RADIOLOGICAL PHYSICS @ e Raphex therapy examination Casa ea iTS a=c ig Cheng-Shie Wuu, Ph.D., Chief Editor Briers alee ea)preface eee ‘The RAPHEX Dherapy Examination 2018 was prepared by members of the Radiological and Medial Physics Society of New York (RAMPS, nc), the New York chapter ofthe American Assocation of Physicists in Medicine (AAPM). ‘he exam content was updated in 2016 to match te syllabi for teaching Radiation Oncology residents published by the The American Society for Radiation Oncology (ASTRO) Physics Core Curialurm Subcommittee (PCCSC). The numbers of questions for each subject are approximately related othe number af teaching hours allocated vo each subject. Exam comme: Sean L. Berry, Ph.., Therapy Ealitor Howard 1 Amols, PRD. Call Ellison, M.S Eugene Lie, PAD. ‘Adam C. Riegel, PhD. Richard Riley, PhD. ‘Cheng-Shie Wi, PAD, Chi Additional questions contsbuts by David Barbee, Ph.D. “Maria Chan, PAD. Jenghwa Chang, Ph.D, Karen Epscopia, MS. Raphael Jakubovic, PhD. Dennis Mab, PRD. Gregory Niyazow, MS, Juss Sillanpaa, PhD. Yanisley Valenciaga, PhD. ‘Matthew Williamson, [Link] Rongiao Ma, MS, Ellen Yorke, PRD. po {you are taking RAPHEX under exam conditions, your proctor will give you instructions on how to fil ‘ou your examince and ste IDs onthe answer sheet + You have 3 HOURS to complete the exam. + Non-programmable calculators may be used. + Choose the most complete and appropriste answer to each question We urge residents to review the exam with their physics instructors Any comments or cometion ae appreciated and shouldbe sent to ‘Cheng-Shie Wut, PRD, Chief Faitor esw6i@[Link] Copyright © 2018 by RAMPS, Inc. dhe New York chapter of the AAPM. All rights reserve. No part ofthis ‘book may be used or reproduced in any manner whatsoever without writen permission fom the publisher or the copyright holder SStion with RAMPS by: -Meslcal Physics Publishing, Ie 44555 Helgesea Drive Madison, WIS3718, 1-800-442-5778 appd@[Link] wow meicalphysis org itd nh Un Sater oF Americatherapy questions m. or 7. ™ 1s. 16. The cutie (Ci) ia unit of radiogctivty based on the activity of | gram of _.1 Ci=37. ‘A. U-235;Bq) B. U235, MBq C. R226; Bg D. Re-226; MBq E, Re-226;GBq Bremsstablung interactions result fom electon ‘A. inelastic collisions with atomic electrons B, inelastic collisions with atomic nice C. laste collisions with atomie nucle! D. clastic collisions with atomic electrons E. capiure [An atomic mass unit (amu) is defined as ‘A. the mass ofa {H atom B. 1/12 ofthe mass of | stom C. the mass ofa proton D. V12of the mass ofa '}C atom E, themass of C atom The 1-192 decay rate is approximately day 1; month Iiyear Ws day 1 month rune Why are thore no naturally occuring isotopes with an atomic number greater han 92? They eamnot be proce by any’ means. ‘They would require too many orbital electron tobe table ‘They would be chemically unstable They exist, bt their hl fves ae oo shor to exist naturally. ‘The Coulomb atractve force between protons i 00 stone. mone In the following Ps the parent isotope, and D isthe daughter: $P decays to $-{D. This is an ‘example of > B c D. E, Bisson Raphex 2018, 1therapy questions ‘fherapy questions . 1 To. ‘A monoenergetc beam of 40 keV photons inveracts with a metal fol and produces photoelectrons (of 20 keV and 30 keV. Prior to the interaction, what are he binding enexpies of these electrons? 20 keV and 10 keV S30 keV and 10 keV 30 keV and 20 keV ‘keV and 30 keV 70 keV ad 60 Ke renee ‘A radiopharmaceutical has a physical hal-ite(F) and biological halite (7), Which ofthe following i true ofthe elationship betwen the eTetive ha ie Tap Ty and 7)? A Top =Ty B. Tyo Tog and Ty> Tag © Tay> Te Ts D. Tap> Ty and Tag> To E Tay To*T ‘Complete the decay equation: > Ry+__ 4p. ani-nextrino Sp + newcon 4p + newino {p+ antisneurino {p+ neutron eeoe> A superficial x-ry treatment using 100 KV x-ays is preseribed tothe skin surface, 4 om cirular Cone witha calibrate output is used. lead ms is fabricated to expose only the desired ‘teatment are, whichis smaller thn the cone. What ational information is needed to compute the beam-on time? ‘A the linea attenuation coeisient for lead BB. the mass atenuation ceficint fr lead CC the room temperature and rescue atthe time of treatment DD, the backscatter fictrs for he cone an ead cutout the percent depth dose at 10 mm A bro spectrum kilovotage ‘ray beam hasan intensity of fy A2 mm AL sheet is placed inthe ‘beam, and the intensity i redaced to one-half fn atonal sheet of Ali ade to the beam, roduing te intensity to one-quarter fg Wht is the thickness ofthis second sheet in mn)? A. 0.6931 B10 © ts b2 EB >2 Raphex 2018,therapy questions thorny questions m1, TH. 14, T18. 1. ‘The use ofthe small focal spot in an x-ray tube has the following advantage): A better spatial resolution B. longer tube lite C patient dose redvetion 1D. motion arias retin B, Allofthe above are tue Automatic brightness contol in @ ganry-mounted KV imaging systems fluoroscopy med can ‘modify the following parameter: KV and mAs B. focal spat size and kV C focal spt size and mAs D. focal spot size and soure-imager distance . source-imager distance and mAs A half val layer (HVL)is equal to_tenh value layers A 02 B03 cos D. 30 B30 Electrons are produced in linge’ electron gun via the physical process known as _ ‘A thermionic emission B. Compton effet CC. photoelectric emission D. Halletect E, relativistic mas increase ‘The main advantage of fatening filter ‘A. lower skin dose B. shower teatment time C. lower neutron dose . move uniform PTV dose FE, lager treatment Feld ean be wd (FFF) photon beams i ‘Why dotinses that deliver “10 MV require bending magnets, bt lower-energy (e446 MV only) Tinaes donot? A The aceelerating tbe for>10 MV nas is oo long 1B. 210 MY linac usually also have clston beam therapy, and electron treatments reguite & bending magnet, ‘Bending magnets yield more stable dose rate contol for higherenergy xays D. Allof the above are tue F. None ofthe above are te 2s Raphex 2018 :therapy questions THe, To. ma. ™. ™. [Aste linac is switched from 10 MY to 15 MV photon delivery, dhe numberof neurons produced ty the mean neutron energy _ increases, significantly inereases increase; significantly deereases fnerease: slightly increases decreases; lightly increases decreases; slightly decreases mpOE> MLC tea transmission on modern linear accelerators is approximately —_ A, 20-24% BIS ce D. 2% Bo Beat-stcering electronics in linear aeclratr primarily maintain the beam ‘output dose rate quality symmety [None ofthe above are cue. renee ‘Some MICs are designed with rounded lef ends _ "A. reduce the possibility of leaf eolsions BB. minimize MLC transmission CC. muinan a elatively constant geometric penumbra at differen leaf positions D. minimize the geometric penumbra E._ None ofthe above is rue, In tinea accelerators, are radiofrequeney-generating components while _are tadiotrequency-anlifeaion components ‘A iystons, hyratrons BB dhyratron,klytrons {magnetron thyratrons DD. magetons, Kystons| EE. Klystrons, magnetons Lis the Hina head eomponens inthe order thatthe beam would pass by oF through them: [Ay inetal target monitor ion chamber; Mating filter; X and Y jaws BB metal anget: flattening iter monitor ion chamber; X and jaws monitor ion chamber; mia target; atening ker; X and Y Sows D. E inonitorion chamber, X and ¥ jaws; metal target; atten iter Hattening filter; metal target; X and ¥ jaws; monitor in chamber — Raphex 2018,4 8. m2. m8. therapy ques Ina Compton interaction, dhe scattered photon will be emitted with an angle, 9, relative tothe incident photon direction The scattered angle @ can range from degrees. ‘A. 04s B 010% ©. O10 180 D. 45%090 B, 9010 180 ‘The dose rate increases bya factor of 2 aller a beam attenuator i removed. Ifthe stenuator has a linear attenuation coefficient of 0.25 em then is thickness is Lem Ina Compton imerscton, the direction of the incoming photon defines O degrees. As the ange of| the seattered electron increases, its energy. As the angle of he scllred photon inreases, its energy ‘A. increases; decreases 'B increases: remains the same decreases: ineeases D. decreases: decreases Given a material with a mass attenuation oeticient 0F 00329 m?/g and density of 1.2 gl’ ‘what thickness ofthe material i necessary to create a partial transmission block delivering 8 the open field dose? AL Lem 3. 2em © 4em D. Sem E. Wem Which of the following isa divetly ionizing particle? ‘A. neutron B. lectron © photon D. Allof the above are tue E, None ofthe above i Raphex 2018, 5therapy questions 1. 30, Tm. 13. ™. Neutrons are produced in high-eneray x-ray beams by _ ‘A. coherent scattering B. photoclecrc effect . Compton effet D. pair prodtion E. photodisintegration Given two filters, one aluminum (AI) andthe other copper (Cu), each of 1 HVL thickness for 125 kVp beam, which of the following is tue? AA. The Cu itr atenuates more photons B. The Cu filters thicker The quality ofthe atiemusted 125 kVp beam wl be the same for bot ites. D. Both filters will tenuate the same intensity of photons. E._ None ofthe above is true. [An incident photon hasan energy of § MeV and undergoes pair production interaction, reducing a posten-eletron pir, The combined kinetic energy ofthis pair will _ MeN! AO Bost cc. 1.022 D. 3978 E4499 “The dimensions of dose (Gy) are_ ke kamg ken? kg tke pone The numberof particles incident upon a sphere oF eross-seetonal area AA i the definition of KERMA ceergy uence energy fluence rate fvence E. fluence rate What isthe purpose ofthe eletrometer when used with an ionization chamber? ‘A tmeasures charg produced in ionization chamber B._Itapplies the temperature correction factor CC Teapplies the pressure correction factor D. provides ionization chamber calibration factor. E,_ None ofthe above is true.therapy questions 35. 136. 1, 18 139. A linear accelerators expected to deliver | eGy/MU at a dose rate of 300 MU‘min fora 3DCRT tweatment. However, it actually delivers 1 Gy/MU at 303 MUsmin. The dose actually delivered to Patents will a a rest be oiow tow correct (no erorin dose will be delivered) high high Ronee Radiation meters that can determine the presence of Radium:226 in radiation safe without ‘opening the safe are based on the detection of, alpha radiation ‘eta radiation ‘gamma radiation Al ofthe above are tru. [None ofthe above is tre pune According © AAPM Task Group SI (the protocol for reference dosimetry for high-energy photon tnd electron beams), the raw ion chamber reading needs tobe corrected for AA. temperature and pressure 'B incomplete ion collection efficiency CC. lecitometer calibration factor D. Allof the above are tue E, None ofthe above is rc Acconling to APM Task Group SL clinical reference dosimetry must be performed in & phantom, polystyrene acrylic Al ofthe above are tue. None ofthe above i re. money Which ofthe follwing sare charac (ostpy? ‘A. OSL can ony be read once B. Signal fading exists ater iadiation. (C. OSLD read-out occurs under high het conditions D. Alot the above are tue E. None of the above is ru. i(s) oF optically stimulated luminescent dosimeters Raphex 2018, 7therapy questions -T40, Given hat Js the intensity of ight prior to passing trough im ad 1s the intensity of light (ie passing through a film, how is optical density (OD) defined? Lngallo 2) Logiolo~1) LoeidyxD. Logllo!) Logiltlo* 9 Ua-D) neoEe. ‘TAL, Avwhole brain MU calculation uses eqully weighted paralle-opposed 6 MV a-rays at 100m Abin 17 220 en collimator sting with a small amount of MLC to shield the eyes, The pression fr 300 eGy per ration to plane depth. The separation onthe cera avs is ese ich ofthe following calculation mistakes would have the biggest effect on the MU? using a 100 SSD setup ting 18 MV rather than 6 MV data tables (© flare to divide the separation in bal D. failure to divide the dose per faction in half failure to account for MLC blocking and sir inside the treatment fields ‘raz, Aratientis eated witha single Ge, SSD ~ 100 em. The preserition is 300 cGyaction at 5 cm at a the dose (eG) action at 10 em dep? Given PDD (5 em) ~ 87.0; PDD (10cm) = 670, A. 210 Bo ©. 254 D. 355 E390 Ta, single eld delivers dose Dy ata reference depth of dy, The TM vals athe depts dy and {Aare TMI (and TMR (especie. The dose atthe depth ofa, Dy canbe cael from | 1A Dy TMA) TRG) BL Dy x TMREA)/TMR(E) ©. Dy xTMR(d)/ TMR(d)> (SSD Hd? / (SSD ¥eHP] D_ D, F50. As the SSD increases, the PDD _ andthe TMR_ 'A. increases increases BB increases: remains te same C. dcreases increases D. decreases; remains the same EE. decreases; decreases ‘TSI. Monte Cerlo-basol dose calculation algorithms are the most advantageous over convolution Superposition algorithms under which af the folowing conditions? ‘Asal fields inthe center of a materia BB, large fields in the centr of material CC. smal fields atthe interface Between two materia’ 1D. lage field tthe interface between two materials F._Allof the above situations are advantageous for Monte Cal, 10 ‘aphex 201therapy questions 52, Fora thre field tchnique, which ofthe following wedge arrangements achieves the most unifoem dose distribution? A Raphex 2018, "therapy questions ‘Sherapy questions Use the table below forthe next three questions (TS3-TS5): ‘Table 1: Data for 6 MV Photons (PDD are for 100 em SSD) | Depin Foi Size (en) cm exe toxtoibxts 20x20 25x25 we 7 we [me 3 3 Ra 0 73 [a 779 roo [0 wa we 2 703 a i 39 3a 37 Ba sa (a a8 2 a aa as | 3 cows [ aes [ose | oo [aoe 7 twa [1 are: [area] eae [oa [onan 5 oe 20 Ce S noms oe | Saeco ae a 5 es up) 1.00 a da (5 106 SAD, Fe Sze: 10s 1c Coup (yA) =0971 de (3 em 100m S80, ll Si: 10% oem? 753. A patient is teated with a pair of parallel-oppose feds, collimator setting 13> 18 en? and {6 MV says, 300 cGsrfraction s prescribed to a midplane depth of $ em a 100m SAD. The treatment fields ate shaped to an equivalent field size of 10x 10 em? with MLC. The MU setting pet field is A. ld MO BION ©. iMU D. 176MU E. 181 MU 2 Raphex 2018154, 755, 156, 181, Raphex 2018, therapy ques A patients eae to the ib witha single posterior field, 100 cm SSD setup, a collimator sting (of 3x13 em and 6 MV x-rays The Fels shaped o an equivalent field size of 88 em with, MLC. The prescription is 400 eGy ta depth ofS em. The MU seting is 463 MU 469 MU 473. MU 478 MU [Link] The maximum dose along the beam cena axis in the previous question is__ eG. “228 Bas C464 D, 469 E483 > What isthe equivalent quae ofa 520 em? rectangular eld? A. 50 B80 13s D. 160 E 200 A punticular fattening fier is designed wo deliver a Mat beam profile foe a 6-18 MV photon beam ata deh of 10cm La depth of dg how does the dose in the cena region ofthe beam change {8 you move laterally away fom the Sentral axis but not near he penumbra)? ‘A. says constant B. increases decreases D. ‘The answer depends on photon ene. FE, There isnot enough information to answer the question The best electron energy to eat a target that is between 1,5 cm and 2.$ cm below the surface while sparing thor issue is ‘AL 6McV Bo OMe ©. 12Mev D. 1SMev E, 20MeVtherapy questions 89. T60, To. 62, Ts. ‘The inimal thickness of Tead wo Block a 6 MeV electon Beam is_ ‘AW Imm B 3mm © Smm D. Tm E. 10mm [A MeV electron field has a 7x 8 em cutout in 10> 10 em? cone the cutout sie is changed to 56cm he eguied number of monitor units (MU) is__ AA increased by 10% B, increased by C. about the same b. E Aeerease by 5% decreased by 10% Asclectron enerzy increases, the distance between PDD(80) and PDD(20)_and the photon a. B, decreases; inereases C increases; decreases D. decreases: decreases There ist enough information to answer the question. ‘Which of the following QA tests is used 1 Tocat the radiation isocenter ona linac? ‘A. eadto-end B, sar shot picket fence D. CTDI evaluation E._ None ofthe above is true Acvonling 0 AAPM Task Group 142, QA tolerances foreach spe linae are defined by its A. available ray enemies intended weatment techniques age All ofthe above ae se, E,_ None ofthe above i re. Raphex 2018therapy questions Toa, 6s. 166. 67. 168. According tothe AAPM Task checked A. daily B. weekly © monthly Di anny E, biannually up 142, imaging and treatment coordinate coincidence should be ‘AAPM Task Group 142 recommends quality assurance tests for all he following technologies, EXCEPT ‘A. are olation 1B respiratory gating Clie eoltimatrs D. CTsimulators 2D and 3D lnac-mounted KV imaging systems A lina quality assurance program is designed ta ‘A. verify thatthe dose output is within 0.5% B. assure that ina characteristics do not deviate from thie baseline values acquired at the lime of acceptance and commissioning by more than a specified amount CC confirm tht treatment planning parameters determined during planning are ascuratly transfered to the record and verity system D._Allof the above are tue. None of the above is tue [A picket fence” testis performed on linear accelerator fo assess A. MV imager resolution BL RV imager resolution CC. MVAEV isocenter alignment . room laser alignment . ultilaf collimator positioning accuracy’ snd alignment PACS allows you to __ digital medial images, ‘AL sore B. view © transfer D. Allof the above are tu. BE, None ofthe above is re Raphex 2018, 1stherapy quest fherapy questions 169. 170. ™m. ™m. 7. “According to HIPPA regulations, whieh of the following types of data should not be stored on personal computers oe sorage devices? Tine alieation records ‘beam data files used for eatment planning QA committe minutes All of the above are tue, None ofthe above is rv, moore In onder to establish DICOM connectivity, which ofthe following are required ‘A. IP address, port number, AE title B. IPaddress, MAC addres, port number ©. MAC address, AE ttle, port mumber . domain name, IP address, por number E. AE tle, domain name, IP address In areas where radiopharmaceutcals ae prepared or adinitered, wipe tests should be performed A periodically BL aera sill if contamination is suspected D. Allof the above are tue E_ None ofthe above is tev, [ATI patients treated to otal dose of 12 Gy in one week ata distance of 400 em from the target. The workload ofthe linac from this treatment is about __Gy/weck. ‘A3 Bo Cc 48 D. 14d FE 1 In omer to legally prescribe Gama Knife teatments physieian must be "A. fulltime employee ofthe hospital BB. board certified in adation oncology adilogy, or nuclear medicine Fisted as an authorized user for Gamma Knife onthe hospital’ radioactive materials license Allo the above are te, None ofthe above i tue nS Raphex 2018,therapy questions 774, The recommended shielding design goal (P) for an uncontrolled area in accordance with NCRP Report I51 is mv per week. ‘A. 10 BS e D. on Bon 775. A radiation survey ofan uncontrolled arwa with an ionization chamber with the beam aimed dleelly at a barrier wal reports 25 mR hr If the we (factor 0.5 fr tht baerie and the beam ison fra total of $ minutes per hour, what isthe estimated mR in any hour at his location? ‘AW Umi any hr BL 2mRinany hr 12min any ir D. 20mm in any be E25 min any he 176, Compared tothe vault shielding fora lina that is limited to 3D conformal radiotherapy, the vaule Shielding fora linge tlizing IMRT wil require ‘A. more primary barser shielding due wo increased bean-on time move primaty barrier shielding dv o increased seater (C. more secondary barter shielding duc to increased leakage D. ireer-shilded doors wo ensure adequate neutron shielding EE. longer mazes to derease photo dose atthe doot 77, EMEA reterstoa rdiosensiizerin current clinical rials B. aati oncology incident learning system sponsored by ASTRO and. AAPM C. risk-based approach to designing evaluating, and improving a quality assurance program . methodology’ to optimize patient selection fr clinica ils E. new form of IGRT > TIB.—ROALS refers 19a radiosenstizer in eurent clinical rial radiation oncology incident leaming system sponsored by ASTRO and AAPM risk-based approach to designing, evaluating, and improving «quality assurance program methodology to optimize patient selection for clinical tals now form of GRE Raphex 2018 7therapy questions ‘779, Failure mods X and Y are estimated to oscur athe same frequency and have the same clinical ‘onsequences, However, X i estimated ibe tice as hard to detect as V. The risk priority umber (RPN) of Xis__the RPN of ¥. AL twice B fourtimes © halt D. one fourth E. thesameas T80, Deformable image registration is the lest reliable when registering which pair of images? ‘A. anold CT to new CT for the purpose of dose summation 1B. theCT portion ofa PET/CT to. simolation CT and applying the transformation tothe PET a diagnostic contrast CT ta simulation CT D, a Tleweighted MRI to simulation CT a simulation CT [Link]-beam CT TAL, 4D CT simulation is most useful for treatment planning of tumors located near the A. brain BL neck ©. diaphragm DL pelvis , extomities T82,—__Incligital imaging, reducing the pine size leads to ‘A. beter spatial resolution B. reduced image storage requirements (Creed processing time D. reduced patient dose E, Allof the above ae tue ‘783. Diagnostic x-ray tubes usally have both a large and a sll Focal spot made, One would use the larger focal spot when ‘A. lage field size iw nceded B. high mAs is required CC sharper field penumbra is needed D. high contrast is needed E. Allofthe abowe are tru, Ted, Which ofthe following is trv regarding T] and T2 relaxation times in normal human tissues? ‘A. Tis always les than o equal to 2. BB TH isalways greater than oF equal © T2 C. THis always exaci equal to 72 DD. Tis ess than T2 in blood but greater than 2 in slid organs. E, Tis greater than T2in blood but less than 2 in solid organs 8 Raphex 2018Tas. 06. 08, therapy questions Which of the following tissue characteristics contributes the most t the contrast in a KV radiography image? ‘A electron density B. number of neuteons ©. atomic ramber D. atomic mass E, None ofthe above isu, le the average velocity of ultrasound in sof tse is 1540 mvs, the wavelength () of aS Mz Ultrasound beam passing though human soft issue is mm, A. 212 B 107 © 078 D. 035 E. 031 ‘When the image fision ofa diagnostic PETICT and a simulation CTs performed, which sans should be registered o each other? ‘A. sim CT «CT from the diagnostic PETICT B, sim CT w PET from the diagnostic PETIT (C. CT fiom the diagnostic PET'CT to PET fom the diagnostic PETICT D._Allof the above ae tue , This typeof registration i not possible, Which image bas the wider CT window? Aa Bb The width ofthe window is the same 1. One is unable tol fom the information given aphex 2018, iytherapy questions therapy questions 0 To. 190, 93, 20 Ina CT scan asthe increases, the signal-to-noise ratio (SNR) decreases. ‘A. mAs B slice thickness C. patiet thickness D. Alf the above ae tre. None of the above is ue ‘A tung V20 025% means that __Soof the Tung receives _Gy 75;at most 20 TS.exaclly20 25; at most 20 25;exacly 20 Patient motion during treatment delivery results in errors in delivered dose and in arget Conformalty, Rank the impact of pain! motion eors forthe treatment modalities below from Smallest largest 'A_protons, 3D conformal x-rays, IMRT x-rays, brachytherapy 1B. brachytherapy, 30 conformal rays, IMRT x4, protons ©. 3D conformal x-rays, protons, IMRT x-rays, brachytherapy D. brachytherapy. protons, IMRT ays, 3D conformal x-rays FE Emors are appronimately the same Fr all ofthese treatment modalities |A.2 mm misalignment between the radiation and imaging isocenters would result ina_ eto fad ts contribution tothe average setup eror would be __2 mm. dom ess than random: greater than random: exactly systematic ess han systematic; exactly mone ‘According t AAPM Task Group 142, in order to be use for accurate image-puded sterotactie ‘body radiotherapy (SBRT) a teatment machine must have __. ‘grout wihin +1 mm between a exact age hit and the target shit determined from an in-room imaging system agreement within-£1 ma ofthe optical distance indicator and a ruler a high-energy (-10 MV} photon beam the ability to deliver volumetric ae therapy (VAT) ft soutee trans distance that greater than TOV i > roofs Raphex 201therapy questions 194, 95, 796. The extended treatment time caused bythe low duty cycle of respratory-gated treatments can be mitigated b ‘A. using Hacningfilter free beams BB. increasing the planning anget volume margin (C increasing the number of beams used 1D. using IMRT to shape th dose disteibution EE, ineeasing the gantry rotation speed Which IGRT technique ulzing orthogonal kilovotage imaging would be the most accurate method of sep verification for arespiatory-gated eeatment ofa liver isin? ‘A. aoguire at endsinspiration with alignment to soft issue BB acquire at end-exhalation with alignment to Soft issue (© aequire during the respiratory gate with alignment to sot tse D. acquire during the respiratory gate with alignment wo bony anatomy FE) acquire during the respiratory ene with alignment oficial markers implanted in the Fluoroscopy mode on a linac gantry-mounted LV imaging system is used for_ "A. imaging the eaten aperture 1B intemal motion assessment CC patient dose redueton compared 10 radiographic mode D. Allof the above ae trv. E. None ofthe above is tue, Whats the most common use of ina gantry-mounted KV imaging systems in clinical radiotherapy? ‘verify patent setup aceuracy ad targeting localization ‘monitor inurafation organ maion track tumor response to treatment ‘monitor patient movement during irradiation None ofthe above iste, moo Flattening filter fre (FFF) beams ae typically not used in conventional 3D planning but they are often used in IMRT because — ‘skin dose i not an issue IMT uses lower maximum dose rates there will be many beam hold-ofls the MLC can be used to produce the desired fluence pattem None ofthe above is trv. Raphex 2018 2therapy ques ns therapy questions 99, ‘Ti00, Tio. 102, T103. “The objective function in IMT optimization determines the ‘A. beam enerzy MAT are length pv ‘beam Muence Allo te above ares, moor ‘Two competing IMRT treatment plans ae created fora piven patent, Plan A requires ‘500 MlUraction, and Plan B requites 40 MUi fraction. Which plan most ikely has higher ‘egree of modulation? AL plan A B plan B C Both plans have approximately the same degree of modulation D._ Anaswer cannot be determined ftom the information given Itis desired to have the intensity across a "step and shoot” IMRT treatment Field decrease by $vglem: Ihe wih of the fe in the direction ofthe intensity gradient is 10cm, whats the ‘minimum numberof steps needed to achieve this intensity patter? moom> The effects of “interplay” between dynamic muli-la collimator motion and tumor motion de to respiration becomes les important as you the number ef factions and__the number of tweatment fields or ars. ‘A. decrease: decrease B decrease increase . inorease: decrease Dinca; increase For the same anatomy; a VMAT plan generally has IMRT plan delivered witha siding window technique. B fewer © about the same number of D, E total monitor wits than a statie-eantry “The answer depends onthe photon energy No elation ean be established ee n Raphex 2018therapy questions —————————— ee ios THs. Tos. Hor. Tio. Raphex 2018 Lf he IMRT optimizer receives an incompatible request of covering the target and sparing an ‘overlapping eriial strut, the resulting dose distribution inthe overlap region wil primarily ‘depend onthe "A. prioitis assigned to each request B, volumes ofeach structure CC. surface areas ofeach structure D, area ofthe avedap F_number of eitiea structures not overlapping with this region “Typically there is higher tegot dose heterogeneity in SBRT plans than in conventional IMRT plans because TA. incoazed lage heterogencty enables the reduction of dose to the volume of normal tissue surounding the target, B, of the higher prescription dose C. ofthe eduction in numberof treatment fetds D. ofthe limitation onthe number of MU tha an be delivered per fel None of the above is tue |Which teatment modality will most ikely deliver the Fowest dose othe hear when treating 8 ete sided breast cancer? parallel opposed tangents using “bar physical wedges parallel opposed tangents using vital or dynamic wedge Paallel opposed tangents using Feline technique truli-bears IMRT photons IMPT protons sooRe Reganding TBI weatmens, which ofthe followings tue? ‘When used spoiler neds o be placed close to the patint Dose homogeneity is better fr lateral beams than for antero-posterior beams ‘The bowel isthe dose-limiting nga. ‘he radiation and light feds are congruent at extended SSDs, Al ofthe above are ie, rooee ‘Which ofthe following is a characteristic of extended SSD beams for TBI? 'A. They can cover ent patient in single field 1B. They have increased dose uniformity They have decreased dose rate D. They have increased treament time, E. Allof the shove are tue atherapy ques ns. therapy questions Tis. vn mn TH. Py Which ofthe following is used to calculate the administered activity for?°Ra treatment of| asration-esstant prostate eancer metastatic to bone? weight height toy-mass index PSA Tevet Gleason score ppae> ‘Yusium-90 microspheres are used in the treatment of hepatocellular carcinoma, Which paste is responsible for delivering almost all ofthe dose? ‘alpha beet beta Radium-223 is used inthe treatment ofcastaton-resstnt prostate cancer metastatic 1 bone. ‘Which parle is responsible for delivering almost al of the dose? A alpha B bea ©. bets D. gamma E) neutton ‘An lecton beam is ypically use for which treatment site? lung brain prostate total body irradiation total skin radiation “The treatment time to deliver 100 Gy using a SRS technique with mulkipl (-200) Co-60 sourees is 25 minutes How many minutes would i take to deliver a presribed dose of 60 Gy with she same plamand the exact same C0 sources five years ler? 20 2s 30 0 Raphex 2018,therapy questions EE Tua, THs. TH. vu, Raphex 2018, Which ofthe following factors affect the dose fall-off outside of the PTV in a SRSISRT plan? ‘A. beam energy B, beam collimation C. prescribed isodose tine D. Allofthe above are tre. BE, None ofthe above ise “According ta the AAPM Practice Guidelines foe SRSISBRT (MPPG 94), end-to-end dosimetric ‘Setuation sing the SRS frame or IGRT system shouldbe performed at inital commissioning and A tno other time B, daily C. weekly D. annually biannually Acconling tothe APM Practice Guidelines for SRS/SBRT (MPG 9), the tolerance of the ‘monthly radiation isoeentriity fest should be within_—__mm for SRS and _mm for SBRT. ‘A. 015305 B. 10:20 ©. 1513 D. 03:10 B LOLs Which ofthe following is a unique consideration when planning with a single, rather than rnutileisoeenter fr twatment of multiple cranial metastases? ‘A. doe silage between targets B, dose conformality CC. image guidance technique D. stance from each target to the skull FE. istnce from each target tothe isocenter For the same dose level, which of the Following types of radiation would most ikely cause the ‘reatest harm to huran tissue? 10 eV neutrons 2. MeV neutrons 12 MeV electrons 133 MeV gamma rays 70 MeV protons ronee atherapy questions rin, ia. rin. Ta. For HDR tratment using #sitanium tandem and ovoid applicator, itis suggested that planing be ‘Gone using MR seans to beter delineate the tumor. Which of the following is correct? sae plan ean be done from an MRI scan, using the same applicator. BL The plan ean be done from an MR scan, but a non-metal applicator must be used The came applicator ean be used, but an additional CT scan should be aeguired to ‘slenlate inhomogeneity corrections. 1. Jenormetale applicator must be used nd in ation tothe MRI, CT sean should also tbe acquired to calculate the inhomogeneity corrections. Speciation for brachytherapy sed strength s given in trms af ir kerma strength. The correct ca me Ro-eq mci Gy meh Gyh nooe> [A brachytherapy source which emits single gamma ray per decay has a hall fama eer 2), and octivity (2). The dose rae mairatS em dstange fom this sour depends ‘A. only the halite B. only the atviy C. only the energy D. ‘bah heal ie and the activity, but not the enersy FE bth the activity a the energy, but nt the hale Why isthe prescibod dase fr Pd-103 permanent brachytherapy implant usally lower than that for F428? a has a longer halflife and therefore, the effete treatment me is Tonge Phas a shorter half-life and, therefor, the ime-dose factor is anger. Pa has a lower energy, so the dose is more conformal Pd has higher ener, 50a lower dose is moe effective {The prescribed dose for Pd-H03 is actually usually higher dha for 1-125. |Atuatch of 901125 seeds total $0 mCi, Whats the air kerma strength per 128 seed? Note: 1 U= (0.787 mCi for F125. ALOU B Lou © 13U D1 E200therapy questions Tim, ris, 1126, 27, riz, ‘According to AAPM Task Group 128 which ofthe following QA toss shouldbe performed annually forthe ulasound system used for prostate brachytherapy’? AA. needle template alignment B, axial and lateral eesolution C. grayscale visibility 1 Allof the above ae tue E, None ofthe above is rie. ‘According tothe ACR-AAPM Technical Standard forthe Performance of High-Dose-Rate [Brachytherapy Physics, atera HDR source exchange the setivity ofthe souree must be veriied to Fall within ofthe manufictrer's certificate A. B © D, E, According tothe ACR and AAPM, what is the maximum allowable deviation between the ‘measured and intended dwell positions inthe applicator and the stepsize spacing between dwell postions for HDR? AO. mm B 0Smm © 10mm D. 20mm E. Som Prior to the second faction ofa vaginal cylinder case, the HDR souree was changed toa higher activity. When delivering the second faction, ‘A dose increases and ime increases dose stays the same and time increases ©. dose decreases and time decreases DD. dose stays the same and time docreases Radioactive seeds fora prostate implant should be calibrated using. ‘wel chamber 4 Farmer chamber at Lem in ait 44 Farmer chamber at 1 cm in water radiochromie fim radiographic film rope Raphex 2018, atherapy questions ra, Ti30. Tis. 32, 133. 8 “According tothe NRC and AAPM Tak Group 9, dil checks for remot afeloner high-dose fate brachytherapy include all of the following except —_. ‘A. temporal accuricy BB. souree positioning accuracy C. doorintriocks DD. soure output measurement All ofthese choices are daly tests for high-dose-rate brachytherapy: “wo patents are boing teated with high-dose-ate aftnlonde using wainaleainers The Frese doe eatnet length (the mera vel postions), ad trgt dep of 0. res cylin surface areal the same for both, Patient is eaedwsing 2. cm damn ‘Splndr spi Bis teted ing 35m diameter ytindr. When compared patient A Seana eran fr patient B willbe and the dose a the cylinder surface willbe _: shorter, lower B. shorter higher CC. shorter, unchanged D. E > Tonge: lower longer: higher ‘permanent sed implant is perormed using am isotope with hal life of 20 day, The ni ara tn target is deteryined to be 0.1 Gy. Aer Full decay, what ol dose il his patent receive (othe nearest Gy)? A 48Gy B, 69Gy c 80Gy D. 91cy E, 102Gy ‘A peoanen sed implant is performed using an stop wth halo 20 days, What percent of acres nll the patient have received 60 days after the implant was performed? During an HDR treatment, which of the following personnel must be presen? ‘reseribing radiation oncologist, Bi, tadiation therapist CC radiation oncology resident D E ‘ualified medial physicist ‘oncology nurse ee Raphex 2018therapy questions Ti34, Tis, 1136, 137. 138, Forthe fist 8 en the dose falloff with distance in water fom a point source fllws the inverse square ny oral fhe following topes exe A Hes as cA D. a 5 Pa I AAPM Task Group 43, the anisotropy factor, F(, 0), secounts forthe angular dependence of [A only photon absorption inthe source encapsulation and the medium B. only photon scattering in the source encapsulation and the media {C. both photon absorption and seatering inthe source encapslation andthe medium D. aly photon absorption inthe source encapsulation ‘only phooa seatterng inthe source encapsulation Use of dual-energy CT scanner for proton beam teatment planning hs the advantage(s) over a single-energy CT seamer of __ "A. moze accurate deterinaton of proton beam ange inthe patient BB. more accurate segmentation of sot issues (Cette information about setup uncertainties D. AlloFthe above are tru, EE. None of the above iste Pencil beam scanning protons have ___than double scattering protons ‘A. alse entrance dose B. higher RBE Ca sharper penumbea D. Allof the above ae tc. E) None ofthe above iste, ‘The proton bear RBE at the end of the spread out Bragg Peakis___the RBE a the center of the spread out Bragg Peak. ‘A. alias higher than B. always lower than (C. always the same as D. higher for passive seatered but lower for pen beam scanning E, lower for passive seatered but higher for pencil eam Seanning Raphex 2018, 9therapy questions therapy questions ‘F139, The primary advantage of protons over xrays fr therapy is_ A. ess cost B. sharper penumbra C. higher RBE D. no-exitdose E. insensitivity o organ motion 7140, The penumbra ofa proton beam i function of _ A. depth energy tirgap between the patient and the aperture Allo the above are te. None ofthe above sue moos eee 30 Raphex 2018