Oncology for Radiation Therapists Exam Review
Course Introduction
This course provides radiation therapy students with a comprehensive understanding of oncology as it relates to their practice. Covering cancer biology, tumor pathology, and the principles of cancer development and progression, students will explore the various types of malignancies treated with radiation therapy. Emphasis is placed on the role of the radiation therapist within the multidisciplinary oncology team, cancer staging and classification, diagnostic procedures, and treatment planning. The course also addresses the psychosocial aspects of cancer care, patient education, and ethical considerations in oncology, ensuring students are well-prepared to contribute effectively to patient-centered care.
Recommended Textbook Principles and Practice of Radiation Therapy 4th Edition by Washington
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Chapter 1: Cancer: An Overview
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Q1) Tumor grade is a measure of ________.
I.aggressiveness
II.differentiation
III.spread
A) I and II
B) I and III
C) II and III
D) I, II, and III
Answer: A
Q2) Which of the following best describes tumor spread?
A) Exophytic
B) Multicentric
C) Dissemination
D) Ulceration
Answer: C
Q3) Which of the following is true of anaplastic tumors?
A) Closely resemble the cells of origin
B) Maintain some resemblance of the cells of origin
C) Do not resemble the cells of origin
Answer: C
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Chapter 2: The Ethics and Legal Considerations of Cancer Management
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Q1) Which of the following is not a sanctionable offence by the American Registry of Radiologic Technologists (ARRT)?
A) Failure to participate in professional activities, share knowledge with colleagues, and investigate new aspects of professional practice
B) Impersonation of a candidate for the examination
C) Failure to perform radiation therapy procedures with reasonable skill and safety
D) Knowingly assisting, aiding, or allowing a person without a current certificate of registration with the ARRT to engage in the practice of radiologic technology, in a jurisdiction that requires such registration
Answer: A
Q2) Which group is responsible for producing the rules of ethics for radiation therapists?
A) American Registry of Radiologic Technologists (ARRT)
B) American Society of Radiologic Technologists (ASRT)
C) American Medical Association (AMA)
D) American Hospital Association (AHA)
Answer: A
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4
Chapter 3: Principles of Pathology
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Q1) Characteristics of malignant tumors include all except which of the following?
A) They have rapid growth.
B) They are encapsulated.
C) They metastasize frequently.
D) There is frequent vessel invasion.
Answer: B
Q2) All except which of the following are organelles?
A) Mitochondria
B) Endoplasmic reticulum
C) Ribosomes
D) Plasma membrane
Answer: D
Q3) Which of the following is the most invasive procedure used to make a diagnosis of cancer?
A) Recovery of exfoliating cells
B) Fine needle aspiration of malignant cells
C) Open biopsy of the tumor
D) Retinoscopy
Answer: C
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Page 5
Chapter 4: Overview of Radiobiology
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Q1) Isoeffect curves are most closely associated with which of the following?
A) Oxygen enhancement
B) Radiation syndromes
C) Tolerance doses
D) Fractionation
Q2) What does the term interphase death mean?
A) The cell dies prior to entering interphase.
B) The cell dies prior to leaving interphase.
C) The cell dies between mitotic phases.
D) The entire organism dies.
Q3) What is the typical oxygen enhancement ratio (OER)value for sparsely ionizing radiation?
A) 0.5 to 1.0
B) 1.0 to 2.0
C) 2.5 to 3.0
D) Greater than 3.0
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6
Chapter 5: Detection and Diagnosis
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Q1) Which of the following factors would not be observed when assessing respiration?
I.Rate
II.Rhythm
III.Character
A) I and II
B) II and III
C) I and III
D) I, II, and III
Q2) Lymphadenopathy in the axilla area could be an indication of cancer spread from which of the following?
A) Breast
B) Larynx
C) Lung
D) Thyroid
Q3) The chance of developing invasive breast cancer at some time in a woman's life is approximately 1 out of every ______ women.
A) 5
B) 7
C) 8
D) 10
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Chapter 6: Medical Imaging
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Q1) 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
Q2) 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
Q3) Three-dimensional imaging using voxels is present in ____________.
A) MRI
B) CT
C) both of the above
D) neither of the above
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Chapter 7: Treatment Delivery Equipment
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Q1) Which of the following limited the use of orthovoltage x-ray machines for radiation therapy?
A) Skin dose tolerance
B) Proton contamination
C) Excessive dose rate
D) Neutron contamination
E) The Nuclear Regulatory Commission requirement
Q2) 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
Q3) Which of the following is the half-life of a cobalt 60 source?
A) 30 years
B) 1,600 years
C) 5.26 years
D) 74.2 days
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Chapter 8: Treatment Procedures
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Q1) Which of the following is used in shaping the field of an electron beam treatment?
A) MLC
B) Bolus
C) Aluminum
D) Cerrobend cutout
Q2) The goal of radiation therapy planning is to deliver an evenly distributed radiation dose to the ________ while minimizing the dose to the normal surrounding tissue.
A) isodose lines
B) target volume
C) hinge angle
D) penumbra
Q3) What is the melting point of Cerrobend?
A) 74° F
B) 100° F
C) 165° F
D) 212° F
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Chapter 9: Infection Control in Radiation Oncology Facilities
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Q1) 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
Q2) Disease communicated through water supply is an example of which route of transmission?
A) Contact
B) Airborne
C) Fomite
D) Droplet
Q3) The agency that mandates the minimum level of respiratory protection in caring for those with tuberculosis is known as what?
A) WHO
B) NCI
C) JRC
D) OSHA
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Chapter 10: Patient Assessment
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Q1) Skin reactions include all except which of the following?
A) Erythema
B) Alopecia
C) Dry desquamation
D) Moist desquamation
Q2) Marasmus is ____________ malnutrition.
A) calorie
B) protein
C) fat
D) carbohydrate
Q3) The affective responses that occur most commonly among cancer patients are ________________.
A) anxiety and depression
B) anxiety and coping strategies
C) depression and coping
Q4) All these sociocultural factors influence pain except which of the following?
A) Spirituality
B) Age
C) Gender
D) Hair and eye color
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Chapter 11: Pharmacology and Drug Administration
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Sample Questions
Q1) Which of the following radioactive isotopes is used in radiation therapy?
A) Strontium 89
B) Technetium 99
C) Fluorine 18
D) Hydrogen 3
Q2) What is the first duty of a therapist if a patient has an adverse reaction to a drug?
A) Locate emergency supplies.
B) Begin cardiopulmonary resuscitation (CPR).
C) Call a code.
D) Observe the patient carefully.
Q3) Which of the following are included in the "six rights" of drug safety?
I.Identify the right patient.
II.Identify the right medication and right dose.
III.Identify the right time.
IV.Identify the route.
A) I, II, and III
B) I, III, and IV
C) II, III, and IV
D) I, II, III, and IV
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Page 13
Chapter 12: Applied Mathematics Review
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Sample Questions
Q1) Express 8.333 in scientific notation.
A) 8.333 × 10<sup>-1</sup>
B) 8.333 × 10<sup>1</sup>
C) 8.333 ×10<sup>0</sup>
D) Cannot be written in scientific notation
Q2) How many significant figures are there in 6,800?
A) Two
B) Three
C) Four
D) Unable to determine
Q3) Express 10<sup>3</sup> in scientific notation.
A) 10<sup>3</sup>
B) 1 × 103
C) 1000
D) log 1000 = 3
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>
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Chapter 13: Introduction to Radiation Therapy Physics
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Q1) The metric system, or SI, unit of energy is ________________.
A) Hertz
B) meter
C) joule
D) angstrom
Q2) A beta minus particle is also known as a(n)____________.
A) electron
B) proton
C) hadron
D) neutron
Q3) The thickness of some added material required to reduce beam intensity to half its original value is called the __________________.
A) half-life
B) inverse square factor
C) half-value layer (HVL)
D) intensity coefficient
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Chapter 14: Aspects of Brachytherapy
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Q1) The radioisotope used to treat uveal melanoma of the eye is
A) iridium 192
B) cesium 137
C) gold 198
D) iodine 125
Q2) Areas commonly treated with external applicators include which of the following?
I.Hard palate
II.Skin
III.Orbital cavity
A) I and II
B) I and III
C) II and III
D) I, II, and III
Q3) Of the following, which radionuclide is used for permanent prostate implants?
A) Gold 198
B) Cobalt 60
C) Cesium 137
D) Iridium 192
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Page 16
Chapter 15: Special Procedures
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Q1) Cone beam CT, TomoTherapy, and CT-on rails correct for _________ motion.
A) interfraction
B) intrafraction
Q2) Image-guided radiation therapy is useful because it can ____________________.
I.result in a more focused treatment
II.account for interfraction and intrafraction motion
III.compare in-room image set with treatment planning image set
A) I and II
B) II and III
C) I and III
D) I, II, and III
Q3) Which of the following is a process that aligns multiple data sets into a single coordinate system so that the spatial locations of corresponding points coincide?
A) Registration
B) Recombination
C) IGRT
D) MIP
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Chapter 16: Particle Therapy
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Q1) What are the typical therapeutic proton beam energies?
A) 6 to 25 MeV
B) 10 to 50 MeV
C) 50 to 250 MeV
D) 300 to 500 MeV
Q2) Protons have an accepted relative biological effect (RBE)value of which of the following?
A) 1.1
B) 2.5
C) 3.0
D) 4.0
Q3) What is the shape of the proton beam as it passes through the transport system?
A) Divergent
B) Conical
C) Fan-shaped
D) Pencil thin
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Chapter 17: Radiation Safety and Protection
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Q1) Slow neutrons have a quality factor of _________.
A) 1
B) 5
C) 10
D) 20
Q2) The current recommended negligible individual risk level is ____ mSv/yr.
A) 0.001
B) 0.01
C) 0.1
D) 1
Q3) Which of the following is not a natural source of background radiation?
A) Cosmic rays
B) Radium and uranium
C) Carbon 14
D) Nuclear fallout
Q4) One half-value layer thickness in concrete would be__________ one half-value layer thickness in lead for a Cobalt 60 beam.
A) less than
B) greater than
C) equivalent to
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Chapter 18: Patient Safety in Radiation Oncology
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Q1) Regular safety rounds may be instituted by a department in order to do which of the following?
A) Discuss items needed to perform tasks successfully.
B) Improve interpersonal and organizational communication.
C) Report various issues noticed during the day.
D) Evaluate the quality of work by others.
Q2) The main objective of peer review activities is to __________________________.
A) break down hierarchy
B) enhance quality of performance
C) improve the quality of decisions made during patient setup
D) evenly distribute the workload
Q3) A culture of safety in the radiation oncology department requires the participation of which of the following?
I.Physicians
II.Physicists
III.Radiation therapists
A) I, II
B) II, III
C) I, III
D) All of the above
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Chapter 19: Quality Improvement in Radiation Oncology
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Q1) TJC quality assurance focuses on performance measurement, which is based on the comparison of processes with which of the following?
A) Outcomes to quality indicators
B) Peer review to data
C) Aspects of care to survey results
D) Care environment to outcomes
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) A daily quality assurance check for the computed tomography (CT)simulator is to check the CT number accuracy for which of the following?
A) Lead
B) Water
C) Air
D) Bone
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Chapter 20: Surface and Sectional Anatomy
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Q1) Which bone is visualized in the anterior portion of the neck on a lateral radiograph; located in the region inferior to the mandible and superior to the suprasternal notch at the superior border of C4?
A) Hyoid bone
B) Thyroid cartilage
C) Tip of the xiphoid process
D) Cricoid cartilage
Q2) 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
Q3) If a breast tumor is located in the outer 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
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Chapter 21: Simulator Design
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Q1) The patient couch tabletop is created out of this material, which has a low density and low x-ray absorption.
A) Plastic carbonate
B) Carbon fiber
C) Steel
D) Polystyrene
Q2) The conventional simulator can define treatment fields by using which of the following?
A) Blades
B) Wires
C) OID
D) Collimator assembly
Q3) Most computed tomography (CT)scanners today are _______-generation imaging systems.
A) first
B) second
C) third
D) fourth
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Chapter 22: Computed Tomography Simulation
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Q1) Of the following list of contrast agents, which is not water soluble and therefore should not be used in the gastrointestinal tract if there is an increased risk of perforation?
A) High-osmolality contrast
B) Low-osmolality contrast
C) Gastrografin
D) Barium sulfate
Q2) A CT scanner specifically designed for use in the radiation therapy department should have which characteristics?
I.High performance scanner
II.Laser and patient marking system
III.Virtual simulation capabilities
A) I and II
B) I and III
C) II and III
D) I, II, and III
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Chapter 23: Photon Dosimetry Concepts and Calculations
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Q1) As the depth increases, what happens to the PDD?
A) Increases
B) Decreases
C) Remains the same
D) No effect
Q2) The intensity of a radiation beam is measured at 10 mR/hr at a distance of 20 cm.What will be the intensity of this beam at 30 cm?
A) 22.5 mR/hr
B) 4.44 mR/hr
C) 6.67 mR/hr
D) 15 mR/hr
Q3) As a field size increases from the standard established, the output factor for a treatment machine will do what?
A) Increase B) Decrease
C) Remain the same
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Chapter 24: Photon Dose Distributions
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Q1) Beam attenuation in energy ranges typically used in radiation therapy is primarily the result of which type of interaction?
A) Compton scatter
B) Photoelectric effect
C) Pair production
D) All are equal
Q2) In the convolution algorithm, primary fluence is represented by what symbol?
A) D(r)
B) \(\psi\)(r)
C) K
D) dV
Q3) The internal target volume (ITV)is the __________.
A) GTV + CTV
B) CTV + IM
C) PTV - GTV
D) ITV + SM
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Chapter 25: Electron Beams in Radiation Therapy
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Q1) Given a mean energy of an electron beam is 6 MeV, what is the depth of the 50% isodose line?
A) 2.5 mm
B) 14.4 mm
C) 2.5 cm
D) 14.4 cm
Q2) Which of the following is one very important consideration during the use of internal shields when administering electron therapy?
A) Shielding materials become radioactive
B) Dose to tissues directly in front of the shield is increased
C) Internal shields need to be secured by suturing
D) Shielding material thickness is found by MeV/3
Q3) 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
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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) Quality and accuracy in documenting medical records are governed by which of the following?
A) Professional guidelines
B) Hospital guidelines
C) Regulatory boards
D) The health department
Q3) ________ is (are)online management of the entire order tracking and documentation process from order entry to return of results.
A) EMR
B) Computerized physician order entry (CPOE)
C) Medical imaging
D) All of the above
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Chapter 27: Bone, Cartilage, and Soft Tissue Sarcomas
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Q1) Which of the following primary bone tumors is the most radiosensitive?
A) Osteosarcoma
B) Chondrosarcoma
C) Fibrosarcoma
D) Ewing's sarcoma
Q2) 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
Q3) Treatment for malignant fibrous histiocytoma 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
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Chapter 28: Lymphoreticular System Tumors
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Q1) Which lymph node chain is more likely to be the original site of Hodgkin lymphoma?
A) Pelvic
B) Inguinal
C) Para-aortic
D) Axillary
Q2) Which treatment field for HD includes the cervical lymph node chain?
A) Mantle
B) Inverted-Y (abdominal portion)
C) Inverted-Y (pelvic portion)
D) All of the above
Q3) The thymus 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
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Chapter 29: Endocrine System Tumors
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Q1) The pituitary gland is located within what portion of the sphenoid bone?
A) Hypothalamus
B) Cribriform plate
C) Sphenoid sinus
D) Sella turcica
Q2) In which gland is epinephrine produced?
A) Parathyroid
B) Pituitary
C) Thyroid
D) Adrenal
Q3) In which gland is antidiuretic hormone (ADH)produced?
A) Pancreas
B) Pituitary
C) Thyroid
D) Adrenal
Q4) What is the most common form of thyroid cancer?
A) Follicular
B) Papillary
C) Medullary
D) Lymphoma
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Chapter 30: Respiratory System Tumors
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Q1) What is the 5-year survival rate for small cell and non-small cell lung cancers?
A) 0.5%
B) 15%
C) 60%
D) 85%
Q2) What is the leading cause of non-small cell carcinoma of the lung?
A) Smoking
B) Asbestos
C) Radiation
D) Genetics
Q3) What is the most effective single-agent chemotherapy drug?
A) Cisplatin
B) Paclitaxel
C) Vinorelbine
D) Gemcitabine
Q4) What T stage is a lung cancer measuring 2.5 cm in its greatest dimension?
A) T1
B) T2
C) T3
D) T4
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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) Which anatomic structure contains the true vocal cords?
A) Glottis
B) Epiglottis
C) Pharynx
D) Larynx
Q3) After what dose of radiation does xerostomia typically first occur?
A) 1000 to 2000 cGy
B) 2000 to 3000 cGy
C) 3000 to 4000 cGy
D) 4000 to 5000 cGy
Q4) What is the most common histologic type of head and neck cancer?
A) Adenocarcinoma
B) Transitional cell carcinoma
C) Squamous cell carcinoma
D) Renal cell carcinoma
Page 33
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Chapter 32: Central Nervous System Tumors
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Q1) What is the most common CNS tumor in children?
A) Medulloblastoma
B) Metastatic lesion
C) Astrocytoma
D) Craniopharyngioma
Q2) From which cells to medulloblastomas arise?
A) Primitive neuroectodermal tumor (PNET)
B) Primitive neuroectodermal cells
C) Astrocytes
D) Lymphocytes
Q3) Which class of chemotherapy drugs has the ability to cross the blood-brain barrier?
A) Antimetabolites
B) Plant alkaloids
C) Nitrosoureas
D) Hormonal agents
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Chapter 33: Digestive System Tumors
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Q1) The width of the anterior field in the treatment of rectal cancer should the iliac lymph nodes.Therefore, the lateral borders of this field should __________________.
A) include the entire width of the iliac crests
B) extend about 2 cm beyond the pelvic brim
C) extend about 2 cm beyond the sacral foramen
D) split the width of the obturator foramen
Q2) Which of the following cancer sites can be treated with endocavitary radiation therapy?
A) Esophagus
B) Stomach
C) Rectum
D) Liver
Q3) Familial adenomatous polyposis (FAP)and hereditary nonpolyposis colorectal syndrome (HNPCC)are most closely associated with which type of cancer?
A) Esophageal
B) Pancreatic
C) Colorectal
D) Anal
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Chapter 34: Gynecological Tumors
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Q1) Which of the following cancers is treated with the patient in the "frog leg" position?
A) Ovarian
B) Cervical
C) Vaginal
D) Vulvar
Q2) Primary peritoneal carcinomas are most closely associated with which cancer?
A) Ovarian
B) Cervical
C) Vaginal
D) Vulvar
Q3) Bolus may be used when treating which of the following cancers?
A) Ovarian
B) Cervical
C) Vaginal
D) Vulvar
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Chapter 35: Male Reproductive and Genitourinary Tumors
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Q1) What region might receive prophylactic radiation therapy for advanced right-sided testicular cancer?
A) Right supraclavicular (SCV)nodes
B) Left SCV nodes
C) Para-aortic nodes
D) Left inguinal nodes
Q2) What is the most common symptom of testicular cancer?
A) Night sweats
B) Fever
C) Dysuria
D) Painless mass
Q3) What is the primary treatment option for kidney cancer?
A) Surgery
B) Chemotherapy
C) Radiation therapy
D) Immunotherapy
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Chapter 36: Breast Cancer
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Q1) What T stage is a breast cancer that is a 1.5-cm tumor near the nipple?
A) Tis
B) T1
C) T2
D) T3
E) T4
Q2) What is the standard dose delivered to the tumor bed following tangential treatments?
A) 4500 to 5000 cGy
B) 5000 to 5600 cGy
C) 6000 to 6600 cGy
D) 7000 to 7600 cGy
Q3) According to the Radiation Therapy Oncology Group bright erythema with patchy, moist desquamation is an example of skin morbidity grade ______.
A) 0
B) 1
C) 2
D) 3
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Chapter 37: Pediatric Solid Tumors
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Q1) Children are most likely to develop which type of leukemia?
A) ALL
B) AML
C) CLL
D) CML
Q2) Medulloblastomas typically begin in which area of the brain?
A) Brain stem
B) Cerebellum
C) Cerebrum
D) Hypothalamus
Q3) What is the most common presenting symptom of a soft tissue sarcoma of the extremity?
A) Pain
B) Mass
C) Loss of mobility
D) Headache
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Chapter 38: Skin Cancers and Melanoma
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Q1) What is the most widely used staging system for melanoma?
A) TNM
B) Breslow
C) Clarke
D) ATCG
Q2) What is the technique in which the tumor is removed and examined one layer at a time?
A) Curettage and electrodessication
B) Mohs surgery
C) Cryosurgery
D) Laser surgery
Q3) What do the ABCDs of melanoma represent?
A) Adenocarcinoma, basal cell carcinoma, carcinoma in situ, dermatoma
B) Abrasion, bruise, cut, dimpling
C) Asymmetry, border, color, diameter
D) Appearance, blackness, contour, depth
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