ASRT SEAL 3 Flashcards
When interacting with mature adults over the age of 65, radiation therapists should remember:
Most of these individuals are senile.
These mature adults consider themselves at a disadvantage because of their age.
These mature adults consider themselves middle aged.
These mature adults are less educated and less health savvy than those under the age of 65.
These mature adults consider themselves middle aged.
When treating a craniospinal field, the PA spine target needs to be split into two fields. Field A has a field length of 14 cm and Field B has a field length of 32 cm. The beams will match at a depth of 5 cm. Both fields are treated at 100 cm source to surface distance (SSD). Calculate the skin gap needed to ensure the fields match at 5 cm.
- 07 cm
- 15 cm
- 42 cm
- 61 cm
1.15 cm
Which of the following are recommended skin care practices for patients undergoing radiation therapy to the head and neck? Please select all that apply.
Covering skin to protect from sunlight.
Use of a loofa sponge.
Application of water based lotion and creams.
If a patient needs to shave, electric razors are preferred.
Covering skin to protect from sunlight.
Application of water based lotion and creams.
If a patient needs to shave, electric razors are preferred.
Which treatment delivery method spares healthy tissue the LEAST?
IMRT
2D
VMAT
SBRT
2D
What size will a 6 cm tumor be on an image if the isocenter is set in the tumor and the imager is at 140 cm, provided the machine isocenter distance is 100 cm?
- 3 cm
- 7 cm
- 4 cm
- 2 cm
8.4 cm
Similar triangles can be used to determine the size of a tumor or other object on an image. To determine the size of an object on an image at a specific target-to-image distance, you can use the similar triangle formula: a/a’= b/b’. You can also find the magnification factor (imager distance/object distance) and multiply the magnification factor by the object size (in this case the tumor).
To ensure patient safety, the NCRP requires testing of the interlocks system at least once per:
Day.
Week.
Month.
Year.
Day
Chemotherapy is administered concurrently with radiation therapy in the treatment of:
Breast carcinoma.
Hodgkin lymphoma.
Lung carcinoma.
Vocal cord carcinoma.
Lung carcinoma.
The standard of care in the treatment of lung cancer is concurrent chemotherapy with radiation therapy. Breast cancer is typically surgically excised, followed by chemotherapy (if necessary), then radiation therapy. Lymphomas are generally treated with chemotherapy first, and carcinomas limited to the vocal cord typically just require radiation therapy.
The administration of a radioactive drug via the wrong route is an example of a:
Medical event
Reportable miss
Medical occurance
Near miss
Medical event
A medical event, as outlined by the NRC, is an event in which the admistration of a radioactive material results in a dose larger than the prescribed dose by more than 5 rem, total dose differs by more than 20%, fractionated dose differs by more than 50%, wrong drug, wrong route, wrong patient, wrong mode of treatment or leaking source.
Indirect action of radiation is the result of the ionization of ___________ surrounding the cell.
proteins
enzymes
water
DNA
water
indirect action is the result of ionizing radiation in the water surrounding the cell in which the molecules are suspended.
The current of a CT scanner’s x-ray tube is controlled by:
Display field of view.
mA.
kVp.
Window width.
mA
kVp, or kilovoltage potential, measures the quality or energy of the electrons passing from the cathode to the anode. Display field of view determines how much of the scan field of view and how much of the image can be viewed. Window width determines the range of CT numbers displayed in an image.
A common distant metastatic site of bladder cancer is the:
Brain.
Colon.
Lung.
Kidney.
Lung
Local spread is invasion through the bladder wall, invading the muscle layer. Lymphatics involved in cancer of the bladder includes the internal and external iliac node, as well as the presacral nodes.
Skin damage, or __________ caused by radiation is evidenced by ulceration and denudation of the skin.
erythema
epilation
alopecia
desquamation
desquamation unintended damage to and loss of the upper layer of skin.
The radiation therapist should check the patient’s skin daily to check for desquamation which may cause an interruption in treatment to allow for healing.
The ________________ is used in high-energy linear accelerators to angle the beam within the head of the gantry.
target
circulator
klystron
bending magnet
bending magnet
The bending magnet is used to angle the beam down toward the patient, sometimes even at a right angle.
The grainy appearance of a CT image is referred to as image:
Noise.
Spatial resolution.
Contrast.
Reconstruction.
Noise
Spatial resolution is the ability to distinguish two high contrast objects in an image. Contrast is the difference between black and white in an image. Reconstruction refers to taking the data gathered by detectors to create an image with computers.
The CT, or Hounsfield, number for fat is:
-1000.
-100.
200.
1000.
-100.
Air, displayed black on an image, has a HU of -1000. Lung tissue ranges between -800 and -300 HU. Bone has a HU between 300 and 1000, displayed white in an image.
A formal ______________ is a written legally valid document that indicates a patient’s decisions about future medical treatment.
advanced directive
informed consent
medical notice
medical testimony
advanced directive
An advanced directive is recognized as a legal document and can be a living will or a durable power of attorney for health care or other statement signed by the patient
The small bowel joins which component of the large intestine?
Ascending colon
Vermiform appendix
Hepatic flexure
Cecum
Cecum
From the cecum, digestive material travels through the ascending colon to the hepatic flexure, across the transverse colon to the descending colon, sigmoid colon and finally the rectum.
Stages of grief including denial, anger, bargaining, depression, and acceptance were introduced by:
Maslow
Kinsey
Kübler-Ross
Karnofsk
Kübler-Ross
The stages of grief were noted by Elisabeth Kübler-Ross. Maslow provided insight for basic needs for all people. Kinsey developed a scale which includes six parameters or sexual tendencies within the population. Karnofsky is associated with the performance scale with ratings from 0 to 100%.
In the CT scanner, movable lasers are used to do which of the following? Please select all that apply.
Display field size
Provide isocenter position information
Reposition the CT table
Provide additional illumination
Display field size
Provide isocenter position information
Movable lasers are used in the CT simulation room and communicate with virtual simulation and/or treatment planning systems. While the most common use of these systems is to provide coordinates for the isocenter of the patient’s treatment plan, some systems can project field size, blocks and multileaf collimation onto the patient’s skin. If movable lasers are used in the CT simulation, radiation therapists should complete daily quality assurance on the system.
The right and ability of a patient to decide the course of medical treatment is patient ____________.
understanding
communication
autonomy
information
autonomy
Communication to provide important information to enhance patient understanding is an important aspect of the patient’s decision making process, while autonomy is the right of patients to do so.
Mean survival time for central nervous system syndrome is approximately _______ days.
10 to 60
20 to 30
4 to 10
0 to 3
0 to 3
At doses greater than 50 Gyt death occurs from CNS syndrome due to elevated fluid content of the brain.
Calculate the Mayneord’s factor for a 6 MV photon field treated at 120 cm source to surface distance (SSD), treating to a depth of 7.5 cm.
- 92
- 01
- 03
- 42
2.03
The Mayneord’s factor is used to correct percent depth dose when treating at extended distances, since percent depth doses are only measured at distances of 100 cm. To calculate Mayneord’s factor, the following equation is used:
The area in the brain that is responsible for motor control and the body’s ability to balance is the:
Show More
Brain stem.
Frontal lobe.
Cerebellum.
Parietal lobe.
Cerebellum.
The cerebellum, located behind the brainstem, receives sensory information from other parts of the brain and body and regulates motor movement. It is an especially important structure for voluntary motor movement.
The component of the CT scanner that converts light to an electronic signal is the:
X-ray tube.
Detector array.
Photodiode assembly.
Slip ring.
Photodiode assembly.
During a CT scan, the x-ray tube emits photons continuously around the patient. Slip ring technology allows the gantry to move in this fashion. After passing through the patient, the photons are absorbed by the detector array. The detectors covert radiation to light. The photodiode assembly then converts the light to an electronic signal, which is communicated to the computer processors.
The maximum field size the linear accelerator can treat at 100 cm is 40 x 40 cm. The physician wants to treat a whole femur in one field, but the length is 52 cm. What treatment distance would you need to treat the femur in one field?
77 cm
90 cm
115 cm
130 cm
130 cm
When the field size needed exceeds the maximum field size of the treatment machine, patients are often treated at extended distances. Similar triangles can be used to determine the treatment distance needed. a/a’ = b/b’; 40/52 = 100/x, x=130 cm.
Chemotherapy is indicated for which of the following?
Carcinoma of the vocal cord
Carcinoma in situ of the breast
Locally advanced invasive breast carcinoma
Basal cell carcinoma
Locally advanced invasive breast carcinoma
Chemotherapy is indicated in the treatment of aggressive and/or advanced cancers. A patient with cancer limited to the vocal cord would only need radiation therapy. The same situation applies to a ductal carcinoma in situ (DCIS) breast cancer case. Similarly, basal cell carcinomas typically do not require chemotherapy, but rather radiation alone.
For a member of the general public, the maximum exposure of radiation should not exceed ________?
50 mrem/year
100 mrem/year
150 mrem/year
200 mrem/year
100 mrem/year
For a member of the general public, maximum exposure should not exceed 100 mrem in one years’ time. For those who work with radiation, the maximum dose limits for adults increases significantly as follows: 5,000 mrem per year for full body dose, 15,000 mrem per year for lens of the eye exposure and 50,000 mrem per year for extremeties. For an undeclared pregnant radiation worker the maximum dose exposure remains 5,000 mrem per year but, once declared the maximum dose exposure drops to 500 mrem over the time period of the pregnancy.
The MOST common malignancy in the pediatric population is:
Leukemia.
Brain tumor.
Soft tissue sarcoma.
Lymphoma.
Leukemia.
Leukemias are the most common malignancy in the pediatric population with acute lymphocytic and acute myelogenous being the most common leukemias in children.
Xerostomia occurs after _________ cGy resulting in significant long-term effects.
500
1,000
2,000
3,000
1,000
Xerostomia places the patient at risk for dental caries and oral infections.
According to ALARA, which of the following is NOT a principle of radiation safety?
exposure
time
distance
shielding
exposure
The three principles of radiation safety are time, distance, and shielding. Decreasing time of exposure, increasing the distance between the patient and/or care provider and the radiation source, and increasing shielding for the patient and/or care provider.
Identifying with the feelings, thoughts, or experiences of another person.
Sympathy
Empathy
Probing
Paraphrasing
Empathy
This term is not necessarily defined as feeling sorry for someone, trying to gather information about them, or in using synonyms to acknowledge that they are being heard.
The imaging size of a CT scanner is most dependent on:
Scanned field of view.
Bore size.
Immobilization.
Contrast administration.
Scanned field of view.
Bore, or aperture, size refers to the size of the opening in the gantry of the CT scanner. This opening is typically 70-90 cm in size. However, even if a patient fits through the bore, their entire contour may not be visualized. The scanned field of view determines the image size, and is smaller than the bore size. This can be defined as the amount of anatomy that is scanned, but does have size constraints. Display field of view describes how much of the scanned field of view is reconstructed for the image.
Electron beam energy is reduced by _____ MeV per cm in unit density tissue.
1
2
3
4
2
Electrons energy is reduced by 2 MeV per centimeter. This means that a 12 MeV beam at a depth of 2cm is 8 MeV.
Whole body exposure to a radiation dose of 1 Gyt results in the _________ period producing acute clinical symptoms that occur within hours.
prodromal
latent
hematologic
gastrointestinal
prodromal
The prodromal period can occur within hours and last for up to 1 or 2 days. Nausea, vomiting, diarrhea and leukopenia can occur.
The patient agreement that includes information needed by a reasonable person to make a decision is _____________________.
implied consent
privacy consent
summary consent
informed consent
informed consent
A person’s agreement to allow a procedure or treatment is based on a full disclosure of the facts needed to make an intelligent decision including risks, benefits, desired outcomes, alternatives, refusal, complications, side effects, and mortality.
Using a lead apron while taking an x-ray image is an example of which priciple of ALARA?
exposure
time
distance
shielding
shielding
Using a lead apron while taking an x-ray image is an example of shielding. A care provider may wear shielding such as a lead apron or they may use the lead apron on their patient to shield parts of the body they do not want to expose. In each situation the aim is to use shielding to limit radiation exposure and maintain the principles of ALARA.
Brachytherapy is administered for which of the following cancers?
Brain
Bone
Cervix
Bladder
Cervix
Brachytherapy is used to treat cervical cancer as a boost therapy following external beam. The purpose is to give additional dose to the tumor, while limiting dose to the bladder and rectum. The other cancers listed are treated with external beam radiation therapy.
The treatment planning volume which encompasses suspected positive lymphnode chains is the:
GTV
CTV
PTV
Irradiated volume
CTV
The GTV, or gross target volume, encompasses disease which can be seen on imaging or can be palpated. The PTV, or planning target volume, includes a margin on the CTV to compensate for set-up uncertainties. The PTV margin has decreased with the addition of Image-guided radiation therapy (IGRT). Irradiated volume is anything that receives substantial dose.
Surgical excision is the first line of treatment for carcinoma of the:
Larynx.
Lung.
Breast.
Rectum.
Breast
Surgical excision is generally the first line of treatment for breast carcinoma. The other cancers are typically treated with concurrent chemotherapy/radiation therapy unless it is more advanced. For example, advanced cancer of the larynx may require a laryngectomy.
Which principle interaction in x-ray production accounts for approximately 75% to 80% of the tubes output and is produced by the sudden deceleration of the high-speed electron as it is deflected around the nucleus of an atom?
characteristic
Compton scatter
bremsstrahlung
pair production
bremsstrahlung
Bremsstrahlung or “braking” radiation is produced as a high-speed electron is deflected around the nucleus of a tungsten atom and accounts for approximately 75-80% of the tube’s output.
The parameters for the radiation therapist’s scope of practice is found in the ASRT _________________.
Practice Standards
Code of Ethics
Mission Statement
Regulations
Practice Standards
The ASRT Practice Standards outline the clinical, quality and professional performance and includes the scope of practice for radiation therapists.
Which grade would be given to a tumor type depicting cells that look more like normal cells and tend to grow and spread more slowly?
low (G1)
intermediate (G2)
high (G3/G4)
undetermined (GX)
low (G1)
Low grade (G1) tumor cells look more like normal, healthy cells and tend to grow and spread more slowly. High grade tumor cells, alternatively, look abnormal and grow and spread more quickly.
__________ is the comparison of a test dose of radiation to a dose of 250 keV x-ray which produces the same biologic effect.
Linear energy transfer
Relative biologic effect
Indirect action
Direct action
Relative biologic effect
Relative biologic effect compares the biologic response by measuring the biologic effectiveness of radiations of different linear energy transfers (LETs).
The legal term that describes the actions of a therapist that would be used by another therapist in similar circumstances is _________________.
scope of practice
physical care
standard of care
therapeutic care
standard of care
Scope of care may vary from state to state and facility to facility. The therapist should be aware of the Practice Standards for the profession to be cognizant of current practice.
Electronic systems used to identify patients must have at least _____ methods for independent confirmation.
one
two
three
four
two
Electronic systems and patient management systems can be used for independent verification of correct patient, correct treatment and correct site.
More pixels in an image matrix results in:
Lower resolution.
Higher resolution.
Lower detail.
Higher distortion.
Higher resolution.
Pixels are associated with resolution. The greater number of pixels, the higher the image resolution.
The center number of a range of CT numbers displayed in an image is referred to as the:
Window width.
Voxel.
Pixel.
Window level.
Window level.
The window level refers to the central CT number displayed in an image, while the window width is the range of numbers displayed in an image. By changing these parameters, one can adjust the contrast and/or density of an image in order to see detail in tissues.
___________ is the ethical theory that bases decisions on individual motives and morals.
Teleology
Consequentialism
Deontology
Virtue
Deontology
This theory is based on individual motives and morals rather than consequences that may occur as a result of the action or inaction.
When should the radiation therapy prescription be signed?
At time of consult
After QA is performed
Prior to the first treament
Within the first three fractions
Prior to the first treament
The prescription must be signed by the radiation oncologist prior to the patient’s first treatment. Electronic signature with date and time stamp is adequate. It is the radiation therapist’s job to check this prior to beaming on each day.
What is a common radiation treatment for mycosis fungoides?
Total Body Irradiation (TBI)
Total Skin Irradiation (TSI)
Stereotactic radiotherapy
Single field electron
Total Skin Irradiation (TSI)
Mycosis fungoides is a cutaneous T-Cell lymphoma that mostly affects the skin but may progress to other organs. The patient is assisted into different poses to ensure that all skin surface areas are exposed to the electron beam.
Medical ________ can be the result of the patient not being made aware of the potential consequences of the recommended treatment.
autonomy
battery
testing
assault
battery
The concept of informed refusal can be the basis of medical battery if the patient is not informed of the risks of and the potential consequences of refusing the recommended treatment.
MV port film image quality is low due to:
Increased scatter.
Decreased scatter.
Increased distance.
Decreased distance.
Increased scatter.
Compton scatter is greater with MV beams than KV beams, thereby reducing contrast and image quality.
Which of the following is a sign or symptom of intracranial pressure?
Seizures
Loss of smell
Aphasia
Memory loss
Seizures
Loss of smell, aphasia, and memory loss are all examples of focal signs and symptoms.
The intensity of the radiation beam at 1m was 100 mR/hr. What would the exposure be at 2m?
50 mR/hr
25 mR/hr
12.5 mR/hr
10 mR/hr
25 mR/hr
Following the inverse square law, at 2m: 1/(2) squared x 100 mR/hr = 1/4 x 100 = 25 mR/hr
The result of indirect action produces an ___________ and _________.
ion pair, free radicals
electron, enzymes
ion pair, enzymes
proton, free radicals
ion pair, free radicals
Indirect action is the result of ionizing radiation in the water surrounding the cell in which molecules are suspended causing an ion pair and free radicals to form.
Damage to the _________ cells is the earliest appearance of radiation damage to the skin.
epidermis
basal
dermis
fascia
basal
Basal cells are stem cells that mature in the process of rising to the epidermal surface
Which of the following is an indication to screen patients for lung cancer with low dose CT scans?
High exposure to second hand smoke
A 30 pack year smoking history
A smoker who quit 25 years ago
The patient is 40 years of age
A 30 pack year smoking history
Low dose CT screening can decrease the mortality of patients who are at high risk for developing the disease.
Which of the following is TRUE regarding grading of the tumor?
A well differentiated cell has a higher grade than a poorly differentiated cell.
Cells that look like the tissue of origin are classified as Grade 4.
Grading can only occur by examining the cancer cells with a microscope.
Grading only occurs if the patient has an oncologic resection of the tumor.
Grading can only occur by examining the cancer cells with a microscope.
A Grade 1 classification is given to cells that are well differentiated, thus look like their tissue of origin. Grade 4 cells are cells that are undifferentiated or anaplastic, and difficult to discern their original tissue of origin.
An exchange of information, thoughts, or messages using methods other than actual words of speech.
Verbal Communication
Nonverbal Communication
Emotional Intelligence
Paralanguage
Nonverbal Communication
Nonverbal communication is the exchange of information, thoughts , or messages using methods other than actual words
When would a wedge be used in a treatment field?
To compensate for missing tissue
To increase skin dose
To block the center of the field
To minimize penumbra
To compensate for missing tissue
Wedges can be used to compensate for missing tissue. The heel of the wedge is placed towards the missing tissue. Wedges are also used to correct dose nonuniformity.
Patients receiving breast external beam irradiation may be positioned in all of the following positions, EXCEPT:
Prone.
Supine.
Decubitus.
Standing.
Standing.
Breast cancer treatment delivery may be conducted in all positions except standing. Supine treatment is most common, especially for women with smaller breasts. Prone is best suited for women with larger breasts and those with left side lesions where treatment may better spare the heart. More rarely, patients may be treated in the lateral decubitus position.
Radiation treatments in which the total dose is divided into small doses and delivered more than once a day is termed:
Hyperfractionation.
Hypofractionation.
SBRT.
Concurrent.
Hyperfractionation.
Hyperfractionation refers to radiation treatments in which the total dose is divided into smaller doses and delivered more than once a day, with treatments typically being delivered 6 hours or more apart. Benefits to hyperfractionation include reduced side effects and total treatment dose may be higher.
A cancerous tumor of the glandular tissue would likely be classified as a:
Adenocarcinoma.
Neuroma.
Leiomyosarcoma.
Squamous cell carcinoma.
Adenocarcinoma.
Squamous cell carcinomas originate from tissues with squamous cell epithelium, such as the head and neck, lung, cervix, anus and vagina. Neuromas are a benign tumor of the nerves, as indicated by the -oma suffix. Finally, sarcomas are cancers of the connective tissue. A leiomosarcoma is a tumor of the smooth muscle.
Myelopathy can occur with radiation doses of _____ Gy using QUANTEC tables for conventional fractionation.
20
30
40
50
50
Myelopathy has a toxicity rate of 0.2% at 50 Gy after conventional therapy and increases significantly at 60 and 69 Gy.
What is the basis of a pixel in digital imaging?
Volume elements
Three-dimensional
Picture elements
Used in MRI
Picture elements
Numbers are collected, stored, and reconstructed to form pixels, which are picture elements. This is the basis for two-dimensional CT imaging.
Average tissue-to-air ratio (TAR) is used when calculating monitor units for which type of treatment fields?
Rotational fields
En face electrons
Parallel opposed fields
Four field box
Rotational fields
When calculating monitor units for rotational fields, several calculation factors are used. Because the depth to the target differs throughout the rotation, an average TAR is used. Historically, TAR was measured every ten degrees and then averaged. Current treatment planning systems have a more sophisticated method for calculating average TARs.
Radiation therapy is the first line of treatment for which of the following cancers?
Leukemia
Larynx
Hodgkin lymphoma
Breast
Larynx
Radiation therapy is typically the first line of treatment for head and neck cancers, unless the disease is too advanced and surgery may be advised. Breast cancer patients typically undergo surgical excision as the first treatment, and lymphomas and leukemias are generally treated with chemotherapy.
If the treatment machine has an isocenter distance of 100 and the field width is 14 cm, what is the field size at isocenter with a target-skin distance (TSD) of 91 cm?
- 9 cm
- 2 cm
- 6 cm
- 1 cm
15.2 cm
Similar triangles can be used to determine field size at different depths with photon fields. The formula is a/a’ = b/b’.
By which two lymph node routes does ovarian cancer spread MOST often?
para-aortics and pelvic
cervical and intramammary nodes
para-aortics and intestinal
pelvic and cervical
para-aortics and pelvic
Ovarian cancer can spread by a variety of different routes. In reference to lymph node metastasis, owing to the location of ovarian cancer, lymph node metastasis may most commonly occur via the para-aortic and pelvic lymph nodes. The para-aortic lymph nodes lie in front of the lumbar vertebrae, near the aorta while the pelvic lymph nodes lie adjacent to the pelvic organs and include the inguinal, internal, external and common iliac, obturator and sacral nodes.
The term used to describe table movement per rotation divided by slice thickness is:
Voxel.
Hounsfield unit.
Roll.
Pitch.
Pitch.
Pitch describes table movement per rotation divided by slice thickness. When pitch is less than 1, there is overlap between rotations. While the image quality is high (because no information is missed between slices), the scan dose is also high. When pitch is greater than 1, image quality is less because there is no overlap of scan rotations. This results in missing information between the rotations, which the computer attempts to reconstruct.
When viewing an axial pelvis image of a supine patient, which structure would be most anterior?
Prostate
Rectum
Pubis
Coccyx
Pubis
In a supine pelvis image, the pubis would be most anterior. Next would be the prostate, then rectum and finally the coccyx. The bladder and seminal vesicles would be visualized in superior slices.
Cataracts can occur after radiation doses of __________ cGy to the whole organ.
50
100
200
1,000
1,000
When treating with two fields 120 degrees apart, what is the most appropriate wedge angle to be used?
15 degrees
30 degrees
45 degrees
60 degrees
30 degrees
When combining two fields, wedges are used to improve dose conformity. To determine the angle of the wedges needed, first determine the hinge angle. The hinge angle is the angle between the central axis of both fields. Next, the wedge angle can be calculated with the following formula: Wedge angle = 90 - (Hinge angle/2). In this example WA = 90 - (120/2) = 30 degrees.
Non-small cell lung cancer commonly metastasizes to the:
Bladder.
Liver.
Kidney.
Brain.
Brain
Non-small cell lung cancer will commonly metastasize to the brain via the blood stream. Prognosis with brain metastasis is generally poor. Whole brain irradiation may be delivered for palliative care or prophylactically as a means of prohibiting metastasis.
Where do medulloblastomas typically metastasize to?
Lung
Bone
Liver
Kidney
Bone
Medulloblastomas commonly metastasize distantly to the bone via the bloodstream and are also known to spread rapidly through craniospinal fluid.The most common bone sites for metastasis include the pelvis, long bones, and spine.
Halfway through treatment, the radiation theraptist notices that the table angle has drifted out of tolerance by 5 degrees. What should the radiation therapy do?
Continue with treatment
Stop treatment, realign the patient, continue treatment and then notify the doctor
Stop the treatment and get the patient off the table while you notify the doctor
Call physics to determine why the table was turned
Stop the treatment and get the patient off the table while you notify the doctor
Always stop treatment if you see a mistreatment is occurring. Notify the doctor of the incidence and consult with physics to determine the best way to rectify mistreatment.
In the TNM staging system, a Tx would indicate:
1 - 3 cm tumor.
Tumor cannot be evaluated.
Tumor > 5 cm.
In situ tumor.
Tumor cannot be evaluated.
In the TNM staging system, T represents the status of the tumor. T0 indicates a tumor that cannot be found (for example - in an unknown primary). Tis represents in situ disease. T1-T4 indicates the size and/or extent of invasion. While the specifics differ for each specific cancer, T1 is the most favorable while T4 is the least favorable.
What methods are acceptable to use when identifying a patient? Please select all that apply.
Hospital identification bracelet.
Having the patient spell their last name
Having the patient state their birthdate
Treatment set-up photo
Hospital identification bracelet.
Having the patient spell their last name
Having the patient state their birthdate
At least two methods should be used. Asking the patient where they are being treated is also part of the daily time out.
This term includes home, respite, inpatient hospital care and support during bereavement.
Hospice Care
Critical Care
Long-term Rehabilitation Care
Skilled Nursing Facilities
Hospice Care
Hospice services include home, respite, inpatient hospital care and support during bereavement. The durable power of attorney is a legal document that allows an individual over the age of 18 years to be designated as a surrogate and decision maker of matters concerning health care. The living will is a legal document which allows a competent adult to provide direction to health care providers concerning their choice of treatment if the individual is no longer competent by reason of illness or other infirmity to make those decisions. Both the living will and durable power of attorney are considered advanced directives.
When treating with multiple fields, what is TRUE regarding beam weighting?
The beam that is further from the tumor is given higher weight
Beam weighting is most useful when the target is midplane
Beam weighting is useful when treating through a sensitive structure
Beam weighting is only used when three or more fields are used
Beam weighting is useful when treating through a sensitive structure
Beam weighting can be used whenever multiple beams are used. Weighting of the fields is useful when the target is not located at midplane, or when the beams pass through a sensitive structure. Beams that are closest to the target are weighted more to pull the dose to the target, and the beam farther from the sensitive structure is weighted more to pull dose away from it.
In digital imaging, what is a characteristic of a voxel?
Three-dimensional
Two-dimensional
Picture elements
Not used in CT
Three-dimensional
CT scan images are made up of three-dimensional voxels and two-dimensional pixels. The combination of the two helps improve image quality
What part of the linear accelerator is responsible for the production of electrons and injecting them into the accelerator structure?
klystron
magnetron
electron gun
accelerating waveguide
electron gun
The electron gun is responsible for the production of electrons and injecting them into the accelerator structure.
Previous
4D respiratory gating is significantly useful for treating tumors in all of the following, EXCEPT:
Bone.
Breast.
Lung.
Abdomen.
Bone
respiratory gating is ideal for treatment sites where the tumor may move due to patient breathing or where patient anatomy may shift. Examples of treatment sites that are best suited for 4D treatment include lung, breast, and abdomen.
The rate at which energy is deposited per unit distance as radiation passes through matter is ________________.
linear energy transfer
relative biologic effect
indirect action
direct action
linear energy transfer
Linear energy transfer is the energy deposited as a charged particle travels through matter and is a function of the mass and charge of the radiation.
Which of the following variations from treatment would be considered a systemic error?
Bolus was omitted for one fraction
Imaging was completed on fraction 7 rather than fraction 6
Wrong electron cutout was used for one day of the boost treatment
Wrong monitor units (MU) were inputed and used for the entire course of treatment
Wrong monitor units (MU) were inputed and used for the entire course of treatment
ystemic errors may take place in planning or when entering data into the record and verify system.
Under the new standards (NCRP Report No. 91), an effective dose equivalent limit of ____rem/year for occupational exposure is recommended.
5
25
35
40
5
The NCRP report states the 5 rem/year is the acceptable limit for occupational exposure.
The first echelon lymph node for prostate cancer is the ____________ nodes.
Inguinal
Obturator
Periaortic nodes
Presacral
Obturator
The obturator node is one of the first lymph nodes involved when prostate cancer spreads through the lymphatics, followed by the external iliacs, hypogastric and common iliac nodes. Distantly, prostate commonly spreads to the bone.
Output factors used in monitor unit calculations for photon fields are measured using what field size?
5 x 5 cm
10 x 10 cm
15 x 15 cm
20 x 20 cm
10 x 10 cm
Output factors are measured with a 10 x 10 cm field size. When treating with a field size other than 10 x 10 cm, a field size correction factor is used. This correction factor is dependent on treatment machine and treatment energy. The field size correction factor is built into treatment planning systems.
A wheelchair should be placed at a _______ degree angle to the table.
15
30
45
60
45
A 45 degree angle of wheelchair to table will provide the patient with sufficient room to pivot.
The annual whole body effective dose limit for an occupational worker recommended by the NCRP is: 5 rem 10 rem 20 rem 25 rem
5 rem
For an adult occupational radiation worker, the recommended annual whole body dose limit is 5 rem (5,000 mrem). Dose limit per year for lens of the eye is 15,000 mrem and exposure for extremeties is 50,000 mrem. For a member of the general public, maximum exposure should not exceed 100 mrem in one years’ time.
Which of the following skin cancer histologies is MOST likely to spread distantly to the lung?
Basal cell carcinoma
Squamous cell carcinoma
Multiple myeloma
Melanoma
Melanoma
Basal cell carcinoma and squamous cell carcinoma are typically localized and spread by direct extension. Of the two histologies, squamous cell carcinoma is more likely to metastasize.
hat is the primary benefit of prone breast irradiation?
Patient comfort
Decreased skin dose
Fewer treatments
Decreased heart dose
Decreased heart dose
The primary purpose of prone breast irradiation is to limit the dose to the heart. This is often the ideal technique for large breasted patients with a left-sided breast cancer. Since the heart is more towards the left, dose would be greater if the patient was in the supine position. The prone position allows the breast tissue to fall away from the chest wall, limiting heart dose.
Stereotactic radiation to tumors of the brain is known as:
SRS.
SBRT.
IMRT.
intercranial irradiation.
SRS.
Stereotactic radiosurgery (SRS) treatment is a focused radation treatment technique. It is commonly used to treat small tumors in the brain and spinal cord.
When paper charts and forms are in use, what is acceptable when making changes?
Correction tape (White-out) Several lines to cross out original entry Writing correct entry over original entry Single line to cross out entry with charting person's initials and date of correction
Single line to cross out entry with charting person’s initials and date of correction
hen making changes to the patient chart, the initial entry should be crossed out with a single line, accompanied by the charting person’s initials and date. There should not be an attempt to obscure the original entry.
Damage by ionization of a biologic macromolecule is caused by _______ action.
indirect
direct
capture
release
direct
Direct action occurs when any macromolecule of the cell is ionized. The damage is caused by direct absorption of the radiation resulting in damage to the DNA, RNA, protein, enzyme, etc.
What step would occur after a patient has been set up in the treatment position and a verification cone beam has been completed?
Treatment is paused
Prescription is changed
Patient is removed from table
Minor adjustments to alignment are made
Minor adjustments to alignment are made
After the patient has been set up appropriately and verification image-guided radiation therapy (IGRT) imaging has been completed, ensuring that shifts are also appropriate, the treating therapist would then apply the isocenter shifts according to the IGRT alignment. Upon completion, the patient and their final position would be ready for treatment delivery.
