Medical Dosimetry
Exam Materials
Course Introduction
Medical Dosimetry is a specialized course focused on the principles and practice of calculating and planning the delivery of radiation doses in cancer treatment. Students learn the theoretical foundations of radiation physics, radiobiology, and treatment planning techniques using advanced computer systems. Emphasis is placed on the development of skills required to design precise radiation dose distributions, optimize treatment plans for individual patients, and adhere to safety and quality assurance standards. The course integrates clinical case studies and hands-on training to prepare students for professional roles as medical dosimetrists within the healthcare team.
Recommended Textbook Principles and Practice of Radiation Therapy 4th Edition by Washington
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Page 2
Chapter 1: Cancer: An Overview
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Sample Questions
Q1) Tumors are the result of which of the following?
A) Black bile
B) Necrotic tissue
C) Abnormal cellular proliferation
D) Traumatic injury
Answer: C
Q2) When compared with surgery, benefits of radiation therapy include all except which of the following?
A) Instantaneous cure
B) Better cosmetic results
C) Preservation of function
D) Noninvasive
Answer: A
Q3) Identify the correct order for the phases of the mammalian cell cycle.
A) G1, G2, M, S
B) G1, G2, S, M
C) G1, M, G2, S
D) G1, S, G2, M
Answer: D
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Page 3
Chapter 2: The Ethics and Legal Considerations of Cancer Management
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Q1) Who is most closely associated with the stages of grief?
A) Nel Noddings
B) Elisabeth Kübler-Ross
C) John Mill
D) Immanuel Kant
Answer: B
Q2) Which patient/provider relationship model devalues autonomy?
A) Engineering
B) Priestly
C) Collegial
D) Contractual
E) Covenant
Answer: B
Q3) Which of the following is a theory of ethics developed by Immanuel Kant?
A) Virtue ethics
B) Communitarianism
C) Contextual ethics
D) Deontology
Answer: D
Page 4
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Chapter 3: Principles of Pathology
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Sample Questions
Q1) A(n)______________ is a term used to describe a gene that accelerates growth.
A) oncogene
B) tumor-suppressor gene
C) nucleoside
D) nucleotide
Answer: A
Q2) Which of the following would likely be a stage I tumor?
A) T1 N0 M0
B) T2 N1 M0
C) T3 N2 M0
D) T3 N1 M1
Answer: A
Q3) All except which of the following are organelles?
A) Mitochondria
B) Endoplasmic reticulum
C) Ribosomes
D) Plasma membrane
Answer: D
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Chapter 4: Overview of Radiobiology
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Sample Questions
Q1) Which of the following is not an early response to radiation?
A) Breast cancer
B) Erythema
C) Diarrhea
D) Chromosome aberrations
Q2) Isoeffect curves are most closely associated with which of the following?
A) Oxygen enhancement
B) Radiation syndromes
C) Tolerance doses
D) Fractionation
Q3) How does oxygen retention affect radiosensitivity?
A) Increases
B) Decreases
C) No change
D) Varies by tissue
Q4) The TD 50/5 for the optic nerve is approximately _____ Gy.
A) 25
B) 35
C) 50
D) 65
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Chapter 5: Detection and Diagnosis
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Q1) A subjective indication of a disease or a change in condition as perceived by the patient is a ________.
A) sign
B) symptom
C) syndrome
D) screening
Q2) Which of the following is a more widely accepted procedure for assessing axillary node status once the primary breast tumor has been identified?
A) Specificity testing
B) Predictive value testing
C) Sentinel lymph node
D) Axillary node surgery
Q3) Which of the following statements are incorrect?
A) Ultrasonography uses high-frequency sound waves.
B) CT scans have a higher resolution than radiographs.
C) Magnetic resonance imaging (MRI)scans use ionizing radiation.
D) Most invasive procedures provide some risk to the patient.
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7
Chapter 6: Medical Imaging
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Q1) Therapeutically, x-rays in the 40 to 300 kVp range are used for which of the following?
A) Treatment of skin cancers and other superficial tumors
B) The planning of a patient's treatment on the simulator
C) Both of the above
D) None of the above
Q2) Because of the mobility of the prostate, which imaging modality is often used at the time of treatment to identify the position of the prostate?
A) Fluoroscopy
B) Ultrasound
C) MRI
D) Nuclear medicine
Q3) Which of the following describes the predominant x-ray interaction in the diagnostic range?
A) Compton scatter
B) Photoelectric absorption
C) Coherent scatter
D) None of the above
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8
Chapter 7: Treatment Delivery Equipment
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Sample Questions
Q1) Depth of maximum dose for a 6-MV machine is how far below the skin surface?
A) 0.5 cm
B) 1.5 cm
C) 2.5 cm
D) 5 cm
Q2) Lipowitz metal is composed of which of the following?
A) Tin, bismuth, lead, and cadmium
B) Lead, tungsten, and tin
C) Tin, bismuth, tungsten, and lead
D) Bismuth, cadmium, and lead
Q3) When using multileaf collimation, which concerns need to be evaluated?
A) Penumbra between the leaves and the transmission of the leaves
B) Movement of MLCs during the treatment give variations in dose that need to be evaluated along with penumbra between the leaves
C) Movement of MLCs during treatment and interleaf transmission leakage
D) Penumbra at the end of the leaves and interleaf transmission leakage
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Chapter 8: Treatment Procedures
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Q1) Based partially on historic studies showing a reduction in treatment error associated with increased portal imaging, ________ portal imaging for radical cases has become an accepted but not universally implemented standard.
A) twice-daily
B) weekly
C) monthly
D) initial and final
Q2) In radiation therapy, which of the following refers to materials whose interactions with the radiation beam mimic those of tissue?
A) Wedge
B) Electron cutout
C) Internal or external shield
D) Bolus
Q3) The comprehensive electronic medical record (EMR)in radiation oncology may include all except which of the following?
A) Patient's history and physical
B) Schedules
C) Clinical charting
D) Radiation treatment details
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Page 10
Chapter 9: Infection Control in Radiation Oncology Facilities
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Q1) The person to whom the infectious agent is passed is a(n)_____________.
A) fomite
B) host
C) pathogenic
D) iatrogenic
Q2) A marker used to apply marks on a patient's skin should not be used on multiple patients to help prevent which of the following?
A) Transmission of disease
B) Drying out of markers
C) Confusion about color-specific field parameters
D) Skin permeability resistance
Q3) What are the five transmission routes that carry disease?
A) Airborne, vector-borne, contact, droplet, common vehicle
B) Airborne, vector-borne, indirect, subdirect, droplet
C) Airway, vector-borne, contact, blood-borne common vehicle
D) Airway, vector-borne, contact, drippings, common vehicle
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Chapter 10: Patient Assessment
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Q1) Anemia is a decrease in _______________________.
A) white blood cell count
B) circulating platelets
C) lymphocyte count
D) red blood cell count
Q2) Cachexia is the loss of which of the following?
A) Appetite
B) Self-esteem
C) Quality of life
D) Cognitive dimension
Q3) Marasmus is ____________ malnutrition.
A) calorie
B) protein
C) fat
D) carbohydrate
Q4) Reflective listening involves listening with _____________.
A) prayer
B) praise
C) sympathy
D) empathy
Page 12
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Chapter 11: Pharmacology and Drug Administration
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Sample Questions
Q1) Select potential reasons why a patient may be unable to take oral preparations of a drug.
A) The patient is experiencing nausea and vomiting.
B) The patient has difficulty in swallowing.
C) The patient refuses to swallow medication.
D) All of the above apply.
Q2) In which part of the body is barium sulfate used as a contrast agent?
A) Gastrointestinal tract
B) Bronchography
C) Myelography
D) Cardiovascular
Q3) Select the organ most commonly used by the body to excrete drugs and their byproducts.
A) Kidneys
B) Lungs
C) Sweat glands
D) All of the above
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Chapter 12: Applied Mathematics Review
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Sample Questions
Q1) Solve for x in the equation 4(x + 6)= 6x - 16.
A) 1.6
B) 3.2
C) 4
D) 12
Q2) Express log<sub>2</sub> 16 = 4 in exponential notation.
A) 4 = v16
B) 42 = 16
C) 1.6 = 10<sup>2</sup>
D) 2<sup>4</sup> = 16
Q3) Solve for x in the equation x<sup>8</sup>/x<sup>6</sup> = 100.
A) -10
B) ±10
C) 10
D) 1
Q4) Simplify (a²)<sup>5</sup>.
A) a<sup>10</sup>
B) a<sup>7</sup>
C) a<sup>32</sup>
D) a<sup>25</sup>
Page 14
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Chapter 13: Introduction to Radiation Therapy Physics
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Q1) If sufficient energy is given to the atom, one or more electrons of the atom can overcome their binding energy and can be completely removed from the atom.This process is called __________________.
A) ionization
B) excitation
C) nuclear force
D) frequency
Q2) The unit for frequency is 1/sec, called the _________________.
A) lambda
B) Hertz
C) meter
D) angstrom
Q3) AMU is an abbreviation for which of the following?
A) Atomic metric unit
B) Atomic measured unit
C) American metric unit
D) Atomic mass unit
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Chapter 14: Aspects of Brachytherapy
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Q1) Of the following, which brachytherapy application would be used to treat the breast?
A) Intracavitary
B) Interstitial
C) Topical
D) Permanent implant
Q2) Which of the following is an advantage of high-dose rate (HDR)over low-dose rate (LDR)?
A) HDR is noninvasive.
B) HDR dosimetry is simpler.
C) Treatment time is decreased from 72 hours to 24 hours.
D) HDR can be given on an outpatient basis.
Q3) As half-life increases, the overall activity ______________________.
A) increases B) decreases C) remains unchanged
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16
Chapter 15: Special Procedures
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Q1) The typical width of the spread-out proton Bragg's peak (SOBP)is _____________.
A) 2 to 16 mm
B) 2 to 16 cm
C) 1 to 25 mm
D) 1 to 25 cm
Q2) Which of the following is a goal of radiation oncology?
A) Reduce side effects
B) Deliver accurate and precise treatments
C) Increase toxic effects
D) All of the above
Q3) Devices that are on the linear accelerator for imaging include all except which of the following?
A) OBI
B) EPID
C) CT-on-rails
D) Cone beam CT (CBCT)
Q4) Cone beam CT, TomoTherapy, and CT-on rails correct for _________ motion.
A) interfraction
B) intrafraction
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Chapter 16: Particle Therapy
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Q1) Which of the following is one common characteristic for uniform and nonuniform scanning systems that they both are able to do?
A) Can also be called intensity modulated proton therapy
B) Geometrically cover the tumor volume with one beam
C) Deliver a uniform dose throughout the tumor with one beam
D) Incorporate simultaneous boosts
Q2) What do the results of a clinical study completed at MD Anderson indicate regarding when adaptive planning is strongly indicated?
A) The first week of therapy is completed.
B) The first day of therapy is completed.
C) The patient loses significant weight.
D) A high Z prosthesis is in the beam path.
Q3) What is one disadvantage of today's synchrocyclotron over the cyclotron?
A) It needs energy degraders.
B) It can generate variable beam energies.
C) It has less current producing longer treatment times.
D) It needs a complex system to extract the beam energy needed.
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Chapter 17: Radiation Safety and Protection
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Sample Questions
Q1) The annual dose equivalent limit to the whole body for educationally exposed individuals is ____ mSv.
A) 0.5
B) 1
C) 5
D) 50
Q2) The total gestational dose equivalent limit is ____ mSv.
A) 0.5
B) 1
C) 5
D) 50
Q3) The annual dose equivalent limit to the lens of the eye for educationally exposed individuals is ____ mSv.
A) 0.5
B) 1
C) 5
D) 50
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Page 19
Chapter 18: Patient Safety in Radiation Oncology
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Q1) ASTRO accreditation program assesses radiation oncology departments using _____ standards.
A) 5
B) 7
C) 14
D) 16
Q2) Which of the following would be a key driving force for the development of staff exhibiting "initiating" and "enhancing" behaviors during culture change efforts?
A) Positive feedback
B) Low staff levels
C) Burdensome reporting system
D) Limited access to training
Q3) Transformational leadership focuses on which of the following?
A) Interactions between leaders and followers
B) Relationship between leaders and followers
C) Rewards for positive behaviors and punishment for negative behaviors
D) Relationship and interactions between leaders and followers
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Chapter 19: Quality Improvement in Radiation Oncology
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Q1) The output constancy of all electron energies on the linear accelerator are recommended to be checked ________________.
A) daily
B) twice weekly
C) once weekly
D) once Monthly
Q2) X-ray output was calibrated during commissioning as 1.0 cGy/MU.During monthly quality assurance checks, the output is calibrated as 1.3 cGy/MU.This monthly output measurement is _____________________.
A) outside of tolerance limits but no action is required
B) within tolerance limits and no action is required
C) outside of tolerance limits and action is required
D) not required until the annual quality assurance routine
Q3) The ASRT have developed practice standards for radiation therapists.They are divided into what three sections?
A) Cognitive, affective, and psychomotor standards
B) Clinical, quality, and professional performance standards
C) Education, professional self-assessment, and ethical behavior standards
D) Patient care, treatment delivery, and Total Quality Management (TQM)standards
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Page 21
Chapter 20: Surface and Sectional Anatomy
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Q1) The adult vertebral column usually consists of _____ bones.
A) 16
B) 25
C) 33
D) 42
Q2) If a breast tumor is located in the inner upper or lower quadrant, the lymph node drainage is to which of the following?
A) Internal mammary lymph nodes
B) Axillary lymph node
C) Supraclavicular lymph nodes
D) Hilar lymph nodes
Q3) Which structure is located approximately 2 cm anterior and 2 cm superior to the external auditory meatus?
A) Maxillary sinus
B) Nasion
C) Sella turcica
D) Ethmoidal sinus
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Chapter 21: Simulator Design
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Q1) The CT number for water is _____________.
A) -1000
B) -100
C) 0
D) 1000
Q2) __________ takes into consideration how an area on the other side of an irradiated wall is going to be used.
A) Workload
B) Occupancy factor
C) Use factor
D) Barrier factor
Q3) Which of the following represents the path of a photon when it enters the image intensifier?
A) Input phosphor, electrostatic lenses, photocathode, anode, output screen
B) Input phosphor, photocathode, electrostatic lenses, anode, output screen
C) Input phosphor, anode, electrostatic lenses, photocathode, output screen
D) Anode, input phosphor, electrostatic lenses, photocathode, output screen
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Chapter 22: Computed Tomography Simulation
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Q1) Which of the following are benefits of CT simulation?
I.The ability to outline critical structures and view these structures in three dimensions
II.Machine setup parameters and treatment accessories unable to be verified on the CT scanner
III.Virtual simulation allows for construction of digitally reconstructed radiographs DRRs without the patient being present
A) I and II
B) I and III
C) II and III
D) I, II, and III
Q2) Which of the following is the window width on a CT image?
A) The range of numbers displayed on a CT image
B) The number of columns and rows of pixels demonstrated on an image
C) An unwanted image characteristic
D) The central Hounsfield unit of all the CT numbers displayed on an image
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24
Chapter 23: Photon Dosimetry Concepts and Calculations
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Sample Questions
Q1) As the energy increases, what happens to the PDD?
A) Increases
B) Decreases
C) Remains the same
D) No effect
Q2) Which of the following is the equivalent square of a rectangular field of 20 × 10?
A) 12 × 12
B) 15 × 15
C) 11.5 × 11.5
D) 13.3 × 13.3
Q3) A patient is treated on a 6-MV accelerator; field size is 10 × 12 cm and depth of tumor is 6 cm.What is the PDD?
A) 83.02
B) 83.18
C) 83.0
D) 83.2
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Chapter 24: Photon Dose Distributions
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Q1) What determines the wedge angle?
A) The angle of the 100% isodose line with a line perpendicular to the central axis
B) The actual measurements of the wedge
C) The angle of the 80% isodose line with a line perpendicular to the central axis
D) Two times the hinge angle
Q2) Which of the following factors can be corrected to adjust the isodose lines of beams with oblique incidences?
I.PDD
II.TAR
III.TMR
A) I and II
B) I and III
C) II and III
D) I, II, and III
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Chapter 25: Electron Beams in Radiation Therapy
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Q1) Which electron beam's diameter (field size)is most likely to have an effect on a 20-MeV beam's surface dose and percent depth dose?
A) 5 cm
B) 10 cm
C) 15 cm
D) 20 cm
Q2) What thickness of lead is necessary to adequately shield a 9-MeV electron beam?
A) 3 cm
B) 3.6 cm
C) 4.5 cm
D) 5.4 cm
Q3) What is the practical range of a 25-MeV electron beam?
A) 12.5 cm
B) 12.5 mm
C) 50 cm
D) 50 mm
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Chapter 26: Electronic Charting and Image Management
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Q1) Who is responsible for the quality of the EMR?
A) Patients
B) Hospital administrators
C) Information systems personnel
D) Caregivers
Q2) _______ is a computer network covering a small geographic area.
A) A local area network (LAN)
B) WAN
C) PACS
D) DICOM
Q3) _______ facilitate the use of wireless PDAs, laptops, and other pervasive computing devices at the point of care.
A) LANs
B) WLANs
C) ASPs
D) Mans
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Chapter 27: Bone, Cartilage, and Soft Tissue Sarcomas
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Q1) Overall, STS requires which dose of radiation to achieve local control and long-term survival?
A) Low
B) Medium
C) High
Q2) Primary treatment for osteogenic sarcoma involves which of the following?
I.Radiation therapy
II.Surgery
III.Chemotherapy
A) I and II
B) I and III
C) II and III
D) I, II, and III
Q3) Bone scans are used to evaluate which of the following?
A) Histology of the specimen
B) Spread of metastatic disease
C) Extent of soft tissue involvement
D) None of the above
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Chapter 28: Lymphoreticular System Tumors
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Q1) The spleen is commonly associated with which of the following blood cell types?
A) Red blood cells
B) B-cell lymphocytes
C) T-cell lymphocytes
D) Macrophages
Q2) Which pathologic type of Hodgkin lymphoma is the least common in the United States?
A) Nodular sclerosing
B) Mixed cellularity
C) Lymphocyte depleted
D) Lymphocyte rich
Q3) Today, the standard treatment for early stage Hodgkin lymphoma is combination chemotherapy and irradiation of the involved field to a dose of ____ Gy.
A) 30
B) 45
C) 50
D) 60
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30
Chapter 29: Endocrine System Tumors
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Q1) What is the most common form of thyroid cancer?
A) Follicular
B) Papillary
C) Medullary
D) Lymphoma
Q2) In which gland is oxytocin produced?
A) Pancreas
B) Pituitary
C) Thyroid
D) Adrenal
Q3) Which of the following critical structures is of most concern when treating pituitary tumors with radiation?
A) Optic nerves
B) Spinal cord
C) Parotid glands
D) Ears
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Page 31
Chapter 30: Respiratory System Tumors
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Q1) What is the primary function of the respiratory system?
A) Immunity
B) Exchange of gases
C) Production of somatostatin
D) Metabolism
Q2) What is the total dose delivered to a primary lung cancer?
A) 3000 cGy
B) 4000 cGy
C) 5000 cGy
D) Greater than 6000 cGy
Q3) What T stage is a lung cancer measuring 2.5 cm in its greatest dimension?
A) T1
B) T2
C) T3
D) T4
Q4) Which of the following syndromes is commonly associated with Pancoast tumors?
A) Paraneoplastic syndrome
B) Down syndrome
C) Tourette syndrome
D) Horner syndrome
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Chapter 31: Head and Neck Cancers
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Q1) Which of the following is not considered a risk factor for larynx cancer?
A) Epstein-Barr virus
B) Poor nutrition
C) Alcohol abuse
D) Human papillomavirus
Q2) What is the most common form of larynx cancer?
A) Adenocarcinoma
B) Basal cell
C) Squamous cell
D) Transitional cell
Q3) What T stage is a glottic tumor that involves both vocal cords but does not impair mobility?
A) T1a
B) T1b
C) T1c
D) T2
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Chapter 32: Central Nervous System Tumors
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Q1) Which class of chemotherapy drugs has the ability to cross the blood-brain barrier?
A) Antimetabolites
B) Plant alkaloids
C) Nitrosoureas
D) Hormonal agents
Q2) Which of the following is most significant to the prognosis of brain tumors?
A) Tumor size
B) Lymph node involvement
C) Metastases
D) Grade
Q3) What is the 5-year survival rate for all CNS tumors combined?
A) 20%
B) 35%
C) 50%
D) 75%
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34
Chapter 33: Digestive System Tumors
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Q1) What condition is most closely associated with gastroesophageal reflux?
A) Barrett esophagus
B) Gardner syndrome
C) Plummer-Vinson syndrome
D) Tenesmus
Q2) Which of the following cancers has the highest incidence of cancer-related deaths in the United States?
A) Esophagus
B) Stomach
C) Colorectal
D) Anal
Q3) In which division of the esophagus does most esophageal tumors occur?
A) Upper third
B) Middle third
C) Lower third
D) Gastroesophageal junction
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Chapter 34: Gynecological Tumors
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Q1) Cancer of which female reproductive organ is most deadly?
A) Ovarian
B) Uterus (endometrium)
C) Vaginal
D) Vulvar
Q2) Bolus may be used when treating which of the following cancers?
A) Ovarian
B) Cervical
C) Vaginal
D) Vulvar
Q3) The prescription point A can be measured from the cervical os ______________.
A) 2 cm superior and 2 cm lateral
B) 2 cm inferior and 2 cm lateral
C) 3 cm superior and 5 cm lateral
D) 3 cm inferior and 5 cm lateral
Q4) Which female reproductive organ is most likely to develop cancer?
A) Ovarian
B) Uterus (endometrium)
C) Vaginal
D) Vulvar
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Chapter 35: Male Reproductive and Genitourinary Tumors
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Q1) What is the 5-year survival of all stages of prostate cancer combined?
A) 39%
B) 59%
C) 79%
D) 99%
Q2) Which cancer can be treated using a water bath to provide dose homogeneity by compensating for the irregular surface with tissue-equivalent material?
A) Penis
B) Testicle
C) Prostate
D) Bladder
Q3) Who has the most significant risk of developing prostate cancer?
A) 45-year-old black male
B) 50-year-old white male
C) 70-year-old black male
D) 81-year-old black female
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Chapter 36: Breast Cancer
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Q1) What T stage is a breast cancer that is a 9-cm tumor with skin invasion?
A) Tis
B) T1
C) T2
D) T3
E) T4
Q2) Which treatment field arrangement is used to increase the midaxillary dose to the prescribed level in some patients?
A) Intact breast tangents
B) Chest wall tangents
C) Supraclavicular (SCV)field
D) Posterior axillary boost field (PAB)
Q3) What T stage is a breast cancer that is a 3-cm tumor invading the chest wall?
A) Tis
B) T1
C) T2
D) T3
E) T4
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Chapter 37: Pediatric Solid Tumors
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Q1) Which of the following cancers would most likely be seen in a child?
A) Retinoblastoma
B) Primary brain
C) Osteosarcoma
D) Hodgkin's disease (HD)
Q2) Treatment of rhabdomyosarcoma with radiation therapy is most effective when the cancer is located in the _______________.
A) orbit
B) bladder
C) skeletal muscle
D) kidney
Q3) Which pediatric cancer occurs in the testes and ovaries?
A) Germ cell tumor
B) Neuroblastoma
C) Rhabdomyosarcoma
D) Wilms' tumor
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Chapter 38: Skin Cancers and Melanoma
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Q1) Which layer of the epidermis forms the skin surface and contains 25 to 30 rows of flat, dead, squamous cells?
A) Stratum basale
B) Stratum spinosum
C) Stratum granulosum
D) Stratum corneum
Q2) The microstaging system for melanomas that categorizes melanomas based on their level of invasion through the epidermis and layers of the dermis is called
A) Clark's
B) Breslow's
C) Mohs
D) Gleason's
Q3) Which cancer is commonly associated with HIV?
A) Rhabdomyosarcoma
B) Mycosis fungoides
C) Melanoma
D) Kaposi sarcoma
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