma knife based SRS treatments a crucial step in ensuring accuracy of targeting/delineating the tumor area is

7.
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The calculation grid of the planning CT scan can be reduced to less than 1mm Minimum INTRA fraction motion is expected and minimum INTRA fraction online imaging is necessary.
No imaging of the patient is required for setup the co-registration of planning CT and treatment imaging is appropriate 9.

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Underestimate the absolute dose and underestimate the coverage of targets. This in turns translates to a possible overdosing of the patient.
Overestimate the absolute dose and overestimate the coverage of targets. This in turns translates to a possible under dosing of the patient.
Overestimate the absolute dose and underestimate the coverage of targets. This in turns translates to a possible overdosing of the patient.
Underestimate the absolute dose and overestimate the coverage of targets. This in turns translates to a possible under dosing of the patient.
The key to conformality of dose around target is For Single fraction SBRT -spine ; immobilization of the patient should be performed such that Use of the wrong volume size detector for small field relative and/or absolute dosimetry will lead to possible?

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Minimizing the target motion using immobilization techniques at the time of simulation.
Using gating techniques during the exhale phase of the breathing cycle.
Adding more margins for tumors than move more than 1 cm.
Using appropriate external and internal surrogate marker.

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Mark only one oval. a brain metastatic tumor of 1 cubic centimeters.
an arterio-venous malformation of 25 cubic centimeters. a brain tumor volume of 100 cubic centimeters. a brain surgical cavity of 8 cubic centimeters.

Angiography.
For IMRT SBRT-Lung minimizing the interplay effect in between target motion and radiation delivery can be BEST and Easiest accomplished by Which of the following diseases can be treated with stereotactic radiosurgery?
Which of the following is not an imaging modality for use in intracranial radiosurgery simulation?
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The GammaKnife system provides a robotic couch capable of correcting patient positioning in six dimensions (x,y,z and rotation: pitch, roll and yaw).
Cyberknife uses non-invasive image guided target localization.
Linear accelerators can use high-definition MLCs or cones for treatment.
Dynamic conformal arcs can be used in linear accelerators for treatment.

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Mark only one oval. lateral photon scattering decreases lateral electron scattering decreases beam energy energy decreases effective photon source becomes occluded Which of the following equipment is not used during stereotactic radiosurgery simulation?
Which of the following sentence is not true regarding stereotactic radiosurgery systems?
Which of the following statements is true at field sizes less than 1x1 cm2:

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The dose in the lung slab will increase because the density of the lung tissue is lower than that of water.
The dose in the lung slab will increase because of increased photon scattering in the lung tissue.
The dose in the lung slab will decrease because the range of scattered photons increases in the lung tissue.
The dose in the lung slab will decrease because the range of scattered electrons increases in the lung tissue.

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The treatment time for radiation delivery of a gated treatment is generally higher than that of a free-breathing treatment.
Surface-based image guidance may sometimes be a poor surrogate for tumor motion.
Patient alignment using volumetric imaging may help reduce treatment margins.
Daily imaging using planar x-rays gives excellent information on the motion of the tumor and normal tissues.
It is important that the strength of the imaging surrogate be considered in the planning margin design.

18.
Mark only one oval. Which of the following statements regarding depth dose measurements for a 2x2 cm2, 6 MV field, in a water (4 cm)/lung (6 cm)/water (10 cm) phantom is True?
Which of the following statements concerning image-guided treatment delivery is false In CT-frame-based radiosurgery, what is the largest source of uncertainty?

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Mark only one oval. In a single-isocenter, conformal radiosurgery treatment of a symmetrical target, the dose gradient outside the target is sharpest for the prescription isodose line of: Which of the following is an appropriate setup verification technique for a single fraction linac radiosurgery treatment?

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Mark only one oval. Accurate target localization at time of treatment is best achieved through which pre-treatment imaging technique?
Which one is the gold standard tumor tracking in Radiotherapy?
Which tumor tracking method is used by Cyberknife for intracranial lesions?

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29.
Mark only one oval. The robotic arm positioning error determined from film measurements should be approximately?

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Prior to each field irradiation Via a CBCT before, during, and after treatment Via optical surface monitoring system (OSMS) None of the above

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Mark only one oval. Standard clinical mask may be permissible with appropriate institutional margins and image-guidance. Uncertainties with masks, even specialized, can be: