FC Rad Onc(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain Reg No 1955/000003/08

Part I Examination for the Fellowship of the College of Radiation Oncologists of South Africa 27 March 2012 Paper 1 Physics, Apparatus Construction (3 hours)

All questions to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer)

a)

b)

Distinguish clearly between i) Absorbed dose and KERMA. ii) Tissue-air ratio (TAR) and tissue maximum ratio (TMR). iii) Fixed SSD and Isocentric (SAD) radiotherapy treatments. iv) Use factor and Occupancy factor as applied to the design of premises for radiation therapy equipment. v) Half life and average (mean) life of a radioactive substance. (15) Explain the purpose and functioning of the following components of a clinical linear accelerator i) Magnetron. ii) Waveguide. iii) Bending magnet. iv) Beam flattening filter. v) Dose monitoring chambers. (10) [25] Distinguish clearly between the following brachytherapy techniques i) High dose-rate (HDR). ii) Low dose-rate (LDR). iii) Pulsed dose-rate (PDR). (6) Which is larger value for a 6MV x-ray beam: the 1st or the 2nd half-value layer (HVL)? Explain your answer. (3) Give a brief discussion as to why water is the most widely used phantom material. (2) On a fully labeled graph, draw ideal Dose-Volume Histograms (DVH) for the following i) Tumour. ii) Critical organ. (5) Draw a typical radiation warning sign. Which colours are usually used for such a sign? (3) State the equation that describes the exponential decay of a radionuclide and define each term in the equation. (6) [25] PTO/ Page 2 Question 3

a)

b) c) d)

e) f)

-23 a) Name and briefly discuss the effects that would be of concern when making use of internal shielding of the jaw and teeth during a high energy electron beam treatment of the cheek. (2) Describe the problems that arise in a dose distribution when irradiating a protrusion like the nose with an anterior electron beam. (3) Explain what is meant by image guided radiotherapy (IGRT) and give examples of imaging modalities that may contribute to an IGRT process. (6) Which of the following is true of alpha decay? i) A changes by 2. ii) Z changes by 4. iii) Charge is not conserved. iv) It is most likely to occur in atoms with A < 82. v) It is most likely to occur in atoms with Z > 82. (2) Backscatter Factor (BSF) i) Is the TAR at Dmax. ii) Increases as energy increases above 1MeV. iii) Is the PDD at Dmax. iv) Is the ratio of dose in air to dose in tissue. v) All of the above. (2) Which of the following is true of Strontium-90? i) It is a pure beta emitter. ii) It is in equilibrium with its radioactive daughter. iii) It is used to make eye applicators. iv) It has a half-life of approximately 30-years. v) All of the above. (2) Which of the following is not ionising radiation? i) 10 KeV x-rays. ii) P-32 beta rays. iii) Ra-226 alpha particles. iv) 2 MHz ultrasound. v) 6 MeV neutrons. (2) Match the unit with the quantity it measures. (Quantities may be used more than once or not at all) Units: i) Gray. ii) Becquerel. iii) Rad. iv) Sievert. v) Curie. vi) Roentgen. Possible quantities: a) Dose equivalent. b) Exposure. c) Absorbed dose. d) Activity. e) Energy. (6) [25]

b) c) d)

e)

f)

g)

h)

PTO/ Page 3 Question 4

-3-

a)

Give a detailed discussion of the following aspects involved in the planning and treatment of a large patient with T2 prostate cancer with a 3D conformal treatment plan of which the required dose to the prostate gland is 76 Gy in 2 Gy per fraction i) The marking up of the patient. ii) Immobilisation of the patient. iii) The imaging modalities you would consider. iv) Your recommended treatment planning procedures including, but not limited to field size selection, gantry angle selection, beam modification devices, etc. v) The criteria you would use for contouring. vi) Where you would choose your prescription point position and why? vii) How verification of the treatment can be carried out. [25]

FC Rad Onc(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain Reg No 1955/000003/08

Part I Examination for the Fellowship of the College of Radiation Oncologists of South Africa Paper 2 28 March 2012 Radiobiology and Cancer Biology (3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer)

a) List 5 mechanisms by which biological damage is caused in cells. (5) b) List 2 processes of repair. (3) Mutations in cancer c) List 5 basic types of genetic alterations observed in tumours. (5) d) Write short notes on genome destabilisation under the following headings i) Microsatellite instability. (3) ii) Nucleoside excision repair (NER) / Base excision repair (BER) defects. (3) iii) Telomere maintenance. (3) iv) Homologous recombination. (3) [25] a) b) Define what is meant by Normal Tissue Tolerance to radiation and discuss the factors affecting this. (10) Discuss the effect of radiation on, and tolerance to radiation of the following organs i) Heart. (5) ii) Lungs. (5) iii) Liver. (5) [25] Define the terms Biologically Effective Dose (BED) and Equivalent Dose at 2Gy per fraction (EQD2). (4) Derive an equation that can be used to convert the total physical dose at X Gy per fraction to an EQD2. (5) Define the term alpha/beta ratio from the Linear Quadratic model and explain how it affects the BED or EQD2 (5) A mistake is made in the first fraction of HDR brachytherapy: 6 Gy is given instead of the prescribed dose of 3 Gy at the reference surface, where the intended prescription was 15 Gy in five fractions as a boost implant for breast cancer. How could the remaining fractions be changed to compensate (assuming the same original number of fractions) to achieve equivalent tumour effects? Assume alpha/beta ratio = 4 for breast tumour and 3 for normal breast.

a) b) c) d)

PTO/ Page 2 Question 3 continue... -2-

How would the therapeutic ratio change if you assumed an alpha/beta ratio = 3 for tumour? The solution to a quadratic equation give this equation). is (need to (11) [25]

a)

b)

c)

Define the terms Relative Biological Effectiveness (RBE), Linear Energy Transfer (LET) and Oxygen Enhancement Ratio (OER), and draw a graph that explains the relationship between these 3 terms. (10) Explain how hyperthermia complements the effect of radiation and chemotherapy on tumours, and explain how hyperthermia can be quantified in a patient undergoing Thermo- Radiotherapy. (7) Discuss the mechanisms of radioprotectors and their application in radiotherapy. (8) [25]

FC Rad Onc(SA) Part I THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain Reg No 1955/000003/08

Part I Examination for the Fellowship of the College of Radiation Oncologists of South Africa 29 March 2012 Paper 3 Applied Anatomy (2 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer)

Describe the anatomy of stomach along with the lymphatic drainage. Outline its relation to the adjacent structures. [25]

Describe the anatomy of cervix and discuss the lymphatic spread of cervix cancer. [25]

Discuss the anatomy and relations with appropriate diagrams of the optic nerve and tract. [25]

Discuss the anatomy of a transverse section through the body on the level of L1 vertebra. [25]