CMD case studies
CMD · Put your knowledge to work in context.
The CMD (Certified Medical Dosimetrist) credential is awarded by the Medical Dosimetrist Certification Board (MDCB), an independent board whose stated mission is "to steer the advancement of the Medical Dosimetry profession by establishing certification and continuing education standards to enhance quality patient care." The credential is aimed at dosimetrists who plan and calculate radiation treatment doses and need a recognized, verifiable professional standard; MDCB also runs a Maintenance of Certification process that requires continuing professional development and publishes a public CMD verification tool. The MDCB Certification Exam is the entry point to that credential. The CMD case studies are 5 cases and about 2,395 words.
1Central Lung SBRT in Severe Emphysema: Coverage Versus Chest Wall Dose
A 74-year-old man with biopsy-proven squamous cell carcinoma of the right upper lobe, 2.6 cm, PET avid (SUVmax 9.1), no nodal or distant uptake, is referred for stereotactic body radiotherapy. He has severe emphysema (FEV1 1.05 L, DLCO 38% predicted), uses 2 L/min oxygen at night, and has a chronic productive cough.
564 words, about 3 min2Adaptive Replanning for Weight Loss During Head and Neck Chemoradiotherapy
A 58-year-old woman with HPV-positive squamous cell carcinoma of the base of tongue, cT2N2b, starts definitive chemoradiotherapy: 70 Gy in 35 fractions to the primary and involved nodes, 56 Gy to the elective bilateral neck, with weekly cisplatin. At fraction 16 she has lost 8 kg (12% of body weight), her neck circumference has decreased by 3 cm, and daily cone-beam CT shows increasing setup variability.
494 words, about 2 min3Left Breast Regional Nodal Irradiation With Cardiac Sparing Trade-Offs
A 47-year-old woman with left breast invasive ductal carcinoma, pT1cN1 (two sentinel nodes positive), status post breast-conserving surgery with oncoplastic closure, is planned for whole breast 50 Gy in 25 fractions, sequential tumor bed boost 10 Gy in 5 fractions, and regional nodal irradiation to the supraclavicular and internal mammary nodes. Two VMAT plans are generated.
443 words, about 2 min4Prostate Brachytherapy Boost Versus EBRT in a Patient With Prior TURP
A 70-year-old man with Gleason 4+4=8, PSA 12.4 ng/mL, cT2c prostate cancer, prostate volume 78 cc, IPSS 18, on warfarin for atrial fibrillation, and prior transurethral resection of the prostate 6 years ago. He is offered either external beam radiotherapy 78 Gy in 39 fractions with 6 months of androgen deprivation, or external beam 45 Gy in 25 fractions plus low-dose-rate brachytherapy boost.
433 words, about 2 min5Spinal Cord Re-Irradiation After Prior Palliative Radiotherapy
A 63-year-old man with metastatic NSCLC, prior palliative radiotherapy 30 Gy in 10 fractions to T4-T6 14 months ago for bone metastasis, now presents with new T7-T8 spinal cord compression, ESCC grade 2, severe pain, and inability to walk. MRI shows cord compression at T7-T8.
461 words, about 2 min