RADIOLOGICAL PHYSICS Published for: RAMPS (Radiological and Medical Physics Society of New York)Errata Raphex 2006 Examination Booklet 1. On page 31, question D86, omit “per minute (epm)” at the end of the first line, 2. On page 6, question G39, change response D, “Radon-226" to “Radon-222" Answer Booklet 1, On page 2, answer G23: B is also not true 2. On page S, angwer G60: In general, the probability of photoelectric interactions is proportional to Z°, However, hydrogen is unlike other elements in the ratio of Z to A, which is 1:1. instead of approx 1:2 for other elements, Thus. io demonstrate the Z° rule, a different element should be used as an example 3. On page 10, answer DI4: D and B are both correct. 17, the answer for D63 should be B, not C. C would be correct if the answer stated% Preface + RAPHEX 2006 was prepared by members of the Radiological and Medical Physics Society of New York (RAMPS, Ine), the New York chapter of the American Association of Physicists in Medicine (AAPM). Contributors to this exam were General: Eugene Lief, Ph.D, Editor Wendel Lutz, Ph.D, Reviewer Susan Brownie, M.Se,, Reviewer Diagnostic: Adel Mustafa, Ph.D., Editor John Humm, Ph.D., Reviewer Steven Balter, Ph.D., Reviewer Lawrence Rothenburg, Ph.D., Reviewer Maynard High, Ph.D., Reviewer ‘Additional contributions b Pat Zanzanico, Ph.D, Therapy: Susan Brownie, MSc,, Editor Howard Amols, Ph.D,, Reviewer Ifyou are taking RAPHEX under exam conditions, your procior will give you instructions. You have 3 HOURS to complete both sections: the GENERAL section, and your SPECIALTY section, 4 Nom-programmable cateulators 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 cominicots or corrections are appreciated and should be sent to: Susan Brownie, Me. Maimonides Cancer Genter Radiation Oncology Departmen 6300 8th Avenue Brooklyn, NY 11220 E-mail: sbrownie@maimonidesmed org Copyright © 2006 by RAMPS, Ine. the New York chapter of the APM. All rights reserved. No part ‘of this book may be used or reproduced in any manner whatsoever without wrilien 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 + SO In all matching questions, the same answer may be used multiple times or not at all, GI. G4, 5-7, Match the quality factor (Q) of radiation weighting factor (W,) used for sof tissue in radiation Protection withthe type of radiation. GI. 1.25 MeV gammas G2. 200 keV x-rays G3. 200 keV neutrons A, 20 B c Dd E rma is the: A. Energy per unit mass absorbed or retained along the path of a charged particle. B. Energy per unit mass transferred from charged particles, C. Energy per unit mass transferred from photons to charged particles. D. Charge released by photons as they pass through a specified amount of ait Match radiation quantities and their descriptions. GS. Radiation exposure G6. Radiation dose G7. Quality factor of radiation A. Is dimensionless. BB. Is defined only for radiation beams of charged particles. C. Is measured in Gray in the SI system D. Is defined by the total charge released in a unit mass of ar. E, Is defined for high-energy photons only. In dose measurements using an ion chamber, have been obtained at the standard tempet A. 32°C, 760 mm Hg. B. 22°C, 760 mm He. C. 0° K, 760 mm Hg. D. 273.2 K, 760 mm Hg, E. 20°C, 760 mm Hg. 1 reading is corrected to the ren and pressure of: ing that would Raphex 2006 'General + Questions @ co. Which of the following particles is not an elementary particle? Alpha-particle. Beta-particle. Proton. Neutron, Muon. room Tracks of high-energy electrons in a magnetic field have different curvature because of differences in: Charge Rest mass. Spin. Energy Speed. mooeD> G11. The antiparticle for a positron is a(n) Proton. Electron, Photon, Neutron. Neutrino, MOND G12. The eneray equivalent rest mass of an electron is: A. O81 Mew B. 1.02 Mev, C. OSI Mew. D. 1.02 keV, E, O51 keV, GI3-17. Match the charge carried by each of the following: (Answers may be used more than once) G13. Alpha particle G14. Neutron GIS. Electron G16. Positron G17. Photon AH B42 Ct Do E+ 2 Raphex 2006GiB. Gia. G20. G21. G22. 623. General + Questions + Which of the following statements about isotopes is true? ‘A. All elements have several stable isotopes, B. Isotopes of the same element can be distinguished by the different charges of their ue C. Only one isotope per element can be found in natur D. The clecisic charge of the isotope’s nucleus determi E. Al isotopes of the same element have the same ator All other isotopes are man-made. which element iis ass, The number of electrons in a neutral atom equals the ‘Mass number, Atomic weight. ‘Atomic number. Nocieon number, ‘Valence number. mpap> A neutral atom has 6 electrons and a mass number of 13. The number of neutrons in the nucleus is AB Bo a7 D. 19 E. None of the above The diameter of an atom ‘A. Ineteases in proportion to the square root of Z, B. Increases in proportion to Z. C. Decreases in prapartion t0 Z. D. Remains of the same order of magnitude regardless of Z. E, Changes erratically with Z. The hydrogen atom has an ionization potential of 13.4 eV. I bombarded with 7 eV photons. ‘The mininvum number af photons needed to ionize the atom is: Al D3 E. None of the above. Which of the following és wot trac? The electron binding energy, A. Decreases with increasing distance from the nucieus B. Decreases with increasing nuclear charge. C. Isa few elec the outer electrons of an atom, D._ Must be overcome if ionization is to take place, E. Does not change with increasing nuclear charge, Raphex 2006 3General % Questions? G14. G25. G26. G27. G28. Atomic shells with the principal quantum number AL 5 Prd. 2, 3... are traditionally roferred to as: A source has a halflife of 12 hrs and an initial activity of 10 mCi, After 6 hours its activity will be mCi 38 85 11 35 25 Pomp Activity can be expressed as; AN/At 0.698772 0.69570 14a 3 a moom> ‘After 10 half-lives, the fraction of activity remaining in a souree is AL (UO Bo 10 C. Dependem on the initial activity D. (aye E 9/10 If a radionuclide decays a1 1% per hour, about how long will it take to decay to one-half its original activity? 11 hours 34 hours 51 hours 69 hours 92 hours moopp Raphex 2006General + Questions + —. G29. G30, G3i. 32-35, 636, ‘A new isotope Cs-131 with a halflife of approximately 10 days can be used for permanent implants. Ifthe activity of a calibration seed is 1.000 mCi on a given day and time, the activity 24 hours prior to this time is__mCi, A. 0.900 B. 0933, Cc 1.072 D. 1100 E1148 Ifthe halflife of a radionuclide is 74 days, the decay constant i. A. 3.7 days B. 37 days C. 106.8 days D. 0.0094 per day E. 0.027 per day Which of the following particles can be emitted as the ony fragment in radioactive decay? A. Alpho-paricle, B. Beta-particle, ©. Positron. D. Neutron. E, There are no such particles Match the process with the description, G32, Fleetron capture G33._ Internal conversion G34. Annihilation radiation G3S._ Pair production A. A positton and an electron are created from a photon of energy greater than 1,022 MeV. B, Electron + proton — neutron + neutrino. C. An electron and a characteristic x-ray are emitted. D. A positron and an electron combine to produce two 0.511 MeV photons ‘The energy of the most prevalent gamma rays emitted by e131 is kev, A. 2t B. 28 © 110 D. 364 E 662 Raphex 2006 .General + Questions G37. ‘When a nuclide is bombarded with protons in a cyclotron, the resulting radioisotope is most likely to decay by: ‘AL Alpha d Gia. G39, Gao. Gal. a2, B. Beta minus decay, C. Beta plus decay. D. Isomerie transition C137 is ‘A. Created by bombarding Cs-138 with neutrons. B. Created in a cyclotron by bombarding a nuclide with deuterons. C. A fission product, which is obtained from used reactor fuel rods. D. A naturally occurring radioisotope found in uranium ore, Which of the followi ‘A. Uranium-235, B. Potassium-a0, C. Carbon-14. D. Radon-226. E. Fluorine-18. not a naturally occurring radionuclide? Which kind of radioactive equilibrium can eceur when 2 very long-lived radionuclide decays te BL Secular. C. Transient D. Non-stable. E, Temporary. ‘The activity of a new 10.Ci tr-192 source for a high-dose becquerels. A. 2.7x10" Bq B. 27x10" Bq C. 32x10" Bq D. 37x10" Bg E, None of the above remote afterloader is equal to ‘A radiation worker standing for 3 hours at 1 meter ftom a 5 mCi radioactive source, for which Roem*/mCi-hr, will be exposed to about ___ mi. A. 06 Bod C3 D. 30 FE. 300 Raphex 2006General Questions + Gas. G44, Gas. Gas. 47-49, Af the physical half-life of an isotope, T,, is much smaller than the biological half-life, Ty, then the effective half-life, Tes. approximately equals AT; BT C +t ya Dn" E 1447, Which of the following does mot improve the heat capacity of an x-ray tube? ‘A. Rotating anode. B, Small target angle. C. Large focal spot D. Thermionic emission, E. None of the above. Two filaments are found in some x-ray tubes. The purpose is to ‘A. Function as a spare in case one filament burns out B, Produce higher tube currents by using both filaments simultaneously. ©. Double the number of heat units thatthe target can accept D. Enble the sniattest focal spot to be used, consistent with the kVp-mA setting. ‘The characteristic x-rays emitted from a tungsten target when 100 keV electrons are fired atit Ay Have a continuous spectrum of energies up to 100 kN. Are about equal in intensity to the bremsstrahlung, C. Hove energies equal to differences in the electron binding energies of tungsten. D. Do not contribute to the imaging process. None of the above A target material has the following binding energies: K=300kV = L=40keV 0 Ma TeV 1£.40.0 keV electrons arc fired at the target, what kind of x-rays can have the following energies? G47. 34 keV G48. 26 keV G49. 40.7 kev A, Characteristic only B. Bremsstrahlung only C. Both A and B D. Neither A nor B Raphex 2006 7General + Questions + ~ G50. csr. 52. G53. G54, G55, ‘The effective energy of an x-ray beam. ‘A. Linearly increases with the atomie namber. B. Is proportional to the mAs. C. [snot affected by added filtration, D. Is equal to the Vp. E, Affects subject contrast ‘The quality of an x-ray beam cannot be characterized only in terms of the peak KV, because ‘beams with the same kVp may have different: ‘A. Inherent filtration, B. Added filtration, C. Half-value layers D. Target materials. E. All of the above. ‘The second half-value layer (HVL) of @ photon beam is approximately the same as the first HVL: A. For all x-ray tube generated photon beams. B. Only ifthe energy is below 100 kVp. C. Only ifthe beam is monoenergetic (eg., gamma rays). D. Never: itis always less. Which of the following is the electromagnetic radiation with the highest frequency? ‘AL Infrared. B. Gamma. C. Radio waves. D. Ultrasound, . Ultraviolet. ‘Which of the following is not ionizing radiation? ‘A. 2 Miz ultrasound, B. Co-60 gamma C. $190 betas D._ 15 MeV photons. E. Auger electrons fiom heavy atoms. Which of the following best describes the difference between an x-ray and a gamma ray? Enemy, Velocity Field ronE> gin. All of the above. — Raphex 2006General + Questions + ——— LS * G56. G57, Gse. G59. S60, él. ‘Which of the following can produce ionization? ‘A. Mechanical impact ofa flying bullet. B. Microwave radiation. C. Heat radiation, D. Auger electrons. E. Ultrasound. Photon energy wavelength. A. Is directly proportional to B. Js inversely proportional to . Does not depend on D. Increases (but not proportionally) with E, Decreases (but not proportionally) with ‘The mass attenuation coefficients for most materials (except hydrogen) are similar When ____ interactions predominate, ‘A. Photoelectric B. Compton . Pair production D. Phoronuciear disintegration A monoenengetic photon beam whose linear attenuation coefficient is 0.0693 em! traverses 10 em of'a medium. The fraction of the beam transmitted is A. 00) B. 037 c. 080 D. 0.69 E. 0.90 Oxygen (2-8, A=16) Photon as hydrogen (1, i), ‘A. 8 times more B. 8 times less C. $12 times more D. E, likely to undergo a photoelectric interaction withthe same 512 times less Equally ‘The maximum number of photoctectrons produced in a photoelectric interaction by a single Photon with incident energy of 150 keV is AL BS © 10 D. Any number, as long as the sum of individual electron energies is equal to 150 keV, E. None of the above. SO Raphex 2006 9General + Questions % 62-63, G64, Ges, 66. G67. Match the following properties of Compton scattering G62. The maximum energy ofa photon seattered at 90° G63. The maximum energy of a photon seattered at 180" A. Equal tothe energy of the incident photon. B. 256 ke, C. Si kev, D. E The incident energy ~ 256 keV. The incident energy ~ 51 keV. ‘The most probable interaction in soft tissue for @ 1.022 MeV photon is. ‘A. Coherent scatter. B. Photoelectric CC. Compton scat. D. Pair production, Photonuclear disintegration Which of the following is nor true regarding pair production? ‘A. The threshold photon energy is 0.511 MeV. B. An electron and a positron are produced in the interaction of a photon with a nucleus. . The positron annibifates with an electcon producing two 0.511 MeV photons. D. The probability of pair production inereases with the incident photon energy. Which imaging modality would allow one to distinguish an artificial diamond made of Zirconium oxide ZO, (zirconium has atomic number 40) from a natural one made of carbon ‘ators (atomie number 6)? A. Ultrasound. B. Diagnostic x-rays. C. MRI. D. PET. E. None of the above. Which parameter(s) change as a result of coherent scatter of a photon from an atom? A. Wavelength. C. Direction of travel. 1D. Electron configuration of the atom E, Alll of the above, Raphex 2006General % Questions i * G68. Gos. 670-74. G75. G76, All of the following reduce resolution in positron emission tomography (PET) excepr: A. Large size of the detector. B, Range of positrons in tissuc. C. Organ motion during the scan, D,_ Size of the focal spot. CT or Hounsfield numbers are linearly related to: Mass density. Electron density. Linear attenuation coefficient. ‘Mass absorption coe ficient, Effective atomie number, moom> Match the most appropriate interoction to the description: (Answers can be used more than once} G70. Is the most probable interaction in soft tissue of @ 50 keV photon, G71. Does not change the photon energy. G72. Probability ofthe intersction, per unit mass, is proportional to Z. G73. Occurs as a result of the interaetion of high-energy photons with heavy nuclei, G74, Probability of the interaction is proportional to E" A. Coherent scatter. B. Photoclectric C. Compton. D. Pair production, For which of the following particles can one observe a Bragg peak in the depth-dose curve? A. Electrons. B, Protons, C. Positrons, D. Neutrons. E, Photons. An electron, a proton, and following statements is true’ A. The alpha panicle travels at almost the speed of light B. The alphs particle has the least total relativistic energy (ic. kinetic plus nest mass energy) C. The proton has the highest total relativistic encrey. 1D, The eleetron travels almost at the speed of tight. E, None of the above. ph particle each have 20 MeV kinetic energy. Which of the Raphex 2006 itGeneral + Questions +” G77. G78. G79. 80-84, Gas, Which of the following particles transforms itself during beta-minus decay? D. Neutron, E, Neutrino, Which of the following statements is truc? A neutron A. Does not exist as a free particle B. Can be accelerated by a linac. C. Demonstrates 2 Brage peak D. Is best shielded by high-Z materials. E. Hasa mass appraxiniately equal to the proton mass. To achieve a standard deviation of 29%, counts must be collected, A. 400 B. 1414 Cc. 2500 D. 10,000 E. 40,000 ‘Match the approximate maximum capacity with the Following storage devices (as of the beginning of 2006) G80, CD. GBI. G82. G83. Flash drive connecting to USB port |. External hard drives A B. c D. Gi 14 MB 700 MB, 19GB 47GB 1.078 According to NCRP Report 93, the average annual dose fram man-made and natural radiation in the United States is 360 mrem, Tite largest contributor to this Radon and its danght Nuclear weapons testing. Medical x-rays, ). Natural radiation sources exeluding radon, Nuclear medicine, Raphex 2006General * Questions % ee RS G86, Based on the ICRP 60 (1990) and BEIR V (1990) reports, what whole-body dose delivered toa large group of people would result in the death of SOG of the group within 60 days, without medical intervention? ‘A. 1000 cGy. B. 700 cGy. C, 450 Gy. DB. 150eGy. E, 50cGy, 87-91. Match the following questions with the radiation doses listed below: G87. ‘The average annual natural background radiation, exeluding radon, in the United States, G88. The monthly recommended maximum dose to the embryo-fetus of a “declared” presnant radiation worker, per NCRP Report 116, G89, The annual recommended maximum dose for ffequent or continuous exposure io mem- bets of the general public. G90. The annual recommended maximum dose for infrequent exposure to members of the general public. G91. The annual recommended maximum dase to the whole body of a radiation therapy resi- dent performing brachytherapy. A, 5000 mrem (50 mSv) B. 500 mrem (S mSv) €. 100 mrem (1 mSv) D. 50 mrem (0.5 mSv) E. 10 mrem (0.1 mSv) G92. A shielding design for a diagnostic or therapy installation (such as a Cyberknife), when there is no restriction on the beam direction, must A. Consider afl walls as primary barriers. B, Assign all walls a use factor (U) of 1. C. Assign all areas adjacent to the installation an occupancy factor (T) of 1. D. Shield all areas o a radiation level of 100 mem por week. E_ Shicld such that adjcent areas will nor receive insiantancous dose rates greater than 2 mar. G93, Which of the following detectors would be the best one to locate a dropped I-125 seed? A. Gas ionization type survey meter B. Thermolumineseent dosimeter, . Airequivalent wall “thimble” ionization chamber. D. Film badge. E. Geiger counter. _ SS Raphex 2005 13General + Questions + G94. Which of the following is true for low-level radioactive wastes, such as tubing and swabs contaminated with Te-99m? ‘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. ©. They can only be disposed of by a commercial rad-waste service. D. They can be stored until reaching background levels and then disposed of with other medical trash, E, None of the above. G95. After installation ofa chest x-ray unit, which agency regulates its operation? ‘A. NRC. B. OSHA. C. HICEA. D. State Department of Health, E, None ofthe above. 14 Raphex 2006Diagnostic Questions * SS Di. List the following types of x-ray equipment in order of increasing focal spot size. ‘A. CT, mammography, angiography, chest unt B, Mammography, angiography, chest unit, CT. . Angiography, CT, chest unit, mammography. D. Mammography, CT, chest unit, angiography. E. Chest uni, mammography, angiography, CT. D2. —_List the following types of x-ray equipment in order of increasing beam half-value layer. A. CT, mammography, barium fluoroscopy, skeletal radiography. B. Mammography, skeletal radiography, CT, barium fluoroscopy C. Barium fluoroscopy, mammography, skeletal radiography, CT. D. Skeletal radiography, barium fluoroscopy, CT, mammography. E. Mammography, skeletal radiography, barium fiuoroscopy, CT. D3. Which of the following types of blur will be the greatest in an image taken with the following Parameters: a target-image receptor distance of 100 cm, a measured focal spot size of 0.6 mm, A target to object distance of 75 em, and an exposure time leading to object motion of 0.3 mm? Assume image receptor blurring of 0.3 mm, A. Penumbra (geometric blur) B. Motion blur D4, An anti-scatter grid has $0 grid lines/cm and a height of 1.8 mm. The width of the lead strips in the grid is 0.05 mm. What is the grid ratio? A. 6:1 B. 8:1 C. 10:1 Ds. Compared with other types of x-ray generators, high-frequency generators are used commonly for digital angiography because, among other reasons, they: ‘A. Produce higher frequency x-ray radiation. B. Do not require the use ofa high-voliage transformer C. Provide a constant potential with no need for voltage rectification D. Allow exposures down to one millisecond with excellent repeatability. E. Allow very high tube current with single-phase voltage room supply. Raphex 2006 15Diagnostic Questions * Ds. DI-I1. DI2-15, In x-ray tubes, off-focus radiation ‘A. Results from some tube electrons scattering from the focal spot and reaching the image receptor, B, Is low-energy bremsstrahlung radiation from the non-target part of the anode. . Will not make up more than 1% of the tube ouput. D, Has no effect on image quality E, Makes no contribution to patient dose. Jn the figure below comparing three x-ray tube spectra from the same target material, answer A for True and B for False. Sa ~, Kg “ kVp fo oo ae en Photon energy (keV) D7. Curve A isa hypothetical, pure x-ray spectrum produced atienuation or fikration. DS, Curve C represents a more penetrating x-ray beam than beam B, D9. ‘The maximum energy in curve B is about 33 keV, DIO. The energy of characteristic x-rays in curve C is higher than that in curve B, DI. ‘The target material for the three spectra could be molybdenum, the target surface without Concerning image quality in sersen-film radiography, select the answer (AE) that is most closely associated with the question (Answers may be used more than once). ‘A. Decreasing the grid tio. B. Decreasing the kVp. C. ncreasing the developer temperature D. Increasing the foca! spot size. E. Increasing x-ray beam filtration. DI2. Will increase the receptor contrast of the DI3_ Will increase subject contrast in a screen-film imaging DIA. Is most likely to increase available exposure time at DIS. Will increase the radiation half-value layer. 16 Raphex 2006Diagnostic + Questions < -—eoOoooooo ees 16-20, bai p22. p23. Concerning fim processing, select the answer ( following processing techniques. ‘A. Daylight processing B, Extended processing C._ Rapid processing. D. Dry processing, E. Laser eamera processing, that is most likely associated with the Di6, No longer popular due to the introduction of higher sensitivity film-sereen mammogra- phy systems. DI7._ Compared to “normal” processing, it requires inerensing the developer concentration, the developer temperature or bath, DIS. Produces a lotent image on film, which may be processed in a standard wet chemistry film processos. DI9. Uses a mechanical system connected to a film processor, and automatically loads and unloads the sercen-film system, 20. Thermal sensitization by a laser beam causes adhesion of the emulsion carbon grains to the polyester film base producing density on the film, For a fixed mAs and kVp, inereasing the exposure time will significantly affect the A. Overall film density. B. Overall film latitude. C. Speed of filmsereen combination, D. Motion unsharpness. E, Patient exposure. A majot limitation of many early ful-ficld di A. Focal spot size, B. Detector size. C. Resolution capability. D._ Lack of compression capabi E. Limited angulation, J maramography units is the The breast cancer serecning technique that is considered as usefal es seree digital mammography is A. Ubtrasound, B. Diaphanography, C. Sestamibi Scintigraphy. D. MRL E. None of the above lm or full-field Raphex 2006 7Diagnostic + Questions? © p24. 2s. D2. p27. 2s. In mammography, what would an SMPTE pattern be used for? Viewbox QC. Evaluation of system resolution. Evaluation of focal spot size. QC of laser image printer and display monitor, Film processor QC, moose fall ofthe following mammography techniques result in the same OD (~1.8) for a certain breast thickness, which is the preferred technique? 24kVp.5s 26KVp.3 5 28 kVp. 155 31 kVp, 0.8 s 34 kVp, 045 mone MQSA-requited mammography sereen-film system resolution is 11 Ip‘mm, The typieal system resolution for FFDM (Fuli Field Digital Mammography) is Ip/mm, A. 25 B20 cs Dou ES Which of the following is nar true about the sweraye glandular dose (AGD) for stereotactic breast biopsy (SBB)? ‘A. MQSA limits the SBB AGD to 3 mGy for an average breast. The ACR SBB accreditation program recommends <3 mGy for an average breast Some siates limit the SBB AGD to 3 mGy for an average breast. The SBB AGD is calculated in the same way as for whole breast mammography. There is no limit on the SBB AGD for a thick, dense breast, poop “When an image intensifier is zoomed from the !2-in, mode to the 5-in. mode: ‘The system spatial resolution increases. The patient's skin dose increases. The patients eilective dose increases. A, Band C are true, A/and B are true, npn Raphex 2006Diagnostic Questions & -_- D29. Which one of the following provides the best estimate of tke maximum skin dose ‘delivered during an interventional procedure? ‘A. The displayed dose at the interventional reference poim B. The displayed KERMA area product (KAP). C. The total fluoroscopic time used for the cas D. The total number of DSA frames used for the case, E, All of the above provide equally good estimates of total skin dose. 30. Regarding flat-panel detectors (FPD), which ofthe following is Trre? A. Digital storage requirements for individual images are alway’ greater than those required for images from an image intensifier. ih. tages re dated w Uc diated eset panel esi C. The intrinsic radiation sensitivity is similar to that of an image intensifier. D. The limiting spatial resolution changes with 200m made in a manner that is similar to tha ofan tage ntnaifer E, Only systems with flat-panel detectors are compliant with international fluoroscopic safety standards. D3I. ‘The interventional reference point [defined by the international electro technical commission (IEC) is located. ‘A. AL ihe errno the image intensifier At Sm fom the soured te nage esepioe © Atte were D. AUS cm from the isocemer toward the x-ray tube, E Attic parte! teeny be a2, Using ucotcope with auaraniedose-ie contro Which ci of ie flowing confgraions wil result nthe great skin dover fo the pan? tmege receptor oO S$ Patient @o OO Xvaytube oY 8 A B Cc BD Ee b33. Jn cardiac catheter procedures, all of the following changes would reduce the patient's dose aa A. Reducing the frame rate. B. Increasing the f number of the lens C. increasing the aperture dian D. Increasing the conversion gain ofthe nage intensifier E. Increasing the source-to-image receptor distance (SID). Raphex 2006 0Diagnostic + Questions + 34. 35, 36. 37. pss. ‘The fluoroscopic operating factors displayed on a monitor are 120 kVp and 10 mA. Which of the following is true? A. The skin entrance dose is unusually low. B. The five-minute timer is broken, C. The skin entrance dose is extremely high. D. The display must be wrong E, The anti-scatter grid is not in the bea. ‘The maximum vertical resolution in Ip'mm for a 23-em input diameter image intensifier coupled to a 1024 line TY system is os Poop A°64-slice” CT scanner can obtain sixty-four 0.625-mm wide slices ina single 0.5-second axial acquisition. How many $-mm wide slices ean it obtain in a single 1.0-second axial acquisition? A. 8 B 6 C3 D. 64 E128 Jn order to estimate the effeetive dose in mSv fro needed? ‘A. CTDlu (mGy) at the surface (periphery) of the patient, B. CTDIjuy ¢mGy) on the axis of the patient CC. A dose-length product to effective dose conversion factor for the body part imaged D. The length (cm) of the CT sean study. E, The patient's weight, CT exam, which of the following is nar ‘The major difference beween a typical CT seanner and one designed for CT simulatton in Radiation Oncology (RO) would be that the latter requires __— ‘A. Higher maximum kV, B. Longer maximum scan times, C. Larger diameter gantry opening, D. Greater table movement. E, Smaller sange of til angie. 20 Raphex 2006Diagnostic + Questions * $$ stiions 39. Compared to a stand-alone CT scanner used in Diagnostic Radiology, a CT scanner used in ‘Nuclear Medicine as part of a PET/CT or SPECTICT has A. Fewer detector elements, B. Longer table travel and no tilt capability. C. Higher beam half-value layer, D. Longer scan times, E, Thinner shielding walls, B40, What is the ACR CT aeereditation program reference dose for @ routine adult abdomen CT scan? ~ 60 mGy, 35 mGy. 25 mGy, 10 msy. 2mSv. PooE> Al. What would be the most appropriate settings for a CT coronary vessel study? . 04 s, 0.5 mm slice, $00 mA, piteh = 0.3 5,0.5 mm slice, 500 mA, pitel 0.5 mm slice, 250 mA, pite 5, 1.0.mm slice, 500 mA, pitc 1.0 mm slice, 250 mA, pitel 42. For which CT exam could the following settings be appropriate? 80 kVp, 05 s, 3 mm slice, piteh =1.3, Large adult abdomen, ‘Small pediatric abdomen, Adult head, Yediatric head. High-resolution chest. mpoR> D43. fa modem 16-64 slice CT scanner is eapable ofa 0.5-second rotation, why are scans of the hhead and spine done at | second or more? Mote views ate acquired per slice for better resolution. More views are acquired per slice for less aliasing artfsets, Higher mAs reduces noise in thin slices. Aand C are te. A.B. and C are true room» Raphex 2006 21Diagnostic * Questions + Daa. 4s. p46. a7. Das, Das. In MRI, which of the following statements is True regarding the function of RF coils? ‘A. The same coil may be used to transmit the RF pulses and to reccive the MR echoes, B. Soparate coils may be used to transmit the RF pulses and to receive the MR echoes. C. A surface coil would be optimal for imaging structures deep within the brain. D. They digitize the received echoes, E, AandB. ‘Which one of the following is ror characteristic of superconducting magnets? ‘A. Requires the use of eryogen. B, Shuts off as soon as the electrical current supply to its windings is stopped. C. Available in clinical systems to produce a magnetic field of 1.5 Tesla. D. Uses electrical current running through wire that has no electric resistance whea kept cold. E. Often used in mobile MRI settings. In MRI, the gradient is on during the time the echo is measured. A. ‘Slice selection B. Phase encoding C. Frequency encoding D. Collimating ‘Afier collecting an echo from one slice, what must the MR system do in order to collect an echo from the next adjacent slice? ‘A. Increase or decrease the range of frequencies encoded into the echoes B. Increase or decrease the center frequency at which the RF energy is transmitted C. Select slice with a different gradient coil D. Frequeney encade with a different gradient coil In MRI, which of the following statements is False? ‘A. TI relaxation and 72 selaxation occur simultaneously: B. 72 relaxation usually occurs much more quickly than TI relaxation. C. TI relaxation refers to the longitudinal recovery of magnetization while T2 relaxation D. refers to the transverse decay of magnetization. Echoes collected in the transverse plane demonstrate only T2 relaxation differences, Concerning image artifacts in MRI, which of the following may be used to eliminate wrap- around artifacts? A. A larger field-of-view. ‘A saturation pulse over the unwanted anatomy. "Selecting 2 “no frequency wrap" and/or a “no phase wrap” option om the system, AandB. A,B,and C. Poop 2 Raphex 2006Diagnostic Questions % ——— ps0, DSI. Ds2. ps3. ps4. pss. Which of the following is a characteristic of MR angiography acquisition? ‘A. The images are post-processed to make projection images. B. Moving blood signal intensity is reduced to match the intensity of stationary tissue signals, . A set of flow-sensitive images is acquired, . The stationary tissues are made to have a high signal intensity E. AandC. ‘A rapid spin echo sequence is faster than a conventional spin echo pulse sequence because: ‘A, T2* contrast takes less time, B. A shorter TR is usually used. C. Several echoes for each slice are colleeted during each TR period. D. A higher matrix is used InMR, is the fastest imaging technique available today, A. Spin echo B. Inversion recovery C. Single-shot EPE D. Rapid spin echo For MR imaging, the patients weight must be entered accurately during patient registration 10 ‘A. Enable calculation of the specific absorption rate (SAR). B. Prevent damage to the RF . Prevent artifacts in the images. D. Prevent damage to the patient table. ‘The speed with which a sound pulse travels through tissue depends on the A. Ultrasound frequency. B._ Duration of the pulse. C. Tissue density and stiffness. D. Pulse amplitude and tissue attenuation, The choice of ultrasound frequency in a particular examination involves a trade-off between ‘A. Convenience in imaging vs. poorer penetration into tissue B. Spatial resolution vs. transducer cost, CC. Spatial resolution vs. penetration into tissue. 1D. Temporal resolution vs. patient exposure, SS Raphex 2006 23Diagnostic + Questions + Ds6. Ds7. ss. 59. 60, Dal. When simultaneous multiple focal zones are used in ultrasound, the frame rate generally decreases. The reason for this is ‘A. Toreduce the acoustical exposure to the patient. B. Multiple transmit pulses arc used for each beam tine, .. To give the operator a longer time to view each image plane ._ Extra time is needed to set elecironic time delays for transmission, By measuring the accuracy with which an ultrasound scanner displays the distance between reflectors separated by 1-cm increments along the central beam axis of a sector scanner, the can be determined, Axial resolution Lateral resolution Depth calibration accuracy “Attenuation coefficient of the medium pOp> ‘The width of an ultrasound beam measured perpendicular to the image plane determines the ‘Axial resolut B. Depth resolution C. Lateral resofution. D. Slice thickness. Jn ultrasound imaging, “Shadowing” refers to decreased echo amplitudes a highly attenvating structure. Distal to Within Proximal to Lateral to poop Color Doppler ultrasound measures blood flow based upon information from al ofthe follow= ing factors except: Impedance Wavelength, Ultrasound speed. Angle of incidence. Frequency shift monp> ‘The largest Doppler ultrasound shifis are from scatterers in ‘A large artery: ‘Aierial branches The aorta, Capillaries. Vessel walls moom> Raphex 2006Diagnostic Questions + ee 62. Ifa gamma camera flood image appears as below, the problem is most likely: Mistuned photomultiplier tube. Center of rotation error. Crack in the ery: Cosmic ray inte Pone> 63. The energy resolution ofa modem gamma camera is specified to be approxima Te-99m, This 8% means A. That the full width of the Te-99m photopeak is 140 8 keV B. That the photons emitted by Te-99m have an wncertainy of 8%. That the full with at haif maximum of the Te-99m photapeak is 1402 8%. DB. Thar the full width at half maximum ofthe Te-99m phoiopeak is 140 # 8 keV B64. What would be the appearance of a gamma eamera image if Te-99m isotope sean were per formed for the same duration but with the wrong collimator: 9 mediuim-energy general-purpose instead of a low-energy general-purpose collimator? ‘A. There woukt be absolutely no effect. B. The image will be more noisy. but probably clinically aeceptable CC. ‘The image quality would he poor due to significam septal penetration, The study would need to be repeated. D. There would be so few counts that the study: would need to be repeated. E, This mistake could never happen, because instrument interlocks would prevem a ‘Fe-99m study being performed with the w#ong collimator, Raphex 2006 28Diagnostic Questions? 6S. How does a dose calibrator used in a radiopharmacy to check the activities of different ‘adiopharmaceuticals dispensed for patient studies discriminate between isotopes? ‘A. By the same principal as a gamma camera, using a sodium iodide crystal, a photomultiplier tube, and a pulse height analyzer, B, By measuring the energy deposition of each photon individually in the ionization chamber surrounding the well. CC. By measuring the fraction of encrgy absorbed vs. transmitted through the chamber. D._ Energy discrimination is irrelevant, since all isotopes of equal activity give the same signal. A dose calibrator measures just activity E, Energy discrimination is not possible, but each isotope has a separate calibrated poten- tiometer setting. 166, What is the cemter of rotation correction for a gamma camera? A. It is.a correction file containing camere specific offSets to correct the image from each projection angle to a common center. B. Itis a correction that is applied during the acquisition of a SPECT study C. It corrects for alignment errors during the rotation of the gamma camera heads. D. It corrects for alignment errors between the heads of single-, duals and triple-headed gamma cameras, E, All ofthe above. 67. Which of the following is nota method of medical radioisotope production? ‘A. Separation from spent reactor fitel rods. B. Bombarding with neutrons in a reactor. C. Bombarding with protons in a cyclotron. D. Elution of ¢ metastable daughter from a parent E, Bombarding with neutrons in a cyclotron. Ds. illoion detector conversion efficiency is ‘The same as the detector detection effietency ‘The fraction of deposited energy that is converted into fight. ‘The fraction of deposited energy that is converied into-eiectrons. Decreases with the scintillator atomic number. Increases with the scinttiator thickness. moOE> 6 Raphex 2006Diagnostic * Questions + D69. Inthe figure below the measurement configuration of a radioactive source with the best geo- metric efficiency is A B c % “ =} T=) of 70. The figure below shows: A. AGM tube, B. A semi-conductor detector. C. A photomultiplier mibe. D. A moltischannet analyzer. visible Hight = photon signal to preamp, a Raphex 2005 ywDiagnostic Questions + D7I, The figure below shows: ‘A. A well counter. B. A dose calibrator. C. A thyroid probe. D. A liquid scintillation counter. E. A pulse height analyzer, eo a Re RS Ss ss sic SS 72. What is the cumulated activity in MBq day for the clearance eurve below? ‘nsaa) 2 ® m 6 5 3 z 1 ° 1 2 3 4 5 tidays) A. ME MBqday B28 MBqday C. 19 MBqday D. 18 MBqday E. 9 MBg.day 28 Raphex 2006Diagnostic + Questions * —_-. p73. 74. Dz. 76. p77. 78. The cumulated activity in the souree organ A. Increases with decreasing physical half-life. B. Increases with increasing activity elimination rate . Increases with increasing biological halflife. D. Is independent of the percentage of activity taken up by the source organ. According to NRC regulations, an individual in an unrestricted area shall not receive more than ‘rem in any one hour ‘The most notable medical effect of the nuclear reactor aveident at Three Mile Istand ‘A. An increase in the incidence of birth defects among chitdren born in the following year, B. An increase in the incidence of thyroid cancer within $ yeurs of the accident. C._ An inercase in the incidence of skin cancer within 10 years of the accident, D, None of the above. Jn cells and tissues, most of the low-LET radiation damage to DNA is caused indirectly, that is, by ‘A. Hydrogen and hydroxyl free radicals produced from water B. Low-energy Compton-seattered photons. . Elastic nuclear interactions. D, Local heating effecis of the radiation. The exposure rate measured at 1 m from the surface of a package containing radioactivity és 0.005 Kb. The transport index (TH) ofthis package is therefore . AO BI B D2 For a declared pregnant radiation worker, such as 4 Nuclear Medicine physician or ¢ Radiologist, what isthe dove limit in mSv to the embryo!fetus? A. OmSv per month. B. 0.5 mSv per month CC. SmSv per month, D. 50 mSv per 9 montis. Raphex 2006 29Diagnostic + Questions + 79, _If the absorbed dose of Co-60 y-rays to kill 50% of HeLa cells in culture is 3 Gy and the absorbed dose of Bi-212 o-rays to kill 50% of the same cell population under the same conditions is 0.2 Gy, then the RBE of Bi-212 c-rays relative to Co-60 yrrays is AO BS c 10 D 15 DBO, The high contribution of radon to the background effective dose equivalent is due to m ‘A. The chemical toxicity of radon. B. The high LET and RBE of plutonium o-rays following intrapulmonary decay of inhaled radon. C. The high-energy yrays emitted. . Plutonium heat production within the lungs. Bi. The most prominent radiation-related effect of the Chernobyl nuclear reactor accident was ‘A. A prompt and pronounced increase in the incidence of childhood thyroid cancer. B._ An increase in the incidence of adult lung cancer. C. An increase in the incidence of birth defects among children exposed in utero, D. None of the above 82. Fora controlled (or restricted) area, such as a radiopharmacy, wipe tests (.., test for remov- able radioactive contamination) must be perfornied A. Daily B. Weekly C. Monthly. D. Yearly 83. What must be checked before any use of a survey meter? ‘A. Check that the meter has been calibrated within the past 12 months. B. Perform a banery check. C. Verify the response with a radioactive check source. D. Allofthe above. E, None of the above 84. Concerning leakage radiation for @ unit used for pediatric chest filming, what is the maximum Jeakage radiation allowed at 1 meter from the x-ray tube source when the system is operated at the maximum continuous allowable tube current and kilovoltage? A. 2 mRiweck B, 10 mB/hour. CC. 100 mRvhour, D. No specified limits. 30 Raphex 2006Diagnostic + Questions + —)] DBS. What isthe record keeping requirement for personnel radiation exposure records? ‘A. One year. B. Three years. C. Five years. D. Ten years. E. Until authorized for disposal by the State Deparment of Health DB. —_A well counter with 50%» detection efficiency is set to collect 10,000 counts per minute (epm) or stop after 5 minutes, Ifthe counter stops after 2 minutes, what are the measured disiniepra- tions per minute (dpm)? A. 2000 B. 5000 C. 10,000 D. 20,000 E. 200,000 87. The earliest clinically detectable effect of radiation on the skin is___. Epilation, Pain, Uteeration, Erythema, Depigmentation. moom> DEB. In order to determine the lead shielding for the walls of an x-ray room, all of the following must be known except ‘A. The maximum kVp. B. The total mAs fora given time period. C. The fraction of time that the primary beam is pointed a¢ a given wall D. The fraction of time an adjacent area is occupied. E. The fraction of time that each focal spot is used B89, The shiciding of atypical x-ray room is__. A. 20m of concrete, B. 1,5 mm (1/16 inch) of concrete, C. 1.5mm (1/16 inch) of lead, D. 2emof lead E. 3mmofAl. —_— Raphex 2006 31Diagnostic + Questions + D90. A Leaded apron containing the equivalent of 2 HVLs of lead is used to protect a radiologist ‘against scaticr radiation. The scaiter during fluoroscopy at the radiologists location is about 30 mrem per hour. To how many minutes per week of fluoroscopy should the radiologist limit his procedures in order to stay below 1.0 rem per year? A. 40 B. 80 c. 160 D. 320 E. 640 91, Well-collimated AP and lateral chest radiographs are taken om a female patient, She later discovers that she was pregnant at the time of this study. The expected fetal radiation dose would be about _____. A, 0,008 niSv (0.3 mrem). B. 0.5 mSv (50 mem). C. 3 mSv (300 mrem). D. E 5 mSv (0.50 rem). 100 mSv (10.0 rem). 192-95, For the following radiographic procedures, select the most appropriate techniques A. HOKVp, 600 mA, 0.1 s, 35" SID B. 29 kVp, 100 mA, 0.7 s, 24° SI C. 135 kVp, 200 mA, 0.015 s, 72" SID D. 60 kVp, 400 mA, 0.0075 s, 40" SID E. 75kVp, 100 mA, 0.15 s, 50” 92. PA chest ‘1D93. Screen-film mammography, D94, Neuro magnification angiography. D9S._ Barium Gl eassete spo film. 32 Raphex 2006Therapy Questions + Oren Th. All of the following are true about Tissue-Maximum Ratios (TMRs) except: ‘A. They are used to calculate moaitor units for an isocentric treatment. B. They can be calculated from measured PDDs. C. They depend on field size at the isocenter. D. They depend on SSD. E. They depend on photon energy. 12, During routine quality assurance checks, the optical distance indicator (ODI) is found to read 100 em when the distance is actually 98 cm. ITuncorrecied, the effect on treatments set up at 100 em would be: A. An overdose of 2%, B. An overdose af 42, €. An overdose of 16. D. Anunderdose of 2% (Questions T3-T8 refer to the following data tables for 6 MV photons. (PDD are for 100 em SSD.) Field Size (em) "5x5 10x10 15x15 20x20 2525 5 856 871 876 879 88.2 8 R20 750763 713 79 PDD 10 642 676692 703 aA 15 417 SG 537 554 564 . 2 3673925 Ba aa 5 0912 0928 09340937 a.98 g 0.809 0.862 0857 0.869 0.877 MR 10 0745 0784 = ONE S18 0,828 1s 0602 0617 = 06750697713 20 0487 053008600586 0608 ‘Output (eGy/MU) at 0950 1.000 «1.088 105s 1.069 depth = 1.6 em, 100. em ‘Output (eGy/MU) at 0.980 1.032, 1.071 1.089 1.103 13. The MU por field to deliver 250 eGy via parallel opposed isacentrie whale brain fields, collimator setting 17x23 em, separation 16 cm, is: A. 125 B. 132 c. 139 D 1s E133 Raphex 2006 BTherapy *% Questions + T4. ‘The maximum dose along the beam axes in T. A. 250 cGy. B. About 20% greater than 250 eGy. G. About 10% zreater than 250 cGy. D, About 2% greater than 250 eGy 5. The location of the maximum dose, for treatment with 6 MV photons. is point onthe Giagram below A B te D E Te. ifthe whole brain deseribed in T3 above were treated at 100.cm SSD, A. The collimator setting and the MU would be red B. The collimator setting and the MU would be increased, C. The collimator setting would be reduced and the MU would he increased. DB. The collimator setting would be increased and the MU would be reduced, E, None of the above. 34 Raphex 2006Therapy Questions + 17. Te. 9, Tio. TH. A spine field, equivalent square 15 em, is treated at £00/em SSD. 1f 220 MU are delivered, the dose at $ cm depth is cGy. A. 193 B. 200 C. 206 D. 213 E. 220 ‘The dose at dyy in question T7 is___ eGy. AL 95 Fpoe A patient is treated with AP/PA isocentric felds to the mediastinum. The sotal midplane dose oon the axis is 4500 eGy. The dose to the spinal cord will exceed 4500 Gy: ‘A. Ifthe patient is treated with 4 MV x-rays, B. Ifthe cord is not « midplane structure C._ Ifthe patient's AP thickness is less at the neck end of the fcld D. All of the above. For 24x24 cm, parallel-opposed isocentric 6 MV photon beams, the patient’s AP thickness ean be up to ‘em, if the maximum tissue dose is not to exceed 110% of the dose at the isocemter In order 10 obtain a farge enough field 10 cover the leg. patient is treated at 200 em SSD. using 6 M 5 cm), The field projects to an equivalent square of 20x20 em: at 200 em SSD. The PDD at 6 cm depth at 100 em SSD for 20 em equivalent square is 0.843, The PDD at the treatment SSD of 200 em will be: A. 0712, B. 0.808. C. 0.840. D. 0.863, 0.880. Raphex 2006 35inerapy + Questions % TI2. Comparing a 10x10 cm field and s 5x20 em field, which has the greatest TMR? ‘A. 10x10, B. $520, C. They are exactly equal TI3. The wedge transmission factor (WTF) is 0.89. The MU setting for an open beam is 150. The [MU setting for the same dose on the central axis with the wedge in would be: A. 150 MU. BL 189 MU. C. 254 MU. D. 203 MU. E. 89 MU. TI4, The angle berween the beam axes in a “wedged pair” is 60°. The most appropriate wedge un would ber A. 60° B. 45° c. 30° Ds E, 10° TIS. Wedges are used for all of the following excepr: ‘A. To increase dose homogencity for breast tangent fields. B. To inctease the anterior hot spot for a larynx treated with lateral-opposed field. C. To increase dose homogeneity for orthogonal fields in partial-brain treatments. D. As amissing-tissue compensator, E, To increase dose homogeneity in a three-feld plan (anterior and two epposing In — KK 6 Raphex 2006Therapy Questions + TI6. Ti. TiB-49. 720. ‘The dose distribution shown for breast tangents could be improved by Using a larger wedge angle. Inverting the direction of the wedges. Using a smaller wedge angle. Using a lower photon energy. Both A and D. mpODP in the treatment of Hodykin’s disease with a mantle field on a linge. patients may experience a skin reaction in the neck region. This could be duc to which of the following? ‘A. Smialler thickness of tissue at neck than on the central beam axis, B, Oblique incidence at sides of neck reduces skin sparing, C. Use of a blocking tray and large field size tend to imercase skin dose. D. All of the above Match: ‘A. Surface dose increases. B. Surface dose decreases. C. No change in surface dose. TIS. Electron energy increases TI9. Photon energy increases. ‘Skin dose is increased in photon beams by sll of the following exept: A. Using bolus B. Treating through a thermoplastic positioning device. €. Using a beam spoiler D. Treating under a skin fol. E. Increasing SSD. Raphex 2006 37therapy Questions + —. Ta. 722, 723, Ta. 725. Parallel-opposed 18 MV photon beams (das = 3.5 cm) are used to treat an area which includes nodes at a minimum depth of 2.0 em, Ifthe nodes are to receive atleast 90% of the midplane dose: ‘A. 3.5 cm bolus is needed. B. More than 3.5 cm bolus is needed, C. Bevween 2 and 3.5 em bolus is needed D. Bolus is not needed. Which of the following could be used as a tissue compensstor? A. Shaped bolus. B. A wedge. C. Shaped Cerrobend™, D. Dynamic MLC. E. All of the above. ‘The formula used to calculate the gap on the skin between adjacent fields, matched at depth, relies on the fact that: Both beams are treated with photons of the same energy, ‘The projection of the edge of the light field follows the 50% decrement line of the radiation field The angle of divergence of adjacent beams is the same. Both fields are treated simultancously. ‘The depth atthe junction is less than 10 cm. roo BP A patiemt is weated with 6 MV photon fields of 15 and 30 em height, respectively, at 109 cm SSD. In order to mateh the fields at S em depth, the gap on skin should be: A. Lbem. B. 15cm C. 19cm, D. 2.0m. E. None of the above, The collimator roation required to of height 36 cm is degrees. AL3S BS C3 D. 10 EW 25x25 em cranial fields with a direct spinal axis field SS, 38 Raphex 2006Therapy + Questions +> 726. 128, T29. 730. Lateral opposed head and neck fields are to be matched 0 a low anterior neck (LAN) field, All of the following would achieve a perfect geometrical match, except: ‘A. A single isocenter placed at the junction, with all fields “half-blocked” B. Symmetrical lateral ficlds, plus couch rotation to remove divergence; half-blocked LAN with isocenter at junction. C. Half-blocked Lats with isocenter at junction; symmetrical LAN, 90°-couch rotation plus a small gantry angle to remove divergence. D. A single isocenter placed at the center of symmetrical lateral fick same isocenter with offset collimators to match the lats on the skin. LAN having the ‘A computer plan is checked by hand using data tables. The plan shows opposed isocentric 6 MV photon beams, 15315 em with a small comer block, normalized to the isocenter at 12cm depth. The hand ealeulation gives 7% Jess MU than the computer plan. The most likely explanation for the discrepancy is: ‘A. Data tables for 18 MV were used by mistake for the hand calculation. B. The plan was heterogeneous, and included 6 em of lung, omitted in the hand calculation. C. The blocking tray factor was omitted from the hand calculation, 1D. The comer block was not accounted for in calculation of the equivalent square. E_ The plan was prescribed to the 93% isodose level, but the hand calculation assumed that the prescribed dose was delivered to the 100% level. Which of the following is fatse? ‘A. Range of 12 MeV electrons in tissue = 6 em, B. Depth of $0% PDD for 6 MV photons (10x10) C. Depth of 50% PDD for 18 MV photons (10x10) D. Depth of da for 1O0KY x-rays = 0. E. Depth of dj, for 10 MV photons 21 em .pprex. 2 em. Which of the following changes would have the sreatest effect on the MU calculation for a 6 MV photon beam, to deliver the same dose? The initial calculation is for 6 em x 6 em, 100 cm SAD, d= 10 em. ‘A. Changing the collimator setting from 6 em x 6 em to 8 cm x 8 em. B. Changing the depth from 10 en to 11 em. C. Changing from 100 SAD to 100 em SSD. D. Adding a I em plastic blocking tray. E. Adding 1 em of bolus. A patient is treated with paralle} opposed isocentrie 15x15 em 6 MV photon fields, calculated for & separation of 26 cm. The patient foses weight and the separation changes to 2? em. If no correction is made to the MU, the result will be approximately: Less than 1% underdose, Less than 1% overdose. 3% underdose. 36 overdose. 7% overdose mooR> Raphex 2006 39Therapy Questions + T31. Which of the following is te regarding geometric penumbra? ‘A. ILincreases as source diameter increases. B. It decreases as SSD increases. C. tis independent of source-collimator distance. D. Ik decreases as depth increases. E. All of the above are true 732, __Flattening filters in megavoltage photon beams are designed to achieve a flat bear at 10 cm depth, This means that ad, the profile of a 30*30 em* 6 MV beam is ‘A. Higher towards the edges tan the center. B. Lower towards the edges than the center. C. The same as at 10 cm depth, 733. Fora 10 MV photon hesm at 10 em depth, the TMR will be she PDD/I00 at 100 cm, for the same collimator setting. A. Greater than B. Less than C. Approx. equal to 734, A superficial x-ray unit has an SSD of 20 cm to the end of the applicator. [fan additional air gap of 2 em is left, and no correction is made, this would cause the dose at da 10 be: A. 22% high, B. 9% high ©. 9% tow D. 17% low. E. 25% low. 135. A superficial x-ray treatment is prescribed with a 2 mm Al filer, By mistake, a ¥ mm filter is used. All of the following will occur except: ‘A. Increased dose rate. BB, Increased dose for the same timer setting. C. Decreased HYL. D. Increased PDD. —_. 40 Raphex 2006Therapy Questions + 736. 137. 738, 13. Tao. AAPM’ Report 85 on “Tissue Inhomogeneity Corrections For Megavoltage Photon Beams” (2004) draws some general conclusions. All of the following are true statements except: A. The widespread availability of CT and 3-D planning systems makes inhomogeneity corrections more accurate than was previously possible. B._Inhomogencity corrections should account for changes in the clectron densities of | tissues traversed. C. Because different treatment planning systems use different inhomogeneity algorithms, making such corrections will introduce even larger errors in dose reporting than were previously made without them, D. Monte Carlo dose calculations can calculate the effects of inhomogeneities on scatter radiation, whereas analytical dose calculations only eorrect for changes in effective depth E. Since most prescriptions and toxicity estimates are based on historical data calculated ‘without inhomogeneity corrections, use of these historical doses introduces eonsider- able uncertainty to dose-response data. Which of the following lists tissues in order of increasing Hounsfield (CT) number? ‘A. Bone, muscle, fat lune, Lung, fat, musele, bone. Lung, muscle, fat, bone. Fat, lang, muscle, bone. Bone, fit, musele, iung, roofs If heterogencity corrections are NOT done, which of the following is likely to give the greatest discrepancy between calculated and actual dose at a point on the beam axis beyond the heterogeneity”? Medium Thickness Photon energy A. Lung 10m 6M Bo Lung J0em IsMV C. Fat J0cm oMV D. Dense bone Sem ov E, Dense bone Sem ISMV ‘The main reason for trating lung lesions with photon energies less than or equal to 10 MY is: ‘A. Gating is more accurate at lower energy. B. To keep heterogeneity corrections as small as possible. C. To reduce the potential for cold areas at lung-tissue interface duc to dase build-up, D. To reduce the maximum tissue dose, The fraction of dose duc to scatter is A. Sem x5 cm field at day B. 10cm x 10 cm fickd at dp . Semx5 em field at 10 em depth, D. 10¢m x 10 cm field at 10 em depth. E. All of the above have an equal fraction of scatter, atest for which of the following 6 MV ficlds? Raphex 2006 4Iherapy + Questions + TAL 742. TAB, 744. Tas. The dose under a 1.5 cm width cord block _(5 HVL thickness) in a 6 MV photon beam at 5 cm depth is approximately % of the dose in the open beam. AS B7 G: Is D. 25 E, 50 A simulator film is taken with the following geometry: 100 om SSD; 20 em patient thickness; 10 cm table top-to-film distance. A cord block is drawn on the film. Its width is 3 cm on the film. The width of the required block on the tray at 65 cm from the source is: The primary beam ofa linac measures 40 cm at the isocenter (100 cm ftom the source). This projects 10 em at the wall, whic is 4 m from the isocenter. A. 80 120 rpaP 3 240 Regerding possibie malfunction during or after exposure to scattered radiation, studies have shown that Implanted Cardiae Defibrillators (RCD) Implanted Cardiac Pacemakers acrs). ‘A. can be more sensitive than B. are much less sensitive than C. have no reported sensitivity, unlike It is recommended that the dose 10 a pacemaker be kept below 2.0 Gy. In.a lung treatment of 40 Gy with 10 MY photons, the fields should be no closer than to the pacemaker, A. Simm B. 2em Cc. Tom D. 10cm a Raphex 2006Therapy Questions * 746. TAT. 748. Ta9. T50, Ti. ‘The approsimate maximum dose to a patient's contralateral breast from tangential breast fields ‘treated with conventional wedges, and delivering a total dose of $000 cGy is of the order of: A. 2500 cGy. B. 250 cGy C. 28 cGy, D. 5 cGy. E. Negligible ‘The main cause of dose inhomogeneity in TB] treatment is Inverse square effects, Use of compensators. Use of high energy photons. Use of a beam spoiler. Differences in patient thickness. nyo 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 inhomogencity corrections in the treatment plan, pope Compared with finac-based stereotactic radiosurgery, treatment on the Gamma knife is likely to result in dose inhomogeneity across the target volume. ‘A. greater B. less C. the same ‘The average primary transmission for 6 MV x-rays through a tertiary multleaf collimator ‘ne used in addition to X and ¥ collimators) is about B 0.5%. Cc. 2. D. E 10%. Which of the following is not included in the CTV (clinical target volume) as defined by ICRU Reports 50 and 62: A. Gross target volume (GTV). B. Internal margin (1M). C. Setup margin (SM). D. Lymphatic spread. Raphex 2006 a3Therapy + Questions + Ts2, Ts3, Ts4. Ts, Ts6, Inan IMRT plan, the physician requests that 95% of the PTV be covered by 95% of the prescribed dose, with the maximum not to exceed 105%. A plan is created with only 85% covering 95% of the volume. Possible reasons include all af the following except: ‘A. The PTV is drawn to include part of the build-up region. B. Field heights have insufficient margin around the PTY CC. The photon energy is 100 low 1D. The PTV abuts a region to be avoided, which has been given high priority ‘Verification of “sliding window” IMRT plans can be performed by all of the following except: Hand caleulation of the MU settings for each beam, Scanning films exposed in a phantom to each IMRT field. Software designed to independently caleulate the MU for each field. Diode arrays irradiated with the IMRT fields. pop> For treatment of the prostate with tight margins, daily pre-treatment localization of the prostate can be achieved with all of the following except: ‘A. Bemode ultrasound. B. Orthogonal radiographs of markers implanted in the prostate C. Pre-treatrient CT, in units designed with 2 common CT/linac tabte D. Orthogonal radiographs of bony anatomy. Regarding PET-CT imaging for radiation therapy localization, all ofthe following are true except ‘A. The PET image may show lymph node involvement not appreciated on the CT. B. The volume of uptake seen on the PET image can depend on several factors, including window and leveling C. Hot spots on the PET image are not necessarily tumor, 1D. Combination single gantry PET-CT sconners eliminate ali uncertaimiies between patients anatomy as seen on the PET and CT scans. Regarding ultrasound used to localize the prostate in treatment position before RT, all of the, following are true excepr: ‘A. The patient must have a full bladder, B. The patient must have an empty rectum. C. The prostate cannot be imaged through the pelvic bone, D. The operator must be trained to correctly interpret the images obtained. E. The system must be calibrated to correctly align with the linac isocenter. 44 Raphex 2006Therapy Questions“ TS7. Ts8. 759. 760-63, Ted, Image Guided Radiotherapy (IGRT) can use a varicty of imaging modalities at the time of treatment, including 2-D images using kV and MV sources. All of the following statements are true except: A. kV images allow easier visualization of bones than MV images. B. kV images look similar to DRRs generated with planning CTs. C. KY images cause less artifacts from metal prostheses and dental fillings than MV images. D, The kV source and detector must be carefully aligned to match the geametry of the treatment (MY) beam, Regarding photan interactions with soft tissue, as the nominal beam energy increases from 6 t0 18 MY, which of the following would be expected? ‘A. An increase in the number of photoelectric interactions, B.A decrease in neutron production. C. A dectease in the linear attenuation coefficient. D._A decrease in the PDD, When a therapy beam of nominal energy 23 MY interacts with soft tissue, which of the following is true? A. Pair production predominates. B. Pair production and Compton are about equally probable. C. Photonticlear disintegration predominates. D. Compton predominates. E, Compton and photoelectric interactions are about equally probable, Match the electron beam energy with the feature deseribed below: A. 6 MeV B. MeV C, 12 Mev D. 16 Mev E, 20MeV 60, Has the highest surface dose. 61. Has a range of 6 cm in tissue, 762. Has a 90% depth dose at 2,7 em depth, ‘T63. Has the sharpest fall-off between 80% and 20%. 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. All ofthe above. pA p> Raphex 2006 45Therapy Questions * Tos. A shaped 9 MeV electron beam with an output factor of 0.91 cGy/MU measured at aay delivers a dose of 200 cGy to the 95% isodose curve. The maximum tissue dose is cGy. A231 B. 220 C2 D. 200 E. 190 766, The thickness of cerrobend required to make an cleetron cutout for a 12 MeV electron beam is approximately: mR. 2a em B. 120m. C. 07 em, D. 03cm, E, 0.12em. T67. Regarding a 3x3 cm Cerrobend™ insert placed in a 6x6 cm applicator in a 16 MeV electron beam, which of the following is truc? ‘A. The dose under the blocked area of the insert can be reduced to zero if the Cerrobend is thick enough, B. The depth dose is the same as that for the 66 em applicator. C. The output (eGy/MU) at dass will be less than that measured for the 6%6 em applicator. D. The depth of djag Will increase compared to that for the 6X6 em applicator. T6B, When electron shaping is placed on the skin instead of at the end of the applicator, this results in: ‘A. A sharper penumbra atthe field edge. B. Less thickness of Cerrobend required . Easier setup. D. Reduced beam energy. T69. Regarding electron field junctions, which of the following is true? ‘When the light ficlds of two adjacent electron fields are matched on the skin: ‘A. The dose variation across the junction will be within 5% if the electrons have the same energy and the light ficids abut. B. There will always be hot and cold spots because of the shape of the clectron penumbra, and these can be reduced by shifting the junction . The formula: gap = (deptlvSAD) x (CI + C2)/2 gives the best match. D. Overlapping the light fields by 0.5 em generally gives the best match. 46 Raphex 2006Therapy Questions + ‘70. TH. 172, 173, 175. In which situation is electron backscatter likely to be a problem? ‘A. Using 1 cm tissue equivalent bolus on the skin. 1B. Using a lead intra-oral shield to protect the tongue when treating the cheek. C. When electrons are incident at an angle greater than 30°, D. When electrons of different energies are matched on the skin. After 10 half-lives the activity A of a radionuclide és reduced to approximately A. ANO. B. Act, C. Afo0o, D. Zero. A batch of 1-125 seeds is ordered so that the activity will be 0.48 mCi/seed on the day of the prostate implant, If the seeds arrive 5 days before the implant, the expected activity on receipt is mCiseed, O45 031 0.55 037 0.59 room| ‘The dose distribution in tissue up to S em from an Ir-192 sced closely follows the inverse square law because: A. No other factors are involved. Up to 5 em, tissue attenuation is always negligible . For this photon energy, tissue attenuation is negligible. . Scatter dose build-up and attenuation approximately cancel each other out, Dose from betas emitted by the source eancels the attenuation, moos ‘To calculate the dose rate at a given distance from 2 patient with a temporary seed implant, all of the following information is requited except: A. Radionuclide. B. Half-life. C. Distance from sources. D. Source strength. ‘A preplan is performed for an 1-125 imptant:100 sceds are required and 115 are ordered. Ifthe procedure has to be delayed for 7 days, and the same batch of seeds is used, the number of seeds now required would be 92. 98. 102, 108. 6. moop> Raphex 2006 47Therapy Questions 76. If apermanent sced implant has « half-life of 17 days, after how many days will 75% of the total dose have been delivered? 34 days. 25 days. 17 days. 13 days, 4 days. mooe> T77. After receiving a batch of loose 1-125 seeds for a prostate implant, the AAPM Task Group 40 report and most state regulations require all of the following to be performed except: ‘A. At least 50% of the seeds should have their activity independently verified by the user. B. Seeds assayed for activity by the user should have a mean activity within +/~3% of the manufacturer’ stated activity. C. After loading the seeds into cartridges and removing them for sterilization, the prepara- tion area and surrounding area should be surveyed for dropped or improperly shielded sources. D, Cartridges prepared for sterilization should be clearly Labeted with the radionuclide, date, and activity. T7B. —_A-brachytherapy source transport container has a dose rate of 18 mFVhr at 20 em from its ‘center At what distance from the center will the dose rate fall to 2 mR/hr? 180 em. 120 em, 80cm, 60 0m. 40 cm, rooe> ‘T79-82, Match the photon energy with the radionuelide: ‘A. 30 keV average B14) keV C. 380 keV average D. 662 keV E. 1.25 MeV average 179. Cs-137 780, 1-125 T81, 1-192 T82, Co-60 783. When an HDR planning sysiem uses optimization to create a homogeneous dose along the surface of a cylindrica! applicator, the dwell times will be: ‘A. Higher in the center than at the ends. B. All approximately equal. CC. Altemately high and tow. D. Higher at the ends than in the center. 48 Raphex 2006Therapy Questions + T84. Tas. TE6. a7. Tes. An HDR treatment takes 366 seconds on the first treatment day, If the source is 1-192 (half-life 74 days), the treatment time exactly one week later will be see. 343 355 372 387 391 moome ‘When an clectron beam is generated in a linac, the order of components along the path of the beam is: 1. Monitor chamber 2. Electron gun 3. Bending magnet 4. Electron applicator 5. Accelerator tube Regarding neutrons produced by therapy linacs with high-energy photon beams, all of the following are true except: ‘A. They are slowed down by materials containing hydrogen. B. Neutron capture may result in megavoltage photon emission C. They can be measured with the same ionization survey meter used to measure photon leakage. D. More neutrons are generated in the photon mode than the eleetron mode ‘The AAPM’s TG-40 report on QA recommends that the individual with overall responsibility for machine QA should be: ‘A. The departmental director. B. The departmental administrator. C. The Radiation Safety Office. D. The clinical physicist E, The service engineer. According to the AAPM’s TG-40 report on quality assurance, all of the following should be checked monthly on a Tinac except: ‘A. X-ray beam flatness constancy. B. X-ray beam symmetry, C. X-ray output vs. gantry angle, D. X-ray ootput constancy. E. X-ray central axis dosimetry parameter (PDD,TMR) constancy. Raphex 2006 aTherapy + Questions +" T89. T90. Tol. 792. 793. 794, (On linear accelerators, the light field coincides with the AL 95% B. 90% C. 80% D. 73% E 50% sodose line at dpa. The output ofa finear accelerators photon beam is calibrated to be 1,0 Gy/MU. This calibra- tion point is alps at depth day, 100 om SSD, 1010 om fice size. B. dept 10 em, 100 em SSD, 10x10 om field size. C._ depth day 100-em SAD, 10310 om field size D. depth 10 em, 100 em SAD, 10x10 em field size E. A depth, distance, and field size specified by the physicist, consistent with data used for treatment planning, > 1 kg of lead 1 kg concrete for shielding against neutron contamination from an 18 MV linear accelerator. ‘A. more efficient than B. less efficient than C. about equally efficient as When calculating the thickness of a conerete wall in the path of the primary beam of a linae, all of the following must be considered excepr: ‘A. Primary beam energy B. Concrete density. ©. Workload, D. Occupancy of the area outside the wall E. Head leakage, The maximum photon energy scattered at 90 degrees from a 10 MY photon beam is about MeV: The occupancy factor used to calculate wall thickness between a linac and the treatment console: ‘A. Isalways 1.0 B. Depends on the photon energy: €. Depends on the workload. D. Depends on the direction of the primary beam, E, Depends on the use fictor for that wall Raphex 2006Therapy “> Questions Tas. 796. 97. 798-99, Which of the following is true, regarding patients scanned on a PET-CT unit? ‘A. Patients should remain in a shielded room afier the sean for the rest ofthe day, and are then released with specific radiation precautions. B. When the dose rate at | meter is less than 5 mR, patients can be released with no radiation precautions. CC. Patients can be released immediately after the sean, but must not share 4 bathroom ‘with other people for 1 week. 1D, Patients arc released when the dose rate at 1 meter is less than 2mR/hr, but must avoid contact with children for 1 week A radiation therapist's whole body monitor reads 15 mR in one month. The mast likely source for this exposure is: ‘A. Treating 35 patients a day on a dual energy (6/18 MV) linac. B, Delivering four vaginal cylinder treatments cach week with HDR, using a new 10 Ci C. Remaking vactocks and adjusting masks for patients about to be scanned in a PET-CT seanner. D. Carrying packages of Pd-103 seeds to be used for prostate implants from the mail room to the hot lab. E. 25 sced into cartridges prior to sterifization, Loading 1- Radiochromie film offers the following advantages as a dosimeter, except ‘A. High resolution. B. No chemicals or darkroom nceded for development, C. Tissue equivalence. D. Small dependence on photon energy. E. Very high sensitivity. Match the quantity measured by the dosimeter with the type of dosimeter: A. Charge collected B. Optica! density C. Light emitted on heating D. Temperature change E. Change in viscosity 798. Calorimeter 799. Thermoluminescent dosimeter (TLD) Raphex 2006 stRADIOLOGICAL PHYSICS Published for: RAMPS (Radiological and Medical Physics Society of New York)Preface? ne eRe ‘The RAPHEX 2006 Exam Answers book provides a short explanation of why each answer is correct, along with worked calculations where appropriate. An in-depth review of the exam with the physics instructor is encouraged, In cases where more than one answer might be considered correct, the most appropriate answer is used. Although one exam cannot cover every topic in the syllabus, a review of RAPHEX examsianswers from three consecutive years should cover most topics. ‘We hope that residents will find these exams useful in reviewing their radiological physics course RAPHEX 2006 Committee Copytighn © 2006 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, W1_$3705-4964 1-800-442-5778 ‘www.medicalphysies.org, —.General + Answers + Gl. D 2. D GA G4. C _Kerma is an acronym for Kinetic Energy Released per unit AMtss. It is defined as the sun of the initial kinetic energies ofall the charged particles liberated by indirectly ionizing radiation in an element of material with unit mass. os. D Gs. oc oA ca. 8 G9. A Analphasparticle isa nucleus of He-4. It consists of two neutrons and two protons. A beta particle is an electron. GIO. D All high-energy particles have speeds close to the speed of light. All electrons have the same charge, rest mass, and spin, The energy determines relativistic mass, which defines the curvature fora given charge in a magnetic field, Gil B G2 Gi. B GI4. D The word “neutron” is derived fro zero electric charge, m “neutral,” meaning electrically neutral, or carrying Gis. Raphex 2006 tGeneral *? Answers @ Gié& C —— Antiparticles carry electric charges opposite to that of the respective particles. GIT. D Gis. D Gia. C G20. C G2. D As the atomic shells are filled, there are more electrons in the shells, and the clectron repulsion tends to push them further apart. On the other hand, the inereasing positive charge of the nucleus pulls the electrons closer to the nucleus. As a result, the stomic radius remains on the order of 10° cm. G22, E Ifthe energy of the photon is less than the binding energy of the electron, ionization is impossible. G23. B As the nuclear charge increases because of the additional protons, so does the strength of the bond between the nucleus and individual electrons. Gi4. B K,L,M... traditionally mean shells with quantum numbers 1, 2, and 3 respectively, while 8, p, refers to orbital momentum equal to 0, 1, 2 G25. C ‘The activity is equal to 10x27", ¢ 6 hours is a half of the 12-hour half-life. G26. A qr. D G28, D Typ = 0.693/A, where the decay constant A in this example is equal to (1/100) br. ‘Therefore the half-life Ty = 69.3 ours. G29. C Aativity = Ag exp(0.693 x UT;2) = 1.000 x exp0.0693 = 1.072 mCi. 2 Raphex 2006General Answers G30, D 4=0.699/ Tio. GH. A G32. B G33. C G34. D G35. A G36. D G37. C ——_Anexcess of protons in the nucleus favors beta plus decay, in which a proton decays to a neutron and a positively charged electron, G38, C Bt is one of the many radioisotopes produced when uranium reactor fuel rods undergo G39. E F-18 is a cyclotron produced positron eminer used in PET. G40. B —— Ancxample is Ra-226 decaying to radon gas. G4. D 1 Ci =3.7x10" Bg. G42. C Exposure (X) = (Tx A td, X= (2x5 x 3V100? = 0.003 R=3 mR, G3. A (11) =(1/T,) + (ITY). IFT, Answers + G93. E To locate a dropped seed, one needs a portable detector that is highly sensitive and gives an instantaneous readout, such as a Geiger counter. G94. D When an unshielded container docs not give any reading above background as measured, “with a sensitive Geiger survey meter, the contents may be disposed of as nonradioactive material. G98. D Once installed, x-ray units are regulated by the state. Mammography units are also regulat- ed by the FDA, under MQSA standards. The FDA regulates the manufacture and installa- tion of x-ray devices under 21 CFR 1020, The NRC regulates the use of “man-made’ radioactive byproduct materials such as Co-60 units and brachytherapy sources. eee 8 Raphex 2006Diagnostic + Answers: DI, B Mammography must visualize submillimeter calcifications, angiography must sce fine vessels of the order of a millimeter, chest radiography utilizes tong target-image receptor distances which allows somewhat larger focal spots, and CT scanners need large focal ‘spots—they have reduced high-contrast resolution whife requiring greater heat capacity for scanning sequences that may take several seconds at high kV and high mA, D2. E Mammography is done at a very low kVp with HVLs of 0.3-0.4 mm Al, skeletal radiogra- phy at 60-70 kVp with HVLs of 1.52.5 mm Al, barium fluoroscopy at somewhat higher kVp with HVLs of 3-$ mm Al, while CT is performed at 120-140 kV with added shaped filters giving HVLs of 6 mm Al or more. D3. B The penumbra is equal tothe focal spot size times the ratio of object-receptor distance to target-object distance = 0.6 mm x 25/75 = 0.2 mm. The motion blur is equal to the distance moved by the object x the magnification factor = 0.3 mm x ratio of target-receptor distance to target-object distance = 0,3 mm x 100/75 = 0.4 mm, Receptor blur was given as 0.3 mm. D4. D —_Thedistance allocated foreach grid stip and associated space is 1/50 em = 0.02 em =0.2 mm, “The open spacé between strips is therefore 0.20.05 mm = 0.15 mm. The height of the strips is 1.8 mm, The grid ratio is defined as the height ofthe strips divided by the inter space distance = 3.8 mm/0.15 mm = 12:1 ratio, DS. D_ _ Imhigh-frequency inverter generators a high-frequency alternate voltsge waveform is used for efficient transformation of low to high voltage. Subsequent rectification and voltage ‘smoothing produce an output voltage with littl ripple, The generator ean turn the voltage to the tube on and off very quickly, which is important in pulsed fluoroscopy and other applications where high frame rate imaging is required. High tube current (greater than about 500 mA) requires three-phase line voltage for any other type of xray generator. DS. B_—_Off-focus radiation is useless fow-energy and low-intensity bremsstrablung x-rays, It results from electrons in the x-ray tube that stray from the target and are accelerated back and strike the anode outside the focal spot. Offefocus x-rays can constitute as much as 25% of the tube’s output. They deposit nonproductive dose in the patient and reduce contrast resolution D7. A This curve represents the continuous bremsstrahlung spectrum produced by 100 kVp electrons, with no beam hardening (by the target itself or by external filters). There is no creation of charaetoristic radiation DB. A The mean energy in beam C is higher than that in beam B, hence it is more penetrating, Raphex 2006 9Diagnostic “ Answers Ds. Dio. Di. DIZ DIB. pia. DIS. DIT. Dia, B The maximum energy in curve B is 100 keV, the same as that in curve C and is equal to the operational kVp. ‘The energy of characteristic x-rays is determined by the target material, which is the same for both curves. ‘The target material in question is rungsten, producing characteristic x-rays at a minimum of $9.3 keV. The characteristic radiation energy from molybdenum is about 16 and 19 keV. ‘This is the only answer that refers to properties of the image receptor. Due to increased attenuation coefficients with reduced kVp, A and E will reduce subject contrast. Focal spot size affects resolution, not contrast. Increasing the focal spot size increases the area over which the instantaneous heat is distributed. This increases the heat loading capacity of the anode, and thus the available exposure times for a given mA. Increasing the beam filtration removes more soft radiation, leaving a beam with higher effective energy, hence higher HVT. Extended processing, or push processing, isthe act of slowing down the flm transport, typically increasing the transport time to 120 seconds. It received interest in mammogra- phy, where it results in a slightly faster sereen-film system and reduction in patient dose. ‘The popularity of extended processing waned after the introduction of higher sensitivity screen-film mammography systems. In rapid processing a 45-second processing time can be achieved by speeding up the roller transport in the film processor. This is one-half of normal processing time, The chemical activity of the developer must be increased by increasing the concentration of the developer, increasing the developer temperature, or increasing both, Laser cameras are used to expose sheets of film, using a set of digital images as the source, ‘The modulsted laser beam intensity exposes the film in the same manner as light from an intensifying screen, A Tatent image is formed on the film, which may be processed in a standard wet chemistry film processer. ey Raphex 2006Diagnostic “ Answers? Daylight processors are automatic mechanical systems connected to a film processor. Exposed cassettes are fed into the processor by the technologist in daylight. The processor removes the exposed film inside a dark chamber and 2 fresh sheet of film is loaded imto the cassette, Dry laser processors are used for producing images from digital modalities. They do not, however, use wet chemical processing. Dry processing works by thermal sensitization of the emulsion (mainly carbon grains or silver halide erystals) using an intensity-modulated laser beam, which causes adhesion of the emulsion to the polyester film base. Increasing exposure time increases motion unsharpness. For a fixed kVp and mAs, the film and patient exposures, atinude, and speed are unaffected. No change in kVp means no change in system latitude, The sereemfilm system is not significantly affected by exposure time variations. {In the early FFDM units the detector size was typically about 18%24 cm, similar to the smaller size mammography film cassettes. When patients with lacge breasts were imaged, double exposures were often necessary in order to fully image the large breast. The two images then had to be viewed sequentially in order to get information on the one breast. Some newer units have larger detectors, capable of imaging approximately 24%30 em, similar tothe larger size mammography film cassettes. The compression and angulation capabilities are essentially the same as on film units. The possible lower resolution of the digital units does not appear to significantly affect diagnosis NCRP Repott No. 149, “A Guide to Mammography and Other Breast Imaging Procedures,” concludes: “Mammography, in Conjunction with physical examination, is the method of choice for early detection of breast cancer. Other methods should not be substituted for mammography, but may be useful adjunets in specific diagmostic situations.” The SMPTE pattern is a standard digital image with steps of different contrast used for QC and setup of laser imagers (digital mammography) and image viewing monitors. ‘The lowest kVp (for good contrast) that results in an exposure time between 1 and 2 sec- onds (for minimum motion blur) should be used. Exposure times in A and B are too long (increased blur). In D and E, the kVp is higher than necessary (reduced contrast), FFDM has a considerably lower system resolution than screen-film because of the rather large pixel size of the digital detectors (0.05-0.1 mm). However, FFDM sensitivity to detect cancer has becn shown to be at least equivalent to screen-film systems, DI. A 20. D bz. D p22. B 23. Di. D Das. B26. E Raphex 2006Diagnostic + Answers D2. A 28. 29. 30. D3I. D2, 33. B MQS TH TI, Ta. Ts. TIS. TI6. TI. Tia. TH. E Increasing SSD increases the PDD. ‘The PDD at 200 em SSD is found by multiplying the PDD at 100 cm SSD (for the same field size on the skin) by Mayneord's F factor. This fector simply removes the inverse ‘square component of the PDD for 100 em SSD and inserts the inverse square factor ‘appropriate for the new SSD of 200 em. PDD (20 x 20 em, 200 SSD) = PDD (20 x 20 em, 100 SSD) F, where Fe (24 S9D4d) (new $5D+dem) “(ad SSD+d_.) (newS9D*d) thus new PDD = 0.843 x (106/101.5)? x (201.5/206)* = 0.880 ‘The equivalent square of a 5x20 cm field is 8.0, so the 10x10 cm field has the greater TMR. The 5x20 cm fieid has an arca of 100 em*; however, the equivalent square is smalter than the square root of 100 (i.e., 10 em), because equivalence is based on scatter dose reaching the axis, and not on area. {dose at depth) Pe ee MU ose rae at dept) where: dose rate at depth = dose rate at daa. (open) 8 TMR x WTE, ‘Thus MU ‘Wedge angie (WA) = 90° - (Hinge angle/2). WA ~ 90° - (60/2) = 60°. ‘The appropriate wedge will provide isodose curves that run parallel to the bisector of the hinge angle. ‘Wedges are used to reduce the anterior hot spot in a larynx plan treated with lateral ‘opposed fields. If hot spot is required, the wedges may be omitted ‘The plan is overwedged SSeS 2 Raphex 2006Therapy * Answers” 720. Ta. 722. T14. 725. 726. 727. 728. E Increasing the SSD can lower the skin dose, because scatter from the collimators, blocking tray, etc., may not be intercepted by the patients skin. Although a spoiler preserves some skin sparing, the surface dose will generally be greater than in an open beam, While day is at 3.5 om depth in an open field, 90% occurs at 1.5 cm in the build-up region For parailel-opposed fields, 100% and 90% of the midline dose move closer to the surface, Bolus can be used with an electron beam to achieve a desired isodose distribution at depth. Wedges are often used as simple compensators, (g., in tangential breast treatment), but have the disadvantage of having uniform thickness in the nonwedge direction. Two- dimensional “missing tissue” compensators can be fabricated using a device that mills the shape in styrofoam™ (based on the patien’s surface contour), which is then filled with cerrobend®. Dynamic MLC can be used to create any desired dose pattern; breast IMRT with tangential fields essentially uses IMRT to create an optimal tissue compensator, The geometry of the gap formula relies on both beam edges meeting at a point where each contributes 50% of the dose on the axis, Thus, the total dose atthe "match" point is equal to that on the axis of either field, at the same depth. Since the edge of the light field is used to represent the edee of the radiation fcld, it is important that the light field follows the line representing 50% of the dose on the axis. Provided the geometry is correct, beams of different energy or different treatment machines may be used for each field. one eter 20 ‘SAD The angle required to rotate the brain fields so that their inferior edge matches the divergence of tie upper border ofthe spine field is: tan [(36/2¥/100) = 10°. ‘The lower borders of the lats would diverge inferiorly, and would only match the LAN at ‘one point, on the skin. Answer A would require about 21% less MU, based on the ratio of TMRs. ‘Answer B would be equivalent to about 4 cm missing tissue, or a difference of about 15% Jess MU in the plan. The blocking way factor in € is about 3%, and the corner block would make only a small difference in the equivalent square, and have & negligible effect on the TMR. ‘The depth of the 50% PDD for 6 MV photons is 16 em for a 10x10 cm field. Raphex 2006 23Therapy + Answers @ 122, 730, EF TRA 732. A 733, A 734, D 735. D 136, 137. B 738. A ‘The attenuation per em at 6 MY is about 3.5% (B, D, and E). A is about 4%%: 2% for the ‘shange in TMR and 2% for the output. C involves an inverse square correction of approxi= ‘mately (110/100)? = 1.21. The depth to midline changes from 13 cm to 11 cm, The attenuation in a 6 MV beam is about 3.5% per em. Thus, a change of 2 em will cause an overdose of 7%, if no MU correction is made, This is why Co-60 units had a wider penumbra than linacs, ‘The flatening filter “overfattens” at shatlow depths, and “underflattens” at greater depths, ‘The dose at day is therefore greater towards the edges of the beam, and this effect increases with field size. ‘TMRs are a measure of attenuation only, whereas PDDs comprise attenuation and inverse square components, By the inverse square lav, the dose at d.,., will be reduced by (20/22) square corrections can be quite large for short SSD units. or 17%, Inverse ‘The thinner filter will increase dose-rate, but will not harden the beam as much as the 2mm filter, so the HVL and PDD will both decrease. Historical data reported in the literature without inhomogeneity corrections actually used a variety of beam energies and path lengths through inhomogencities. The doses reponied therefore included these uncertaimies, Although different planning systems use different algorithms, the use of corrections is expected to educe the uncertainty in dose reporting, The Hounsficld number is 1000 > [(tssnee ~ Hae) Hoyer) Where jt refers to the linear atvenu- ation coefficient of the materia! a¢ the CT beam quality: Thus, the Hounsfield aumber for ‘water is 0. Materials with negative Hounsfield numbers have linear attenvation coefficients less than water, and those with positive Hounsficld numbers have finear attenuation cocfli- cients greater than water, ‘The greatest attenuation difference oceurs for the lowest energy and the medium with the greatest effective depth difference. 10 em lung is approximately equivalent to 3 em muscle tissue, of 7 em missing tissue. 5 em of dense bone is approximately equivalent to $ em muscle, of 3 ¢m exra tissue Raphex 2006Therapy Answers * T39. C Dose build-up at the lung-tissue interface may underdose the tumor; this effect increases ‘with increasing photon energy. T40. D The fraction of dose due to scatter increases with both depth and field size Tat. C Five HVLs is equivalent to 3% transmission. The additional dose is due to scatter from the surrounding tissue. T42, B Using similar tiangle geometry, the block width is: 3 em x (way distance/film distance) = 3 x 65/130 = 1.5 cm. T43. D By similar triangle geometry: (size on wall/size at isocenter) = (source to wall dist./source to isocenter dist.) = 500 cmv/100 em, Thus size on wall = 40 x 5 em = 200 em, (Note: The distance to the wall must be measured from the source, not the isocenter:) T44. A Although individual units vary, and testing is limited, ICDs have been shown to fail at doses as low as 50 eGy, while pacemakers are generally considered able to tolerate doses of 200 cGy. In either ease, pre-treatment dose estimates and in vivo dose measurement are advisable, as is careful monitoring by the cardiologist. TAS. B 2Gy outof 40 Gy is $%. This occurs at about 2 cm from the field edge. T46, B Each field contributes about 2.5% of the prescribed dose: the lateral field contributes inter- ral scatter, and the medial field contributes dose from the physical wedge. [fa dynamic ‘wedge is used, this will reduce the contralateral breast dose by almost one-half, T47, E —_ Inhomogencity is mainly due to differences in thickness (¢.g., forearms vs. trunk). B, C, and D tend to improve dose homogeneity. 748, D Only CT provides a map of electron densities. MRJ can map hydrogen density. 749. A Gamma knife radiosurgery is often prescribed to the 30% isodose, which means that some point in the volume receives 200% of the prescribed dose. Linac-based SRS is generally prescribed to the 70%-90% isodose, giving less variation across the treatment volume, 150. C Raphex 2006 25Inerapy > Answers + OO TSI. Ts2. TS3. Ts4, 55. 756. 57, 758. 159. Too. Tel. Tez. c c Setup margin is included in creation of the PTV from the CTY. ‘With IMRT, 6-MV photons can give good results even for large depths (e.g. for a prostate). However the integral dose outside the PTV will generally be greater for lower energy. Because of the complexity of IMRT calculations, verification by hand calculation of moni- {or units is not feasible as a routine method. Reproducible alignment of the bony ansiomy does not guarantee alignment of the prostate itself. Differences in rectal and bladder filling can cause movement of the prostate. The DVH showing bladder, rectal, and prostate doses is only as accurate as the accuracy of the daily prostate locelization and the reproducibility of the adjacent organs. ‘The PET sean takes much longer than the CT sean, so breathing or other patient movement aust be considered, even ifthe geometry of the seanner is identicat in each scan, Although rectal (and bladder) filling may alter the position of the prostate relative to skin rmarks oF bony landmarks, ultrasound localization customizes the daily setup to the actual ‘prostate position om that day. A full bladder is, however, necessary to transmit the wltra- sound, Artifacts from metal fillings, etc, are worse for kV than for MV images. Linear attenuation decreases as photon energy increases, in the range of energies used for therapy: In soft-tissue, Compton interactions predominate over the whole range of therapy photon energies. For monocnergctic photons, Compton interactions are most likely berween 25 kV and 25 MV. The “aominal” energy of a linac is generally based on the highest photon encr- 8; while the peak of the spectrum is about one-fiflh to one-third of the maximum, Electrons lose 2 MeV per em in tissue. Rule of thumb: 90% depth dose = Energy(MeVy3. — Ss 26 Raphex 2006Therapy Answers ‘The most noticeable effect of increased SSD is increased penumbra width. PDD and beam energy are unaffected, and output decreases. ‘The maximum dose is at dry (100% depth dose), and is 200/0.95 cGy, 0.6 mm per MeV is a rule of thumb for cerrobend (1.2 times the thickness of lead). High-energy electrons generate bremsstrablung x-rays when stopped in metal, asin the target of an x-ray machine. The cutout cannot be made thik enough to completely remove these x-rays, There will also be scattered electrons contributing to the dase under the block. The PDD, output, and depth of d,,, Will all be reduced for the smaller inser ‘The reason for placing field shaping on the skin is to achieve a sharper penumbra, The ‘output factor may not be the same as for the same effective field size with an insert in the applicator. Regardless of energy, there will always be hot and cold spots because the 90% isodose curves in and the 20% isodose curves out. Overlapping the fields removes the cold spot, ‘but increases the hot spot, and leaving a gap does the reverse. The formula given is for matching photon fields at depth, and does not apply to electrons. Abutting light fields and ‘moving the junction two or three times during the course of treatment is the most effective ‘way to minimize hot and cold spots. Electron backscatter (EBS) occurs when high Z materials are used as shields in an electron ‘beam, EBS is greatest for lower energy, and when a high PDD is incident on the shicld, and can cause as much a5 a $0% inerease in dose to tissue in contact with the upstream side of the shield. EBS can be absorbed by a sufficient thickness of low Z material (e-g., wax) placed on the upstream surface of the shield Ay sal! = 41024, ‘The haif life of 1-125 is 60 days. The activity 5 days earlier is 0.48 » exp(0.693 x 5/60) = 0.51 mCi. Te. A T64. A Tes. C T66. T87. C Tee. A 169. B 170. B Tl. 1. B 17. D Raphex 2006 PyTherapy + Answers 4. B Dose rate in air = Air Kerma streagth x i/distance* x attenuation in patient, T76. 17. ‘178, 179. Teo. Tal. 183. Tad, ‘Tes. A A Half-life is only used when calculating the total dose for a permanent implant The half-life of 1-125 is 60 days. In 7 days the activity decays by a factor of ‘exp-0.693 x 7/60 = 0.92. Thus 8% more secds or 108 are required. ‘The total dose delivered = {initial dose rate) x (half-life!0.693) Dose rate is proportional to activity. After one half-life, $0 of the dose has been delivered. After another half-life, 30% of the remaining 50% is delivered, or a total of 75% in two halflives, TG40 recommends 10% of loose seeds be assayed. Dose rate falls off with distance according to the inverse square law DRYDR= (42/6,) 182 = (4/20). ds = 60 crn, Due to the inverse square law, 9 point near the end of the cylinder is further away from most of the sourees than a point at an equal radius near the center. Thus, longer dwell times are required at the ends to compensate for this effect. Times = Time exp(0.693 dT, = 366 x exp(0.693 x 7/74) 28 Raphex 2006I herapy + Answers aS T86. C Neutrons are indirectly ionizing. They are therefore measured by detecting the products of their interactions, such as protons or alphas, or by foil activation. TB7. D_ The physicist may delegate QA measurements to other staf (For example, therapists usually perform daily QA each morning), but TG40 recommends thatthe overall design, implementation, and monitoring be the responsibility ofthe clinical physicist. TSB. C This is part of the annual QA. Ta9. T90, ‘and C are commonly used for the calibration geometry, but there is no rule that states ‘hat a particular geometry must be used to define 1 MU. iis vital, however, that all data tables, treatment planning systems, and MU checking programs use data consistent with ach other, and with the department’s definition of | MU, This can be verified by calculating a simple plan, delivering it to a phantom, and compar- ing the measured dose in the phantom with that prescribed in the plan end that obtained with hand calculations TH. OB Neutrons are best attenuated by materials with a low atomie number, 192, ‘Compared with the primary beam, leakage is negligible. If the wal is sufficiently thick to shield against the primary beam, it will be sufficient for head leakage also. 793. D_ For megavoltage photons, 90-degree scatter is of the order of 500 keV T94. A Occupancy factor is always 1.0 in a controlled area, B-E ary factors that, like occupancy factor, affect the ealeulation of shielding thickness. T95. B This dose rate is generally achieved by the time the scan is completed. The halflife of FDG is #10 minutes, —_——<-— Raphex 2006 29‘Therapy * Answers + 196. ‘Therapists should receive no measurable dose from treating patients on a linac, of atthe treatment console of an HDR unit. Modern HDR units are well shielded, and even older ‘models should not exceed 2 mR in an hour at I m from the safe. 1-125 and Pd-103 seeds ‘mit low-energy photons, which are easy to shield, both for transport and loading; only the hands receive a very small dose from loading, Patients who have had FDG injected for a PET scan emit faitly energetic 0.51 MeV’ photons from positron-eleciron annihilation, ‘Although the dose at 30 cm from the patient would be low (typically 8 miVhr one hour after the injection), protonged therapy simulation/setup procedures could result i ‘contact with the patient, and should if possible be completed before the patient is with FDG, to minimize staff exposure. Radiochromic film offers many advantages as a dosimeter. However, it does require doses of several Gy or more for accurate dosimetry. 197. E 798. D 199. C 30 Raphex 2006