RADIOLOGICAL PHYSICS Raphex% Preface + ——EEr EE —— — — rr —— RAPHEX 2001 was prepared by members of the Radiological and Medical Physics Society of New York (RAMPS, Inc.), the New York chapter of the American Association of Physicists in Medicine (AAPM). Contributors to this exam were: General: Susan Brownie, M.Sc., Editor Robert Barish, Ph.D., Reviewer Therapy: Susan Brownie, M.Sc., Editor Wendell Lutz, Ph.D., Reviewer Bhudatt Paliwal, Reviewer Diagnostic: Lawrence Rothenburg, Ph.D., Editor Maynard High, Ph.D. Steven Balter, Ph.D. John Humm, Ph.D. If you are taking RAPHEX under exam conditions, your proctor will give you instructions. od You have 3 HOURS to complete both sections: the GENERAL section, and your SPECIALTY section. % Non-programmable calculators may be used. ~% Choose the most complete and appropriate answer to each question. We urge residents to review the exam with their physics instructors. Any comments or corrections are appreciated and should be sent to: Susan Brownie, M.Sc. Department of Radiation Oncology, HC107 New York University Medical Center 560 Ist Avenue New York, NY 10016 Copyright © 2001 by RAMPS, Inc., the New York chapter of the AAPM. All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission from the publisher or the copyright holder. Published in cooperation with RAMPS by: Medical Physics Publishing 4513 Vernon Boulevard Madison, WI 53705-4964 1-800-442-5778General “+ Questions GI. The f-factor is all of the following except: The roentgen-to-rad conversion factor. Generally greater for high-Z materials. Generally greater for low energy. Has the value 0.871 in air. Is 1.0 for water at 1 MeV. HOOD p> G2. An exposure of 100 R: A. Results in the same absorbed dose to muscle, bone or fat. B. Isa measure of the ability of a photon beam to ionize air. C. Applies to photons and particulate radiation. D. Is a unit used in the SI system. G3-6. Match the following units with the quantities below: Bq Sv Cikg Gy J MOOn > G3. Absorbed dose G4. Activity G5. Exposure G6. Dose equivalent G7. The rest mass of an electron is: 981 MeV 1.02 MeV 0.51 MeV 1.02 keV 0.51 keV HOOw> G8-12. Match the charge carried by each of the following: (answer may be used more than once) +4 +2 +1 0 -l BOO > G8. Alpha particle G9. Neutron G10. Electron G11. Positron G12. Photon Raphex 2001 IGeneral “ Questions * G13. Rank the following in terms of increasing LET: (all have 5 MeV kinetic energy) . Neutrons, alphas, electrons Alphas, electrons, neutrons Electrons, neutrons, alphas Neutrons, electrons, alphas Electrons, alphas, neutrons mMOOM> GIA. A radionuclide can decay by either beta-minus or positron emission. The two daughter nuclei are: A. Isomers. B. Isobars. C. Isotones. D. Isotopes. GI5. The number of neutrons in a U-238 atom (Z = 92) is: 330 238 146 92 Cannot tell from information given. MOAW > GI6. The binding energy of an electron in the K shell of an atom is the energy needed: To remove an electron from the K shell. For the electron to jump from the K to the L shell. To keep an electron in the K shell. For the electron to jump from the L to the K shell. VOWp> GI7. From the following data, calculate the minimum energy required to separate a deuteron into its component parts (1 amu = 931.2 MeV) particle amu proton 1.00727 neutron 1.00866 deuteron 2.01355 1.875 MeV 2.02 MeV 2.22 MeV 2.38 MeV 4.03 MeV MOOS a 2 Raphex 2001General “- Questions G18. GI9. G20. G2l. G22. How many of the following elements have 8 electrons in their outer shell? Element: Sulphur Chlorine Argon Potassium Z: 16 17 18 19 A. None B. 1 C. 2 D. 3 E. 4 Regarding the decay constant, A, all of the following are true except: It is inversely proportional to the half-life. It is the fractional decay in a given time. 1/X is the average life. It is the number of decays per unit time. COwp A radionuclide has a physical half-life of 6.0 hrs, and a biological half-life of 12.5 hrs. The effective half-life is: 2.08 hrs. 4.05 hrs. 9.25 hrs. 12.5 hrs. 18.5 hrs. HOODS The half-life of a radionuclide is 60 days. After how many days will it decay to 0.1% of its original activity? A. 300 600 900 3000 6000 MOOW A source with a half-life of 14 days has an activity of 4.0 mCi at noon on Thursday. What was its activity at noon on the previous Monday? A. 4.64 mCi 4.58 mCi 4.09 mCi 3.50 mCi 3.45 mCi moO Raphex 2001 3General “ Questions + G23. G24. G25. G26. G27. G28. After 4 half-lives, the activity of a radioactive source will be times its initial activity. 0.5 0.25 0.125 0.0625 0.031 MOOD > The mass number A changes for: Alpha decay. Beta minus decay. Beta plus decay. Electron capture. All of the above. MOOD > A radionuclide with an excess of neutrons generally decays by: Alpha decay. Beta minus decay. Beta plus decay. Electron capture. Internal conversion. MOOS Which process emits a continuous spectrum of radiation? Alpha decay. Isomeric transition. Electron capture. Beta decay. Both alpha and beta decay. MOOWS A radionuclide decays to a nuclide with the same A, and with Z reduced by 1. This is an example of decay. Alpha Beta minus Beta plus Electron capture CorD MOOD > Gammas may be emitted following a(n) decay. Beta minus. Beta plus. Isomeric transition. Electron capture. All of the above. MOOW pS Raphex 2001}! General “» Questions G29. G30. G3l. G32. G33. G34. Radionuclides which decay by internal conversion emit all of the following except: Gammas. Characteristic x-rays. Auger electrons. Betas. IAw> The binding energy per nucleon generally: A. Increases after radioactive decay. B. Remains the same after radioactive decay. C. Is independent of Z. D. Is highest for higher Z nuclides. In Positron Emission Tomography (PET), the image is created by detecting: Positrons. Auger electrons. Characteristic x-rays. Annihilation photons. None of the above. MOODS Regarding methods of radioisotope production, bombarding a nuclide with neutrons from a reactor creates a radioisotope which decays by: Alpha decay. Beta minus decay. Beta plus decay. Isomeric transition. DOW p When a nuclide is bombarded with protons in a cyclotron, the resulting radioisotope is most likely to decay by: Alpha decay. Beta minus decay. Beta plus decay. Isomeric transition. DAW > Cs-137 is: Created by bombarding Cs-138 with neutrons. Created in a cyclotron by bombarding a nuclide with deuterons. A fission product, which is obtained from used reactor fuel rods. A naturally occuring radioisotope found in uranium ore. None of the above. HOO > Raphex 2001 5General | “ Questions + G35. In secular equilibrium the half-life of the parent is__ that of the daughter. Much longer than Somewhat longer than The same as Somewhat shorter than Much shorter than MOO > G36. In transient equilibrium the half-life of the parent is that of the daughter. A. Much longer than B. Somewhat longer than C. The same as D. Somwhat shorter than E. Much shorter than G37. 10 mCi = MBq A. 3.7x 10" B. 3.7x 10? C. 2.7x 10! D. 2.7x 10° E. 2.7x 108 G38. Which of the following is mot a unit used to describe the strength of a radioactive source? MBq uci mg Ra equ Gy m? hr! amu MOOD > G39. The exposure rate at 1 meter from a point source of 10 mCi of Cs-137 is . (I for Cs-137 is 3.3 R.cm?/mCi.hr ) . 3 mR/min 3.3 R/min 3.3 mR/hr 3.3 R/hr 33 R/hr MOODS G40. The purpose of the x-ray tube filament found in an x-ray circuit is to: Allow the current to flow in one direction only. Increase or decrease voltage. Create thermionic emission. Measure the time of exposure. Measure tube current. moOW> 6 Raphex 2001General “* Questions + Intensity 0 20 40 60 80 100 keV For questions G41—44, regarding the spectra in the diagram: G4l. Characteristic radiations appear between 50 and 70 keV for: A. Spectrum I. B. Spectrum II. C. Both spectra. D. Neither spectra. G42. The maximum photon energy is 50 keV for: A. Spectrum I. B. Spectrum II. C. Both spectra. D. Neither spectra. G43. The beam with the higher HVL is: A. Spectrum I. B. Spectrum II. C. Cannot tell from information given. G44. The photons below 10 keV have been removed by filtration for: Spectrum I. Spectrum II. Both spectra. Neither spectra. Dae> G45. The maximum photon energy in an x-ray beam is determined by the: Atomic number of the target. Atomic number of the filter. kV across the tube. Maximum mA. Type of rectification. mMoOw> Raphex 2001 7General * Questions + G46. A diagnostic beam has a first HVL of 3 mm AI. If the unattenuated intensity is measured, and then a total of 6 mm of Al filtration is added, the intensity will be reduced to: A. 50%. B. Somewhat more than 25%. C. 25%. D. Somewhat less than 25%. E. 12.5%. G47. For a polyenergetic x-ray beam, the first half value layer: A. Is greater than the second. B. Decreases as kV increases. C. Is dependent on intrinsic and added filtration. D. Is independent of the type of rectification used. G48-49. The following measurements are made in good geometry for a photon beam: added filtration exposure (mm Al) (mR) 0 200 0.5 158 1.0 142 2.0 110 3.0 90 4.0 70 5.0 58 6.0 50 8.0 36 G48. The second HVL is approximately mm Al. A. 0.75 B. 2.0 C. 2.5 D. 3.5 E. 6.0 G49. The measurements are repeated starting with 1 mm inherent AI filtration. The first HVL will now be approximately mm Al. A. 1.0 B. 2.5 C. 3.0 D. 3.5 E. 6.0 8 Raphex 2001General “- Questions G50. When measuring the HVL of an x-ray beam, a narrow beam must be used because: A. The beam must be smaller than the detector. B. A broad beam could introduce scattered x-rays, giving a false reading. C. The average beam energy would be greater with a broad beam. D. All of the above are true. GSI. Which of the following has the highest photon energy? Radio waves Visible light Ultrasound X-rays Ultraviolet HOOD > G52. Which of the following has the longest wavelength? Radio waves Visible light Ultraviolet X-rays Gamma rays mOOW pS G53. Of the following types of electromagnetic radiation, which cannot be detected by film? 1. 2 3. 4 Microwaves . Radio waves Gamma rays . Visible light 1 only 1&2 1,2,4 4 only 2&4 mMoOaAWS G54. Which of the following best describes the difference between x-rays and gamma rays? Raphex 2001 Energy Velocity Field Origin All of the above. MOOD >General “* Questions * G55. G56. G57. G58. G59. The output of a fluoroscopic unit is 10 R/min at 50 cm. The output at 75 cm is R/min. 15.0 22.5 AOA S a a The fractional number of photons removed from a beam per cm of absorber is called the . Linear attenuation coefficient Mass absorption coeficient Scatter coefficient Mean attenuation length DaAw> The intensity of a beam is reduced by 50% after passing through x cm of an absorber. Its attenuation coefficient, p, is: (0.693)x x/0.693 0.693/x 2x 0.693 x? MOOW > How much more likely is an atom of neodymium (Z = 60, A = 144) than an atom of carbon (Z = 6, A = 12) to undergo a photoelectric interaction with a 15 kV photon? 1 12 100 144 1000 BOAD> An 88.5 keV photon is most likely to undergo a photoelectric interaction with an electron in the shell: Shell K L M Binding energy (keV) 88 20 4 A. K B. L C D .M . All shells are equally likely. Raphex 2001General “* Questions G60. Gél. G62. G63. G64-69. A photoelectric interaction occurs between an 8 keV photon and a K shell electron. A 3.6 keV photoelectron is emitted. The binding energy of the K shell is keV. moOOw> ay tb In the Compton interaction of a megavoltage photon: The scattered photon generally retains most of the initial photon energy. The recoil electron generally acquires most of the initial photon energy. The initial photon energy is generally divided equally between the photon and electron. None of the above is true. DOW > All of the following are true regarding Compton interactions except: Photons can be backscattered. The electron acquires most energy when it is scattered forward. Compton electrons can be backscattered. Any dose measured at a diagnostic x-ray operator’s console would be due to Compton scattered photons. DOW > Concerning pair production, which of the following is true? The threshold energy for pair production is 0.51MeV. An electron and a positron are produced. The total energy of the incident photon is divided between the kinetic energies of the pair of particles. Annihilation produces 1.02 MeV photons. The pair of particles are emitted in opposite directions. moO OP Match the most appropriate interaction to the description (answers can be used more than once). A. Coherent scatter B. Photoelectric C. Compton D. Pair production G64. Chiefly responsible for loss of contrast in a diagnostic radiograph. G65. Most probable at photon energies between 100 keV and 2MeV. G66. No energy is transferred or locally absorbed. G67. Probability of interaction, per unit mass, does not depend on Z. G68. Involves “bound” electrons. G69. Increases with increasing photon energy. Raphex 2001 1General “+ Questions + G70. Which type of nuclear radiation has the shortest range in tissue? (assume equal energy) A, Gamma rays B. Betas C. Neutrinos D. Alphas E. Neutrons G7. Concerning neutron interactions with matter, which of the following is false? The neutron: A. May remain in the target nucleus. B. Interacts primarily with the oxygen in H,O. C. May cause the ejection of an alpha particle. D. May induce radioactivity in the target nucleus. E. May transfer a large fraction of its energy in the process of elastic scattering. G72. A radiograph transmits 10% of the light from a viewbox with an illumination level of 400 lux. The optical density of the radiograph is . A. 10 B. 2 Cc. 1 D. 0.1 E. 1/400 G73. A radioactive sample is counted many times, and the mean is 2500 counts. 96% of the readings will lie between and counts. A. 2300 2500 B. 2400 2500 C. 2400 2600 D. 2450 2550 E. 2500 2700 G74, For radiation protection purposes, the dose equivalent of 100 mrem of neutrons is mSv. A. 1 B. 2 C. 10 D. 20 E. 100 ee 12 Raphex 2001General “* Questions G75. G76. G77. G78. G79. All of the following contribute about equally to the average annual dose equivalent received by . a member of the U.S. population, except: Internal. ; Terrestrial, other than radon. Medical x-rays. Nuclear medicine. Cosmic. MOOS The highest dose received by the population from natural background radiation is from: A. Cosmic radiation. B. Radon. C. Internal radiation. D. Terrestrial, other than radon. Current models of radiation dose v. effect assume that 100 mSv (10 rem) delivered over a year to 1 thousand people will cause additional cancer deaths, compared to an unexposed group of the same size. A. 0.05 B. 0.5 Cc. 5 D. 50 E. 100 The latent period for radiation-induced carcinogenesis (solid tumors) is about years A. 1 B. 5 Cc. 10 D. 20-30 E. 40-50 Perinatal death (at or around the time of birth) is most likely to occur as a result of irradiation in humans which occurs in the gestational period of: . Implantation of the embryo. Major organogenesis (2 1—40 days). Second trimester. Just before birth (30—36 weeks). DOWD Raphex 2001 13General “ Questions G80. In radiation protection the embryo/fetus is considered more vulnerable to radiation than an adult, for all of the following reasons except: A. Ina given volume, more embryonic cells are proliferating than adult cells. B. Ina given volume, more embryonic cells are differentiating than adult cells. C. Anembryo consists of fewer cells, making the loss of cells by radiation injury potentially more damaging. D. The higher oxygen tension of the embryo/fetus results in a higher oxygen enhancement ratio (OER). G8l. Which of the following is true about film badges? Can measure total dose, but cannot distinguish between high- and low-energy x-rays. Can measure exposures of 2 mR. Are insensitive to heat. Are used to determine exposure by measuring the optical density of the film. None of the above is true. MOOD > G82. The annual recommended dose to the lens of the eye of a radiation worker is: 500 mSv (50 rem) 150 mSv (15 rem) 50 mSv (5 rem) 5 mSv (500 mrem) 1 mSv (100 mrem) MOO W > G83. The recommended weekly effective dose equivalent permitted for radiologists under current regulations is: 10 Sv 50 wSv 100 uSv 0.5 mSv 1,0 mSv HOOw> G84. Regulations limit the dose equivalent to the embryo/fetus of a declared pregnant radiation worker to mSv/month. 50 10 5 0.5 0.1 moO wD a 14 Raphex 2001General “* Questions * G85. If the workload of a diagnostic x-ray room is increased by a factor of 4, (all other factors, e.g., energy, use factor, etc., remaining unchanged), the shielding at the console should be increased by: 1 HVL B. 2 HVLs C. 4HVLs D. 2 TVLs E. 4TVLs > G86. When calculating radiation barrier thickness requirements, the use factor “U” refers to: A. The weekly dose delivered at 1 m from the radiation source. B. The fraction of operating time during which the area on the other side of the barrier is occupied. C. The fraction of operating time during which the radiation is directed towards the barrier. D. The fraction of the work week during which a particular individual is in the area of interest. G87. A “controlled area” is defined as: A. Any area around a radiation facility where the exposure rate is above background. B. An area that one cannot enter unless one is wearing a film badge. C. An area where workers will not receive more than 5 mrem/week. D. An area where the exposure of workers is under the supervision of the Radiation Safety Officer (RSO). G88. A dose rate of 2 mrem/hr is measured in a non-radiation worker’s office, adjacent to a source storage room. How much shielding must be added to reduce this to an acceptable level? No additional shielding is required. 1 HVL 2 HVLs 1TVL 2 TVLs MOOS G89. An ionization chamber is calibrated at 22°C and 760 mm Hg. If a measurement is made at 18°C and 750 mm Hg, what correction factor must be applied to the chamber reading? 0.81 0.98 1.00 1.02 1.19 MOOW > Raphex 2001 I5General “+ Questions + G90. Geiger counters: A. Operate on the principle of scintillation. B. Are less sensitive than ionization chambers. C. Can be used in high-intensity radiation fields. D. Can detect individual photons or particles. G9l. In general, which of the following detectors has the greatest energy dependence for x- and gamma rays? A. Thin window geiger tube. B. Air equivalent wall ionization chamber. C. LiF thermoluminescent dosimeter. D. Nal scintillation detector. G92. Which of the following detectors would be the best one to locate a dropped iodine-125 seed? Large volume ionization type survey meter. Thermoluminescent dosimeter. Air-equivalent wall “thimble’ ionization chamber. Film badge. Nal scintillation probe. moO > G93. The basic consideration when disposing of radioactive waste in the sewer system is: Entrance into the food and fresh water chain. Contamination of the sewer system. Fish death. Risk to swimmers. Evaporation into the air. moO S G94. A unit dose radioisotope is delivered to a hospital. The vendor supplies a calibration of its activity. Regulations require the hospital to do all of the following except: Wipe test the package before opening it. Treat the packaging material as low-level radioactive waste. Independently verify the activity. Quantify any residual activity left following use of the radioisotope. Keep logs of receipt, use, and disposal (or storage) of all radioisotopes. MOODS a 16 Raphex 2001Diagnostic “¢ Questions Dl. D2. D3. D4-6. D7. The probability of a Compton scattering interaction in bone at 60 keV compared with 20 keV is approximately: 10 times as great. 2 times as great. The same. 2 times less. 10 times less. MOOS Breast microcalcifications are seldom seen on routine chest radiographs because: A. The film size is too large. B. Of an increased mass attenuation coefficient for soft tissue. C. Of a decreased mass attenuation coefficient for soft tissue. D. Of an increased mass attenuation coefficient for Ca. E. Ofa decreased mass attenuation coefficient for Ca. Carbon dioxide can be used as an angiographic contrast medium because: The K absorption edges of CO, are significantly higher than tissue. The K absorption edges of CO, are significantly lower than tissue. The linear attenuation coefficient of CO, is significantly higher than tissue. The linear attenuation coefficient of CO, is significantly lower than tissue. Of differences between the mass attenuation coefficients. AOOW > To determine the safe operating condition of portions of the x-ray tube assembly, which of the following charts would be the most appropriate to consult in each of the following situations? Anode cooling chart. Housing cooling chart. Radiographic ESE chart. Radiographic technique chart. Single exposure rating chart. MOO > D4. Number of exposures allowed in 20 minutes. D5. Number of exposures allowed in 2 minutes. D6. Number of exposures allowed in 0.2 minutes. Approximately % of the energy carried by electrons which bombard the anode of an x-ray tube is converted into x-ray photons MOOD pS wa So Raphex 2001 17Diagnostic “+ Questions + D8. D9. DIO. DI. D12. Geometric magnification can improve the detection of high contrast objects. The fundamental limitation on useful magnification is: Blurring due to focal spot size. Blurring due to removal of the grid. H&D curve of the image receptor. MTF of the image receptor. Size of the image receptor. MOOD > The imaging system which is best for visualizing small high contrast objects is: Computed tomography. Film-screen radiography. Image intensified fluoroscopy. Magnetic resonance imaging. Ultrasound. MOO > Flood replenishment of a processor involves all of the following except: Draining and refilling the developer tank each day. Putting starter solution into the replenishment tank. Replenishment of developer on a timed basis (e.g., every 15 min). Stabilization of sensitometry for low volume processors. A possible compromise in film contrast. MOO A Base + Fog level of OD = 0.31 on a film may be due to: Contaminated fixer. _ Dryer temperature too high. Expired or improperly stored film. Running single emulsion film with emulsion side down. Developer temperature too low. moaAD> The x-ray department runs out of green-sensitive film for use with its gadolinium oxysulfate intensifying sreens. What would happen if blue sensitive film were to be used, and techniques were changed to give proper optical density? Degraded MTF. Decreased noise. Increased noise. Increased system speed. No change in image quality. MOOS Raphex 200!Diagnostic + Questions D13. D14. DI5. DI6. DI7. D18. For a contact hand radiograph with a 400 speed screen-film system, the system MTF is primarily limited by: . Light spread in the screen phosphor. Screen-film contact. Film grain size. Focal spot blur. Motion blur. HOO > Which system has the highest noise and the highest resolution? Thin GdOS screen with slow film. Thin GdOS screen with fast film. Medium GdOS screen with medium speed film. Thick GdOS screen with slow film. Thick GdOS screen with fast film. MOA > If the absorption efficiency of each intensifying screen in a dual screen system is 30%, what percentage of x-rays is stopped by the screens together? 9% 30% 51% 60% 10% moa S The medical physicist has measured the Average Glandular Dose for your mammography unit to be 0.7 mGy (70 mrem). What does this probably say about image quality? Entire image may be unsharp. " Image may be noisy. Motion blurring may be noticable. Contrast may excessively high. Image may be too dark. MOO p Which of the following is not an advantage of good compression in mammography? Reduced patient motion blur. Reduced geometric blur. Reduced scatter. Reduced average glandular dose. Increased magnification. MOOS The main reason the kVp in mammography is increased for thicker breasts is to: Reduce average glandular dose. Improve contrast. Reduce scatter. Reduce exposure time. Reduce focal spot size. MOAW > Raphex 2001 19Diagnostic + Questions + DI9. D20. D2I. D22. D23. ideal, the AEC (phototimer) sensor in mammography should be placed: moap> As close to the chest wall as possible. Under the densest portion of the breast. Under the least dense portion of the breast. Under the most anterior portion of the breast. In the center of the breast. Subject contrast in mammography is affected by: moO W > Beam filter choice. Focal spot size. AEC density setting. Exposure time. Film processing conditions. Small, white, speck-like artifacts are seen on a mammogram; the most likely cause is: MOA pS Plugged chemistry filter in processor. Oxidized Mo filter in x-ray unit. Improper film storage. Dust on the intensifying screen. Improper drying temperature in processor. An occupationally exposed person undergoing fluoroscopy of the abdomen has mistakenly left his personnel monitor on in such a way that it is at the point of entry of the primary beam. It would take about minutes for the monitor to record the person’s annual maximum permissible whole body dose. MOOD > Less than 5 More than 120 A fluoroscope is switched to the magnification mode (9” to 6” II). This will increase all of the following except: DAm> Conversion gain. Quantum mottle. Patient dose. Spatial resolution. 20 Raphex 2001Diagnostic “ Questions * D24-28. For the image intensifier shown above, match the following: (answers may be used more than once) Light photons. X-ray photons. Microwaves. Electrons. Infrared photons. MOOW > D24. I represents D25. II represents D26. III represents D27. IV represents. D28. V represents D29. The maximum resolution of fluoroscopy images displayed on television in the 6” field of view with a 1024 line system with a Kell factor of 0.7 is about {p/mm. MOOD > 20 D30. The reason for overframing in cine filming is to: Improve spatial resolution. Increase the field of view. Reduce patient dose. Change the shape of the cine image. Increase the framing rate. MOOW > D31. A CT in helical mode with collimation of 5 mm and pitch of 1 is compared to axial mode with 5 mm collimation. The measured slice width will be: No larger than 5 mm in either mode. The same for both modes. Smaller in the helical mode. Larger in the helical mode. Not measurable in helical mode. MoOOWS Raphex 200! 2IDiagnostic “* Questions + D32. D33. D34. D35. D36. An advantage of multislice CT scanners over single slice units is: Shorter single slice scan times are possible. X-ray tube heat-load is reduced. Better spatial resolution for same slice thickness. Better contrast resolution for same slice thickness. Lower patient radiation dose. MOOD > Some CT units offer 0.5 mm slice thickness. The primary advantage of a thin slice is: Reduced volume averaging. Smaller pixels are possible. Quantum mottle is less. Faster scan times. Lower patient radiation dose. BOOS For the same collimation, at which pitch would helical mode CT have a higher patient dose than the axial mode: A. 3 B. 1.5 Cc. J D. 0.8 E. None of the above. The CT reconstruction kernal or algorithm chosen by the operator affects: Only pixel noise. Only spatial resolution. Only patient radiation dose. Pixel noise and spatial resolution. Pixel noise and spatial resolution and radiation dose. MOOn > A CT image is abnormally noisy; this could be from: Using a higher than normal kVp. Using a thicker than normal slice width. Using a smoothing reconstruction algorithm. Using a larger than normal pitch. Scanning a head using a body scan mAs setting. MOO W > 22 Raphex 2001Diagnostic + Questions D37-41. Concerning digital subtraction angiography: (Answer A for True and B for False) D37. X-rays exiting the patient are normally captured in a cesium iodide II tube to produce a visible image. D38. The TV cameras used for DSA normally have a signal-to-noise ratio of about 100:1. D39. The video signals from the TV camera are processed in a digital-to-analog converter to obtain a matrix of numbers corresponding to the image. D40. Systems with the greatest capability for artifact correction for re-masking are those which store the subtracted image in analog form on a video disk. D41. Compared with film subtraction images, electronically subtracted images normally have somewhat poorer spatial resolution, but better iodine contrast resolution. D42. On a frame-by-frame basis, digital systems deliver about times the cine dose. 1/50 (very much less) 1/2 1 (the same) 2 AUaAW> 50 (very much more) D43. In MRI, the RF frequency is dependent on the: Diameter of the body part being imaged. _ Magnetic field strength. Pulse sequence. RF coil. Relaxation time. BOR PE D44. In MRI: T1 of CSF is longer than T1 of soft tissue. T2 of soft tissue is longer than T2 of CSF. For most soft tissues, T2 is longer than T1. T2 increases with field strength. T1 decreases with field strength. MOO W > D45. Superconducting magnets,compared to resistive magnets: A. Are more easily turned off. B. Are less expensive. C. Do not require liquid helium. D. Have higher field strength. Raphex 2001 23Diagnostic “* Questions + D46. Gradient fields in MRI are principally used to: Maintain a uniform magnetic field in the field of view. Eliminate perturbations in the magnetic field due to site location. Shorten T1 to reduce scan time. Provide spatial localization. Measure the spin coupling. HOOD > D47-49. Using a normal spin-echo pulse sequence in MRI, match the timing with the type of image: TE (msec) TR (msec) 20 A. 400 B. 100 400 Cc. 100 2000 D. 1000 400 E. 20 2000 D47. T1 weighted. D48. T2 weighted. D49. Proton density. DSO. Which of the following does NOT generally affect the total exam time of an MRI study? # of frequency encoding steps. # of phase encoding steps. # of pulse sequences in the study. # of acquisitions. TR. AoW > D51-52. Match the attenuation of a 1 MHz ultrasound beam with the material Absorption (dB/cm) 40 12 1 0.2 0.002 moAw> DS51. Air D52. Blood DS53. In ultrasound, the largest reflections will occur between: Liver and muscle. Blood and water. Kidney and muscle. Blood and kidney. Fat and liver. MOOD pS 24 Raphex 2001Diagnostic ** Questions + D54. D55. D56. D57. D58. D59. Approximately what fraction of an ultrasound beam is reflected from an interface between two media with Z values of 1.65 and 1.55? A. 1/2 B. 1/10 C. 1/100 D. 1/500 E. 1/1000 In ultrasound, acoustic impedance (Z) is equal to: A. fe where: h = Planck’s constant B. 12.4/A f = frequency C. 10 logy (1p) A. = wavelength D. pe c = velocity of sound E. he/A I = intensity p = density A 5 MHz ultrasound beam passes through 4 cm of soft tissue (absorption coefficient 1.0 dB/em-MHz). The original intensity is reduced by a factor of: . 20 40 100 1000 10,000 MOOD > Aliasing in real-time ultrasound may be reduced by: Increasing transducer frequency. Decreasing transducer diameter. Increasing the number of scan lines. Increasing the frame rate. UaAWS> All of the following are types of ultrasound transducer except: Coded aperture. Rotating sector. Phased array. Linear array. Annular ring. MOO > In doppler ultrasound the frequency change depends on: The nominal transducer frequency. The speed of sound in the medium through which the beam passes. The angle between the beam and the moving structure. A and C. A, B, C. MOOW > Raphex 200! 25Diagnostic + Questions + D60. D6!. D62-66. D67. D68. A Thallium unit dose has an activity of 2.2 mCi at noon. How much activity was present at 9:30 a.m. on the same day? 3.23 mCi 3.05 mCi 2.25 mCi 2.15 mCi 2.04 mCi mow S Tc-99m mainly decays by isomeric transition. The type(s) of radiation produced during the decay include: Internal conversion electrons. Auger electrons. Characteristic x-rays. Gamma rays. All of the above. MOOD > Match the most common or important radionuclide impurity listed below with the radionuclide with which it is associated: (answers may be used more than once) Molybdenum-99. Iodine-131 iodide. Iodine-124. Thallium-202. None. MOOm> D62. Iodine-123 capsules D63. Technetium-99m pertechnetate D64. Iodine-131 hippuran D65. Gallium-67 D66. Thallium-201 Which detector system is most suitable for measuring the activity of a pure beta source? Ionization chamber. Nal well scintillation counter. Liquid scintillation counter. Geiger-Mueller tube. Thermoluminescent dosimeter. moO > A pulse height analyzer (PHA) window can be used to: Identify the energy of a radionuclide. Reject Compton scattered photons. Separate a mixture of radionuclides. Alter the sensitivity or resolution of the system. All of the above. Moa > 26 Raphex 2001Diagnostic ¢* Questions D69. D70. D7I. D772. D73. When counting an I-125 source of unknown activity, the multi-channel analyzer shows a peak at 60 keV, in addition to the main peak at 30 keV. This is due to: Compton scatter. Pulse pile-up. Bremsstrahlung. Collimator scatter. A characteristic x-ray. MOOS How many counts must be collected in an instrument with zero background to obtain an error limit of 1% with a confidence interval of 95%? 1000 3162 10,000 40,000 100,000 MOO > A radioactive sample was counted for 1 minute and the number of counts was 122. The background count for 1 minute was 22. The relative standard deviation of the net counts is: 0.07 0.08 0.10 0.11 0.12 moOW> In nuclear medicine, the modulation transfer function (MTF) represents: The energy resolution of the imaging system. The sensitivity of the imaging system. The overall spatial resolution characteristics of the system. The full width at half maximum of the line spread function. The temporal resolution of the system. MoOOW> The typical spatial resolution (FWHM) of a gamma camera with a collimator is mm. (i.e., the size of a point source in the image) A. 1 B. 4 Cc. 11 D. 20 E. 30 Raphex 2001 27Diagnostic + Questions + D74. D75. D76. D77. D78. The probable effect of using a wider “window” setting on a gamma camera would be: Improved spatial resolution. Degraded spatial resolution. Increased sensitivity. B and C. No effect on spatial resolution or sensitivity. MO OW > A cold spot artifact appears in a scintillation camera image. The artifact could be caused by " of the following except: . The camera is incorrectly peaked for the radionuclide utilized in the study. The photomultiplier tube is defective. The patient is wearing metallic jewelry. The uniformity correction is out-dated. The study is performed with the wrong collimator. MOO W > The resolution of a SPECT image vs. a stationary image with the same camera is: Much worse. Slightly worse. The same. Slightly better. Much better. MOOD > The major limitation on the resolution of an FDG scan on a modern whole body PET scanner is: Range of the positron. Image matrix size. The physical size of the individual detectors. The non-collinearity between the annihilation photons. Attenuation correction. moOOW > A nuclear medicine resident discovers, just prior to injecting a Tc-99m bone scan agent, that the patient had a PET scan 3 hours ago at 9 a.m. in another hospital. When should the resident recommend that the bone scan be performed? A. Straight away. There is no interference between the Tc-99m and F-18, since they can be distinguished by energy discrimination. Wait until 3 p.m. allowing a 6-hour interval between tests (>3 half lives of F-18). Wait until the next day to ensure complete decay of the F-18. Postpone for one week, to ensure any residual long lived F-18 daughters have decayed. oO 28 Raphex 2001Diagnostic “* Questions D79. D80. D8I. D82. D83. Methods of assessing spatial resolution of an imaging system include all of the following except: Bar patterns. Step wedges. Wire mesh pattern. Hole pattern. Wire impulse response. MOOD > Daily quality control of an x-ray film processor includes tests of all of the following except: Base and fog density. Speed. Contrast. Replenishment rate. Developer temperature. MoOwD> Bioeffects of radiation exposure are influenced by all of the following factors except: Age. Dose fractionation. Hysteresis. LET. Cell differentiation. MOODS Rank the following organs in order of sensitivity to radiation damage, starting with the most sensitive. Central nervous system Gastrointestinal system Bone marrow Eyes Genetic organs AWN = v v v we mMmoOaADD> PWN Ww Mm wn MN Nn Sw fp rat me DON DN . w . wns oo. Wh NO ee Re Re The most sensitive portion of the cell cycle to radiation damage is: Gl. G2. ES and LS. M. G2 and M are equally sensitive. moO > Raphex 2001 29Diagnostic ¢, ° ¢, + Questions * D84. For an AP abdominal radiograph, the exit exposure is about % of the entrance exposure. A. 85 B. 50 C. 25 D. 10 E. 2 D85-86. Match the exposure with the appropriate exam: A. 15mR B. 30mR C. 60mR D. 5R E. 10R D85. CT head scan ESE D86. Lateral chest ESE D87. Assume that the maximum activity of the thyroid is obtained 24 hours after the administration of I-131. How many days after administration will the activity in the patient be half the maximum level? (Biological half-life = 15 days. Half-life of I-131 = 8 days) A. 1.2 B. 4.2 C. 5.2 D. 6.2 E. 7.2 D8s. Patient dose in radiography can be reduced by all of the following except: A. Using rare earth intensifying screens. B. Using high ratio grids. C. Increasing filtration on the x-ray tube. D. Reducing the patient to image-receptor distance. E. Raising the kVp, with appropriate mA compensation. D89. Conservative advice for people who have undergone pelvic radiography and who are concerned about transmitting mutations to their offspring would be: A. Attempt conception as soon as possible after the exposure, as immature gametes are radiosensitive. B. Do not attempt conception after pelvic radiology. C. Delay conception for about 6 months. D. Delay conception for about 60 months. E. Conception can be attempted at any time, as pelvic radiology will not affect fertility or the genetic mutation rate. 30 Raphex 2001Diagnostic “ Questions D90. An apron with a 0.5 mm lead equivalent thickness typically attenuates about % of the scattered x-rays for tube potentials around 100 kVp. AOD > ws So D9I. Which imaging system has the highest spatial resolution? Direct film extremity radiograph. TV of an R/F unit. DVI. Screen-film. CT, mMOOW> D92. Filtered back projection is used to reconstruct cross-sections for all of the following except: A. SPECT B. MRI C. PET D. CT D93-97. Match the following with the definitions listed below. Line focus principle Heel effect Vignetting Bucky factor Intensification factor moaw> D93. The value of the radiation dose with a grid divided by the dose without the grid. D94. The reduction in radiation intensity toward the anode side, along the anode-cathode axis. D95. The value of the radiation dose of a plain film divided by the dose of a film plus screen system. D96. The reduction in the effective focal spot size due to the angulation of the anode. D97. The reduction in intensity towards the periphery of an image intensifier. D98. Going from a 256 x 256 image to a 512 x 512 image, which of the following may be true? Resolution Pixel noise Storage bytes A. Decreases Decreases Increase x2 B. Increases Decreases Increase x2 C. Increases Increases Increase x4 D. Increases Increases Increase x2 Raphex 2001 31Diagnostic *¢ Questions * D99. A 256 x 256 matrix nuclear cardiology image can display 128 different colors. How many bytes of storage are needed? 32 KB 64 KB 128 KB 512 KB 1 MB HOOD > ee ee eee ree eee ee ee eee eee 32 Raphex 2001Therapy “ Questions Ti. T2. All of the following are true regarding Percentage Depth Dose (PDD) except: Increases with increasing energy. Depends on field size. Is the dose at depth expressed as a % of the dose at dmax. Decreases with increasing SSD. Decreases as depth increases. mOOW > For a 10 MV photon beam at 10 cm depth, the TMR will be the PDD at 100 cm, for the same collimator setting. A. Greater than B. Less than C. Approx. equal to DATA FOR NEXT 3 QUESTIONS T3. TA. Depth (cm) TMR 8x8 TMR 20x20 PDD 8x8 PDD 20x20 5 0.924 0.937 86.2 87.9 75 0.847 0.880 76.0 79.0 10 0.772 0.818 66.4 70.3 15 0.632 0.697 50.2 55.4 OUTPUT at dmax in tissue 8x8 20x20 At 100 cm SSD 0.985 1.055 At 100 cm SAD 1.018 1.089 The MU setting to deliver 180 cGy at a depth of 5 cm, at 100 cm SSD, for a field of equivalent square 8x8 cm is MU. A. 106 B. 153 C. 198 D. 204 E. 212 For the field in the previous question the dose at 10 cm depth is cGy. 115 139 C. 143 D. 170 E. 185 > Raphex 2001 33Therapy “+ Questions + TS. The MU setting per beam to deliver 250 cGy total to the isocenter via parallel opposed, 23x18 cm whole brain fields, for a patient separation of 15 cm is U. 130 156 182 208 265 MOODS T6. If 150 cGy is delivered at a depth of 7 cm, at 100 cm SSD, using a field for which the PDD is 65% the dose from that field at dmax is__—s cGy. 65 130 195 215 231 MoOw> T7. Parallel opposed AP/PA mantle fields are treated isocentrically. Using the data below, for a total dose of 4000 cGy at the isocenter, the dose to the neck at midplane is cGy. (Ignore off-axis factors.) AP PA Beam axis SSD = 92 SSD = 92 thickness = 16 cm Neck SSD = 93 SSD = 97 thickness = 10 cm Depth (cm) 3 5 7 8 TMR 0.987 0.945 0.901 0.879 3721 3950 HOA pS > S S S T8. For 24x24 cm, parallel opposed isocentric 6 MV photon beams, the patient’s AP thickness can be up to cm, if the maximum tissue dose is not to exceed 110% of the dose at the isocenter. BOO p> No " el 34 Raphex 2001Therapy “* Questions + T9. If 4000 cGy is delivered to a patient’s mediastinum via AP/PA fields, the lowest total dose at dmax is obtained using: Co-60, 80 cm SSD. 6 MV photons, isocentric fields. 6 MV photons, 100 cm SSD. 18 MV photons, 100 cm SSD. 18 MV photons, isocentric fields. AUDA P> TI0. If the SSD of a photon beam is increased from 100 cm to 150 cm, the PDD at 10 cm depth will: Increase less than 2%. Increase more than 2%. Remain the same. Decrease less than 2%. Decrease more than 2%. MOOW > TI, The equivalent square of a 6x30 cm photon beam is a square CxC cm, where C is: A. Closer to 30 than 6. B. Equal to the square root of (6x30). C. The side of the square field which has the same PDD as the rectangular field. D. Is approximately equal to the (area / perimeter) for the rectangle. THz. From the data below, calculate the MU setting for the lateral fields of the three-field plan shown. Wedge factor (WF) = 0.58 TMR = 0.782 Output = 0.90 cGy/MU 180 cGy / fraction at isocenter Beams are weighted to deliver equal doses at the isocenter. 49 MU 85 MU 120 MU 147 MU 162 MU MOS TI3. When Photon beams are wedged, the “wedge angle” is: The angle between the isodose curve at d = 10 cm and the beam axis. The angle of the metal wedge itself. The angle through which the isodose curve at d= 10 cm is turned by the wedge. Half the hinge angle. DOw> a Raphex 2001 35Therapy * Questions + T14. TIS. xe ie During treatment of the wedged pair in the diagram, the wedge for field 2 was accidentally omitted, but the planned MU were delivered. The consequence is: Point A Isocenter Point B A. Cold Same Hot B. Hot Hot Hot C. Hot Same Cold D. Cold Cold Cold E. Hot Cold Hot Which of the following treatment techniques would not deliver a homogeneous dose to the volume V shown below? ANT Two posterior oblique wedged fields. A posterior 180° arc pinned at the center of the volume. A posterior open field and two lateral wedged fields. A posterior 180° arc, split into two 90° wedged arcs (thick ends post). An anterior field and two posterior oblique wedged fields. moOW> SSS SSS SS 36 Raphex 2001Therapy “* Questions ~ T16. A patient’s skin dose is increased in a megavoltage photon beam by all of the following except: Increasing the beam energy. Adding a 1 cm lucite blocking tray. Increasing the field size. Adding bolus. Increasing obliquity. BO OD > TI7. The purpose of a “beam spoiler” in a photon beam is to: Increase dose in the build up region. Reduce the PDD at 5 cm depth. Filter out scattered electrons, to reduce the skin dose. Reduce the energy of a photon beam. Increase the TMR beyond dmax. MOO p> TI8. Tissue compensating filters used in megavoltage beams: Eliminate skin sparing. Must be made of material with the same density as tissue. Should be placed as close as possible to the patient’s skin. Have an advantage over the use of bolus as a missing tissue compensator. GaAWp TI9. All of the following are techniques used to improve dose homogeneity at the junction between adjacent or orthogonal photon fields except: Using half-blocked beams to remove divergence. Calculating a gap so that the beams match at a defined depth. Using gantry, couch or collimator rotation to remove divergence. Shifting the junction during a course of treatment. Overlapping coplanar fields on the skin. AoUaAw> T20. Adjacent pairs of isocentric 10 MV AP/PA fields are to be matched at a patient’s midline, at 9 cm depth. The fields have collimator lengths of 20 cm and 24 cm respectively. The gap on the skin is cm. moO PS ND 00 Raphex 2001 37Therapy + Questions * T2I. In treatment of the craniospinal axis, the upper spine field length is 25 cm at 100 cm SSD. To align with this diverging spine field, the lateral brain fields should have a collimator rotation of: [data: tan 25° = 0.47; tan 14° = 0.25; tan 7° = 0.125; tan 2.5° = 0.044] 25 14 7 2.5 None of the above. mMOOWS 722. A patient is treated with parallel opposed isocentric 15x15 cm 6 MV photon fields, calculated for a separation of 20 cm. The patient loses weight and the separation changes to 16 cm. If no correction is made to the MU, the result will be approximately: Less than 1% underdose. Less than 1% overdose. 3% underdose. 3% overdose. 6% overdose. AUS T23. The depth of dmax for a 6 MV photon beam is approximately: . 0.5 cm. 1.0 cm. 1.5 cm. 2.0 cm. 2.5 cm. MOOD > T24. i i 100cm SSD § i } dmax reading = 136.0 dem reading = 92.0 The readings above are obtained for a 6 MV beam in a water tank. Depth “d” is cm. 1.5 5.0 10.0 15.0 20.0 mOOW > ‘SSS 38 Raphex 2001Therapy “* Questions T25. T26. T27. T28. T29. Regarding geometric penumbra: A. It is smaller for a Co-60 unit than a 6 MV linac. B. It decreases with increasing effective focal spot diameter. C. It decreases with increasing SSD. D. It decreases with increasing source-collimator distance. If the dose rate is 250 cGy/min at 100 cm, at what distance will the dose rate be 100 cGy/min? 40 cm. 158 cm. 200 cm. 250 cm. 285 cm. MOOD > A craniospinal axis field calculated for treatment at 120 cm SSD, d = 5cem, requires 320 MU. On the first day, it is decided to treat the patient at 140 cm SSD. The new MU setting is approximately: 431 MU. 480 MU. 510 MU. 556 MU. 564 MU. mMoaw> All of the following are required to calculate the timer setting to deliver a prescribed surface dose on a superficial x-ray machine, except: Filter to be used. BSF for the field size on the skin. Dose rate in air at the end of the applicator to be used. Air gap, if any, between the applicator and the patient’s skin. PDD tables for the appropriate HVL and SSD. MOOS When CT images are used in treatment planning: A. Tissue inside the outer contour is always assumed to have a density of 1.0. B. The CT number of each pixel is proportional to the linear attenuation of the treatment beam. C. Pixel-by-pixel heterogeneity corrections are mandatory. D. Heterogeneity corrections are based on the electron density of the tissues. Raphex 200! 39Therapy “+ Questions + T30. A lung tumor is treated with oblique 10 MV photon beams. The depth of each field is 12 cm, of which 6 cm is normal lung. If no lung corrections are made, the actual dose to the isocenter will be about compared with the calculated dose. 10% high 5% high The same 5% low 10% low MOOD > T31. For the breast plan shown in the diagram above, the use of a CT scan allowing lung corrections would tend to have the following effect on the wedge angle chosen for optimal homogeneity, compared to a plan with no lung corrections: A. A decreased wedge angle. B. An increased wedge angle. C. No change in the wedge angle. T32. A patient is treated with 4 MV photons to the anterior neck field shown. ORCI 5 ESebeGeeSe Scares] rea aoescseaterere OR OC CIC ORT HAH tet DOR OC caer Oe ae eaes poe See ae] ee eh tae bacee re eacececeee ee pesca oceees carrera ett peecetcareesrecacs seicaesesesee reser oy CERES 20 The dose to the cord at 8 cm depth under the cord block due to scattered radiation only is: A. Proportional to SAR (10x20,d = 8 cm) — SAR (10x3, d= 8 cm). B. Proportional to SAR (10x3, d = dmax). C. About 3% regardless of the size of the block. D. Much less than the primary transmission through the block. (eT TE eee ee errr ee rere 40 Raphex 2001Therapy “* Questions T33. T34. T35. T36. T37. If a cerrobend block has an HVL of 1.5 cm in a 6 MV photon beam, then a 7.5 cm thick block will transmit: 1.5%. 3%. 4.5%. 75%. 9%. moO wD A simulator film is taken at a source-to-film distance of 140 cm. If an area measuring 15x15 cm is drawn on the film, this is equivalent to a collimator setting of: 7.7 x 7.7 cm. 10.7 x 10.7 cm. 12.4 x 12.4 cm. 13.6 X 13.6 cm. 21.0 X 21.0 cm. MOOD > A patient is treated with tangential breast fields. The dose to the patient’s ovaries, 20 cm inferior to the fields, is approximately % of the prescribed dose. 0.005 0.05 0.5 5 10 MOOD > A TBI patient is treated at 400 cm SSD. If the linac is calibrated to deliver 1.0 cGy/MU at dmax, 100 cm SSD, approximately how many MU are required to deliver 100 cGy from one field at dmax to the TBI patient? 4000 1600 800 400 200 MOOD p> Regarding treatment planning for stereotactic radiosurgery of the brain, which statement is false? CT images generally exhibit less geometrical distortion than MRI images. MRI is generally better than CT for imaging brain lesions. CT and MRI can be used together to provide optimal tumor localization. Both CT and MRI provide electron density information needed to make inhomogeneity corrections in the treatment plan. VawP Raphex 2001 4Therapy “ Questions + T38. Currently, the most common MLC leaf width is cm at the isocenter. 0.1 0.3 1.0 1.5 2.0 MOOW > T39. For a single field, stepping at an MLC defined edge is most dramatic at the % isodose level (normalized to the dose on the beam axis at the same depth). A. 95 B. C. 50 D T40. The figure shows integral dose-volume histograms for the lung, for plans A and B. Which of the following is false? 40 50 60 1/0 80 9O 100110120130 Dose (& of Prescription) Approximately the same lung volume receives 90% of the prescribed dose for both plans. Plan B gives a dose 30% greater than the prescribed dose to less than 10% of the lung volume. In plan B all the lung receives at least 50% of the prescribed dose. In plan A 80% of the lung receives 80% of the prescribed dose. vO wD > el 42 Raphex 2001Therapy “¢ Questions ¢ T4l. Which factors influence the construction of a PTV from a CTV? 1. Patient set-up uncertainty. 2. Organ motion. 3. Proximity of critical structure. 4. Extent of microscopic disease. 1,2,3 1,3 2,4 4 only 1,2,3,4 MOOS T42. Advantages of 3-D over 2-D treatment planning systems include all of the following except: A. Use of dose-volume histograms. B. Ability to perform pixel-by-pixel heterogeneity corrections. C. Use of non-coplanar beams. D. Visualization of beam’s-eye-view of target and critical structures. T43. A patient is treated with a field set up at 100 cm SSD. If the patient must be treated on a stretcher at 120 cm SSD, which of the following is/are true? 1. The collimator setting will increase. 2. The exit dose will decrease slightly. 3. The PDD will decrease slightly. 4. The MU will increase. 1,3 2,4 4 only All of the above. DOw> T44. The approximate range of a 6 MeV electron beam passing through | cm tissue, overlying lung (density 0.25 g/cm’) is cm, . 1 MOAw> Oo BA Wh LLL SS Raphex 200! 43Therapy *% Questions + T45. The part of the electron depth dose curve labeled A on the diagram is mainly due to: % Dose Depth (cm) Electrons with the highest energy which have the greatest range. Bremsstrahlung x-rays created by electron interactions with tissue. Characteristic x-rays generated by electrons striking the collimators. Bremsstrahlung x-rays created by electron interactions with high Z components in the head. DOD T46. Compared with 6 MeV electrons, 16 MeV electrons have: 1. A greater surface dose. 2. A lower bremsstrahlung tail. 3. A broader plateau region. 4. A sharper fall off between the 80% and the 20% isodose levels. 1,3 2,4 1,2,3 4 only 1,2,3,4 mOOW > T47. Cervical neck nodes treated with electrons often require extended SSD, in order to avoid the shoulders with the applicator. If field shaping is achieved only with inserts in the end of the collimator, the effect will be: Increased penumbra width. Increased PDD. Increased output. Decreased beam energy. Om > 8 44 Raphex 2001Therapy “* Questions T48. A 12 MeV electron field delivers 200 cGy at the 90% isodose level. The output of the cone and insert is 1.02 cGy/MU. The MU setting is MU. . 176 184 218 227 250 MOO > T49. A lesion of maximum depth 3 cm is treated with 12 MeV electrons. (PDD data given below). 1 cm of bolus is placed on the skin. If 200 cGy is delivered to the distal edge of the tumor, the skin dose and the maximum tissue dose are: Depth 0 l 2 3 4 5 6 PDD 90 95 98 100 80 40 5 Skin Tissue max A. 180 200 B. 211 250 C. 200 238 D. 238 250 E. 195 200 T50. When electron shaping is placed on the skin instead of at the end of the applicator, this results in: A. A sharper penumbra at the field edge. B. Less thickness of cerrobend required. C. Easier set-up. D. Reduced beam energy. TSI. To reduce hot and cold spots at the junction between adjacent electron fields: A gap of at least lcm should be left on the skin. The fields should be overlapped by at least 1cm. Only one field should be treated per day. The junction should be moved at least once during the course of treatment. Ow > ee Raphex 2001 45Therapy %~* Questions * T52. Which of the following can be used in total skin electron beam treatment? T53. T54. TS55. T56. Low energy electrons Multiple patient positions Beam scatterer or diffuser Boost fields Eye shields weeny r 1,3,5 1,2,3,4,5 mMOOWD> bo - A Fletcher applicator is loaded with Cs-137 sources. The activity reported to the Radiation Safety Officer is 160 mg Ra equ instead of the true value of 160 mCi. The dose rate he measures at 1 meter from the patient will be he expects. [exposure rate constant for Ra = 8.25 R-cm?/mg-hr; for Cs-137 = 3.26 R-cm’/mCi-hr]. A. Higher than B. Lower than C. The same as A Cs-137 source had an activity of 15.5 mg Ra equ in June 1992. Its activity in December 1998 i mg Ra equ. . 8.8 12.5 13.3 14.7 17.8 MOOS The exposure rate at 4 m from a patient containing 60 mg Ra equ of Cs-137 is about mR/hr. Assume a point source, and that the patient absorbs 30% of the radiation. 1 2 3 4.5 16 HOO > The dose distribution in tissue up to 5 cm from an Ir-192 seed can be predicted from inverse square alone because: No other factors are involved. At short distances tissue attenuation is negligible at this energy. Dose build-up from betas emitted by the source cancels out attenuation. Scattered radiation is of very low energy and does not contribute to absorbed dose. Scatter dose build-up and attenuation cancel each other out. MOIOW > Ls 46 Raphex 2001Therapy “ Questions T57. On the plan of a permanent Au-198 seed implant, the initial dose rate of 50 cGy/hr covers the volume. The fotal dose to this volume, after decay, will be cGy. (The half-life of Au-198 is 2.7 days.) . 9330 DOA > wn S = S T58. The diagram below represents a Jateral film of a Fletcher-type gynecological applicator. “Point A” is represented by which point on the diagram? ANT 1 Scale: 2cm SUP wm w POST Point 1 Point 2 Point 3 Point 4 Point 5 MOOD p> T59. The dose rate at 1 m from a brachytherapy safe is 64 mR/hr. How many HVLs of shielding are required to reduce this to 2 mR/hr? MOO P> = On On Ww — Raphex 2001 ATTherapy + Questions + T60. The dose rate is 40 mSv/hr at 1 m from a brachytherapy patient. How many minutes can a person remain at 2 m before receiving a dose of | mSv? A. 6 moO No & Tél. When patients are treated with Cs-137 brachytherapy sources, the dose deposited at 1 cm in tissue is from: Gamma and beta minus. Beta minus only. Gamma and alpha. Gamma only. Beta plus and x-rays. MOOS 762-65. Match the photon energy with the radionuclide: A. 30 keV average B. 141 keV C. 380 keV average D. 662 keV E. 1.25 MeV average T62. Cs-137 T63. I-125 T64. Ir-192 T65. Co-60 T66. Cs-137 sources used for brachytherapy have a similar distribution to radium sources because: A. They have similar half-lives. B. They have almost the same maximum energy. C. The inverse square law dominates the dose distribution. D. The same activity (in mCi) can be used. T67. Pd-103 is sometimes favored over I-125 for permanent prostate implants because: The half-life is shorter. The time taken to deliver 90% of the total dose is longer. The initial dose rate is lower. The initial activity is lower. All of the above. MOODS SSS SSS 48 Raphex 2001Therapy “* Questions + T68. For an “ideal” Fletcher tandem and ovoids, with the loading shown below, the typical dose rate at point A is ceGy/hr. Tandem: 15-10-10 mg Ra equ Ovoids: 15 each AOA pS wa wa T69. When an HDR planning system uses optimization to create a homogeneous dose along the surface of a cylindrical applicator, the dwell times will be: A. Higher in the center than at the ends. B. Ali approximately equal. C. Alternately high and low. D. Higher at the ends than in the center. T70. An HDR treatment takes 366 seconds on the first treatment day. If the source is Ir-192 (half-life 74 days) the treatment time exactly one week later will be sec. 343 355 372 387 391 MOOw> T7i. In linear accelerators, flattening filters are required in order to: Reduce dose rates to a safe level for treatment. Compensate for the pulsing of the radiation. Increase the maximum energy of the beam. Attenuate the peak and create a broad, flat beam. None of the above. MOOS T72. A monitor unit is: A. Part of the hardware of a record and verify system. B. A length of time (fraction of a minute) that the linac beam is turned on. C. A unit used to describe the electron energy of a linac. D. Proportional to the dose delivered at a reference point. Raphex 2001 49Therapy “+ Questions + T73. Bending magnets are required in linear accelerators for energies greater than 6 MV because: 1. The accelerator waveguide is too long to be mounted parallel to the beam axis. 2. Higher beam currents are required in the electron mode. 3. They are needed to select the correct energy. 4. They are used to boost the electron energy. 1,3 2,4 1,2,3 4 only 1,2,3,4 moO S T74. Most of the neutrons produced by a high-energy linac are produced: A. In the head of the linac. B. In the patient. C. In the floor and walls of the room. D. In the electron mode rather than the photon mode. T75. Borated polyethylene is used in entrance doors and mazes of high-energy linac rooms. Its function is to: A. Attenuate high-energy photons. B. Thermalize high-energy neutrons, and absorb thermal neutrons. C. Make the door lighter than one composed entirely of lead. D. Absorb low-energy scattered photons. T76. After a superficial x-ray treatment, it was found that a 3 mm Al filter had been used instead of the intended 2 mm Al filter. The effect on the patient is: Skin dose PDD A. Increase No change B. Increase Increase C. Increase Decrease D. Decrease Decrease E. Decrease Increase T77. According to AAPM’s TG-40 report, linear accelerator output should be : Spot checked daily before treatment. Spot checked bi-weekly by the physicist. Calibrated monthly by the physicist. Calibrated annually by the physicist in a water tank. Calibrated bi-annually by the physicist in a water tank. 1,3,4 1,2,4 1,2,5 2,4 2,5 wWeenyr MOODS rr ee 50 Raphex 2001Therapy “* Questions T78. The edge of the light field on a linac coincides with the isodose line which is of the dose on the axis in the plane of the film. 100% 95% 90% 80% 50% BOOS T79. According to AAPM’s TG-40 report, the coincidence between the light and radiation fields should be checked: Daily Weekly Bi-weekly Monthly Annually AOS T8090. Ionization chambers that are not sealed require temperature and pressure corrections to account for: Variations in the mass of gas in the collection volume. The expansion of the gas at high pressure. The contraction of the gas at high temperature. Variations in the probability of ionization at different temperatures. None of the above. moO > T8l. If a linac dose rate is 500 cGy/minute at the isocenter, the shielding required to reduce this to under 2 mrem/hour at 4 meters is TVLs. A. 1 B. 2 C. 6 D. 9 E. 20 T82. Which of the following would not be used in therapy room shielding calculations? Beam energy. Use factor. Inverse square law. Scatter-air ratio. Occupancy factor. MO OW> Raphex 2001 51Therapy “- Questions + T83. The dose to a resident’s hands from a brachytherapy procedure is 25 mSv (2.5 rem). The number of procedures that the resident can perform per year without exceeding maximum permissible dose is: 1 2 5 10 20 mOOW PS T84. All of the following are true regarding film badges worn by radiation oncology residents, They record the whole body dose. B. They should be removed for brachytherapy cases, and a ring badge worn instead. C. They can distinguish between different types of radiation. D. They should be worn on the trunk. E. They should be changed every month. T85. The instrument best suited for finding a dropped Ir-192 seed is: Thimble Farmer chamber Large volume ionization survey meter Geiger counter Thermoluminescent dosimeter Diode MOO W > T86. When surveying a patient after removal of radioactive sources, all of the following procedures are necessary except: Check detector batteries are functioning. Check detector function against a check source. Use a detector that has been calibrated within the last year. Move container of removed sources away from patient during measurement. Calibrate detector against a source of the same type before each use. mow > T87. Orthogonal films of a gynecological applicator are required for dosimetry planning. AP and lateral films are taken, but the lateral film has very poor contrast. All of the following solutions may provide films with acceptable contrast except: Retake lateral, and reduce collimator setting to the minimum area possible. Retake lateral using a higher ratio grid. Retake lateral with increased mAs. Take orthogonals at 45° and 315° instead of 0° and 90°. DaAwp a 52 Raphex 2001Therapy “+ Questions * T88. Bone-soft tissue contrast is better in a simulator film than in a megavoltage “‘port” film because: A. Of the type of cassette used. B. Of the type of film used. C. Of the absence of Compton interactions in the simulator beam. D. Of the absence of photoelectric interactions in the megavoltage beam. E. Of the predominance of pair production in the megavoltage beam. T89. What type of MRI study best helps differentiate CSF from surrounding edema? A. T1 with gadolinium. B. T2. C. Fluid attenuated inversion recovery (FLAIR). D. Perfusion. T90. In MRI, when gadolinium is given for a T1 acquisition, which of the following is true? A. Nasal mucosa will appear bright. B. CSF will appear bright. C. Vitreous fluid will appear bright. D. Bone is well delineated. TI. A 6 MeV photon incident on water will most probably interact by: A. Photoelectric absorption. B. Compton scatter. C. Pair production. D. Photonuclear disintegration. E. Coherent scatter. T92-95. Match the PDD at 10 cm depth with the beam energy. 85% 64% 56% 33% 5% MOOS T92. Co-60 T93. 6 MV photons T94. 20 MeV electrons T95. 18 MV photons Raphex 2001 53Therapy “* Questions + T96-98. Match the following annual dose equivalent with the correct value. 0.4 mSv 1 mSv 20 mSv 50 mSv 5000 mSv MOOD > T96. Average dose to a member of the U.S. population from natural background radiation (excluding radon). T97. Average dose to a member of the U.S. population from medical x-rays. T98. MPD for a radiation worker. 54 Raphex 2001