B.

Electron beams
C. Proton beams
Radiation Therapy – Practice Exam D. Gamma rays
(1–50)
9. A linear accelerator primarily produces:
A. X-rays and electrons
1. The primary goal of radiation therapy in
B. Gamma rays
oncology is:
C. Protons
A. To eliminate all malignant cells
D. Neutrons
B. To shrink tumors only
C. To prevent metastasis without killing cells
10. Which tumor type is most radiosensitive?
D. To stimulate immune response
A. Lymphoma
B. Melanoma
2. The unit of absorbed dose in radiation therapy
C. Glioblastoma
is:
D. Renal cell carcinoma
A. Gray (Gy)
B. Becquerel (Bq)
11. Brachytherapy refers to:
C. Sievert (Sv)
A. Internal radiation treatment
D. Roentgen (R)
B. External beam radiation therapy
C. Chemotherapy with radiation
3. Which imaging modality is most commonly
D. Radioisotope imaging
used for treatment planning in radiation therapy?
A. Ultrasound
12. Which isotope is most commonly used in high
B. MRI
dose rate (HDR) brachytherapy?
C. CT Scan
A. Iodine-131
D. PET
B. Iridium-192
C. Cesium-137
4. The concept of fractionation in radiation
D. Cobalt-60
therapy refers to:
A. Dividing the total dose into multiple smaller
13. Which organ is most sensitive to radiation?
doses
A. Brain
B. Increasing radiation dose each session
B. Lung
C. Delivering dose in one session
C. Bone marrow
D. Using two modalities simultaneously
D. Muscle
5. The term "IMRT" stands for:
14. The planning target volume (PTV) accounts
A. Intensity Minimization Radiation Therapy
for:
B. Intensity Modulated Radiation Therapy
A. Tumor only
C. Internal Measurement of Radiation Therapy
B. Tumor + margins for movement
D. Invasive Modular Radiation Therapy
C. Tumor + surrounding organs
D. Tumor + dose calculation errors only
6. The tolerance dose of the spinal cord is
approximately:
15. Radiosensitizers are used to:
A. 20 Gy
A. Protect normal tissues from radiation
B. 30 Gy
B. Increase tumor cell sensitivity to radiation
C. 45 Gy
C. Neutralize free radicals
D. 60 Gy
D. Enhance immune response
7. Which device is used to shape radiation beams?
16. The term "OAR" in treatment planning refers
A. Collimator
to:
B. Dosimeter
A. Organ at risk
C. Radiometer
B. Oxygen and radiation
D. Ion chamber
C. Optimal area ratio
D. Organ and region
8. The Bragg peak is associated with:
A. Photon beams
17. Stereotactic radiosurgery (SRS) is best suited 25. A wedge filter is used in radiation therapy to:
for: A. Reduce beam intensity uniformly
A. Diffuse brain tumors B. Modify dose distribution
B. Small, localized brain lesions C. Block scattered radiation
C. Bone metastasis D. Focus beams
D. Skin cancers
26. Which of the following is considered an acute
18. Which factor contributes most to radiation- radiation effect?
induced DNA damage? A. Cataracts
A. Direct ionization B. Sterility
B. Thermal effect C. Skin erythema
C. Free radical formation D. Fibrosis
D. Photochemical reaction
27. The unit commonly used to measure radiation
19. In total body irradiation (TBI), the usual therapy beam output is:
purpose is: A. Coulomb/kg
A. Preconditioning for bone marrow transplant B. Monitor units (MU)
B. To shrink brain tumors C. Roentgen equivalent man (rem)
C. To treat lung cancer D. Sievert
D. To treat prostate cancer
28. The most common isotope used in external
20. Which organ is considered dose-limiting in beam radiotherapy before linear accelerators was:
pelvic irradiation? A. Cobalt-60
A. Bladder B. Iridium-192
B. Rectum C. Iodine-125
C. Small intestine D. Technetium-99m
D. Femoral head
29. A bolus in radiation therapy is used to:
21. The relative biological effectiveness (RBE) of A. Increase skin dose
protons compared to photons is approximately: B. Decrease skin dose
A. 0.5 C. Protect deeper tissues
B. 1.0 D. Shield critical organs
C. 1.1
D. 2.0 30. A patient undergoing whole brain irradiation
may develop:
22. Radiosurgery is typically delivered in: A. Memory loss
A. Multiple fractions B. Nephritis
B. Single high-dose fraction C. Leukopenia
C. Continuous low dose D. Pulmonary edema
D. Brachytherapy implant
31. The term "fraction size" in radiation therapy
23. The most common side effect of head and refers to:
neck radiation therapy is: A. Size of tumor fraction
A. Xerostomia B. Dose per session
B. Nephrotoxicity C. Daily treatment duration
C. Pulmonary fibrosis D. Beam energy
D. Alopecia
32. The unit Sievert (Sv) measures:
24. The four R’s of radiobiology include all A. Equivalent dose
EXCEPT: B. Absorbed dose
A. Repair C. Exposure
B. Repopulation D. Activity
C. Redistribution
D. Reoxygenation 33. Which type of radiation has the highest LET
E. Reaction (linear energy transfer)?
A. X-rays 41. Acute radiation syndrome primarily affects:
B. Protons A. Skeletal muscles
C. Alpha particles B. Hematopoietic system
D. Gamma rays C. Nervous system only
D. Musculoskeletal system
34. Which of the following is a stochastic effect of
radiation? 42. Which is considered the "gold standard" for
A. Cataract formation prostate cancer radiotherapy?
B. Skin erythema A. External beam radiotherapy
C. Carcinogenesis B. HDR brachytherapy
D. Sterility C. LDR brachytherapy
D. Stereotactic body radiotherapy
35. The main purpose of immobilization devices
in radiation therapy is: 43. Which organ is at highest risk in craniospinal
A. Improve patient comfort only irradiation?
B. Reproducible patient positioning A. Liver
C. Reduce treatment time B. Lungs
D. Decrease beam energy C. Kidneys
D. Bone marrow
36. The most radiosensitive phase of the cell cycle
is: 44. Radiosensitivity of tissues is highest in:
A. G1 A. Highly differentiated cells
B. S B. Rapidly dividing cells
C. G2/M C. Non-dividing cells
D. G0 D. Muscle cells

37. The standard fraction dose for conventional 45. What is the primary late effect of radiation
radiotherapy is approximately: therapy on lung tissue?
A. 0.5 Gy A. Fibrosis
B. 1.0 Gy B. Pneumonia
C. 1.8–2.0 Gy C. Emphysema
D. 5.0 Gy D. Bronchitis

38. What is the main advantage of proton therapy 46. Which modality uses rotating gantry with
over photon therapy? helical delivery for radiation treatment?
A. Cheaper cost A. IMRT
B. Greater availability B. Tomotherapy
C. Reduced exit dose C. SRS
D. Less equipment required D. Brachytherapy

39. The primary function of a multi-leaf 47. The tolerance dose for the lens of the eye is
collimator (MLC) is: approximately:
A. Patient immobilization A. 2 Gy
B. Beam shaping B. 5 Gy
C. Dose measurement C. 10 Gy
D. Imaging guidance D. 50 Gy

40. Which treatment technique delivers radiation 48. Which of the following improves tumor
from multiple angles converging on a single oxygenation and radiosensitivity?
point? A. Hypoxia
A. Arc therapy B. Hyperbaric oxygen
B. Tomotherapy C. Anemia
C. Stereotactic radiosurgery D. High altitude
D. Fluoroscopy
49. Radiation recall is a reaction triggered by: 57. The main goal of palliative radiotherapy is:
A. Prior radiation re-exposure a. Cure of disease
B. Chemotherapy after radiation b. Pain relief and symptom control
C. Infection during radiation c. Prevent recurrence
D. Delayed genetic mutation d. Total tumor eradication

50. Which type of beam is most suitable for 58. The wedge filter is primarily used to:
treating superficial tumors? a. Increase skin dose
A. Proton beam b. Modify isodose distribution
B. Photon beam c. Harden the beam
C. Electron beam d. Reduce beam intensity to half
D. Gamma beam
59. Which unit is commonly used to measure
51. Which type of radiation therapy delivers absorbed dose in radiation therapy?
radiation during surgery? a. Gray (Gy)
a. IMRT b. Sievert (Sv)
b. SBRT c. Roentgen (R)
c. IORT d. Coulomb/kg
d. Brachytherapy
60. For prostate brachytherapy, which isotope is
52. The immobilization device most commonly commonly used?
used for head and neck treatments is: a. Ir-192
a. Vac-Lok b. Cs-137
b. Thermoplastic mask c. I-125
c. Bite block d. Co-60
d. Wing board
61. Which of the following best describes
53. The “four Rs” of radiobiology include: hyperfractionation?
a. Repair, Reoxygenation, Redistribution, a. Fewer, larger doses
Repopulation b. More, smaller doses per day
b. Radiation, Reduction, Repair, Redistribution c. One high-dose treatment
c. Rest, Repair, Repopulation, Radiation d. Twice weekly dose
d. Redistribution, Regeneration, Repair, Reduction
62. A linear accelerator produces which type of
54. The dose delivered by a cobalt-60 unit radiation?
decreases over time due to: a. Gamma rays
a. Leakage b. Protons
b. Source decay c. X-rays and electrons
c. Beam hardening d. Alpha particles
d. Scatter
63. What is the recommended dose limit for the
55. Brachytherapy sources are commonly made lens of the eye in occupational workers?
of: a. 50 mSv/year
a. Lead b. 20 mSv/year
b. Iodine-125, Cesium-137, Iridium-192 c. 150 mSv/year
c. Barium and Technetium d. 15 mSv/year
d. Tungsten
64. SBRT delivers:
56. In radiation therapy, “conformal therapy” a. Low-dose over long periods
means: b. High-dose radiation in few fractions
a. Uniform dose delivery c. Continuous exposure for weeks
b. Shaping beams to tumor contour d. Intraoperative treatment only
c. Rotating gantry use only
d. Multibeam scatter dose 65. Radiosensitivity is greatest during which cell
cycle phase?
a. S c. To check billing accuracy
b. M d. To evaluate staff performance
c. G0
d. G1 74. The treatment field margins in radiotherapy
include:
66. In IMRT, beam intensity is modified by: a. Tumor only
a. Manual collimators b. Tumor + microscopic disease + setup error
b. Wedge filters c. Normal tissue only
c. Multileaf collimators (MLCs) d. Only the largest lymph node
d. Bolus
75. The Bragg peak is characteristic of:
67. The half-life of cobalt-60 is approximately: a. Electrons
a. 30 years b. X-rays
b. 5.26 years c. Protons
c. 10 years d. Gamma rays
d. 2 years
76. Radiation necrosis is an example of:
68. Brachytherapy classified as “permanent a. Acute effect
implants” includes: b. Late effect
a. Ir-192 c. Stochastic effect
b. Cs-137 d. Carcinogenic effect
c. I-125 seeds
d. Co-60 pellets 77. The most radiosensitive blood cell is:
a. Erythrocyte
69. The main purpose of bolus in radiation therapy b. Lymphocyte
is: c. Neutrophil
a. Reduce patient dose d. Platelet
b. Increase surface dose
c. Absorb leakage radiation 78. The primary unit for source activity is:
d. Modify beam energy a. Becquerel
b. Sievert
70. The radiosensitivity of tissues is described by: c. Gray
a. Bragg peak d. Roentgen
b. Bergonié and Tribondeau law
c. Inverse square law 79. What is the function of the flattening filter in
d. Linear energy transfer LINACs?
a. Absorb scatter
71. The main imaging tool for treatment planning b. Flatten beam intensity across the field
in radiation therapy is: c. Harden the beam
a. X-ray d. Reduce dose rate
b. CT scan
c. Ultrasound 80. What type of therapy delivers radiation
d. MRI internally via bloodstream?
a. EBRT
72. Prophylactic cranial irradiation is usually b. Brachytherapy
given to patients with: c. Systemic therapy
a. Breast cancer d. SBRT
b. Small cell lung cancer
c. Prostate cancer 81. HDR brachytherapy refers to:
d. Cervical cancer a. High-dose rate >12 Gy/hour
b. High-density radiation
73. The purpose of QA (Quality Assurance) in c. Highly directional radiation
radiation therapy is: d. Hyperdynamic radiation
a. To verify physician prescriptions
b. To ensure equipment and treatment accuracy
82. TBI (Total Body Irradiation) is commonly 90. What is the primary limitation of using cobalt-
used in preparation for: 60 units today?
a. Bone marrow transplant a. Large size
b. Organ donation b. Source replacement and decay
c. Brain surgery c. High energy only
d. Prostatectomy d. No skin sparing

83. What is the unit of exposure in air? 91. The depth of maximum dose for a 6 MV X-ray
a. Coulomb/kg beam is about:
b. Sievert a. 1.5 cm
c. Gray b. 5 cm
d. Becquerel c. 0.5 cm
d. 10 cm
84. Which patient position is standard for breast
irradiation? 92. What is the purpose of MLCs (multi-leaf
a. Supine with arms up collimators)?
b. Prone with arms down a. Patient immobilization
c. Trendelenburg b. Beam shaping and modulation
d. Lithotomy c. Beam hardening
d. Dose measurement
85. The term "fractionation" in radiotherapy refers
to: 93. Which radiation effect is considered
a. Total dose only stochastic?
b. Division of dose into multiple sessions a. Erythema
c. Type of radiation used b. Cataracts
d. Field size reduction c. Carcinogenesis
d. Sterility
86. Which of the following is NOT a late effect of
radiation therapy? 94. Which isotope is commonly used in HDR
a. Fibrosis brachytherapy?
b. Necrosis a. Ir-192
c. Erythema b. I-131
d. Sterility c. Co-60
d. Cs-137
87. Radiation dose to the rectum and bladder is a
concern in treatment of: 95. The unit Sievert is used to express:
a. Lung cancer a. Absorbed dose
b. Prostate cancer b. Equivalent and effective dose
c. Brain tumor c. Exposure
d. Head and neck tumor d. Source activity

88. The purpose of simulation in radiotherapy is 96. The therapeutic ratio is the balance between:
to: a. Tumor dose and normal tissue tolerance
a. Practice treatment setup and verify fields b. Dose rate and treatment time
b. Measure dose rate c. Absorbed dose and exposure
c. Record patient history d. Fractionation and beam energy
d. Replace QA checks
97. A stereotactic head frame is used in:
89. Which cancer is most often treated with TBI a. SBRT
and BMT? b. SRS (Stereotactic radiosurgery)
a. Leukemia c. IMRT
b. Breast cancer d. IORT
c. Prostate cancer
d. Lung cancer 98. Which treatment is best for superficial skin
lesions?
a. Electron therapy
b. Proton therapy
c. Photon therapy
d. Neutron therapy

99. Which QA test is done daily on LINACs?

100. The main principle of ALARA in radiation