Course Introduction
Radiation Biology Exam Solutions
Radiation Biology explores the fundamental principles of how ionizing and non-ionizing radiation interact with living systems at the molecular, cellular, and organismal levels. This course covers radiation physics basics, mechanisms of DNA damage and repair, dose-response relationships, cellular effects, mutagenesis, and carcinogenesis. It also examines the biological consequences of acute and chronic exposures, the influence of radiation on tissues and organs, and the methods for protection and risk assessment. Emphasis is placed on medical, environmental, and occupational contexts, preparing students to understand both the beneficial applications and potential hazards of radiation in biological systems.
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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Q1) What is the "workup"?
A) The initial nursing visit
B) The initial physician visit
C) A series of diagnostic examinations
D) A physical assessment of the patient
Answer: C
Q2) Which of the following is an example of an etiologic factor?
A) Gender
B) Sex
C) Race
D) Social habits
Answer: D
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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Page 3
Chapter 2: The Ethics and Legal Considerations of Cancer Management
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Q1) Which two ethical principles may clash when dealing with consent?
I.Beneficence
II.Nonmaleficence
III.Autonomy
IV.Confidentiality
A) I and III
B) I and IV
C) II and III
D) II and IV
Answer: A
Q2) A company being punished for the actions of one of its employees is an example of which doctrine?
A) Doctrine of foreseeability
B) Doctrine of personal liability
C) Doctrine of res ipsa loquitur
D) Doctrine of respondeat superior
Answer: D
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Chapter 3: Principles of Pathology
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Q1) Which of the following is not a characteristic of a malignant tumor?
A) Grows by local invasion
B) Can be life threatening
C) Grows rapidly
D) Malignant cells are encapsulated with fibrous tissue
Answer: D
Q2) Which of the following describes the accidental leakage of intravenous drugs into the surrounding tissues?
A) Permeation
B) Metastasis
C) Extravasation
D) Hypoxia
Answer: C
Q3) Which of the following describes the cell membrane?
A) Contains genetic DNA
B) Contains organelles
C) Is a permeable structure
D) Is the powerhouse of the cell
Answer: C
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Page 5
Chapter 4: Overview of Radiobiology
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Q1) To calculate the nominal standard dose (NSD), what factors must be known?
I.Total dose
II.Fraction size
III.Elapsed days
A) I and II
B) I and III
C) II and III
D) I, II, and III
Q2) To produce the same biological effects seen after a single dose of 5,000 cGy, the total dose of a fractionated dose would be _________.
A) less
B) greater
C) equivalent
Q3) Which term describes certain chemicals or drugs that enhance the response of cells to radiation?
A) Free radicals
B) Radiosensitizers
C) Radioprotectors
D) NSAIDs
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Page 6
Chapter 5: Detection and Diagnosis
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Q1) Which of the following indicates a hematocrit value within normal limits for a healthy 40-year-old woman?
A) 20%
B) 30%
C) 40%
D) 50%
Q2) 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
Q3) In which of the following modalities might the patient be injected with a radionuclide, making the patient radioactive for an image?
A) Medical radiography
B) Nuclear medicine
C) Ultrasonography
D) CT
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Chapter 6: Medical Imaging
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Q1) Which of the following is responsible for transforming invisible x-rays into energy and then into visible light?
A) Grids
B) Glass envelop
C) Densitometer
D) Intensifying screens
Q2) Who is the discovery of x-rays in 1895 credited to?
A) Wilhelm Conrad Roentgen
B) Theodor Boveri
C) Marie Curie
D) Sir Godfrey Hounsfield
Q3) Unlike digital radiography, conventional imaging media includes which of the following?
A) Film
B) Screens
C) Cassettes
D) All of the above
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Chapter 7: Treatment Delivery Equipment
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Q1) In treatments using kilovoltage equipment, filters are used to
A) filter low-energy x-rays
B) shield the patient from all radiation exposure
C) collimate the beam
D) increase quantity
Q2) Orthovoltage x-ray machines have energies in the range of which of the following?
A) 1 kV to 100 kV
B) 150 kV to 500 kV
C) 200 MeV to 400 MeV
D) None of the above
Q3) When did installation of the first fully isocentric linear accelerator in the United States occur?
A) 1942
B) 1952
C) 1961
D) 1979
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Chapter 8: Treatment Procedures
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Q1) The radiation therapist is responsible for which of the following?
I.Delivering radiation therapy treatments
II.Monitoring and operating sophisticated equipment
III.Maintaining detailed records of treatment
IV.Producing the patient's treatment plan
A) I and II
B) I, II, and III
C) I, III, and IV
D) I, II, and IV
Q2) Which of the following opposing field techniques is specifically designed for treatment of the breast?
A) AP/PA arrangement
B) Tangential fields
C) Box technique
D) Right and left laterals
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 is the most reliable, available, and economical method of destroying microorganisms?
A) Gas
B) Liquid
C) Heat
D) Radiation
Q2) Hepatitis B is a virus transmitted mainly through which of the following?
A) Contact with blood and body fluids
B) Indirect contact with airborne droplets
C) Direct contact with respiratory droplets
D) Common vehicle or fomite exposure
Q3) Disease communicated through water supply is an example of which route of transmission?
A) Contact
B) Airborne
C) Fomite
D) Droplet
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Chapter 10: Patient Assessment
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Q1) A general health assessment can include all except which of the following?
A) An interview
B) Taking medical history past and present
C) A self-report
D) Asking when the person last attended church
Q2) Special attention is needed in caring for which of the following?
A) Elderly
B) Children
C) Adolescents
D) All of the above
Q3) Cultural assessment looks at factors including one's ________________.
A) upbringing, health behaviors, values
B) customs, beliefs, and norms
C) customs, values, beliefs
D) beliefs, customs, validity
Q4) Skin reactions include all except which of the following?
A) Erythema
B) Alopecia
C) Dry desquamation
D) Moist desquamation
Page 12
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Chapter 11: Pharmacology and Drug Administration
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Q1) What type of medication administration bypasses the gastrointestinal tract?
A) Topical administration
B) Parenteral administration
C) Mucous membrane administration
D) Administration via the rectum
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 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.
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13
Chapter 12: Applied Mathematics Review
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Sample Questions
Q1) Express 10<sup>3</sup> in scientific notation.
A) 10<sup>3</sup>
B) 1 × 103
C) 1000
D) log 1000 = 3
Q2) 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
Q3) 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
Q4) Solve for x in the equation x² - 1 = 0.
A) 0
B) 1
C) -1
D) ±1
14
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Chapter 13: Introduction to Radiation Therapy Physics
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Q1) The number of protons and neutrons in the nucleus is known as _______________.
A) atomic weight
B) strong force
C) atomic mass number
D) nuclear stability
Q2) A beta minus particle is also known as a(n)____________.
A) electron
B) proton
C) hadron
D) neutron
Q3) The unit for frequency is 1/sec, called the _________________.
A) lambda
B) Hertz
C) meter
D) angstrom
Q4) Which statement is not true?
A) The nucleus of the atom consists of protons and neutrons.
B) Protons and photons are collectively called nucleons.
C) Protons are positively charged particles.
D) Neutrons are neutral with no electric charge.
Page 15
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Chapter 14: Aspects of Brachytherapy
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Q1) Which of the following is the radionuclide with the largest average photon energy?
A) Cobalt 60
B) Cesium 137
C) Iridium 192
D) Radium 226
Q2) The shape of the isodose distribution for a tandem and ovoid treatment is ____________.
A) apple shaped
B) triangular
C) mushroom shaped
D) pear shaped
Q3) Which of the following is true regarding cobalt 60?
A) It is a common radionuclide used in brachytherapy.
B) It has a half-life of 5.27 years.
C) Its energy is 3.25 MeV.
D) It was not effective as an external beam source.
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Chapter 15: Special Procedures
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Q1) For the ultrasound unit to know where it is in reference to the linear accelerator, it must be ________________ with the treatment delivery unit.
A) localized
B) attenuated
C) B-moded
D) registered
Q2) 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
Q3) 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
Q4) Cone beam CT, TomoTherapy, and CT-on rails correct for _________ motion.
A) interfraction
B) intrafraction
Page 17
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Chapter 16: Particle Therapy
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Q1) Although several heavy particles may be used therapeutically, proton therapy represents _____% of the particle therapy market in the United States.
A) 60
B) 75
C) 88
D) 100
Q2) 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
Q3) The proton beam is focused and shaped by devices in which of the following?
A) Magnet
B) Nozzle
C) Compensator
D) Accelerator
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Chapter 17: Radiation Safety and Protection
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Q1) The average annual dose received by the general public from all medical radiation procedures is ____ mSv.
A) 3
B) 2
C) 1
D) 0.5
Q2) The average annual dose received by the general public from all naturally occurring radiation sources is ____ mSv.
A) 3
B) 2
C) 1
D) 0.5
Q3) What is the radiation weighting factor for gamma-rays?
A) 1
B) 5
C) 10
D) 20
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Page 19
Chapter 18: Patient Safety in Radiation Oncology
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Q1) Transformational leaders likely focus on the ______________.
A) tasks to be completed
B) methods for completing tasks
C) rationale for tasks
D) reward and punishment
Q2) ASTRO accreditation program assesses radiation oncology departments using _____ standards.
A) 5
B) 7
C) 14
D) 16
Q3) A therapist who seems cynical toward coworkers and patients may be experiencing burnout at the level known as ______________________.
A) emotional exhaustion
B) depersonalization
C) reduced personal accomplishment
D) occupational stress
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Page 20
Chapter 19: Quality Improvement in Radiation Oncology
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Q1) The recommended frequency for checking the audio-visual system in the treatment room is _______________.
A) daily
B) weekly
C) monthly
D) yearly
Q2) 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
Q3) This federal agency has as its scope of responsibility the regulation of nuclear reactors; medical, academic, and industrial uses of nuclear materials; and the transport, storage, and disposal of nuclear materials and waste.
A) NRC
B) EPA
C) DOT
D) FDA
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Page 21
Chapter 20: Surface and Sectional Anatomy
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Q1) The sella turcica is a depression of the _____ bone, which holds the pituitary gland.
A) ethmoid
B) temporal
C) sphenoid
D) occipital
Q2) The asthenic body type represents what percentage of the general population?
A) 5%
B) 10% to 12%
C) 30% to 35%
D) 50%
Q3) Which of the following structures or landmarks is associated with the bifurcation of the trachea?
A) Tip of the scapula
B) Tip of the xiphoid process
C) Sternal angle
D) Both a and b
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22
Chapter 21: Simulator Design
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Q1) CT numbers are also known as which of the following?
A) Hounsfield units
B) Godfrey units
C) Attenuation coefficient units
Q2) As the field of view increases and the matrix size remains constant, the spatial resolution ____________.
A) increases
B) decreases
C) stays the same
Q3) The conventional simulator can define treatment fields by using which of the following?
A) Blades
B) Wires
C) OID
D) Collimator assembly
Q4) The matrix size is determined by the number of ___________.
A) voxels
B) Hounsfield units
C) detectors on the scanner
D) pixels
Page 23
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Chapter 22: Computed Tomography Simulation
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Q1) 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
Q2) When using intravenous (IV)contrast to enhance the anatomy of the brain, the best interval for contrast administration should be before the scan by _____________.
A) 30 seconds
B) 60 seconds
C) 30 minutes
D) 60 minutes
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24
Chapter 23: Photon Dosimetry Concepts and Calculations
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Q1) Calculate the PDD of depth (d)if the dose at Dmax is 250 cGy and the dose at d is 231 cGy.
A) 70%
B) 75%
C) 85.2%
D) 92.4%
Q2) Which of the following is the equivalent square of rectangular field of 10 ´ 15?
A) 12 × 12
B) 3.6 × 3.6
C) 11.5 × 11.5
D) 13 × 13
Q3) The physician prescribes the AP/PA field to be weighted 3:1 for the posterior field.How much dose is coming from the AP and the PA if total dose prescribed is 200 cGy?
A) AP = 50 cGy, PA = 150 cGy
B) AP = 75 cGy, PA = 125 cGy
C) AP = 150 cGy, PA = 50 cGy
D) AP = 175 cGy, PA = 25 cGy
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Chapter 24: Photon Dose Distributions
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Q1) In which tissue heterogeneity correction method are both the field size and the depth "scaled" to account for the presence of heterogeneities?
A) Power law TAR method
B) Generalized Batho correction
C) Equivalent TAR method
D) Delta volume method
Q2) 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
Q3) What is (are)spatial representation(s)of the magnitude of the dose produced by a source of radiation?
A) Treatment planning
B) Dose distributions
C) Dose calculation matrix
D) Dose-volume histogram (DVH)
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Chapter 25: Electron Beams in Radiation Therapy
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Q1) Which processes are responsible for the majority of energy loss for electron energy ranges useful in radiation therapy?
I.Collisional processes
II.Radiation processes
III.Gradient processes
A) I only
B) II only
C) III only
D) I and II
Q2) What is the depth of the 80% isodose line of a 15-MeV electron beam?
A) 3 cm
B) 3.75 cm
C) 5 cm
D) 7.5 cm
Q3) What thickness of Lipowitz alloy 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
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Chapter 26: Electronic Charting and Image Management
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Q1) All of the following except which personnel provide support for EMRs?
A) System analyst
B) Network specialist
C) Engineers
D) Information systems specialist
Q2) Which communication standards are routinely applied in radiation therapy EMRs?
I.HL7
II.DICOM
III.PACS
A) I and II
B) II and III
C) I and III
Q3) What are standards of care?
A) Set of education standards for a profession
B) Compilation of the customs and behaviors of a profession
C) Set of moral and religious conduct
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 is the most common primary site that leads to bone metastasis?
A) Breast
B) Prostate
C) Kidney
D) Lung
Q2) Preoperative radiation therapy for STS is performed to _________________.
I.kill the reactive rim of tumor cells before they are cut into II.decrease the risk of implantation
III.attempt to preserve as much normal function as possible
A) I and II
B) I and III
C) II and III
D) I, II, and III
Q3) What type of bone marrow is contained in the diaphysis of long bones?
A) Red
B) White
C) Blue
D) Yellow
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Page 29
Chapter 28: Lymphoreticular System Tumors
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Q1) What stage is a Hodgkin lymphoma with extralymphatic extension?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Q2) Which treatment field for HD includes the para-aortic lymph node chain?
A) Mantle
B) Inverted-Y (abdominal portion)
C) Inverted-Y (pelvic portion)
D) All of the above
Q3) Which treatment field for HD includes the iliac lymph node chain?
A) Mantle
B) Inverted-Y (abdominal portion)
C) Inverted-Y (pelvic portion)
D) All of the above
Q4) What stage is a Hodgkin lymphoma affecting only the right cervical lymph nodes?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
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Chapter 29: Endocrine System Tumors
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Q1) In which gland is prolactin (PRL)produced?
A) Pancreas
B) Pituitary
C) Thyroid
D) Adrenal
Q2) Which endocrine gland contains a medulla and a cortex?
A) Pancreas
B) Pituitary
C) Thyroid
D) Adrenal
Q3) In which gland is luteinizing hormone (LH)produced?
A) Pancreas
B) Pituitary
C) Thyroid
D) Adrenal
Q4) Which of the following is the most common type of functioning pituitary adenoma?
A) Prolactin secreting
B) Growth hormone secreting
C) TSH secreting
D) Chromophobe adenoma
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Chapter 30: Respiratory System Tumors
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Q1) One symptom associated with superior vena cava syndrome is orthopnea.Orthopnea is ____________________.
A) difficulty breathing
B) a bluish color of the skin
C) difficulty swallowing
D) inability to lie flat
Q2) What T stage is a lung cancer measuring 2.5 cm in its greatest dimension?
A) T1
B) T2
C) T3
D) T4
Q3) According to the American Cancer Society, what is the percentage of lung cancers caused by smoking?
A) 37%
B) 67%
C) 87%
D) 97%
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32
Chapter 31: Head and Neck Cancers
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Q1) What is the name of the leaf-shaped cartilage that protects the larynx?
A) Glottis
B) Epiglottis
C) Pharynx
D) Larynx
Q2) What defines the posterior radiation field border for the treatment of a low-staged larynx cancer?
A) Posterior aspect of the hyoid
B) Anterior aspect of the vertebral body
C) Midvertebral body
D) Posterior aspect of the vertebral body
Q3) What condition frequently develops in users of smokeless tobacco?
A) Erythroplakia
B) Leukoplakia
C) Thrush
D) Dysplasia
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33
Chapter 32: Central Nervous System Tumors
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Q1) Patients treated to the cranium should be advised to protect their heads from direct sunlight because the sun _____________________________.
A) enhances radiation-induced side effects
B) causes lower white cell blood counts
C) enhances feelings of nausea
D) lowers tolerance to anti-inflammatory medications
Q2) What is the current 5-year survival of patients with glioblastoma multiforme (GBM)?
A) 35%
B) 55%
C) 75%
D) 95%
Q3) Which portion of the brain is the site of intelligence and judgment?
A) Cerebrum
B) Cerebellum
C) Brain stem
D) Thalamus
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34
Chapter 33: Digestive System Tumors
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Q1) What is the treatment of choice for most anal cancers?
I.Surgery
II.Chemotherapy
III.Radiation therapy
A) I only
B) III only
C) I and II
D) II and III
E) I, II, and III
Q2) A three-field technique using hinge angles of 120 degrees can be used in the treatment of which cancer?
A) Esophageal
B) Gastric
C) Rectal
D) Hepatic
Q3) Which of the following is not a risk factor for anal cancer?
A) Diet
B) Human papillomavirus
C) Anal intercourse
D) Immunosuppression
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Chapter 34: Gynecological Tumors
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Q1) Who has the most significant risk of developing ovarian cancer?
A) 35-year-old woman with one child
B) 35-year-old woman with five children
C) 65-year-old woman with one child
D) 65-year-old woman with five children
Q2) Cancer of which organ can be genetically linked to breast cancer?
A) Ovarian
B) Uterus (endometrium)
C) Vaginal
D) Vulvar
Q3) Which of the following cancers is treated with the patient in the "frog leg" position?
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 is the most common form of kidney cancer?
A) Adenocarcinoma
B) Transitional cell carcinoma
C) Squamous cell carcinoma
D) Renal cell carcinoma
Q2) What is the most common symptom of testicular cancer?
A) Night sweats
B) Fever
C) Dysuria
D) Painless mass
Q3) Gleason's grading system is based on the tumor's _______________.
A) morphology
B) histology
C) extent
D) size
Q4) What is the 5-year survival of all stages of prostate cancer combined?
A) 39%
B) 59%
C) 79%
D) 99%
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Chapter 36: Breast Cancer
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Q1) 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
Q2) 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
Q3) Which of the following increases the risk for developing breast cancer?
A) Breast implants
B) Late menarche
C) Early menarche
D) Early oophorectomy
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Page 38
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) The craniospinal treatment technique is used to treat what specific type of pediatric cancer?
A) Medulloblastoma
B) Neuroblastoma
C) Rhabdomyosarcoma
D) Retinoblastoma
Q3) Wilms' tumors are cancers of which organ?
A) Kidney
B) Bone
C) Skeletal muscle
D) Smooth muscle
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Chapter 38: Skin Cancers and Melanoma
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Q1) Pigmentation following therapeutic doses of radiation is caused by which of the following?
A) Dwelling of capillaries of the dermal layer
B) Shedding of the epidermis
C) Increased production of melanin
D) Destruction of cells at the basal layer
Q2) In instances where malignant melanoma is treated with radiation, delivering one fraction per day, which of the following is the most effective fraction size?
A) 100 to 150 cGy
B) 150 to 180 cGy
C) 180 to 200 cGy
D) 200 to 400 cGy
Q3) Which layer of the epidermis contains melanocytes?
A) Stratum basale
B) Stratum spinosum
C) Stratum granulosum
D) Stratum corneum
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