

Radiation Therapy
Exam Answer Key
Course Introduction
Radiation Therapy is a comprehensive course designed to introduce students to the principles and applications of radiation in the treatment of cancer and other diseases. The course covers the biological basis of radiation therapy, radiation physics, treatment planning, patient care, and safety procedures. Students will learn about the various types of radiation equipment, techniques used to deliver therapeutic doses, and the multidisciplinary role of radiation therapy within oncology. Emphasis is placed on understanding dose calculation, minimizing side effects, and protecting healthy tissue, preparing students for clinical practice and advanced studies in medical radiation sciences.
Recommended Textbook
Principles and Practice of Radiation Therapy 4th Edition by Washington
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38 Chapters
954 Verified Questions
954 Flashcards
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Page 2

Chapter 1: Cancer: An Overview
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Sample Questions
Q1) A cancer designated with an N1 classification using the TNM staging system likely indicates which of the following?
A) No positive lymph nodes are involved.
B) Positive lymph nodes are involved at distant sites.
C) Positive lymph nodes are involved near the site.
D) Lymph nodes cannot be accessed.
Answer: C
Q2) 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
Q3) What is the most common tumor staging system?
A) AJCC
B) FIGO
C) TNM
D) UICC
Answer: C
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Page 3

Chapter 2: The Ethics and Legal Considerations of Cancer Management
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Sample Questions
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 of the following ethical principles relates to faithfulness or loyalty?
A) Beneficence
B) Maleficence
C) Fidelity
D) Veracity
Answer: C
Q3) 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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Sample Questions
Q1) The cancer of chimney sweeps identified by Percival Pott in mid-eighteenth-century England was related to which of the following chemicals?
A) Hydrocarbons
B) Asbestos
C) Arsenic
D) Nitrosamines
Answer: A
Q2) Which of the following is a malignant tumor of fat?
A) Chondrosarcoma
B) Ewing's tumor
C) Seminoma
D) Liposarcoma
Answer: D
Q3) Hodgkin's disease is a neoplasm that typically involves the _________.
A) brain
B) lung
C) lymph nodes
D) liver
Answer: C
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Page 5

Chapter 4: Overview of Radiobiology
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Sample Questions
Q1) The TD 50/5 for the optic nerve is approximately _____ Gy.
A) 25
B) 35
C) 50
D) 65
Q2) Which of the following terms is used to describe radiation damage to a cell that is not sufficient to kill the cell?
A) Relative biological effect
B) Sublethal damage
C) Tumor lethal dose
D) Lethal dose<sub>50/40</sub>
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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Chapter 5: Detection and Diagnosis
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Sample Questions
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) The diastolic norm would be within a range of which of the following?
A) 40 to 50 mm Hg
B) 60 to 80 mm Hg
C) 110 to 140 mm Hg
D) 140 to 160 mm Hg
Q3) What was the leading site of new cancer cases in females in 2013?
A) Lung
B) Colon
C) Cervix
D) Breast
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Chapter 6: Medical Imaging
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Sample Questions
Q1) Which technical factor has the most effect on radiographic density?
A) mAs
B) kVp
C) Distance
D) All of the above
Q2) Attenuation is the process by which an x-ray beam ___________________.
A) is focused
B) is reduced in intensity
C) diverges
D) exposes a film
Q3) Interactions at the anode that produce x-rays may be described as which of the following?
A) Bremsstrahlung radiation
B) Characteristic radiation
C) Compton scattering
D) All of the above
E) Both a and b
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Chapter 7: Treatment Delivery Equipment
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Sample Questions
Q1) Which of the following is (are)true of electron beams?
A) Require a flattening filter to make the electron beam profile symmetric and flat
B) Require a scattering foil to make the electron beam profile symmetric and flat
C) Interact with the transmission target before leaving the exit window
D) a, b, and c
E) b and c
Q2) Of the following treatment units, which has the least amount of skin sparing?
A) Orthovoltage
B) Cobalt
C) 4 MV beam
D) 10 MV beam
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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Sample Questions
Q1) Which of the following is one of the main advantages of a multileaf collimator (MLC)?
A) Correct for tissue inhomogeneity
B) Customize treatment volume
C) Eliminate skin sparing
D) Replace the need for interlock system of holding blocks
Q2) A shifting field arrangement (feathering)often used in treatment of the brain and spinal cord is used primarily to _______________.
A) prevent "hot" spots
B) prevent "cold" spots
C) increase the dose of the gapped area
D) spare overlaying skin tissue
Q3) Individual treatment doses may be defined as which of the following?
A) Fractionation
B) Protraction
C) Treatment field
D) Beam modifiers
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10
Chapter 9: Infection Control in Radiation Oncology Facilities
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Sample Questions
Q1) Infection cycle includes all except which of the following?
A) Transmission
B) Incubation
C) Natural immunity
D) Convalescence
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) Nosocomial infections affect which of the following?
A) Patients
B) Health care workers
C) The public
D) Both a and b
E) All of the above
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11

Chapter 10: Patient Assessment
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Sample Questions
Q1) __________ pain is the persistence of pain for longer than 3 months with a less well-defined onset.Its cause may not be known.
A) Onset
B) Chronic
C) Sudden
D) Acute
Q2) Dry desquamation occurs at _________ cGy.
A) 1,600 to 2,000
B) 4,000 to 6,000
C) 2,000 to 3,000
D) 3,000 to 4,000
Q3) Assessment of the patient allows health care providers to do all except which of the following?
A) Determine the nature of the problem.
B) Select an intervention for that problem.
C) Find a cure for their disease.
D) Evaluate the effectiveness of the intervention.
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Chapter 11: Pharmacology and Drug Administration
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Sample Questions
Q1) An allergic reaction to the administration of certain drugs may cause urticaria.Urticaria describes ________________.
A) pain
B) hives
C) nausea
D) fainting
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) Contrast agents used for the imaging procedure known as cholecystography should be administered by which of the following routes?
A) Oral
B) Intravenous
C) Intramuscular
D) Intradermal
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Chapter 12: Applied Mathematics Review
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Sample Questions
Q1) Find the log of log453.
A) 2.656
B) 6.116
C) -19.08
D) 8.752
Q2) Which of the following is not a fundamental SI unit?
A) Time
B) Distance
C) Weight
D) Electrical current
Q3) Transposition of numbers in a patient's chart is an example of which type of error?
A) Systematic
B) Random
C) Blunder
D) None of the above
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Page 14
Chapter 13: Introduction to Radiation Therapy Physics
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Sample Questions
Q1) A mCi (millicurie)equals which of the following?
A) 10<sup>3</sup> Ci
B) 10<sup>-3</sup> Ci
C) 10<sup>-6</sup> Ci
D) 10<sup>6</sup> Ci
Q2) The force responsible for interaction between particles with a nonzero mass and having infinite range is _________________.
A) electromagnetic
B) gravity
C) weak force
D) strong force
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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15

Chapter 14: Aspects of Brachytherapy
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Sample Questions
Q1) Permanent implants involve which of the following?
I.Sources packaged as tiny seeds
II.Sources with long half-lives
III.Sources implanted with needles in surgery
IV.Tumors that cannot be reached surgically
A) I and II
B) I and III
C) II and III
D) I, II, and III
Q2) An autoradiograph is taken to ________________________.
A) determine the energy of the source
B) check source placement in the patient
C) verify uniformity of source
D) determine source strength
Q3) 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.
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Chapter 15: Special Procedures
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Sample Questions
Q1) 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)
Q2) Stereotactic treatments have been improved on linear accelerators because of which of the following advances?
A) High-quality in-room imaging
B) Tighter mechanical specifications
C) Small field treatments
D) Only a and b
Q3) A single fraction of radiation to a brain metastasis would be what kind of stereotactic treatment?
A) Stereotactic radiation therapy (SRT)
B) Stereotactic body radiation therapy (SBRT)
C) Stereotactic radiosurgery (SRS)
Q4) Cone beam CT, TomoTherapy, and CT-on rails correct for _________ motion.
A) interfraction
B) intrafraction

17
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Chapter 16: Particle Therapy
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Sample Questions
Q1) The proton beam is focused and shaped by devices in which of the following?
A) Magnet
B) Nozzle
C) Compensator
D) Accelerator
Q2) Most small footprint proton systems have gantry rotation capabilities up to which of the following?
A) 90 degrees
B) 180 degrees
C) 270 degrees
D) 360 degrees
Q3) Internal target motion can be accounted for by _____________ the compensator used in proton therapy.
A) smearing
B) shaving
C) rotating
D) waxing
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Page 18
Chapter 17: Radiation Safety and Protection
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Sample Questions
Q1) The average annual dose received by the general public from radon is ____ mSv.
A) 3
B) 2
C) 1
D) 0.5
Q2) What is the radiation weighting factor for alpha particles?
A) 1
B) 5
C) 10
D) 20
Q3) The average annual dose received by the general public from naturally occurring internal radiation is ____ mSv.
A) 0.2
B) 0.11
C) 13
D) 11
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Page 19

Chapter 18: Patient Safety in Radiation Oncology
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Sample Questions
Q1) One tool used to show problem areas leading to potential solutions is a graph showing the range of data collected.Data would be displayed in a
A) fishbone graph
B) Pareto graph
C) histogram
D) control chart
Q2) Transactional-transformational leadership (TTL)focuses on which of the following?
A) Interactions between leaders and followers
B) Relationship between leaders and followers
C) Reward for positive behaviors and punishment for negative behaviors
D) Relationship and interactions between leaders and followers
Q3) Which of the following would be a key restraining force in the development of staff exhibiting initiating and enhancing behaviors during culture change efforts?
A) Positive feedback
B) Pressure to conform
C) Job-related autonomy
D) Accountability
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Chapter 19: Quality Improvement in Radiation Oncology
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Sample Questions
Q1) A QI plan has a(n)_____________ that verifies that all aspects of the radiation oncology process meet national, state, institutional, or departmental quality standards and have a mechanism to institute change if necessary.
A) audit mechanism
B) oversight committee
C) action plan
D) support staff
Q2) Appropriate use of CQI assists the health care organization in responding to all except which of the following?
A) Increased competition
B) Escalating costs
C) Quality concerns
D) Development of individual performance
Q3) The recommended frequency for checking the audio-visual system in the treatment room is _______________.
A) daily
B) weekly
C) monthly
D) yearly
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Page 21

Chapter 20: Surface and Sectional Anatomy
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Q1) A patient is to be treated with a pelvic field on a linear accelerator.The patient is quite obese and the port films show that the field shifts superiorly and inferiorly on a daily basis.What bony landmark may measurements be taken from to stabilize this treatment portal?
A) Umbilicus
B) Anterior superior iliac spine (ASIS)
C) Pubic symphysis
D) Patella
Q2) Which of the following imaging studies could be best described as studies that do not use ionizing radiation?
I.X-ray
II.X-ray studies using contrast agents
III.Computed tomography (CT)
IV.Nuclear medicine
V.Ultrasound
VI.Magnetic resonance imaging (MRI)
A) I and II
B) III and IV
C) V and VI
D) None of the above
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Chapter 21: Simulator Design
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Sample Questions
Q1) Which of the following details the difference in completing an axial scan as compared to spiral CT?
A) Aperture size is larger in an axial scanner.
B) Detector size is larger in the spiral CT scanner.
C) Gantry is rotating in a diagonal.
D) Table moves for the spiral CT.
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) Most computed tomography (CT)scanners today are _______-generation imaging systems.
A) first
B) second
C) third
D) fourth
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Page 23

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) 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
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Chapter 23: Photon Dosimetry Concepts and Calculations
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Sample Questions
Q1) Find the skin gap necessary to match two symmetric ports at midline that are 21 and 37 cm in length.Assume the midline depth is 13 cm and both ports are treated at 100 cm SAD.
A) 1.53
B) 3.6
C) 2.5
D) 3.77
Q2) What is the patient's depth from the AP if the source-axis distance (SAD)is 100 cm and source-skin distance (SSD)is 91 cm?
A) 8 cm
B) 9 cm
C) 10 cm
D) 11 cm
Q3) What is a TAR at the depth of Dmax used to correct for scatter of dose called?
A) Scatter-air ratio
B) Tissue-phantom ratio
C) Backscatter factor
D) Mayneord's F factor
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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) The internal target volume (ITV)is the __________.
A) GTV + CTV
B) CTV + IM
C) PTV - GTV
D) ITV + SM
Q3) Which of the following accounts for target motion and uncertainty in positioning?
A) GTV
B) CTV
C) PTV
D) Treated volume
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Chapter 25: Electron Beams in Radiation Therapy
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Q1) What will be the energy of an electron beam at a depth of 4 cm that had a surface energy of 16 MeV?
A) 4 MeV
B) 12 MeV
C) 14 MeV
D) 16 MeV
Q2) What is the danger to tissue in front of an internal shield when used with electron beams therapy?
A) Photon contamination
B) Under dosing
C) Electron backscatter
D) Infection
Q3) To produce a therapeutically useful electron beam, the stream of electrons leaving the electron gun must contact the ___________ before exiting the gantry head.
A) target
B) scattering foil
C) flattening filter
D) mirror and bulb assembly
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Chapter 26: Electronic Charting and Image Management
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Q1) What is the most common method for restricting unauthorized access to EMRs?
A) Passwords
B) Fingerprints
C) Retinal scans
D) Both a and b
Q2) HIPAA provides guidelines and regulations for which of the following?
A) Computerizing medical records
B) Patients' right and responsibilities
C) Standards of care
D) Use and disclosure of patient information
Q3) All of the following except which personnel provide support for EMRs?
A) System analyst
B) Network specialist
C) Engineers
D) Information systems specialist
Q4) _______ is a computer network covering a small geographic area.
A) A local area network (LAN)
B) WAN
C) PACS
D) DICOM

28
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Chapter 27: Bone, Cartilage, and Soft Tissue Sarcomas
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Q1) The most common symptom associated with STSs is __________________.
A) lymphadenopathy
B) palpable mass
C) leukopenia
D) pain
Q2) Which of the following has the highest incidence of bone tumors?
A) Ewing sarcoma
B) Chondrosarcoma
C) Metastatic bone lesions
D) Multiple myeloma
Q3) Most STSs generally spread through _________________.
I.the lymphatic system
II.direct invasion and extension
III.hematogenous spread
A) I and II
B) I and III
C) II and III
D) I, II, and III
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29

Chapter 28: Lymphoreticular System Tumors
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Q1) Which of the following chemotherapy regimens is not used to treat HD?
I.CHOP
II.MOPP
III.ABVD
A) I and II
B) I and III
C) II and III
D) I, II, and III
Q2) Which of the following is not a B symptom?
A) Weight loss
B) Night sweats
C) Fever
D) Diarrhea
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
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Chapter 29: Endocrine System Tumors
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Q1) In adults, somatropin-secreting pituitary tumors can present as which of the following conditions?
A) Cushing's syndrome
B) Gigantism
C) Acromegaly
D) Diabetes insipidus
Q2) Radiation is a known risk factor for cancers of which of the following endocrine glands?
A) Adrenal
B) Pancreas
C) Pituitary
D) Thyroid
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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Chapter 30: Respiratory System Tumors
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Q1) What is the most significant risk factor associated with mesothelioma?
A) Asbestos exposure
B) Smoking
C) Sun exposure
D) Radiation exposure
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) In what part of the lung are primary squamous cell carcinomas usually found?
A) Superior
B) Central
C) Lateral
D) Peripheral
Q4) What is the 5-year survival rate for early-stage lung cancers?
A) 10%
B) 15%
C) 60%
D) 85%
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Chapter 31: Head and Neck Cancers
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Q1) What is the most common form of larynx cancer?
A) Adenocarcinoma
B) Basal cell
C) Squamous cell
D) Transitional cell
Q2) 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
Q3) Bloody discharge from the nose would be a common symptom of a tumor located in the _____________________.
A) oropharynx
B) nasopharynx
C) hypopharynx
D) larynx
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Chapter 32: Central Nervous System Tumors
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Q1) Chemicals that enhance the lethal effects of radiation are known as ____________.
A) cytotoxins
B) corticosteroids
C) radioprotectors
D) radiosensitizers
Q2) Epilation may be permanent when the cranium is treated beyond the threshold dose of ______ cGy.
A) 1000
B) 2000
C) 3000
D) 4000
Q3) 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
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Chapter 33: Digestive System Tumors
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Q1) What is the dose-limiting structure of most concern for radiation treatments of the esophagus?
A) Normal esophagus
B) Heart
C) Spinal cord
D) Trachea
Q2) What is the most common histologic type of cancers that occur in the lower third of the esophagus?
A) Adenocarcinoma
B) Transitional cell carcinoma
C) Squamous cell carcinoma
D) Renal cell carcinoma
Q3) The vermiform appendix is most closely associated with which portion of the digestive tract?
A) Ileum
B) Cecum
C) Duodenum
D) Rectum
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Chapter 34: Gynecological Tumors
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Q1) 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
Q2) Which of the following cancers is treated with the patient in the "frog leg" position?
A) Ovarian
B) Cervical
C) Vaginal
D) Vulvar
Q3) Overall, cervical cancer occurs most frequently with those associated with which of the following factors?
I.Women of lower socioeconomic status
II.Early sexual activity and multiple partners
III.Multiple instances of pelvic infection
A) I and II
B) I and III
C) II and III
D) I, II, and III
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Chapter 35: Male Reproductive and Genitourinary Tumors
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Q1) What is the primary treatment option for kidney cancer?
A) Surgery
B) Chemotherapy
C) Radiation therapy
D) Immunotherapy
Q2) 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
Q3) Which of the following treatment techniques can be used to treat the prostate?
A) 4-field box
B) IMRT
C) Brachytherapy
D) All of the above
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Chapter 36: Breast Cancer
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Q1) What is the medial treatment border when the internal mammary lymph nodes are to be included in the tangential field?
A) Midline
B) 1 cm beyond midline to the contralateral side
C) 3 cm beyond midline to the contralateral side
D) 3 cm beyond midline to the ipsilateral side
Q2) 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
Q3) 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)
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Chapter 37: Pediatric Solid Tumors
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Q1) To what dose are medulloblastomas traditionally treated?
A) 2600 cGy
B) 3600 cGy
C) 4600 cGy
D) 5600 cGy
E) 6600 cGy
Q2) Children are most likely to develop which type of leukemia?
A) ALL
B) AML
C) CLL
D) CML
Q3) The most common pediatric cancer is _________________.
A) medulloblastoma
B) retinoblastoma
C) acute leukemia
D) Wilms' tumor
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Chapter 38: Skin Cancers and Melanoma
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Q1) Which cancer is commonly associated with HIV?
A) Rhabdomyosarcoma
B) Mycosis fungoides
C) Melanoma
D) Kaposi sarcoma
Q2) Which of the following is the correct order to the layers of the skin from deep to superficial?
A) Stratum granulosum, stratum spinosum, stratum lucidum, stratum basale, stratum corneum
B) Stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale
C) Stratum basale, stratum granulosum, stratum spinosum, stratum corneum, stratum lucidum
D) Stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum
Q3) What is the most superficial layer of the skin?
A) Hypodermis
B) Dermis
C) Subdermis
D) Epidermis
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