Radiation Therapy Techniques
Exam Preparation Guide
Course Introduction
This course offers a comprehensive exploration of the principles and practices involved in modern radiation therapy techniques. Students will learn about the fundamentals of radiation physics, treatment planning, and the delivery of therapeutic doses using advanced technologies such as 3D conformal radiation therapy, intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), and stereotactic radiosurgery (SRS). Emphasis is placed on patient positioning, immobilization methods, quality assurance, and safety protocols to ensure effective and precise treatment while minimizing exposure to healthy tissues. The course also covers the multidisciplinary nature of cancer care, with attention to the roles of radiation oncologists, medical physicists, and radiation therapists in the treatment process.
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) Which of the following acts as a radioprotector?
A) Amifostine
B) Actinomycin D
C) Adriamycin
D) Etoposide
Answer: A
Q2) Injecting monoclonal antibodies is an example of which type of treatment?
A) Surgery
B) Radiation therapy
C) Chemotherapy
D) Immunotherapy
Answer: D
Q3) Which of the following is a radiosensitizing chemotherapy agent?
A) Cyclophosphamide
B) 5-Fluorouracil
C) Doxorubicin
D) Cisplatin
Answer: C
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Chapter 2: The Ethics and Legal Considerations of Cancer Management
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Q1) What occurs when the obvious solution to a problem is prohibited by institutional constraints?
A) Ethical dilemma
B) Ethical dilemma of justice
C) Ethical distress
D) Locus of authority
Answer: C
Q2) 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
Q3) Who is most closely associated with clarification of values?
A) Immanuel Kant
B) Louis Rath
C) Elisabeth Kübler-Ross
D) John Mill
Answer: B
Page 4
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Chapter 3: Principles of Pathology
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Sample Questions
Q1) Cancers are broadly divided in terms of the malignant neoplastic process as which of the following?
A) Carcinomas and sarcomas
B) Carcinomas and myomas
C) Hyperplasia and metaplasia
D) Sarcomas and pleomorphic forms
Answer: A
Q2) Irreversible changes in a cell are indicated by all except which of the following?
A) Cellular swelling
B) Nucleus appears fragmented
C) Nucleus is enzymatically destroyed
D) Upon staining, cell appears as a series of color alterations
E) None of the above
Answer: A
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Chapter 4: Overview of Radiobiology
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Q1) 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
Q2) Which of the following is the most important treatment-related variable for the development of the late-term effects of ionizing radiation?
A) Treatment volume
B) Elapsed days
C) OER
D) Dose
Q3) Which macromolecule is most radiosensitive?
A) Lipids
B) Carbohydrates
C) Proteins
D) Deoxyribonucleic acid (DNA)
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6
Chapter 5: Detection and Diagnosis
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Q1) 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.
Q2) Mass screening is based on all except which of the following?
A) Specific results obtained
B) Cost-effectiveness
C) Risk to the patient
D) Geographic location
Q3) Which of the following is not considered one of the four senses?
A) Sight
B) Touch
C) Taste
D) Smell
Q4) Which of the following is a normal white blood count?
A) 3.9 to 5.4 million/mm3
B) 3,900 to 10,800/mm3
C) 12 to 16 million/mm3
D) 150,000 to 425.000/mm3
7
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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) 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
Q3) Attenuation is the process by which an x-ray beam ___________________.
A) is focused
B) is reduced in intensity
C) diverges
D) exposes a film
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8
Chapter 7: Treatment Delivery Equipment
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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) Depth of maximum dose for a 15-MV machine is how far below the skin surface?
A) 0.5 cm
B) 1.5 cm
C) 2.5 cm
D) 3 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
Q4) Depth of maximum dose for a 10-MV machine is how far below the skin surface?
A) 0.5 cm
B) 1.5 cm
C) 2.5 cm
D) 5 cm
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Chapter 8: Treatment Procedures
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Sample Questions
Q1) Methods of matching abutting fields include all except which of the following?
A) Penumbra method
B) Gaps
C) Feathering
D) Use of nondivergent beam edges
Q2) Which of the following two-field arrangements is considered parallel opposed?
A) Field 1 gantry = 0; Field 2 gantry = 90
B) Field 1 gantry = 310; Field 2 gantry = 130
C) Field 1 gantry = 90; Field 2 gantry = 280
D) Field 1 gantry = 180; Field 2 gantry = 10
Q3) 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
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Chapter 9: Infection Control in Radiation Oncology Facilities
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Sample Questions
Q1) All of the following statements describe the use of Standard Precautions except which of the following?
A) Wear gloves when touching blood and body fluids.
B) No hand washing is necessary if using gloves.
C) Use mouthpieces when performing cardiopulmonary resuscitation (CPR).
D) Never recap used needles.
Q2) Which of the following chemical methods of asepsis is applied to the skin?
A) Disinfectant
B) Antiseptic
C) Both a and b
D) All of the above
Q3) A person who is colonized but not ill is known as a ________________.
A) host
B) carrier
C) vector
D) fomite
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11
Chapter 10: Patient Assessment
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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) Nonspecific side effects include all except which of the following?
A) Fatigue
B) Pain
C) Weight loss
D) Sleep
Q3) Reflective listening involves listening with _____________.
A) prayer
B) praise
C) sympathy
D) empathy
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Page 12
Chapter 11: Pharmacology and Drug Administration
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Q1) Intrathecal administration means that medications are injected directly into which of the following?
A) Brain
B) Spinal canal
C) Bone joint
D) Urinary bladder
Q2) Which of the following routes of drug administration is not considered a parenteral route?
A) Oral
B) Intradermal
C) Subcutaneous
D) Intrathecal
Q3) In which part of the body is barium sulfate used as a contrast agent?
A) Gastrointestinal tract
B) Bronchography
C) Myelography
D) Cardiovascular
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Chapter 12: Applied Mathematics Review
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Sample Questions
Q1) 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
Q2) Which of the following is not a fundamental SI unit?
A) Time
B) Distance
C) Weight
D) Electrical current
Q3) Express log<sub>10</sub> 100 = 2 in exponential notation.
A) 1.0 × 10<sup>2</sup>
B) 102 = 100
C) 2<sup>10</sup> = 100
D) 10 = v100
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Chapter 13: Introduction to Radiation Therapy Physics
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Q1) The unit for frequency is 1/sec, called the _________________.
A) lambda
B) Hertz
C) meter
D) angstrom
Q2) There are four major quantities that are important in radiation physics.They are radiation exposure, radiation absorbed dose, radiation dose equivalent, and ________________.
A) radioactivity
B) magnetism
C) electromagnetism
D) frequency
Q3) Nuclear binding energy is measured in which of the following?
A) keV
B) Amu
C) MeV
D) Coulombs
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Page 15
Chapter 14: Aspects of Brachytherapy
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Sample Questions
Q1) The half-life of radium is __________________.
A) 1.6 years
B) 162 days
C) 1,622 years
D) 16 years
Q2) The average or mean life of iridium 192 is __________ days.
A) 51
B) 74
C) 107
D) 148
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.
Q4) What is the average energy of iridium 192?
A) 170 keV
B) 730 keV
C) 450 keV
D) 380 keV
Page 16
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Chapter 15: Special Procedures
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Sample Questions
Q1) Which of the following is the motion management method that defines an internal target volume?
A) OBI
B) compression
C) conservative
D) MIP
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) Forced shallow breathing technique is used to control which of the following?
A) Compression
B) Imaging
C) Motion
D) Interfraction dose
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Chapter 16: Particle Therapy
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Q1) 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
Q2) Which of the following is the most reliable method for verifying beam clearance before a patient is treated?
A) Utilization of three-dimensional (3D)room models
B) Performance of manual verification
C) Use of room blueprints and computer plans
D) Robust review of treatment plans
Q3) The spread out Bragg peak (SOBP)is created by which of the following?
A) Nozzle
B) Aperture
C) Compensator
D) Modulator wheel
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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 naturally occurring internal radiation is ____ mSv.
A) 0.2
B) 0.11
C) 13
D) 11
Q2) 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
Q3) The annual dose equivalent limit to the whole body for infrequent nonoccupationally exposed individuals is ____ mSv.
A) 0.5
B) 1
C) 5
D) 50
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Chapter 18: Patient Safety in Radiation Oncology
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Q1) The step in the plan-do-study-act improvement cycle associated with making adjustments to address a problem is the ______________ step.
A) plan
B) do
C) study
D) act
Q2) Which of the following is one tool used to depict how different processes change over time?
A) Fishbone diagram
B) Control chart
C) Pareto chart
D) Histogram
Q3) 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
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Chapter 19: Quality Improvement in Radiation Oncology
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Q1) Which organization guides specific radiation oncology staff in the development of a quality assurance (QA)program as it relates to treatment planning and delivery?
A) ACR
B) NRC
C) AAPM
D) ASRT
Q2) 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
Q3) The tolerance for light/radiation field coincidence on the linear accelerator is _____ mm.
A) 1
B) 2
C) 3
D) 4
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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) Which of the following describes why ultrasound is not useful when imaging the skull, lungs, or intestines?
A) Ultrasound does not penetrate bone.
B) Ultrasound does not penetrate air-filled spaces.
C) Ultrasound may not undergo reverse photoelectric absorption.
D) Both a and b are correct.
E) Both a and c are correct.
Q3) Which organ begins at the lower border of the cricoid cartilage and travels through the diaphragm to the cardiac sphincter?
A) Trachea
B) Bronchus
C) Esophagus
D) None of the above
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22
Chapter 21: Simulator Design
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Q1) Most computed tomography (CT)scanners today are _______-generation imaging systems.
A) first
B) second
C) third
D) fourth
Q2) Light photons are produced and transmitted electronically through to a video image at which of the following?
A) Output phosphor
B) Tube housing
C) Photocathode
D) Focusing lenses
Q3) The conventional simulator can define treatment fields by using which of the following?
A) Blades
B) Wires
C) OID
D) Collimator assembly
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Page 23
Chapter 22: Computed Tomography Simulation
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Q1) 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
Q2) The reconstructed field of view that is displayed on the computer monitor should be large enough to display which of the following?
I.Entire contour
II.Immobilization device
III.Pertinent anatomy only
A) I
B) II
C) III
D) I and II
Q3) What is a maximum intensity projection, or MIP?
A) Measurement of table translation
B) Result of noise on an image
C) Relationship between the matrix size and the pixel size on an image
D) Fused scan that shows the maximum amount of tumor movement during the respiratory cycle
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Chapter 23: Photon Dosimetry Concepts and Calculations
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Q1) Find the PDD at 10 cm of a 6-MV beam of radiation that has a 5 × 5 cm treatment field.
A) 68%
B) 64.1%
C) 65.1%
D) 62.8%
Q2) Find the PDD at 19 cm of an 18-MV beam of radiation that has a 12 × 12 cm treatment field.
A) 56%
B) 55.6%
C) 53.7%
D) 51.7%
Q3) Mayneord F factor is used in which of the following?
A) Isocentric setups when distance is increased
B) Isocentric setups when field size changes
C) SSD setups when field size changes
D) SSD setups when distance increases
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Page 25
Chapter 24: Photon Dose Distributions
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Q1) The internal target volume (ITV)is the __________.
A) GTV + CTV
B) CTV + IM
C) PTV - GTV
D) ITV + SM
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) Which of the following is the palpable, visible, or demonstrable extent and location of malignant growth and is the volume of known disease?
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 effect will an increase in the energy of an electron beam have on the lateral bulge of the 80% isodose line?
A) Increase
B) Decrease
C) Remain the same
D) Dose dependence
Q2) 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
Q3) What is the depth of the 90% isodose line of a 9-MeV electron beam?
A) 2.25 cm
B) 3 cm
C) 4.5 cm
D) 9 cm
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Chapter 26: Electronic Charting and Image Management
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Q1) All except which of the following medical personnel are involved in the radiation oncology record?
A) Radiation therapists
B) Radiation oncologists
C) Nurses
D) Physical therapists
Q2) The design of the interface affects the amount of the time the user spends to perform which of the following?
A) Input information
B) Interpret the output
C) Neither a nor b
D) Both a and b
Q3) All of the following except which personnel provide support for EMRs?
A) System analyst
B) Network specialist
C) Engineers
D) Information systems specialist
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28
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) The most common symptom associated with STSs is __________________.
A) lymphadenopathy
B) palpable mass
C) leukopenia
D) pain
Q3) Which of the following has the highest incidence of bone tumors?
A) Ewing sarcoma
B) Chondrosarcoma
C) Metastatic bone lesions
D) Multiple myeloma
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29
Chapter 28: Lymphoreticular System Tumors
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Q1) Which stage is a Hodgkin lymphoma affecting two lymph node groups on the same side of the diaphragm?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Q2) 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
Q3) Which lymph node chain is more likely to be the original site of Hodgkin lymphoma?
A) Pelvic
B) Inguinal
C) Para-aortic
D) Axillary
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Page 30
Chapter 29: Endocrine System Tumors
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Q1) What is the most common form of thyroid cancer seen in irradiated individuals?
A) Follicular
B) Papillary
C) Medullary
D) Lymphoma
Q2) Which of the following hormones is not secreted by the pituitary?
A) ADH
B) TSH
C) FSH
D) PTH
Q3) Survivors of the atomic bombs developed which type of endocrine gland cancer most frequently?
A) Pancreas
B) Pituitary
C) Thyroid
D) Adrenal
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Chapter 30: Respiratory System Tumors
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Q1) At what anatomical location does the trachea bifurcate into the right and left main stem bronchi?
A) Pleura
B) Primary bronchi
C) Carina
D) Alveoli
Q2) What performance status score is assigned to patients with disabilities who require special care and assistance but not hospitalization?
A) 20
B) 30
C) 40
D) 50
E) 60
Q3) Which of the following is not a common acute side effect a patient may experience during the course of radiation treatments for lung cancer?
A) Dermatitis
B) Erythema
C) Esophagitis
D) Diarrhea
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Page 32
Chapter 31: Head and Neck Cancers
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Q1) What defines the inferior radiation field border for the treatment of a low=staged larynx cancer?
A) Superior aspect of the hyoid
B) Cricoid cartilage
C) Clavicles
D) C7-T1 intervertebral space
Q2) Which of the following is a function of saliva?
A) Lubricate the food bolus
B) Digestion
C) Oral hygiene
D) All of the above
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
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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) Which of the following cells is responsible for myelin production?
A) Neurons
B) Schwann cells
C) Astrocytes
D) Ependymal cells
Q3) Which of the following conditions is a contraindication for stereotactic radiosurgery (SRS)?
A) Spherical tumor
B) 2-cm tumor
C) Brain metastases
D) Five lesions
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Chapter 33: Digestive System Tumors
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Q1) Which of the following is not a risk factor for anal cancer?
A) Diet
B) Human papillomavirus
C) Anal intercourse
D) Immunosuppression
Q2) 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
Q3) What condition is most closely associated with gastroesophageal reflux?
A) Barrett esophagus
B) Gardner syndrome
C) Plummer-Vinson syndrome
D) Tenesmus
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Page 35
Chapter 34: Gynecological Tumors
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Sample Questions
Q1) Which is true of a cervical cancer with a stage II classification?
I.The cancer invades beyond the uterus but not to the pelvic sidewalls.
II.The cancer extends to the lower third of the vagina.
III.Bladder or rectum involvement is possible.
A) I
B) II
C) III
D) I, II, and III
Q2) Which of the following cancers can be treated using whole abdomen irradiation?
A) Ovarian
B) Cervical
C) Vaginal
D) Vulvar
Q3) Pap testing is a screening tool used to detect which cancer?
A) Ovarian
B) Cervical
C) Vaginal
D) Vulvar
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Chapter 35: Male Reproductive and Genitourinary Tumors
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Sample Questions
Q1) A total dose of 2500 cGy in fractions of 160 cGy is used to treat which male reproductive cancer?
A) Penis
B) Testicle
C) Prostate
D) Bladder
Q2) What is the primary treatment option for kidney cancer?
A) Surgery
B) Chemotherapy
C) Radiation therapy
D) Immunotherapy
Q3) What is the most common symptom of testicular cancer?
A) Night sweats
B) Fever
C) Dysuria
D) Painless mass
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Page 37
Chapter 36: Breast Cancer
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Sample Questions
Q1) What is the standard dose delivered to the SCV field?
A) 4000 to 4600 cGy
B) 4500 to 5000 cGy
C) 5000 to 5600 cGy
D) 6000 to 6600 cGy
Q2) 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
Q3) The lower border of the breast extends to which rib?
A) Fifth
B) Sixth
C) Seventh
D) Eighth
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Chapter 37: Pediatric Solid Tumors
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Sample Questions
Q1) Which pediatric cancer occurs in the testes and ovaries?
A) Germ cell tumor
B) Neuroblastoma
C) Rhabdomyosarcoma
D) Wilms' tumor
Q2) The most common pediatric cancer is _________________.
A) medulloblastoma
B) retinoblastoma
C) acute leukemia
D) Wilms' tumor
Q3) The craniospinal treatment technique is used to treat what specific type of pediatric cancer?
A) Medulloblastoma
B) Neuroblastoma
C) Rhabdomyosarcoma
D) Retinoblastoma
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Chapter 38: Skin Cancers and Melanoma
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Sample Questions
Q1) What form of skin cancer has the highest mortality rate?
A) Basal cell carcinoma
B) Squamous cell carcinoma
C) Melanoma
D) Kaposi sarcoma
Q2) Bolus may be used with electron therapy to _______________.
I.compensate for missing tissue
II.maximize surface dose
III.reduce underlying tissue dose
A) I, III
B) II, III
C) I, II
D) I, II, III
Q3) What is the most significant cause of skin cancer?
A) Radiation exposure
B) Sun exposure
C) Arsenic exposure
D) Human papillomavirus
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