Radiological Physics HE Examination RAMPS ‘The New York Chapter of the American Association of Physicists in MedicineRAPHEX 1996 was prepared by members of the Radiological and Medical Physics Society of New York (RAMPS), the New York chapter of the American Association of Physicists in Medicine (AAPM). ‘Contributors to this examination were: Susan V. Brownie, Co-Chair, Therapy Section Albert Sabbas, Co-Chair, Therapy Section Richard Riley Lynn Shih Andrzej Szechter Howard Amols James Galvin Kerry Han, Chair, General Section Joe Hanley Eugene Lief Gig Mageras Howard Amols Adel Mustafa, Chair, Diagnostic Section Edward L. Nickoloff W. Gordon Monahan If you are taking RAPHEX under exam conditions, your proctor will give you instructions. * You have three hours to complete both sections; the General section and your specialty (diagnostic or therapy). + Non-programmable calculators may be used. * Choose the most complete and appropriate answer to each question. We urge residents to review this exam and the accompanying answer booklet with their physics instructor. ‘Any comments or corrections are appreciated, and should be sent to: Susan Brownie, M.Sc. ‘Chair, RAPHEX 1996 Division of Radiation Oncology, HC107 New York University Medical Center 560 Ist Avenue New York, NY 10016 Copyright © 1996 by the Radiological and Medical Physics Society of New York, the New York chapter of the American Association of Physicists in Medicine. 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.GL 2, G58, Gs. Gr. G8. GENERAL Questions ‘A coball-60teletherapy machine has an activity of 10,135 cutis and decays by emission of eta-minus particles. Ifthe emission of these electrons is considered to be an elecisic current what i its magnitude (electron charge = 1.6 x 10 Coulomb) ? A.1x10Amp B10 x10 Amp C6 x10%Amp D. 60x 10% Amp E600 x 10¢Amp ‘How many electrons per gram are there for the hydrogen atom (Avogadro's number = 6.0228 x 10") ? 4.30% 109 B.6.0x 10? C.9.0« 102 D.1.0« 102 E.16x108 ‘An %2r source has an activity of 3.7 x 10°Bq. What is the activity in mCi ? ‘A.100 B.O1 c.10 D, 1000 F.0,0001 Which of the following is not equal toa centigray? ‘A, 100 erg/gram Bind C, 1/0.873 roentgen absorbed in air D. 10.873 roentgen absexbed in tissue ‘Match the quality factor (Q) used in radiation protection with the type of radiation: A.10 B.2 ca D.0.693 B20 1.25 MeV gammas 100 keV x-rays Fast neutrons, 9°Mo betas APHEX 1996 © General Questions © Page 1G0. Gu. Gia, ais. Gis. Gas. A given exposure: ‘A. always results in the same absorbed dose to muscle or bone B. isa measure of the ability of a photon beam to ionize air C. isa measure ofthe ability of a panicle bead Co ionize air D, cam be measured in roentgen in the SI system E.alf of the above thas been said that a hydrogen atom consists mostly of empty space. This is because the ratio of the ‘nominal radius of the electron orbit to the radius of the nucleus is approximately = A108 B.10* e108 D, 108 E10 ‘A muon is a sub-atomic particle which has a mass 207 times that of the mass of an electron. What is the approximate mass of the muon in units of MeV ? A207 MeV B40 MeV C.106 MeV D500 MeV E300 MeV Directly ionizing radiations do not include: A. electrons, B. positrons C. neutrons D. alpha particles E. beta-rays ‘An electron, proton, and photon each have 1000 MeV total energy (kinetic energy + rest, 1mass energy). Which ofthe following statements is tue? A the electron travels at almost the speed of light B. the proton travels at almost the sped of light . the photon ravels at almost the sped of light D. the proton has the most kinetic energy the electron andthe proton have the same rest mass ‘Which of the following is never emitted during radioactive decay? ‘A. alpha particle B. proxor C. positron D. gamma-ray E neutrino Electron binding energy: Ais greater in the K-sbell than the L-shell B. is greater for the K-shell of barium than the K-shell of hydrogen C. increases with increasing Z D. all of the above E.none of the above RAPHEX 1996 © General Questions © Page 2Gis. au. Gis. Gis. G20, Gal, For the elements Z = 16, 17, 18, and 19 (sulfur, chlorine, argon, and potassium), how many have 8 electrons in the M-shell? AO Bl C2 D3 E4 (Of the following radioactive isotopes which one has the shortest half-life ? A7Ra B. Pq can D.?Rn Eo fit is assumed that a “Co beam is monoenergetic and that its half-value layer is 1.1 em of lead, how much, lead is required to attenuate a Co beam by approximately a factor of 1000 ? A. 110m B.$50.cn tem D. 550m E.220cm ‘The half-life of a radionuclide is 60 days. After how long will a source of this nuclide have only 0.1% of its original activity. ‘A. 200 days. B. 300 days. C. 600 days D. 720 days B, 800 days ‘Which type of nuclear radiation has the shortest range in tissue ? A. alpha panicles B. beta particles . positrons D. neutrinos . gamma rays Radionuclide X decays to Y¥ which decays to Z. The half-lives of X and ¥ are 1000 years and 1 day respectively. When equilibrium is reached, bow does A, (the activity of X) compare to Ay. APHEX 1996 © General Questions © Page 3G2. G26. ‘What kind of radioactive equilibrium can occur when a very long-lived radionuclide decays to a very short- lived one ? A. thermal B. secular C. transient D. non-stable E. No equilibrium will occur How many mCi of a radioactive isotope (T= 2.7 days) are required so thatthe sample's activity will be 10 mCi 24 his tater? A.11.29 B. 15.89 c.1293, D.4734 E2257 Heavy radioactive nuclei decay most frequently with the emission of which of the following A. beta particle B. alpha particle C. gamma ray D. Auger electron E. characteristic X-rays ‘Which of the following is a true statement? ‘A. naturally occurring radioactive elements are grouped into 3 series : uranium, actinium, and radium B. in bota decay, the emitted particle is monoenergetic, C. positron-emitting nuclei have a deficit of neutrons D. in alpha decay, the emitted alpha particle has a spectrum of energies E. in positron decay, a neutrino is not emitted Characteristic x-rays are a consequence of an inner atomic shell vacancy caused by which of the following processes (choose all that apply) ? 1, Internal conversion 2. Negatron decay 3. Electron capture 4, Gamma ray emission 5. Alpha decay ‘A.all of the above B. none of the above C.1and3 only D.4and 5 only E.2only RAPHEX 1995 © General Questions © Page 4G27. For the decay schemes for radionuclides X and Y shown below, how many beta rays and gamma rays are ‘emitted per disintegration for X and Y? bsMmev aire A. one beta and two gammas from X; one beta and one gamma from Y BB. one beta and one gamma from X; one beta and one gamma from Y C. no betas and one gamma from X; two betas and two gammas from Y D. no betas and two gammas from X; two betas and one gamma from Y Eno betas and no gammas from X; no betas and no gammas from Y 628-30, Match the device found in an x-ray circuit with its purpose 2s. G2. G30. Ga. G32, A. allows current to flow in one direction only B. increases or decreases voltage CC. thermionic emission D, measures time of exposure E, measures tube current ‘Transformer Milliammeter Rectifier ‘Which of the following does not improve the beat capacity of the x-ray tube? ‘A. rotating anode B, small target angle CC. dual focus D. thermionic emission E. all of the above “The effective energy of any x-ray bet ‘A. is proportional (o the atomic number (Z) of the anode material B. is proportional to the mAs C. is not affected by the added filtration D. will affect image density but not subject contrast E is always less than the kVp RAPHEX 1995 © General Questions © Page 5G33. 634-43, Intensity G34. Gas. G36. G37. G38, G39. Gal Ga, Gas. Gus, ‘The quality of am x-ray beam can not be characterized only in terms of the peak voltage because beams ‘with the same vollage may have different 1, Amounts of filtration 2. Half-value layers 3, Maximum wavelengths 4, Minimum wavelengths Aonly 1 and 2 are true. B. only 1 and 3 are tue. C.1, 2, and 3 are tue D.allare true E, none are true ‘Compare specra Ind 11 in the diagram below (tungsten target). Choose the most appropriate answer from tbe list below for the next 10 questions, A. spectrum I B. spectrum Il . both D. neither E. cannot be determined 20 wo c 7% 70 keV Characteristic radiations appear between 50 and 70 keV. Low energy photons have been removed by filtration, ‘Maximum photon energy is 100 keV. ‘Minimum photon energy is 50 keV. ‘The K characteristic x-rays have been removed by filtration, ‘Maximum kVp is 50 kVp. Higher exposure rat. Higher HVL. Produced by three-phase or constant potential generator. ‘Will produce relatively less scatter in soft tissue. In an electromagnetic wave, the component electric and magnetic fields are oriented at what angle with respect to each other ? A.30° Bo c.90° D, 120° E150" RAPHEX 1996 © General Questions © Page 6G48-52, Gas. Gas. G50. G51. G52. G53. oss. Of the following, which is the most penetrating electromagnetic radiation ? A. infrared B. ultrasound C. radio waves D. gamma rays E. ultraviolet radiation Some substances when exposed to incident light will emit light of their own, Substances for which the emission of light ceases immediately after the excitation is removed are called : A. incandescent B. phosphorescent C. fluorescent D. photonic E, nascent Electromagnetic waves are transverse waves, unlike sound waves which are longitudinal waves. Of the following experiments, which can be used to reveal the wansverse nature of electromagnetic radiation ? A reflection B. refraction C. polarization D. interference E. diffraction Match the effect in tissue and type of radiation withthe name of the radiation (answers may be used more than once). A. ionizing elementary panicles B. non-ionizing elementary particles . ionizing photons D. non-ionizing photons E, none of the above Beta-rays Heat radiation Visible light X-rays ‘Ultrasound ‘Which of the following is most descriptive of the difference between x-rays and gamma-rays? A. energy B. velocity C. field D. origin E-allof the above Visible light has a wavelength of approximately 6 x 10°7m. Cobalt-60 gamma-rays have a wavelength of 1x 10"? m and an energy of 1.2 MeV. What is the approximate energy of the light photons? A.T20 MeV. B.2eV C.2x108eV D.2x104eV RAPHEX 1996 © General Questions © Page 7ss. G56. Gs7. 658-61. ‘The ratio of Compton interactions in one gram of hydrogen to one gram of water is about: AOS B.10 C.20 1D. dependent on the photon energy E. the ratio of the density of hydrogen to water ‘Which of the following statements about Compton interactions is true? ‘A. Compton electrons can be ejected in both the forward and backward direction B. Compton interactions have no effect on backscatter CC. the most energetic Campton electrons are those ejected at angles close to 90 degrees of the poton's incidence angle ‘Da secondary photon scattered in the direction of the primary photon loses the most energy. E- a secondary photon scattered at 180 degrees cannot have an energy greater than 256 ke. The figure below shows the energy spectrum of photons after Compton scattering. What is the initial energy of the photon ? Compton Scattering Spectrum ZERER ze a a es Seatering Angle (den) A600 keV B. SI keV C.256 keV D.176 keV E. insufficient information is given For questions G58-61, match the description of the process with te type of photon interaction AA coberent scatiring BB. photoelectric interaction Compton interaction D.none ofthe above EB and C are both uve [No energy is transferred to an orbital electron, ‘The incident photon wavelength decreases. ‘The incident photon can be back-scattered, ‘The incident photon is completely absorbed. RAPHEX 1996 © General Questions © Page 8(662-65. For questions G62-65, match the interacting particles or fields withthe type of photon interaction (use each Ge4, 666. Gor. Gos. G70. on. answer once and only once): ‘A. coherent (Rayleigh) scatter B. photoelectric effect C. Compton effect D. pair production E. triplet production ‘Tightly bound atomic electron Electrostatic field of the nucleus Loosely bound atomic electron Electrostatic field of an atomic electron Electrons in the entire atom ‘The outstanding characteristic of a charged particle beam’s interaction with matter is its: A. high LET B. high degree of skin sparing C. limited range D, low RBE_ E. high keV. What is the LET of a 9 MeV electron in soft tissue? A.1MeV Jem B.2MeV/em C.5MeV/em D.10MeV/cm E,12MeV/em ‘The dominant mode of energy 10ss for a therapeutic electron beam is: ‘A. bremsstrahlung radiation B. ionization C. Compton interactions D. collision with protons E. pair production ‘The dominant mode energy loss fora therapeutic neutron beam is: ‘A. bremsstrahlung radiation B. ionization C. Compton interactions D. collision with protons E. pair production ‘The Bragg peak is not seen in the depth-dose curve of an electron beam because of: A. scattering B. nuclear absorption . emission of Bremsstrahlung radiation D, Compton effect E. x-ray production APHEX 1996 © General Questions © Page 9Gn. Gn. om, ors. G76. on. Gr. Some patients with brain malignancies located near the eyes notice a faint blue light during treatment with high-energy electrons. This phenomenon is most likely due to: A. fluorescence B. the physiology of human vision C magnetic fields of the moving electron D. Cerenkov radiation E. luminescence ‘The slope or gradient ofthe characteristic curve (or H and D curve) fora film is also known as the film's: A. density B. gamma . transmittance D. opacity B,Jambda ‘Two x-ray films, each with optical density of 1.5, are placed on top of one another. The fraction of incident light transmitted through the “sandwich” is: A003, B.0015 C.0.001 0.0225 A grid improves the quality of diagnostic x-ray primarily by A. attenuating primary photons B. attenuating Compton scattered photons C- attenuating electrons produced by Compton scatter D. attenuating electrons produced by photoelectric effect E. atenuating coherently scattered photons Ina diagnostic radiograph the process mostly responsible for differentia! attenuation is: ‘A. coherent scatter B. Compton interaction CC. photoelectric interaction D. pair production ‘The probability of “outcome A" from an experiment is 0,001. The experiment is repeated 1000 times. It each experiment is independent of all other experiments, what is the probability that “outcome A" will ‘occur atleast once ? A.0.001 B.0.500 ¢.0.632, D.0.999 E, 1.000 ‘A radioactive sample is counted fora ten minute interval many times, yielding a mean count rate of 1000 pm. The most probable distribution is: ‘A. 68% of the measurements fall between 990 and 1010 cpm BB. 68% of the measurements fall etween 936 and 1064 cpm 68% of the measurement fall between 900 and 1100 epm 1.95% of the measurements fall between 936 and 1064 cpm EE. 959 of the measurements fll between 800 and 1064 cpm RAPHEX 1996 © General Questions © Page 10GP. G80. 81-84, Gai. G82, G83. G4, as, G86, ‘To achieve a standard deviation of 2%, _ counts must be collected. 4.400 B.IdI4 c.2500 D. 10000 E, 40000, ‘A measurement is made in which 2500 counts are collected. There is a 96% probability that repeated measurements will yield between ‘and _counts. ‘A. 2300, 2500 B. 2400, 2500 C. 2400, 2600 D. 2450, 2550 E, 2500, 2700 Speed ° ve Storage Cay city For questions G81 to G84, match the computer storage device 10 its letter position on the graph above. The ‘raph depicts the relative advantage of each device in terms of the relative storage capacity (ordinate) and relative access speed (abscissa) Floppy Disk Drive Hard Disk Drive Optical Disk Drive RAM ‘Which of the following is the term for 10" bytes ? A. gigabyte B. megabyte CC. overbyte D. terabyte E. pelabyte ‘A “smouse" or trackball is connected to which computer interface ? ‘A, serial port B. parallel port C. SCSI port D, Ethernet port E. air port RAPHEX 1996 © General Questions © Page 11G87. Which of the following fies can be read and understood by using a text-editing program ? A. pixel file B. vector file C. ASCH file D, binary file E. tertiary file G88. Approximately how many Megabytes (MB) of disk space are needed to store a single raw image file consisting of 512 x 512 pixels with each pixel having a 16-bit pixel depth ? A.025MB B.0.50 MB €.0.75 MB D.1.00MB E.1.25MB G89, Which of the following is the name for a particular data compression scheme? ‘A, Newton-Raphson B. Huffman C. Rumge-Kutta D. Savitsky-Golay E, Wiener G90. The binary number 10000001 has what hexadecimal value? AML B.16 co D,81 Es G91. The most recent Intemational Commission on Radiological Protection estimate of the lifetime risk of ‘cancer induction to the general population by low dose rate ionizing radiation is approximately how many cases per Sv? A.dx 104 B.4x 10° C.4x 102 D.4x 107 E.4x 10° G92. Which of the following is true for low-level radioactive wastes, such as tubing and swabs ‘contaminated with 99%Te ? ‘A. they can never be thrown away, since some activity always remains B. they can be thrown away immediately, since the amount of activity is generally harmless C. they can only be disposed of by a commercial rad-waste service D. they can be stored until reaching background levels, chen disposed of with other medical trash APHEX 1986 © General Questions © Page 12G93. A person’s exposure rate is 100 mR/r at 1m from an 1-125 source, A 0.04 mm thick lead shield is place between the source and the person, What is the new exposure rate? [HVL in lead is 0,02 mum.] A.1mR/r B.25 mR/or C.50mRimr D. 75 mR/r E, 100mR/hr G94, A radiotherapy clinic is located near a local power line, Do the patients receive a radiation dose from the powerline? If so, how should this dose be taken into account ? ‘A. proponionally tothe time spent in the clinic B, mostly during the hours of peak energy consumption . only for very high voltage lines . only for altemating current lines E, nodose atall Cong Cotte Vato 695.99. The above graph shows the response curve fora gas filled detector. Give the appropriate region for each of the following descriptions (answers can be used more than once): G95, The region where current is passed in the absence of radiation, G96. The pulse heights are proportional tothe incident particle energy. G97. _Anionization chamber is operated in this region. G98. A Geiger survey meter is operated inthis region. G99. The saturation region where all charges are collected without multiplication. RAPHEX 1996 © General Questions © Page 13DI. D2. D3, Ds. DIAGNOSTIC RADIOLOGY Questions ‘Which of the following is not correct: the x-ray tube current is: A. used to heat the tube filament B, measured in milliamperes C. limited by the space charge effect 1D, defined as electrons moving from the filament to the anode E. caused by thermionic emission Increased ripple in the kVp waveform of some types of x-ray generators has all the effects listed below, except: A. lower maximum photon energy B. lower average photon energy C. lower x-ray intensity . lower heat load ratings for the x-ray tube E, lower tissue penetration ‘The ___rating of an x-ray tube is the maximum cumulative heat load that the x-ray tube target can sustain without damage, AKW B. single exposure C. cathode KHU D. anode heat capacity E. housing beat capacity ‘Small anode angles in x-ray tubes are used to: A. increase the field-of-view B. increase the anode heat capacity C. decrease the heel effect D, decrease filament size E, decrease anode mass Methods to assess spatial resolution of an imaging system include all of the following ways, except: ‘A. bar pattems B. step wedges CC. wire mesh pattern D, hole pattems E. wire impulse response RAPHEX 1996 © Diagnostic Questions © Page 14pr. DB. Dio. DI-IS. pu. Concerning grid controled x-ray tubes, the grid 1. Controls the tube current 2. Collimates the x-ray beam 3. Allows fast exposures '4.Can be used to synchronize the exposures with the cine film 5. Causes an increase in tbe heating A. only 3 is correct B. both 2nd 3 are comect C.1,3, and 4 are correct D.2and 5 are correct, E.1 through 5 are all correct, Fora fixed mAs and kVp, increasing the exposure time will significantly affect the: ‘A. overall film density B. overall film latitude CC. speed of film/sereen combination D. motion unsharpness E, patient exposure ‘The visualization of low contrast objects is primarily limited by: A. focal spot blur B. motion . screen unshagpness D. film grain E. radiographic mottle the decrease in film density due to delays between x-ray exposure of flm-screen and the film processing, ‘A. heel effect BB. space charge effect, C. reciprocity failure D, latent image faling E. recombination loss is the decrease in film density due to either very long or very short radiation exposures while using appropriate mAs values. A. heel effect B. space change effect C. reciprocity failure D. latent image fading E, recombination loss ‘Match the following items withthe questions listed below: A. Gl abdomen radiography B, extremity radiographs C. mammography D. chest radiographs E, pelvimetry radiography ‘The characteristics of a film-screen system include: a spatial resolution of 15 to 20 Ip/mm; high contrast gradient; anda relative speed less than 100, BAPHEX 1996 © Diagnostic Questions © Page 15DI2. Dia. Did. Dis. Di6. Div. Dis. pi, p20. ‘The characteristics of a contrast gradiet ‘im-screen system include: a spatial resolution of 8 to 12 Ip/mm; high and a relative speed less than 100, The characteristics of a film-sereen system include: a spatial resolution of 6 to 10 Ip/mm; low contrast gradient; anda relative speed of 200 to 300. ‘The characteristics of a fil-screen system include: a spatial resolution of 4 to 8 Ip/mm; medium contrast gradient; and a relative speed of 400. ‘The characteristics of a film-sereen system include: a spatial resolution of 1 to 4 Ip/mm; medium contrast gradient; and a relative speed greater than 400. ‘The use of a film/screen combination receiving system will: A, decrease exposure tothe patient by a factor of 1000 when compared with the use of film without a screen increase spatial resolution when compared with film alone ‘absorb photons of a lower energy than it emits ). absorb less photons than it emits Increase absorption at energies slightly lower than the K edge of the screen phosphor as opposed 10 slightly bigher than the K edge. roo In 2 film/screen system, how can one obtain increased speed with no change in the image noi ‘A. use a phosphor with a higher x-ray-to-light conversion efficiency Buse a faster film C. increase the phosphor layer thickness D. add a light absorbing dye to the phosphor E.all of the above Failure 10 use adequate fixer for the processing of radiographs will: A. decrease film contrast gradient B. decrease film speed C. increase quantum mottle D. increase silver reclamation E, decrease archival storage is the persistence of an image on the fluoroscopic TV monitor; and with motion, the image becomes blurred because of this persistence. A. vignetting B. flare C.lag D, veiling glare E. blooming During GI fluoroscopy with automatic brightness control (ABC), the typical patient entrance radiation exposure rte is__R/min and the maximum is_ R/min A.05, 10 B.10,30 €.20,50 D.2.0,100 . none of the above RAPHEX 1996 © Diagnostic Questions © Page 16D2. 23. 24-28, D2, Dos. D26. 27. 28. (Compared with an iodine IVP exam, a barium exam produces better contrast resolution because: ‘A, the mass attenuation coefficient of barium is much greater than that of iodine B. the K-edge of barium is much greater than the K-edge of iodine CC. the caliber of the bowel is bigger than the caliber of the ureter D, the atomic number of barium is significantly greater than the atomic number of iodine E. a higher concentration of barium can be achieved than with iodine Which of the following is not crue? In the diagnostic x-ray range, as the tbe kVp is increased, the: ‘A. bremsstrahlung radiation intensity increases BB. characteristic radiation energy increases C. scatter becomes increasingly forward 1D. mAs must be reduced to produce an equivalent exposure E. effective focal spot size decreases ‘Added filtration in a diagnostic x-ras tube: ‘A, decreases the intensity of the x-ray beam at the lower end of the energy spectrum B. decreases the intensity of the x-ray beam at the higher end of the wavelength spectrum decreases patient skin exposure D. decreases the linear attenuation coefficient E. allof the above ‘Match the following x-ray tube operation characteristics with one given answer: A.25 KI B.2.5KI C.50kW Ds E60 “The anode hat loading for 4 minutes of fluoroscopy at 100 KV and 2.5 mA. “The anode head loading for $ seconds digital run at 100 kV, 100 mA, 10 ms, and 5 frames per second, “The anode heat loading for 100 KV, $00 mA, 100 ms exposure. ‘The x-ray tbe rating at 100 KV, 500 mA, 100 ms exposure. ‘The x-ray anode tube loading after four successive exposures at 100 KV, 250 mA, 250 ms. ‘A detail screen with an effective blur of 0.2 mum is used in a radiographic procedure with the small focal spot (0.6 mn) forthe x-ray tube, If ess than 1.1 magnification of the object being imaged is achieved, what is the resultant blur for the filml/sereen radiograph? A.02 mm B03 mm 04mm D.05mm E.0.6mm RAPHEX 1996 © Diagnostic Questions © Page 1730. DBI. p32. 33. Dad, If an imaging system is said to have a resolving power of about 5 Ipfmm, then this represents a system MTF response of about: 4.90% B. 15% C.50% 1.20% E, 10% ‘Changes in subject contrast are affected by changes in: 1. Fil-screen contact 2. Tissue atomic number 3. Object-film distance 4. Beam quality 5. Development cate and temperature AL B.3and5 C.only 2 D. both 2 and 4 E.allof the above Ifthe exposure time, the focus flm distance, and the screen thickness are all doubled: A. screen unsharpness will not change B. patient skin exposure will increase C. geometric unsharpness will decrease D. film density will decre E heel effect will increase Regarding film density, which of the following is correct? 1. As optical density increases, transmittance decreases 2. Two superimposed films with 10% transmittance each would have a total optical density of 1 3. Fast films require more radiation to produce a given film density 4, A film characteristic curve with a gradient of 3.0 is suitable for mammography 5. The ratio of highest o lowest exposure that can be usefully detected is 40:1 A. both 2 and 3 B. 1 only C.1,4, and 5 D.1,2,and3 E.all of the above ‘Which of the following is not a contributing factor to average glandular dose in a mammogram’? A. Xotay tube target material B. x-ray tube focal spot size C.KVp applied D.HYL of the bean E, degree of compression APHEX 1996 © Diagrostic Questions © Page 18Das. 36-40, 36. Dav. p38. Da, ‘The MTF of a composite imaging system ata given spatial frequency is: ‘A. equal tothe product of the MTFs of the individual components of the system at that frequency B. less than the product of the MTFs of the individual components of the system at that frequency CC. always less than the MTF of the system component with the poorest resolution at that frequency D. better with increased number of system components E.only A and C Match the following digital subwraction angiography characteristics: ‘A. logarithmic transformation B. vignetting . frame integration D. narrow windowing E hybrid subtraction Assures direct relation of absorption over a wide range of patient thickness, Reduces image noise contrast in the image Decreases artifact from motion in bones Fall off in brightness atthe periphery of an image intensifier mn the conversion table, calculate the average glandular dose (AGD) for a 4.5-cm compressed breast imaged at 27 kVp with an x-ray beam half value layer of 0.31 mm Al and a measured entrance skin ‘exposure (ESE) of 0.8 R, Glandular Tissue Dose (mrad) for 1 R ESE, HVL (mm A) ‘Compressed Breast Thickness (cm) 3 4 5 030 220 175 140 032 230 184 47 034 250 202 161 A. 112 inrads B. 129 mrads C. 140 mrads D. 147 mrads E. none of the above In mammography quality assurance: ‘A, federal performance standards allow a field size extension of up to 5% of SID atthe chest wall edge of the image receptor B. the chest wall edge of the compression paddle should be seen in the mammogram C, the average glandular dose to an average breast should not exceed 0.3 mGy per view for grid sereewfilm mammography D. measured kVp accuracy should be within +5% of nominal kVp setting E. darkroom fog should be no greater than 0.18 RAPHEX 1996 © Diagnostic Questions © Page 19Daa, Das. ‘The filtration in mammography units primarily transmits the characteristic x-rays, The very fow energy bremsstrablung x-rays are filtered because they contribute to __and the higher energy bremsstrahlung x-rays are filtered because they contribute to__ ‘A. tube heating, off-focus radiation B. heel effect, focal spot blooming C. radiation dose, loss of contrast . grid cut-off, septal penetration E, coherent scatter, K-edge photons ‘The following film processor parameters all alfect mammography image quality, except: A. replenishment rates B. developer concentration C. developer temperature D. nivave depletion E. developer immersion time During a typical Nuoroscopy procedure a radiologist wearing a protective apron and no protective eyeware receives a uniform whole-body exposure of 20 mR. How many of these procedures can the radiologist perform in one week and not exceed the NCRP maximum occupational radiation exposure? Als 8.50 100 D.250 none ofthe above Concerning Auorascopic imaging systems, which of the following is not rue? A. Csl is commonly used for the input phosphor B. amodem image intensifier has a modulation transfer function similar to radiographic film MTF used for Gl examinations CC. with automatic brightness control (ABC) systems, patient dose will increase when the image intensifier input size is reduced D. different electronic lenses are employed to obtain magnified images E. with ABC systems, patient dose will increase when patient to image intensifier distance is increased In fluoroscopy with an image intensifier, for a given output phosphor area, increasing the input phosphor size from 4.5 to9 inches will ‘A, double the minification gain B. have no effect on the minification gain C. increase the minification gain 4 times D. increase patient skin exposure 4 times . increase image resolution In order to reduce the radiation dose to both patients and personnel, a radiologist chooses to use the C-armn ‘ivoroscopy unit in the lowest sensitivity mode, What effect does this have on image quality? ‘A high contrast resolution increases B. high contrast resolution decreases C. low contrast resolution increases D. low contrast resolution decreases E, none of the above APHEX 1995 © Diagnostic Questions © Page 20Ds0. Ds1 ps2. Ds3. ps4, Dss. In a digital radiography device, a plumbicon tube is used to obtain the video image. If the tube is driven at standard broadcast TV rates, how long does it take to scan one line? A.5.29 psec B.31.7 wsee C.63.5 usec D.90.1 psec E.none of the above In ultrasound a 4 MHz transducer has a useful range of 10 em, What is the maximum pulse repetition frequency for this ansducer? ATT KH. B. 10KHz C40 kHz D. 154 Kitz E. 10 MHz. In onder to have fat appear darker than surrounding tissues, spin echo (SE) pulse sequences require a___ ‘TEanda__TR, A. short, short B. short, long C. long, short D. long, long. E. long, medium ‘The spatial resolution with MRI is about the same as that obtained with: A. SPECT B, mammography CC. chest radiographs D.cT E, better than all of the above ‘The signal-to-noise ratio (SNR) can be improved in MRI studies by using: A. thinner slice thicknesses B. smaller pixel sizes C. more NEX D. short TR times E. ow magnetic field strengths Although MRI units do not use ionizing radiation, safety concerns for MRI units include all of the following factors excep A. fringe magnetic field interference B. electrical potential induction in neurons C. RF heating effects D, ferromagnetic surgical clips in patients E. flying metallic objects If the count rate of a radioactive sumple is 3330 cpm and measured background 10 cpm, to achieve ‘measuring accuracy of 1% the sample should be counted for: A.3 min B. 10min ¢.20min D. 30min E.50min RAPHEX 1996 © Diagnostic Questions © Page 21Ds6. ps7. Ds8. ps9. De. the X-Y distances in an MRI image are distorted, the most likely source ofthe problem is due to: A. RE transmitter BB. RF shielding leaks CC. gradient field non-linearities D. eddy currents E. shim coils adjustments ‘Which of these pulse sequences results in a TI weighted image: A.TR 600s, TE 208 B. TR 600 s, TE 600s C. TE 600s, TR 2000s D.TR 1000 s, TE 600 s E, TE 20s, TR40s, A 1.0 FMRI system is operated at the water proton resonant frequency of 42.6 MHz. If it uses an x- ‘gradient of 0.1 mT/cm, what will be the frequency difference of the signals from two vials of water placed 4 cam apart on the x-axis? ARH: BAT Kitz C.21 Kitz D.43 kHz E.82KHz A3TMRI machine is used for proton spectroscopy and operates at 128 MHz. If wo peaks in the spectrum are separated by 8 ppm, what is their separation in frequency units? A.1.024 Hz B, 1024 He, C, 1024 kHz D.24 MHz, E. 128kHz, The thyroid burden of 4 can be efficiently measured with: A. ionization chamber B. geiger counter Nal (1) scintillation probe D. liquid scintillation counter E-all of the above For patient studies, CT image quality can be improved by all factors listed below except: ‘A, short scan times BB. optimized reconstruction algorithms . smaller pixel sizes D. lower kVps E. administration of contrast media All the following factors influence CT spatial resolution except: A. focal spet size B, scanning geometry C, detector size D slice thickness E. pixel size RAPHEX 1996 © Diagnostic Questions © Page 22‘The two materials used to calibrate the CT number scale of CT scanners are: ‘A. tissue and bone B. water and bone CC. water and acryli D. air and acrylic . air and water ‘The percent low contrast discrimination for large object sizes is film-sereen chest radiography. ‘A. 20 times greater B.5 times greater C. the same D. 5 times smaller . 10 times smaller for CT scanners as compared to One of the disadvantages of helical (spiral) CT scans over axial CT slices of the same tissue volume is: A. increased slice profiles B. increased radiation dose C. increased seatter radiation D. longer scan times E. higher kVps ‘The typical x-ray tube heat load from a series of 40 helical (spiral) CT slices is about_to_of the anode heat capacity, A. 1%, 2% B.4%, 8% C. 10%, 20% D. 25%, 50% E, 80%, 100% ‘Non-erasable optical disk storage represents a category of memory units called: A. WIPS B.NEMA C.RAM D.CcPU E, WORM Software that has multiple complex processing sections requires a large: A.CPU B. hard disk C.MIPS 1D. DOS E. modem In order to transmit data over telephone lines to another computer, a computer system must have: A. icon B. parallel processing C. ethernet D. modem E.CD-ROM RAPHEX 1996 © Diagnostic Questions © Page 23D710. bq. D7. D7. Dis, D1. ‘The number of binary bits that are required to represent all CT numbers from -1024 to +3096 Hounsfield units s__bits. AB B.o c.10 Du E12 ‘An ultrasound transducer which ut (o form a rectangular image is call ‘A. annual array B. phased array linear array D, sector scanner E, variable focus scanner izes a series of elements that transmit sequential sound waves in order ‘The speed of an ultrasound wave in a body tissue depends upon the ___ and the A. frequency, viscosity B. atomic number, wavelength C. density, compressibility D. refraction, diffraction E.none of the above ‘Modem ultrasound units have spatial resolution limits of about {in both axial and lateral directions. A.0Sem B.O1cm C.0.05 em D.0.01em E, 90.005 em Possible adverse biological effects from ultrasound procedures include: A. cavitation B. genetic transmutation C. ionization D. production of radicals E.none of the above All ofthe following types of radiation are possible from isomeric transitions except: ‘A. photons. BB. neutrinos C. internal conversion electrons D, Auger electrons E. fluorescent x-rays If a TC-99m generator eluant contains 100 mCi of Te-99m and 5 Ci of Mo-99, the amount of activity after 33.5 hours is_ mCi of Te-99m and _1Ci of Mo-99, A25,48 B.65,43 C.37,40 D.21,35 E1215 RAPHEX 1996 © Diagnostic Questions © Page 2477-81. In nuclear medicine imaging, match the following quality control procedures with the relevant choice D7. DIB. Da. Dao. Dal. a2. 83, D8, below. ‘A. gamma camera resolution B. gamma camera field uniformity CC. photopeak window of the gamma camera pulse height analyzer D, dose calibrator linearity E. dose calibrator constancy Is checked daily by placing a uniform flood source in front of the camera, Is checked daily by measuring two standardized long half-life sources. Is checked quarterly by measuring the decay of Te-99m over 72 hours or more. Is checked daily by placing a small amount of known source of radioactivity in front of the camera, Is checked weekly using a bar phantom without a collimator. For a 256 x 256 matrix with an 11-inch diameter crystal, the limiting spatial resolution of a scintillation ‘camera study with Te-99m is dominated by: A. septal penetration B. collimator hole size C. Compton scattered photons D. pixel size E. inherent camera limits Factors which complicate SPECT studies include all ofthe following items exept: ‘A. attenuation corrections, B. detector non-uniformities . positron range D. Compton scatter photons E, tissue inhomogeneities In nuclear medicine studies, the critical organ dose is usually limited to ess than _eGy. AL B.2 cs D.10 E. no limit; use risk verses benefit ratio ‘The typical thyroid ablation procedure involves the administration of _ MBq of "I which delivers a ‘radiation dose to the thyroid of __ Gy. ALS:1S ‘An apron which contains 0.5 mim of lead equivalent attenuates about 95% of the scattered diagnostic x- rays. Regulations only require 0.25 mm of lead equivalence in protective apparel. These leaded aprons ‘would be expected fo attenuate about __% of the scattered x-rays. A.90 B. 88. c.82 D.77 E74 RAPHEX 1996 © Diagnostic Questions © Page 25a7. 91.95. D9. p92, a3. Dos. 9s. Regulations limit the radiation dose equivalent to patients undergoing radiological procedures to ___ mSviyear. A500 B.50 cs Di E.none of the above ‘The radiation dose equivalent to the fetus of a pregnant patient is not considered to pose a significant risk nti itexceeds _ mv, A105 B.510 10 C.25 1050 D. 5010 100 E, 200 0 400 If a radiation badge placed outside a leaded apron at the collar level measures 1500 Sv per month, the effective dose equivalent would be computed as_ Sv per month. ‘A.1200 B. 1000 c. 500 D.250 £50 ‘The radiation shielding required in the walls of a diagnostic x-ray room to protect only against scattered x- rays is related to all ofthe following factors except: A. distances B. workload C. use factor D. occupancy factor E. tube potential (kVp) ‘Match the following exposure conditions with the appropriate dose. ‘A. 1mSv (100 mrem) B. 0.1 mSv (10 mem) C. 2 mSv (200 mrem) D.2uGy (0.2 mrad) E, 50 mGy (5 rads) ‘The approximate gonadal dose from a PA chest radiograph at 120 kVp. ‘The approximate detection limit ofa thermoluminescent dosimetry system. The maximum organ dose for patients undergoing nuclear medicine procedures. ‘The regulatory weekly dose limit in controlled areas. ‘The approximate typical annual effective dose equivalent for a nuclear medicine technologist. RAPHEX 1996 © Diagnostic Questions © Page 26TI 14, RADIATION THERAPY Questions All ofthe following are independent of $SD except: A.TMR B.TAR C.PDD D. BSF TAR atd,,,, can be calculated from the BSF by: ‘A. multiplying by the SAR BB. dividing BSF by the collimator output factor CC. applying inverse square correction to the BSF 1D, no need to calculate; they are the same at pag A patient is simulated with a 10 x 10 cm field at 80 cm SAD to deliver 200 cGy at 8 cm depth on a cobalt. 60 unit. If the technique is now changed to 80 cm SSD, what values are required to calculate the timer setting? 1. Percent depth dose for a 10%19 em field, 8 em depth, 80 cm SSD 2. Dose rate in air at 80 em for a 10°x 10 cm field 3. Dose rate in air at 80.5 cm for a 10 x 10 cm field 4. Dose rate at 80.5 cm in air for a 9x9 cm field 5. TAR for a 10 x10 cm field at 8 cm depth 6. Backscatter factor fora 10 x 10 cm field 7. Backscatter factor for a9 x 9 em field 8. Percent depth dose for a9 x9 cm field, 8 cm depth, 80 em SSD A478 B.3,6,1 €.2,6,5 D.4,5 £28 ‘The dose rate in air for a 10 x 10 cm cobalt-60 field is 100 cGy/min at 80 SAD. The BSF = 1.035. The dose rate in tissue at depth = d,,,., 80.em SSD is: A. 103.5 cGy/nin B. 102.2 oGy/min C. 100 cGy/min D. 115 cGyhnin E125 cGy/min RAPHEX 1996 © Therapy Questions © Page 2715. 16. Use the following cobalt-60 data: Dose rate in air at 80 cm for 10 x 10 cm field size = 115 eGy/min Collimator Setting (em) 6 8 10 2 4 Output factor (air) 0970 0985 1.000 1.013 1.026 BSF 1022 102910351041 1.087 TAR (d= 9 cm) 069 0729-0755 0.775 (0.791 TR (d= 9 cm) 0.684 = 0.708 «0.729 0.744 «= 0.755 PDD (80SSD,d=9cm) 0571-0590 -0.604 «0616 (0.627 For parallel opposed 80 cm SAD fields, separation 18 cm, field size at midplane 12 x 12 cm, 200 oGy total dose pet fraction, the timer seting per beam is: A107 min B11 min 1.15 min D. 1.39 min E141 min ‘A patient's separation is 20 cm. For parallel opposed fields treated at 100 cm SSD, what is the total dose to 2.cm, as a percentage of the total midplane dose? depth depth dose = TMR 2on 100% 1.00 10cm 70% 0.80 18cm 45% 0.60 20m 40% 055 A. 90% B. 100% C.108.5% D. 105% E.113% ‘A mantle is treated at 100 cm SAD, at d =8 cm on the axis. Ifthe dose is 4000 cGy at the axis, the total dose to the neck (ignoring off-axis factor) is: SSD (cm) Separation (em) APPA AX 2 92 16 neck 9 OT 10 depth (em) 305 7 8 IMR 987 945-901-879 A372 B, 3950 c. 4000 D.4300 4613, APHEX 1996 © Therepy Questions © Page 2810, TL 712. Patient thicknesses of up to ___cm can be treated on a coball-60 unit with paralle opposed 15 x 15 em fields at 80 SSD if the total dose at d,,,, is not to exceed 110% of the midpiane dose. A8om B. 14cm C.20cm D.24cm E.8cm For parallel opposed photon beams, the total entrance and exit dose at dys Expressed as a percentage of the midplane dase: 1 Decreases as photon energy increases 2, Decreases as field size increases 3. Increases as patient thickness increases 4, 1s greater for a 100 cm SSD set up than fora 100 cm SAD setup, for the same field size at midplane. A123 B.A C24 D.4only E.allof the above Ifthe PDD ofa beam at 10 cm depth is 75% at 100 cm SSD, the PDD at 10 cm depth for 80 em SSD is: (Gay is 0.5 cm) A105% 271.9% C.15.0% D.785% E,80.0% ‘The equivalent square of a rectangular field: 1. Has the same PDD on the axis a the rectangular field 2. Is approximately twice the area divided by the perimeter, 3. Has the same backscatter factor as the rectangular field, 4, Has the same area as the rectangle. A123 B.L3 C24 D.4 only E.all ofthe above ‘When wedges are used in photon beams, the “wedge angle” i: A.90° — the hinge angle B. the angle between the 100% isodose line and the beamn axis C. the angle of the metal wedge itself . the angle through which the isodose at D10 is turned by the presence of the wedge E.AandB RAPHEX 1996 © Therapy Questions © Page 29113. m4, TIS. TI6. 11. TB. ‘Wedges are used forall of the following except: ‘A. 10 increase homogeneity for breast tangent fields B. to increase the anterior hotspot for bilateral larynx treatments C. to increase homogeneity for orthogonal fields in partial brain treatments . as a compensator fora single upper spinal field with a sloping surface E, to increase homogeneity in a3 field plan (anterior and 2 opposing laterals) A disadvantage of teating the prostate with lateral ares i: ‘A. port films to check beam position cannot be taken. B. dose uniformity across the volume is better with four fixed fields . conformal blocking cannot be used D. Setup and treatment take significantly tonger than with fixed fields A patient's skin dose is reduced in a megavoltage photon beam by: ‘A. adding 2 f cm Lucite blocking tray ‘B, reducing the beam energy CC. increasing the field size D. adding bolus none of the above Field matching techniques for total craniospinal irradiation include: 1, Couch rotation of approximately 5° to 10° on the whole brain, 2. Collimator rotation of approximately 5° wo 10° on the whole brain. 3. Shifting the junction between spine and brain fields. 4, Couch rotation of 5° to 10? on the spine field. A123 B13 C24 D.4only E.all of the above ‘A patient isto be treated on a cobalt-60 unit at 80 cm SSD to a depth of $ cm with a 10x 10 om field, The calculation is done for an 80 SSD treatment but toa depth of 6 cm. What is the magnitude of error in dose delivered ata depth of 5 cm when the time-on was used for a depth of 6 em? Ade B.2% C5% D.10% E.15% ‘Which ofthe following statements regarding penumbra is correct? ‘A. penumbra depends of source or focal spot size B. the penumbra decreases as the block-skin distance decreases, all other factors being equal C. all other things being equal, penumbra increases as the distance from the source increases D. in general, the sharpest penumbra will be achieved on an accelerator in the 4-6 MY x-ray range E.all ofthe above APHEX 1996 © Therapy Questions © Page 30719. 720. Tai. ‘The imtegral dose: 1, Should be maximized ina treatment plan, 2. Is least when beams using the shortest surface to isocenter distance are used. 3. 1s the most important factor to consider when choosing between treatment plans. 4. 1s generally greater for lower energy beams. A123 B.1,3 C.24 D, 4only Eallof the above ‘The dose rate ata patient's midplane is found to be 250 cGy/min at 100 cm SAD. A protocol requires that the dose rate be no more than 100 cGy/min. The patient must therefore be treated at. em to ‘midplane. A40 B.250 C.293 D, 158 E.160 Tissue compensating filters: 1. Eliminate the skin sparing effect, 2, Must be made of material having the same density as tissue. 3. Should be placed less than 15 em from the patients skin 4. Have advantages over the use of bolus in high energy radiation therapy. A123 B.1,3 C24 D.4 only E.allof the above RAPHEX 1996 © Therapy Questions © Page 31‘722-26. Match the treatment modality with its corresponding isodose curves. 1722, T21. 22. MV xrays A Cesium insertion Electron therapy Cobalt therapy 200KV x-rays A patient is to be treated on a superficial x-ray unit with a 6 cm diameter cone in contact with a4 cm diameter lead cutout. The data required to calculate the timer setting to deliver a given dose of 300 cGy are: 1, PDD tables. 2, The BSF for a 4 cm diameter field 3. The output in air forthe 6 cm cone. 4, The BSF fora 6 cin diameter field, Aland 4 B.1,2,3,4 C.1,2,3 D.1,3,4 E.2and3 ‘Two superficial x-ray therapy units both have 3 mm Al HVL. This means that one can assume: A. they have the sane KVp B. they have the sume kVp and mA C. if operated atthe same SSD, they will have approximately the same percent depth dose D. they are both single phase, half-wave rectified E. they have the same inherent + added filtration RAPHEX 1995 © Therapy Questions © Page 32730, TI. 732, For megavoltage treatment planning using CT images, which of te following islarenocessary? 1. A flat table insert 2, Markers, such as plastic caeters, over skin marks on the patient (e.g, triangulation poi 3. Patient in he treatment postion (supine vs. prone, etc.) 4, Treatment planning system with pixel-by-pixel heterogeneity correction, ) A123 B13 C24 D.4 only E.all ofthe above Regarding inhomogeneity corrections: 1. Build up and build down effects at ssue-lung interfaces are not generally accounted for in current ‘reatment planning systems, 2. 10cm of lung in a cobalt-60 beam will increase the dose beyond the lung by about 35%. 3. In a cobalt-60 beam the correction for dense bone is about the same percent per em as for lung, but in the opposite direction, 4, The corrections are more important in a 10 MV photon beam than ina cobalt-60 beam. A123 B.1,3 C24 D.4only E. all of the above ‘Consider the two radiation portals shown below which have equal dimensions, SSDs and energies. The shaded regions represent beam shaping blocks, 5 HVL thick, of equal area. Which of the following is true? ia ‘A. the dose at point ‘I’ is greater than the dose at point ‘2” B. both fields have the same equivalent square C. field ‘2° has a larger equivalent square than field ‘1" D. Aand C are correct E,mone of the above are true a 2 A 10x 10 cm field is treated at 80 cm SSD. The field size at a depth of 7 em is __ cm, A92x92 B.10x10 €.10.9x 109 D.1xil E121x 121 RAPHEX 1996 © Therapy Questions © Page 33733. 134, 13S. 736. 137. 738. ‘A patient is simulated at 80 cm SAD for treatment on a cobalt-60 machine, Iis then decided to treat the patient on a 100 cm SAD linac. Which of the following will be different? ‘A. field size at the isocenter as shown by the field edge wires onthe simulator film B. triangulation points CC. depth to isocenter D. collimator settings E, skin marks showing field edges ‘What isthe approximate range of a 6 MeV electron beam passing through 1 cm tissue overlying the lung (density 0.25 glem’)? A.Lom B.2an C.3cn D.9em Elem ‘You can obtain a readable port film for a 20 MeV electron beam head and neck treatment: ‘A. because there is enough penetration ofthe 20 MeV electrons through the patient to the film and only few monitor units are needed BB. same as answer A but the film must be let in forthe entre treatment CC. because there is enough bremsstrahlung production and only a few monitor units are needed 1. same as answer C but the film must be left in for the entire treatment , under no conditions All ofthe following are factors which prevent 3D treatment planning from being routinely used for radiotherapy, except: A. it requires a large investment of time to perform B, the cost of a 3D treatment planning system is high CC. acceptance testing the planning system is complex and time consuming . evaluation of and comparison between plans is complex E, 3D planning requires specialized beam data, which cannot easily be acquired with most commercial water tank systems ‘An electron cone has an output of 1.13 cGy/MU at daa. What is the MU setting to deliver 200 cGy to the 93% isodose level? A243 B.215 C. 190 D7 E,165 Lead eyeshields can be used when treating superficial lesions with electron beams, These shields are often, ‘coated with wax becaus ‘A. wax is less irritating tothe eye than lead B. wax reduces the bremsstrahlung production in the lead CC. wax reduces the scattered electron dose from the lead D. all ofthe above E.none of the above RAPHEX 1996 © Therapy Questions © Page 34739. 740, Tal. 742, 743, 744, Pd-108 is favored over I-125 for prostate implants in patients with a higher Gleason score due to pallai A. shorter half life B. superior dose distribution CC. longer time to deliver 90% of the total dose, D. all of the above In the treatment of superficial lesions, electrons have the following advantages over superficial x-rays: 1. No bolus is required 2. The dose to underlying bone is lower 3. The field can be easily shaped with a thin sheet of lead 4, The dose in the target volume is more homogeneous. A123 B.1,3 C24 D.4 only E.allof the above A cobalt-60 source has a certificate stating that the exposure rate at 1 meter is 120 R/min on Jan 15. Ifthe source is installed on June 15, the dose rate toa small mass of tissue in air at 80 em on that date is__ Gy/min, AISI B.85 c.10 D.170 E115 1-125 seeds are ordered for a prostate implant. The procedure is then delayed for one week, but the same seeds are implanted. The change in the actual dose delivered tothe prescription isodose is: A. 16% 3.8% C4% D.24% E08% ‘A cesium-137 source had an activity of 30 mg Ra eq in September 1989. What isthe activity in mCi in ‘March 1994? (The exposure rate constant of Cs-137 is 3.32 R.cm?/mCi.hr), AQT 3.59 cor D.74 E86 ‘The exposure rate 4 meters from a patient containing 60 mg-Ra eq, filtered with 0.5 mm Ptis about __ ‘mR, Consider the applicator to be a point source and thatthe patient absorbs about 30% of the radiation, Al B.2 C3 D.45 E16 RAPHEX 1996 © Therapy Questions © Page 35,745. 746. 747, 748, 149, ‘750, ‘An “anisotropy correction” is used in treatment planning to correct for: A. differential attenuation ofan electron bean by tissues of different densities B, the normalization of a treatment plan with multiple beams having more than one isocenter C. the decay of iridiuin-192 seeds during a temporary implant D. changes in the isodose pattem due to oblique incidence of photon beams E, increased absorption causing a reduction in dose rate along the axis ofan iodine-125 seed ‘The average life ofa radioisotope is: ‘A. used to calculate the total dose delivered by a permanent seed implant B. equal to 1.44 half-life C. used to calculate the dose rate mid-way through a temporary insertion 1D. also called the decay constant Eval of the above Compared to 1 mg radium, 1 mg Ra equivalent of cesium-137 has: ‘A. the same mass B. the same bal life C. the same activity D. the same dose rate at 1 cm E. the same number of atoms ‘The main advantage of stereo shift films over orthogonal films for localizing brachytherapy seeds i: A. itcan be easier to identify comresponding seeds B. stereo shift films are more forgiving of patient movement between films C. the x, y, z coordinates of each seed are calculated more accurately D. digitizing the seeds if much quicker aterson-Pasker tables can be used to calculate treatment times forall ofthe following except: ‘A. a radium tube mould B. a cesium-137 needle volume implant of the tongue C.aneedle implant without crossed ends _D. an implant with equal activity per cm around the periphery E, an iridium-192 breast implant with equal activity seeds in lines 1 em apart Cesium-137 sources used for implants have a similar isodose distribution to radium sources because: A. they have simitar half-lives B. they bave similar gamma energies . the inverse square law dominates the distribution D. the same activities can be used E. all ofthe above APHEX 1996 © Therapy Questions © Page 36TSI. 782. 753. TS4, 755. Regarding palladium-103 model 200 seeds and iodine-125 model 6711 seeds, which of the following is true? 1. Palladium has a half life about 3.5 times longer than iodine. average photon energy of Palladium makes it dificult to shield, 3, Palladium bas a significantly higher exposure rate constant 4. Both seeds exhibit significant anisotropy, which is generally accounted for in treatment plans by using ‘a dose rate averaged over al angles. A123 B13 C24 D.4only E.all of the above ‘The emissions from a strontium-90 source used in radiation therapy are: ‘A. alpha, beta and gamma B. gamma only C. alpha only D. beta only E. positrons, A radium source with its daughters, ‘Ais in wansient equilibrium B. is in secular equilibrium C. never achieves equilibrium ‘A brachytherapy treatment for carcinoma of the cervix is being delivered using shielded Fletcber style colpostats only. There is no tandem tube. The treatment planning computer, however, is unable to account forthe shielding in the calculations. The dose tothe bladder trigone and anterior wall of the rectum is approximately how much less than indicated by the computer? A. 75% 10 85% B, 55% 10 65% C. 35% t0 50% D. 15% 10 25% E less than 5% ‘Conventional low dase rate brachytherapy shows a clear advantage over external beam therapy in which of the following areas? 1. Radiation safety 2. Dose uniformity inthe target volume 3. Complexity of dose calculation 4, Dose to normal tissues A123 B13 C.2,4 D.4only E.allof the above APHEX 1996 © Therapy Questions © Page 37756. 157. 78, 159. ‘161. T62 “To achieve equal dose rates, a 20 MV linac that produces both 20 MV photons and 20 MeV electrons must ‘run at greatly increased beam current forthe x-ray mode, compared with the electron mode, because: A. bremsstrahlung production efficiency is <10% for high energy electrons B, most photons are produced at large angles C. the patient dose per incident electron is much les than the dose per incident photon. _D, most photons are absorbed in the lattening filter E, most photons are self absorbed in the target Bending magnets are required in linear accelerators for energies greater than 6 MV because: ‘A. the length of the accelerator cavity is too long for it to be mounted in the direction of the beam axis B. higher beam currents are required at higher energies C. bending magnets are needed to select the correct energy D. bending magnets are required to boost the electron energy ‘According to NRC regulations, a cobalt-60 unit used for patient treatment must have all ofthe following except: ‘A. the unit must be equipped witha door interlock B. the technologist must be in visual contact with the patient a all times CC. the unit must be equipped with a record and verify system . the attending physician must have a license for application of radioactive materials E. the output must have been calibrated within the lst year According to NRC Part 35, if the therapy dose delivered difers by more than 10% from the final prescription, all of the following must be reported to the NRC (Nuclear Regulatory Commission) except radiation dose from: ‘A.a brachytherapy souroe B. a cobalt-60 source C. linear accelerator D. aradiopharmaceutical therapy dose E. none of the above since the regulation is for a 50% difference from the prescription ‘The photon beam energy at which neutron contamination of the beam and neutron dose to personnel must be considered is__ MeV. A. below 2 B4 C6 D8 E above 10 Polyethylene is sometimes found on entrance doors to high energy accelerators in order to: ‘A. absorb low energy photons BB, make the door lighter CC. absorb high energy neutrons D. scatter and thermalize high energy neutrons ‘Therapeutic proton beans operate in the _ MeV range: A.0.25 B.25 c.25 D.250 E2500 APHEX 1996 © Therapy Questions © Page 38763. 765. 167. ‘168-70, During QA tests on linaes, bean symmetry and flamess can be checked using several different methods However, the baseline data measured during acceptance testing ofthe new linac must be measured with: A. film exposed parallel to the beam axis and evaluated using a scanning densitometer B. an array of diodes providing a real-time display of the dose profile CC. a small volume ion chamber scanned across a water tank D. a calibrated thimble chamber with a build-up cap exposed in air at 1 cm intervals across the beam at the level of te isoventer ‘The AAPM's report on quality assurance published in 1994 lists QYA tests to be performed at what frequencies? 1. Daily 2. Weekly 3. Monthly 4, Annually A134 B12 C34 D.4 only E.all ofthe above ‘The annual calibration of output and safety checks on a Co-60 unit must be performed ‘A.asuitably tained technician, under the supervision of the teletherapy physicist B, any physicist employed at the institution C. only a Board Certified physicist with more than 6 yrs experience inthe field of radiotherapy D. the teletherapy physicist named on the license E, a qualified engineer provided by the manufacturer ‘An accelerator has an unsealed chamber inthe head to control the monitor units delivered, The chamber is calibrated at STP (22 degrees C and 760 mam Hg) Ifthe temperature/pressure Sensor in the head, which is used to correct the chamber readings, breaks what effect will dhis have on patient dose, if the ambient ‘conditions are 750 mm Hg and 25 deg C? A.03% overdose B. 0.3% underdose C. 24% overdose D. 2.4% underdose E, none ofthe above Leakage for cobal-60 in the “off” position is: A.1R/hrat 1 meter B. 5 mR in any one hour C.0.1% primary beam intensity at 1 meter D. average 2 mR/br at 1 meter E. 100 mR in any one hour jon for 6 MV x-rays with the type of collimator: RAPHEX 1996 © Therapy Questions © Page 3910. T™. 773. 774, 775, ‘Maltileaf collimator Adjustable collimators Tem cerrobend blocks ‘The contrast of an 8 MV x-ray port film is optimized by: ‘A. using ready-pack therapy verification film without a cassette B. using a hard cassette with thin lead screens C. using a hard cassette with ready-pack therapy verficaion film, . using a high ratio grid cassette clean up scatter ‘A diode can be used for all ofthe following except: A. daily output checks of linacs as part of a QA program BB, measurements of bladder and rectal dose inpatients with gynecological applicators CC measurements of in vive doses during treatment with an appropriate build-up cap D, calibration of the output of a linac E, asa probe ina scanning water phantom dosimetry system, where spatial resolution is important Asiever is: A. 100 ergs per gram B. the ST unit of dose equivalent C. dose/RBE D. the ST unit of exposure ‘A patient is treated with tangential breast fields. The approximate % of the prescribed dose received by the patient's ovaries, 20 cm inferior to the treatment field edge is: A. 0.005% B. 005% 6.05% D.5% 10% A series of dosimeters are irradiated in water with Co-60 and then with SMV x-rays. In both cases the. dose to the water at the position of the dosimeter was 1 Gy. For which dosimeter will the readings for the wo energies differ the least? AA. ionization chamber (air cavity) B. diode (silicon) C. fil (silver halide) D.TLD ir) RAPHEX 1996 © Therapy Questions © Page 40‘7716-78. The following three questions about room shielding refer tothe diagram below of a 25 MV linear accelerator room. MG. 1I]KMI 5 ® N MN Wwy«wé«CiYLQW«W Yi T76. ‘The door must be designed to shield for: 1. Scattered radiation 2, Neutron radiation 3. Leakage radiation 4, Primary radiation A123 B13 C24 D. 4only E. all ofthe above T77. The use factor for leakage radiation on wall A would be: ANG B14 cin D.34 El T78. If two nurses oocupy the nurses’ station, which is part of the controlled area, the occupancy factor would be: A.1N6 B14 cn DL E2 APHEX 1996 © Therapy Questions © Page 41779. 780, TR. 183, ‘The floor marse taking care of a cesium-137 brachytherapy patient is concemed about precautions to take to reduce staff exposure. She asks which would be more effective: 1, Cutting time spent with the patient in half 2. Doubling the distance from the patient 3. Wearing a lead apron Al B.2 C3 D. 1or2, as hey are equally effective E.1, 2, or3 areequaly effective ‘TLD ring badges are worn in addition to film badge for brachytherapy procedures because: A. the film badge cannot discriminate between different types and energies of radiation B. the MPD for the hands is higher than forthe whole body and requires a separate measurement CC. the rng badge is simply a back-up for ike film badge in case the film is damaged during processing D. TLD is uniquely sensitive to the particles emitted from brachytherapy sources E. the skin ofthe hands has a lower MPD than the whole body NCRP Report 116 (1993) sets an annual dose limit of ‘general public. A. Ol mSy B, .1mSv C.LOmSy D.5.0mSv F, 100 mSv for infrequent exposure to members of the ‘The NRC requires that sealed radioactive sources be leak-tested: A. nitially (when received) B. initially hen monthly CC. intially then every 6 months, D. initially then annually E annually {fa standard 0.5 mm Pb apron were used to cover the gonads of a patient receiving cobal-60 teletherapy to the pelvic area, the result would be: AA. gonadal dose is significantly reduced B. genetic dose is significantly reduced C. risk of sterility is significantly reduced D. skin sparing is lost E, depth dose improves due to a deerease in scatter ‘When the aperture of a custom electron cutout is equal o or less than the approximate range of the electrons in wate, all ofthe following occur except: Adj Sifts a shallower depth B. the output is significantly reduced . the surface dose decreases D. the PDD decreases at depths beyond Jue RAPHEX 1996 © Therapy Questions © Page 42TES. 786, 787. 788, 789, ‘The advantages of "beamns-eye-view" treatment planning are generally considered to be: 1. Easier selection of optimum couch and gantry angles 2. Automated tumor volume contouring 3. Computer assisted block design 4. Computerized optimization of beam weights A123 B.1,3 C24 D.4only E.allof the above Regarding multileaf collimators (MLC), which of the following isare true? 1. ‘The convenience of using a MLC outweighs the negative aspect of possible loss of edge definition due to stepping, 2. The leaf width can vary between manufactures, but most commonly projects to 0.5 cm at the isccenter. “Island” blocking can be achieved using multiple fields atthe same gantry angle, 4. Fora single “en face” fel, stepping at an MLC defined edge is most dramatic atthe 80% isodose (normalized to the beam axis atthe same depth) and less obvious atthe 50% and 20% levels. A123 B13 C24 D.4only E.all of the above ‘Advantages of cerrobend blocks, compared to a multileaf collimator (MLLC) include: 1, Sharper geometric penumbra, due to larger source-tray distance 2..No leakage through adjacent leaves as with the MLC 3. Can be made for any arbitrary field shape 4, Block edges exactly match beam divergence A123 B.1,3 C24 D.4only E.all ofthe above Tn measuring beam profiles for small x-ray beams, which of the following is the detector with the best spatial resolution? A.diodes B. film C. ionization chambers with detector dimensions equal to or greater than 2mm, D. none of the above Regarding treaiment planning for stereotactic radiosurgery ofthe brain, which statement isnot true? A. CT imaging generally exhibits less geometrical distortion than MRI B. MRIs better than CT for imaging brain lesions C. both CT and MRI provide electron density information needed to make inhomogeneity comections in the treatment plan D. CT and MRI can be used together to provide optimal tumor localization APHEX 1996 © Therapy Questions © Page 43TL. 792, 193. ‘The advantages of dynamic stereotactic radiosurgery (ie simultaneous movement of gantry and couch ‘during reatment) include: 1. less overlap between entrance and exit doses 2. better flexibility in optimizing the shape ofthe target volume 3. nearly equal penumbra in all planes 4, sharper penumbras in all planes A123 BA, C24 D.4 only E. all ofthe above ‘Which ofthe following would render a linear accelerator unsuitable for stereotactic radiosurgery? A. dual independent jaws B. fixed beam stopper C. lack of digital readouts D. multileaf collimator In stereotactic radiosurgery in common practice, very iregularly shaped lesions are covered using: A. mulilea collimators B. regularly shaped blocks C. wedges D. multiple isocenters Regarding radiation safety with an Ir-192 high dose rate afterloader: ‘A. the patient should be surveyed before the procedure to establish normal background, B. nursing staff can stay wit the patient during treatment, . if the control console indicates that the source has returned to the safe postion, a patient survey is not necessary D. the in-room radiation monitor needs to be tested at monthly intervals, ‘The universal wedge and dynamic wedge used on linacs are designed to simplify treatment. Which ofthe following techniques could use the universal wedge, but not the dynamic wedge? ‘A. ascs with wedges B. asymmetric jaws with wedges C. wedged tangential breast fields D. using a wedge as a compensator RAPHEX 1986 © Therapy Questions © Page 44