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preface
The RAP HEX Therapy exam 2010 was prepared by members of the Radiological and Medical Physics
Society of New York (RAMPS, Inc.), the New York chapter of the American Association of Physicists in
Medicine (AAPM).
The exam format was changed in 2009 to match the syllabi for teaching Diagnostic Radiology and Radiation
Oncology residents published by the AAPM's Subcommittee for Review of Radiation Physics Syllabi for
Residents (RRPSR). The numbers of questions for each subject are approximately related to the number of
teaching hours allocated to each subject.
There are now two exams, Diagnostic and Therapy, each with about 130 questions, including general physics
questions appropriate to the specialty.
Exam committee:
Doracy Fontenla, Ph.D., Editor
Susan Brownie, M .Sc., Reviewer
Howard Amols, Ph.D., Reviewer
Eugene Lief, Ph.D., Reviewer
Richard Riley, Ph.D., Reviewer
Contributors:
Alex Kapulsky, Ph.D.
John Keane, M.Sc.Abishek Dwedi, M.Sc.
John Napoli, M.Sc.
John Humm, Ph.D.
Lawrence Dauer, Ph.D.
Ruimei Ma, Ph.D.
Sandra Fontenla, M.Sc.
Dale M. Lovelock, Ph.D.
Yeh Chi-Lo, Ph.D.
Chen-Shou Chui, Ph.D.
Shantini Rajaratnam, Ph.D.
If you are taking RAPHEX under exam conditions, your proctor will give you instructions on how to fill out
your examinee and site IDs on the answer sheet.
You have 3 HOURS to complete the exam.
Non-programmable calculators may be used.
Choose the most complete and appropriate answer to each question.
We urge residents to review the exam with their physics instructors.
Any comments or corrections are appreciated and should be sent to:
Adel Mustafa, Ph.D.
Rap hex Chief Editor
E-mail: adelmustafa@gmail.com
Copyright 2010 by RAMPS, Inc., the New York chapter of the AAPM. All rights reserved. No part of this
book may be used or reproduced in any manner whatsoever without written permission from the publisher or
the copyright holder.

Published in cooperation with RAMPS by:

Medical Physics Publishing

4513 Vernon Boulevard
Madison, WI 53705-4964
1-800-442-5778
E-mail: mpp@medicalphysics.org
Web: www.medicalphysics.org

Printed in the United States of America

therapy questions
Tl-4.

Match the following (answers may be used more than once):

A. Electrons.
B. Protons.
C. Neutrons.
D. Neutrinos.
E. Gamma rays.
Responsible for nuclear medicine imaging with 99mTc.
Responsible for MR imaging.
Most difficult to detect.
Emitted in beta minus decay with antineutrinos.

Tl.
T2.
T3.
T4.

TS.

In stable isotopes with heavy nuclei:

A. The number of protons equals the number of neutrons.
B. The number of protons is higher than the number of neutrons.
C. The number of neutrons is higher than the number of protons.
D. The numbers of neutrons and protons are unrelated.

T6.

Which
A.
B.
C.
D.

T7-IO.

Match the elementary particle, as described by its characteristics below, to the following
description. (Answers may be used more than once.)
A.
B.
C.
D.

T7.
T8.
T9.
TlO.
T II.

of the following is true? Iodine-131 and Iodine-125 _ __

Have different chemical properties
Have different Z values
Have the same number of neutrons
None of the above.

Charge
+1
+1
0
-1

Rest Mass
0.51 MeV
938 MeV
940MeV
0.51 MeV

Is the nucleus of a hydrogen atom.

Is responsible for x-ray production in CT scanners and linear accelerators.
When this particle combines with an electron, annihilation photons are emitted.
There are 2 ofthese in a Tritium nucleus.

Which one of the statements below is true for the characteristic x-ray.s emitted from a tungsten
target when 100 keV electrons are fired at it:
A. Have a continuous spectrum of energies up to 100 keV.
B. Are about equal in intensity to the bremsstrahlung.
C. Have energies equal to differences in the electron binding energies of tungsten.
D. Do not contribute to the imaging process.
E. Have a non-isotropic distribution.

Raphex 2010

therapy questions
J" 12.

Increasing the kVp of an x-ray beam without changing any other control setting will increase
all of the following, except:
A. Amount of heat produced at the anode.
B. Intensity of the x-ray beam.
C. Exposure to a person in the room out of the direct beam.
D. Contrast in a film taken at the higher kVp.

T 13.

In diagnostic x-ray systems, filters are used to "harden" the beam. This process is
mainly due to:
A. Coherent scattering.
B. Photoelectric effect.
C. Compton effect.
D. Pair production.

T 14.

What tests should be performed daily on a CT Simulator in a radiation therapy department?

A. Laser accuracy
B. Constancy of CT-to-density conversion for treatment planning software
C. Half-value layer determination
D. Optical Distance Indicator accuracy
E. All ofthe above

T 15.

Which of the following does not utilize electromagnetic radiation?

A. Diagnostic x-rays
B. Positron emission tomography
C. Gamma camera
D. B-mode ultrasound
E. Gamma knife

T 16.

Which of the following does not occur when a linac is changed from the x-ray mode to the
electron mode? (Excluding units with scanned electron beams)
A. The target is removed.
B, A scattering foil is placed in the beam.
C. The monitor chamber is removed.
D. An electron applicator is attached.
E. The beam current decreases.

Tl7.

In linacs which use flattening filters, which of the following is false?

A. It must be carefully centered on the beam axis.
B. It is needed to convert a narrow, forward peaked beam into a more useful broad,
fiat beam.
C. The same filter is used for the 6 MV photon beam and the 6 MeV electron beam.
D. It can become radioactive, depending on beam energy.
E. Flattening filters create "horns" at ~ax

Rap hex 20 I 0

therapy questions
T 18.

Bending magnets are needed in high-energy linear accelerators:

A. To rotate the electron beam so that it points towards the isocenter.
B. Only in the photon mode.
C. Only for linacs with the waveguide mounted perpendicular to the gantry rotation axis.
D. Only in the electron mode.
E. Only with dual-energy photons.

T 19.

When a linear accelerator is used in the electron n1ode, the electron beam passes through each
of the following components, except:
A. Accelerator wave guide.
B. Bending magnet.
C. Target.
D. Primary collimator.
E. Monitor chamber.

T20.

Neutron contamination is greatest in a

A. Co-60
B. 6 MV photon
C. l 0 MV photon
D. 20 MV photon
E. 20 MeV electron

T21.

Which is the predominant reaction by which fast neutrons dissipate energy in tissue?
A. Neutron capture by hydrogen giving rise to 2.2 MeV y-rays by the (n, y) reaction
B. Elastic collisions with hydrogen nuclei (protons) present in the tissue
C. Inelastic collisions with heavier nuclei, resulting in disintegration, of which the
reaction with nitrogen giving rise to a proton of0.66 MeV is the most important
D. Elastic collisions with heavier nuclei present in tissue

T22.

Which of the following is a directly ionizing radiation?

A. 2 MHz ultrasound
B. 6Co gammas
C. 90Sr betas
D. 15 MeV photons
E. Thermalneutrons

T23.

All of the following are properties of electromagnetic radiation, except:

A. Obeys the inverse square law for point source.
B. Travels at a constant velocity in a vacuum.
C. Can be deflected by a magnetic field.
D. Is exponentially attenuated by a medium.
E. Is composed of perpendicular electric and magnetic fields.

Raphex 2010

beam.

therapy questions
T24.

In the interaction of ionizing radiation and matter, absorption of dose is associated with the
transfer of energy:
A. To electrons.
B. To photons.
C. Only in the photoelectric process.
D. Only from incident photons.

T25.

Hounsfield numbers in aCT image are linearly related to the:

A. Mass attenuation coefficient.
B. Linear attenuation coefficient.
C. Electron density of the patient.
D. Number of photoelectric interactions per em.

T26.

With the exception of hydrogenous materials, for which interaction is the mass attenuation
coefficient similar for most materials?
A. Photoelectric
B. Compton
C. Pair production
D. Photonuclear disintegration
E. Nuclear scattering reactions

T27.

When a 10 keY photon undergoes a photoelectric interaction with a K-shell electron

of binding energy 6 keV:
A. A 6 ke V photoelectron is emitted.
B. The photon is scattered with reduced energy.
C. A characteristic x-ray is emitted.
D. An electron-positron pair is created.

T28.

Suppose that a photon undergoes a Compton interaction in which the backscattered photon has
the minimum energy. At what angle is the Compton electron emitted relative to the direction
of the initial photon?
A. Cannot be determined from the information given.
B. 0
c. 90
D. 180
E. None of the above.

T29.

If the linear attenuation coefficient of a photon beam is 1.0 cm- 1, the half-value layer (HVL) is:
A. 0.693 em
B. 1.39 em
C. 1.44 em
D. Cannot calculate without knowing the energy of the beam.

Raphex 20 I 0

therapy questions
TlO.

Collecting all the charge produced by a beam ofphotons in a small volume of air, under
conditions of electronic equilibrium, is a direct measure of:
A. Dose equivalent.
B. LET.
( . Absorbed dose.
D. Exposure.
E. Specific ionization.

Tll.

The x-ray spectrum of a 10 MV linac has:

A. Photons, all of which have an energy of 10 MY, 5%.
R. A maximum photon energy of 10 MeV and an average of about 3 MeV
C. A maximum photon energy of30 MeV and an average of about 10 MeV
D. Equal numbers of photons at all energies up to 20 MeV
E. Prominent peaks at the characteristic x-ray energies of the target.

T32.

A superficial x-ray unit has an HVL of 2 mrnAl. Which ofthe following will cause
the greatest increase in dose rate at the patient's surface?
A. Increasing the filtration by 1 mm.
B Increasing the beam current from 8 to 12 rnA.
C. Changing the kVp from 100 to 80.
D. Increasing the SSD from 15 to 18 em.

Tll.

The f factor is all of the following, except:

A. Not defined above 3 MeV
B. 0.876 cGy/R for 6Co in air.
C. Dependent on the composition of the medium and the photon energy.
D. Greater for fat than for bone at 100 ke V

T34.

Apart from heat production, which of the following predominantly occurs when electrons
of 150 kVp hit a tungsten anode?
A. Compton scatter
B Elastic scatter
C. Bremstrahlung radiation
D. Coherent scatter
E. Photoelectric interaction "

TlS.

The depth of maximum dose for a photon beam is approximately equal to:
A. The depth at which dose and kerma are equal.
B. The maximum range of the secondary electrons.
C. The depth at which electronic equilibrium occurs.
D. All of the above.
E. None of the above.

Raphex 2010

therapy questions
T36.

In order to convert exposure (R) to absorbed dose (mGy), the factor for diagnostic x-rays and
muscle tissue by which exposure is multiplied is closest to
A. 0. 1
B. 5

c.

D. 20
E. 90

TJ 7.

Which
A.
B.
C.
D.
E.

T38.

When a cylindrical chamber is used to measure percent depth dose for a megavoltage photon
beam in a water phantom, the measured ionization curve should be shifted:
A. Toward the phantom surface by about one-half of the chamber inner radius.
B. Away from the phantom surface by about one-half of the chamber inner radius.
C. By an amount dependent on the beam energy.
D. Only for electron beams, but not for photon beams.

T39.

A parallel-plate chamber is used to measure the percent depth ionization of an electron beam
in water. The measured percent depth ionization distribution:
' A. Equals the percent depth dose distribution.
B. Equals the percent depth dose distribution only after the build-up region.

therapy unit would produce the highest beam energy:

Gamma Knife
Linear accelerator
TomoTherapy
CyberKnife
Proton Therapy

C. Needs to be multiplied by

("L/P)::rer to obtain the percent depth dose.

water

(I )

D. Needs to be multiplied by J1 p a1r.

T40.

to obtain the percent depth dose.

According to the AAPM TG-51 calibration protocol, all of the following are true, except:
A. TG-51 applies for photon and electron beams with energies between Co-60
and 50 MeV.
B. TG-51 provides a way to nteasure absorbed dose in water, in Gy, at the point of
measurement of the ion chamber, when it is absent.
C. Ionization chamber must have a calibration factor obtained in water, at an Accredited
Dosimetry Calibration Laboratory (ADCL).
D. Reference dosimetry must be performed in a phantom with dimensions of at least
30x30x30 em.
E. Electron beams must be calibrated with chambers having an electron calibration factor
provided by an Accredited Dosimetry Calibration Laboratory (ADCL).

Raphex 2010

therapy questions
T 41.

Linear accelerators must have the TG-51 full calibration in a water tank for all photons and
electrons beams in clinical use:
A. Every month.
B. Once a year.
C. Monthly.
D. Daily.
E. Only at acceptance testing of a new linac, for all clinical beams.

T42.

In dose measurements using an ion chamber, the reading is corrected to the reading that would
have been obtained at the standard temperature and pressure of:
A. 32 C, 730 mm Hg.
B. 22 C, 760 mm Hg.
C. OK, lOOmmHg.
D. 273 K, 101.33 kPa.

T43.

"Homogeneity index" is used to express:

A. The degree of dose uniformity in the target volume.
B. The degree of dose uniformity in organs at risk.
C. The degree of CT number uniformity in a CT image.
D. The degree of intensity uniformity in an intensity-modulated field.

T44.

The dose beyond 3.0 em dense bone in a 6 MV beam, compared to that calculated without a
heterogeneity correction, would be about _ _ _ .
A. 6% greater
B 3% greater
C. 3% less
D. 6% less
E. 12% less

T 45.

A spine field set up at 100 em SSD delivers 250 cGy at 5 em depth. The maximum tissue dose
is
cGy.

Data: Depth (em)

PDD
TMR
1.6
100.0
1.0
5.0
87.1
0.928
Output in tissue= 1.000 cGy/MU at 100 em SSD, <1max
1.032 cGy/MU at 100 em SAD, <1max
A. 303
B. 298
c. 287
D. 269
E. 255

Raphex 2010

therapy questions
T46.

Wide tangents used to treat a left breast cancer that has spread to the IMN are NOT ideal
because of all of the following, except:
A. Heart dose.
B. Lung dose.
C. Possible dose to the contralateral breast.
D. Inadequate coverage of breast tissue.

T47.

If the dose rate is 250 cGy/min at 100 em, at what distance will the dose rate be 100 cGy/min?
A. 40 em.
B. 158 em.
C. 200 em.
D. 250 em.
E. 285 em.

T48.

A patient's spinal axis is treated at an extended SSD of 130 em to avoid splitting the field
into two. By approximately what factor will the MU be increased over the same field
treated at 100 em SSD?
A. 1.3
B. 1.5
C. 1.7
D. 1.9
E. 2.1

T49.

All ofthe following are true regarding percentage depth dose at d=10 em in megavoltage
photon beams, except:
A. Increases with increasing SSD.
B. Increases with increasing field size.
C. Increases with increasing beam energy.
D. Decreases exponentially from the surface.

TS0-52.

Match
A.
B.
C.
D.

the depth of dmax with the type of beam.

Ocm
0 .5 em
1.2 em
2.5 em

T50. Superficial x-rays: 2 mm AI HVL

T51. 10 MV photons
T52. 6 MeV electrons

Raphex 2010

therapy questions
TS3.

All of the following are true for a 6 MV photon beam, except:

A. The attenuation is approximately 6% per em.
B. The PDD for a 10x10 cm2 beam at 10 em depth is approximately 68%.
C. The.TMR for a 10x10 cm2 beam at 10 em depth is approximately 0.784.
D. Dmax is approximately 1.5 em.

TS4.

A patient's spine is treated with 6 MV photons at extended distance, in order to obtain a large
enough field. The total length is 52 em on the skin, and the SSD is 135 em. Compared to that
at 100 em SSD, the PDD at 6 em depth will _ _ _
A. Increase by about 2%
B. Increase by about 10%
C. Increase by about 20%
D. Decrease by about 10%
E. Decrease by about 2%

TSS.

All of the following are true regarding Percent Depth Dose (PDD), except:
A. The value can be calculated for extended SSD using Mayneord's F factor.
B. It comprises an attenuation component and an inverse square component.
C. It is always 100% at dmax.
D. It is defined as: (dose rate at dmax/dose rate at depth) x 100%.

TS6.

Percent depth dose (PDD) tables are useful for all of the following, except:
A. Hand calculation of monitor unit settings for photon fields set up with the isocenter
on the skin.
B. Comparing depth dose ctJ.aracteristics of photon beams with different energies.
C Hand calculation of monitor units for photon beams set up with the isocenter at depth.
D. Hand calculation of monitor unit settings for electron beams.
E. Comparing depth dose characteristics of electron beams of different field size.

TS7.

A possible disadvantage of using parallel opposed 18 MV photons for treating a volume which
includes superficial nodes is:
A. Increased skin dose.
B. Higher total dose at dmax
C. Insufficient dose in the build-up region.
D. Higher dose rate.

TS8.

The output at dmax in tissue at 100 ern is 1.03 cGy/MU. The TMR for a 15x15 cm2 field
at 12 ern depth is 0.686. A small corner block is used, and the tray factor is 0.96. The MU
setting to deliver 90 cGy isocentrically at 12 ern depth is
MU.
A. 120
B. 122
c. 127
D. 133
E. 147

Raphex 2010

therapy questions
T59.

In linacs that use flattening filters in megavoltage photon beams, these are designed to achieve
a flat beam at 10 em depth. This means that at ~ax the profile of a 30x30 cm2 6 MV beam:
A. Increases with increasing radius from the center.
B. Decreases with increasing radius from the center.
C. Is the same as at 10 em depth.

T60.

A patient's pelvis is treated with parallel opposed 10 MV x-ray fields, 20x20 cm2, set up
at 100 em SAD. The prescribed dose is 4500 cGy in 25 fractions. The AP thickness is 26 em.
Both fields are treated each day. The total dose per fraction at dmax is
cGy.
A. 162
B. 175
C . 180
D. 194
E. 21 6

T61.

Tissue-Maximum Ratio (TMR) depends on:

A. Energy, SAD, depth, and field size.
B. Energy, SAD, and field size.
C. SAD, depth, and field size.
D. Energy, depth, and field size.
E. SSD only.

T62.

Changing parallel opposed fields from 100 em SAD to 100 em SSD while treating to the same
prescription dose at patient midline would cause which of the following changes in MU and
total dose at ~ax:

A.
B.
C.
D.
E.

T63.

10

MU
Decrease
Decrease
Increase
Increase
Increase

Total dose at dmax

Large increase
Large decrease
Small increase
No change
Small decrease

For a 10xl0 em photon field, the TMR and FDD (fractional depth dose= PDD/ 100) are both
1.0 at depth ~ax At depth d=10 em, the TMR is larger than the FDD. This is because:
A. TMRs do not account for attenuation.
B. FDDs contain an inverse square component.
C. TMRs contain an in~erse square component.
D. Of the difference in divergence between the geometries.
E. FDDs do not contain a correction for scatter.

Raphex 2010

therapy questions
T64.

All of the following statements below are true for breast tangential field irradiation with
wedges, except:
A. _Wedges can be used to reduce a hot spot at the apex.
B. The contralateral intact breast will receive less dose compared with open-field
treatment because the wedge will block scatter dose from the gantry head.
C. Dynamic wedges do not harden the beam, unlike conventional wedges.
D. Dose scattered to the contralateral breast is less for dynamic wedges than for
conventional wedges.

T65.

All of the following are true statements regarding dynamic wedges, except:
A. The wedge effect is created by closing one collimator jaw during irradiation.
B. The field length in the non-wedged direction can be equal to the maximum collimator
setting.
C. The depth dose on the beam axis is the same as that of an open 6eam.
D. For a wedge in theY direction, one of theY collimators cannot be set to zero.

T66.

A 10x 10 em photon beam is used to deliver 100 cGy at the depth of 10 em. If a 2x2 em central
block with a 5% narrow beam transmission is used to protect a critical organ, the dose on the
central axis at the same depth is:
A. 5 cGy.
B. Greater than 5 cGy.
C. Less than 5 cGy.
D. Depends on the pfioton beam energy.

T67.

An effective wedge angle of 15 could be achieved by all of the following, except:

A. Use of a 30 wedge and an open beam for equal numbers of monitor units.
B. A "universal wedge" of 60, combined with an open field, with appropriate weighting.
C. A combination of a 30 wedge and an open beam to deliver equal doses on the axis.
D. A forward planned "step-and-shoot" field.

T68.

In the diagram below, the wedge angle is _ __

A.

B.

c.

D.
E.

Raphex 2010

II

therapy questions
T69.

All of the following are true regarding capabilities of the TomoTherapy unit, except:
A. It uses a 6 MV photon beam.
B. It can deliver a 6 MeV electron beam.
C. It uses a MLC to deliver IMRT treatment.
D. It uses megavoltage CT to align the patient.

T70.

The PDD at 5 em for a 9 MeV electron beam is approximately

A. 90
B. 85
50
D. <5

%.

T71.

The electron field size required to treat a volume with a 5 em width at the treatment depth
lS
em.
A. 5
B. 6
c. 7

D. 8
E. 10

T72.

A broad electron beam in the middle of its range in soft tissue generally loses
about
MeV/cm.
A. 5
B. 2

C. 1
D. 0.5
E. 0.1

T73.

A cervical neck node is to receive a boost with 16 MeV electrons using a 3.0 em diameter
circular cut-out in a 6x6 em cone. This field must be treated at 115 em SSD to avoid the
shoulder. All of the following are true, except:
A. The electron output (cGy/MU) is reduced compared to an open 6x6 em cone.
B. The penumbra width will increase, compared to that at I 00 em SSD.
C. The depth of the 90% isodose will be less than that of the open 6x6 em cone.
D. The output at 115 em SSD will be (1001115)2 times that at 100 em SSD.

T74.

Which
A.
B.
C.
D.

12

ofthe following is true regarding the surface dose of an electron beam?

Depends on the design of the collimators
Is the same as that of a photon beam of the same energy
Is the same as that of an orthovoltage beam of HVL=0.5 mm Cu
Decreases as energy of the electron beam increases

Raphex 2010

therapy questions
T7 5.

If an air gap between the electron cutout and the skin increases from 5 em to 10 em,
the maximum dose in tissue (for the same MU) decreases by approximately
%.
A. 2
B. 5
c. 10
D. 20

T76.

Typical
A.
B.
C.
D.
E

T77.

According to AAPM's TG-40 report on QA, daily checks on a linac should include all of the
following, exllflJ}t:
A. Accuracy of the Optical Distance Indicator (ODI).
B. Accuracy of the laser alignment system.
C. Photon output.
D. Function of door interlock.
E. Photon flatness.

T78.

Regarding linac output. AAPM's TG-40 report on QA recommends all of the following, except:
A. The daily output constancy check should be within 10% of the standard.
B. The output is checked monthly by the physicist, and should be within 2% of the
correct value.
C. Action should be taken if parameters exceed tolerance.
D. At the annual calibration the output must be within 2% of the required value.

T79.

Which of the following tasks require the use of the DICOM standard?
A. Modeling the treatment machine for patient plannirlg
B. Defining the file format for medical imaging and the network communication protocol
C. Defining the file format needed for HL-7 interfaces to billing systems
D. For transferring data in compliance with HIPAA (Health Insurance Portability and
Accountability Act)

T80.

A linac is being decommissioned after use at both 6 MV and 15 MV for more than
12 years and is being dismantled for removal as trash. Which of the following must be
evaluated prior to sending the parts to a general landfill or metal recycling plant?
A. Nothing, all parts can go to general waste.
B. Check for any lead, depleted uranium, or activated metal parts.
C. Wipe the unit down to remove ozone particles.
D. Check only that the target has been removed.

Raphex 2010

beam flatness specifications for a linac photon beam are:

10% over the whole width of the beam measured in air at the isocenter.
6% over 50% of the field width measured in water at dmax
3% over 80% of the field width measured in water at 10 em depth.
1% over 90% of the field width measured in air at the isocenter.
20% over 50% of the field width measured in air at the isocenter.

13

therapy questions
T81.

The average surface anterior air kenna rate at the symphysis pubis from patients receiving
1-125 seed implantation in the prostate is about:
A. 0.5 f.l.Gylh
B. 25 f.l.Gylh
C. 50 f.l.Gylh
D. 2.50 mGylh

T82.

According to the National Council on Radiation Protection and Measurements (NCRP) Report
101 1 regarding recommendations on limits for exposure to ionizing radiation, what is the
weekly shielding design goal for an uncontrolled area?
A. 0.2 mGy/week
B. 0.1 mGy/week
C. 0.01 mGy/week
D. 0.02 mGy/week

T83.

Modern radiotherapy facilities often employ techniques, such as intensity-modulated radiation

therapy (IMRT), that build up dose in the target volume through the accumulation of multiple
beamlets. These treatment delivery methods can lead to linac leakage-radiation workloads that
are higher than for conventional radiotherapy by a factor of:
A. 1; leakage-radiation workloads are the same as for conventional RT.
B. 1.5 times higher.
C. 2- 10 times higher.
D. 100 times higher.

T84.

In the shielding formula B = W UT/d2 the symbol U represents:

A. The fraction of the workday during which staff occupy the area to be shielded.
B. The fraction of the total machine workload during which the beam is pointed at the
, barrier in question.
C. The ratio of the current wall thickness to that required to reduce the dose rate to the
required level.
D. The fraction of the workday during which the radiation beam is turned on.

T85.

All of the following types of radiation contribute about equally to the average annual dose
equivalent received by a member of the U.S. population, except:
A. Internal.
B. Terrestrial, other than radon.
C. Medical x-rays.
D. Nuclear medicine. E. Cosmic.

NCRP Report No. 101, Exposure of the U.S. Population from Occupational Radiation, Bethesda, MD: National
Council on Radiation Protection and Measurements (1989).

14

Raphex 2010

therapy questions
125

T86.

The instrument best suited for finding a dropped

A. Thimble Farmer chamber.
B. Geiger counter.
C. Thermoluminescent dosimeter.
D. Diode.
E. Ionization survey meter.

T87.

If space is not restricted, concrete may be used in preference to lead for primary shielding in
an 18 MV linac instaltation for all of the following reasons, except:
A. Concrete is less expensive.
B. Concrete is more efficient than lead for neutron shielding.
C. Lead is more difficult to install than concrete.
D. Lead would weigh too much.

T88.

A patient treated with 6 MV breast tangents requests a lead apron to shield her ovaries. All of
the following are true, except:
A. The ovaries are far enough away from the breast tangents that they would receive no
measurable dose.
B. 6 MV head leakage has an HVL of about 12 rnm of lead.
C. A typical lead apron contains about 0.5 mm of lead, which would have negligible
shielding effect.
D. The lead apron is ineffective against internal scatter.

T89.

Computed tomography images are typically acquired with a 120-to-140 kV peak x-ray beam.
Which best describes the interactions of the incident x-rays in a patient's body?
A. Mostly photoelectric absorption with some Compton scattering
B. Mostly Compton scattering with some photoelectric absorption
C. Mostly Compton scattering with some pair production
D. Mostly pair production with some Compton scattering

T90.

Which of the following is not true for CT images of the torso used directly for computerized
treatment planning?
A. The patient must be scanned in the treatment position.
B. A flat top is required for the CT table.
C. The patient must be scanned with the same immobilization device that will be used
for treatment.
D. Triangulation points or surface marks are unnecessary since the isocenter can be
related to internal organs.

1 seed is a(n):

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therapy questions
T9.1.

PET (positron emission tomography) images can be fused to CT images for improved
lung tumor target definition. However, PET/CT fusion can be subject to which of the
following problems?
A. High doses of FOG can cause artifacts on the CT image.
B. PET resolution is much better than that of the CT scan .
C. Long PET scan times can increase apparent tumor size d1.1e to respiration.
D. Hypoxia cannot be detected with PET.

T92.

Ultrasound can be used to help to localize all of the following except:

A. The site of surgical resection of a brain lesion.
B The prostate, during radioactive seed implantation.
C The prostate, prior to external beam radiation therapy.
D. A breast lumpectomy site to help to localize an electron breast boost.

T93.

The usual settings for a portal film are 2 MU (treatment field) plus 4 MU (full field), with a
source-film distance of 130 em. For treatment at extended SSD, where the source-film distance
is now 160 em, the appropriate settings would be
MU plus
MU.
A. 2, 4
B. 3, 6
c. 4, 8
D. 6, 8

8, 16

T94.

Amorphous silicon electron portal imaging devices (EPIDs) are currently in widespread
clinical use. The conversion of x-rays into electrons occurs primarily in:
A. The photodiode array of the EPID.
B. The patient.
C. The phosphor screen in front of the EPID.
D The metal plate in front of the EPID.

T95.

Portal images taken on a radiotherapy linac are typically acql!ired with a 6 MV x-ray beam.
Which best describes the interactions of the incident x-rays in a patient's body?
A. Mostly photoelectric absorption with some Compton scattering
B. Mostly Compton scattering with some photoelectric absorption
C. Mostly Compton scattering with some pair production
D Mostly pair production with some Compton scattering

T96.

Which
A.
B.
C.
D.

16

linac portal imaging system provides the best image resolution?

Liquid ion chamber array
Fluorescent screen with a CCD camera
Amorphous-silicon array
Radiographic portal film with cassettes

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therapy questions
T97.

To obtain a DVH, all of the following are required, except:

A 3D patient data set.
B. 3D definition ofPTV & OARs
C. 3D dose computation of , , 1e points in CT data set.
D. 3D planning system

T98.

According to ICRU definitions, an lTV accounts for~

A Possible microscopic spread of the GTV.
B. The envelope of possible movement ofthe CTV.
C. A margin on the CTV for set-up error.
D. The reduced set-up margin required when IGRT is used daily.

T99.

Deformable imag~ fusion is a technique which can be useful in all of the following
s1tuauons, except:
A Fusing an MRI of the head to a planning CT, to localize a partial brain PTV.
B. Fusing a PET image taken at a different facility with a treatment planning CT.
C Fusing pre- and post-surgical CTs to help define a PTV.
D When using an atlas to automatically draw OARs on a CT.

T IOO.

Many radiation therapy treatment units now feature kilovoltage (kV) imaging systems. The
traditional electronic portal imaging system, which uses the treatment (MY) beam to create an
image. retains one important advantage over the newer kV imaging systems. It is:
A Bone contrast is better in an MY image because of Compton scattering.
B In addition to bony anatomy, the position of the beam-shaping devices such a multileaf
collimator or a block can also be seen.
(. It is capabte of cone beam scanning while kV systems are not.
D. It can be used to acquire fluoroscopic images of targets influenced by respiratory
motion while kV systems cannot.

TI OI.

All of the following procedures are commonly used for pre-treatment setup verification. For an
IMRT prostate treatment, all of the following would be acceptable methods of verifying the
pros' ate position, except:
A Orthogonal kV images of gold seeds implanted in the prostate.
B. Orthogonal kV images of bony anatomy.
C. Cone beam CT.
D Imaging the prostate with ultrasound.
~- Imaging implanted RF transponders.

TI 02.

The TomoTherapy Hi-Art radiation therapy system allows for:

t\. Image acquisition during the treatment delivery.
B Image-guided radiation therapy using a single energy linac and kVp imaging system.
C. A simple gated treatment delivery using 360 degrees of gantry rotation.
D MVCT-based imaging of patients for setup verification.
E kVCT-based imaging of patients for setup verification.

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therapy questions
TIOl.

All of the following are true of IMRT except:

A. IMRT dose distributions are always more inhomogeneous than conventional 3-D plans.
B. In prostate treatment, IMRT can reduce rectal toxicity.
C. A 3-D data set is required for IMRT planning.
D. Immobilization is more important because of the tighter margins.

TI04.

IMRT using MLC usually requires an increased number of monitor units compared with
conventional radiation therapy because:
A. Of increased leakage through the MLC compared with cut blocks.
B. A fraction of the treatment field is blocked at any given time.
C. IMRT is usually delivered with lower energy photons.
D. Field margins are usually smaller.

TIOS.

The newly available method of delivering radiation by modulated arc therapy [Elekta VMAT,
Varian Rapid Arc, and Siemens CBT (cone beam therapy)] delivers radiation by rotating the
gantry of a linac through one or more arcs with the radiation continuously on. These systems
vary among manufacturers, but on at least one system all of the following parameters can vary
during arc rotation, except:
A. MLC aperture shape.
B. Fluence output rate (dose rate).
C. Gantry rotation speed.
D. Collimator angle.
E. Beam energy.

TI06.

Potential advantages of iMRT over 3-D conformal treatment include all ofthe following,
except:
A. Dose conformity for irregularly shaped volumes.
B. The possibility of dose escalation.
C. Reduced OAR morbidity at conventional tumor doses.
D. Ability to treat a volume with a concave surface, conformally.
E. Significantly lower hot spots in the PTV.

TI07.

A radiotherapy department has a choice of 6, 10, and 18 MV photons. For IMRT prostate
MV photons are chosen, because ___.
plans,
A. 6 MV,
this delivers the lowest dose to normal tissue outside tQe PTV.
B. 10 MY,
this delivers a lower neutron dose than 18 MY, but acceptable dose to
normal tissues.
this delivers the lowest neutron dose and the lowest normal tissue dose
C. 18 MY,
outside the PTV
although this delivers the highest neutron dose, it gives the best dose
D. 10 MY,
distribution, and the neutron dose is clinically acceptable.

18

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therapy questions
TI08.

Intensity-modulated radiation therapy (IMRT) can be delivered using either "Step-and-Shoot"

(segmental IMRT) or "Sliding Window" (dynamic IMRT) techniques. The major difference
between these two methods is:
A. "Step-and-Shoot" does not require a multileaf collimator (MLC).
B. "Sliding Window" requires fewer monitor units.
C. Only "Step-and-Shoot" requires inverse treatment planning.
D. With "Sliding Window" the beam is not interrupted during MLC movement.
E. "Step-and-Shoot" produces more neutron contamination.

TI09.

Which are the most important QA tests to be conducted before every stereotactic case?
A. Field flatness and symmetry
B. Winston-Lutz and Laser check
C. Output factor verification and output linearity
D. Photon and neutron leakage

TIIO.

With the following random uncertainties in radiosurgery treatment: laser: 0.5 mm,
gantry: 0.5 mm, couch: 0.5 mm, and CT: 0.5 mm, the total uncertainty is
mm.
A. 0.5
B. 0.75
C. 1.0
D. 1.5

E. 2.0
Till.

Basic dosimetry measurements to be done prior to implementing total body irradiation (TBI)
include:
A. Central axis dose calibration made under conditions representative of the actual
treatment geometry.
B. Central axis data such as percent depth dose or tissue maximum ratios measured with
treatment geometry.
C. Test of inverse square law over the range of treatment distances.
D. Dose profiles of the flatness and symmetry ofthe beam (OCRs) at the treatment
distance.
E. All of the above.

Till.

All of the following can be used in total skin electron beam treatment, except:
A. Low-energy electrons.
B. Multiple patient positions.
C. Lung blocks.
D. Boost fields .
E. Beam scatterer or spoiler.

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therapy questions
Till.

All of the following are true statements about the CyberKnife unit, except:
A. Cannot be used for radiosurgery procedures.
B. Allows beam gating.
C. Acquires images during treatment delivery.
D. Can follow a moving PTV in real-time during treatment, using robotics.

Tll4.

All of the following are good reasons for moving from low dose rate to high dose rate
brachytherapy in the treatment of cervical cancer, except:
A. Higher dose rate is radiobiologically advantageous.
B. Geometry: The shorter irradiation time assures that packing will not move over the
time of the implant.
C. Shielding: Irradiation of staff members is basically nonexistent.
D. Less chance of deep vein thrombosis (DVT).
E. The possibility of only one OR visit.

TIIS.

The seed vendor has contacted you shortly before a scheduled implant and informed you that
they have changed palladium-! 03 models. They are able to provide you with the same number
and strength seeds as originally ordered.
All of the following are likely to change with the new seed model, except:
A. Data in the treatment planning system.
B. Dose rate constant.
C. Anisotropy correction.
D. Radial dose function.
E. Prescription dose.

Tll6.

For a Stage IIIB cervical cancer, the appropriate brachytherapy applicator is:
A. Henschke applicator.
B. Fletcher/Suit tandem and colpostats.
C Fletcher/Suit colpostats alone.
D. Syed/Neblett or MUPIT applicator.
E. Vaginal Cylinder.

Tll7.

Whtch of the following is not a unit in current or recent use, for specifying activity or source
strength in brachytherapy?
A. mg Ra equivalent
B. mCi
C. Bq
D Air kerma strength
E. Joules/kg

20

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therapy questions
Til B.

A shipment of 192Ir (T 112 = 74 days) has an activity of35.5 mCi on November 5. The activity on
the return date on November 19 is
mCi.
A. 33.4
B. 31.1
C. 28.2
D. 25.3
E. 21.7

Tll9.

A batch of 125I seeds is ordered for a prostate implant. On arrival, the activity is
0.455 mCi/seed. The activity will be 0.420 mCi/seed after
days.
A. 14
B. 10
C. 7

D. 5
E. 2

TllO.

After 5 half-lives, the remaining activity of a radioactive isotope is approximately

equal to
% of the initial activity:
A. 50
B. 10
c. 5

D. 3
E. 2

Till.

Which ofthe radioisotopes below has a gamma energy of0.66 MeV?

A. 226Ra
B. 32p

c.

12si

D. 192Ir
E.

137

Cs

Till.

Iodine-125 seeds are used in brachytherapy for their

A. Auger electron
B. Positron
C. X-ray and gamma ray
D. Alpha particle
E. Beta minus

Till.

All of the following are true of 192Ir, except:

A. It can be used in the form of strands of seeds for temporary implants.
B. It is the radionuclide most often used in HDR Afterloaders.
C It is created by neutron activation in a reactor.
D. Mean photon energy is about 35 keV:

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therapy questions
Tl24.

Tl25.

Which of the isotopes below is used for temporary implants of the eye?
A. 137Cs
B. 1251
c. 131 1

D.

192Ir

E.

6Co

The figure below shows an AP radiograph of a Tandem & Ovoid application. The Rx is written
for which point(s)?
A. Points 1,6
B. Points 2,5
C. Points 3,4
D. Point 7

APFILM
'-l__../

"

Tl26.

22

All of the following are acceptable methods of Accelerated Partial Breast Irradiation (APBI),
except:
A. HDR MammoSite balloon brachytherapy.
B. HDR Multicatheter balloon brachytherapy.
C. 3-D conformal external beam radiation.
D. Interstitial multicatheter HDR brachytherapy.
E. Permanent seed implant brachytherapy.

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therapy questions
Tl27.

The (small) dose received by staff caring for PET patients injected with 18F is primarily
due to
emitted by the patient.
A. 0.511 MeV photons
B. 0.511 keV photons
C. Positrons
D. Positrons and electrons

Tl28.

Radioactive decay is a random process governed by which kind of statistics?

A. Binomial
B. Poisson
C. Gaussian
D. Multinomial
E. Kaplan-Meyer

Tl29.

The requirement for releasing a patient after a PET scan using 18 F is:
A. None: there are no restrictions.
B. The patient cannot travel on public transport for 24 hours after the scan.
C. The dose rate at 1 m from the patient must be less than 5m.Rih.
D. The dose rate at 1 m from the patient must be equal to background.

TllO.

Some ofthe problems encountered with hyperthermia include all of the following, except:
A. Difficulty achieving uniform heating.
B. Difficulty measuring temperatures accurately.
C. Having adequate QA protocols.
D. Doing treatment planning before treatment.

Till.

In hyperthermia treatments the ability to uniformly heat tumors is limited by:

A.
B.
C.
D.

The ability to deposit energy uniformly.

Blood flow in tumors.
Different thermal properties of tissue.
All of the above.

Till.

A 2 em air gap in tissue in the path of which beam will generate the largest inhomogeneity
coiTection?
A. 15 MV photons
B. 6 MV photons
C. 170 MeV protons
D. 14 MeV neutrons

Till.

Which of the following is true for proton radiotherapy as compared to 15 MV x-rays?

A. The skin dose is usually lower for protons.
B. The lateral dose penumbra at depths greater than 15 em is usually better for protons.
C. The Oxygen Enhancement Ratio is significantly lower for protons.
D. The integral whole body dose is lower for protons.

Raphex 2010

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