Physics Flashcards
After performing a 4D CT study, what reconstructed CT image set best identifies the ITV of a hypodense lesion in the liver?
A. Average CT
B. 50% phase CT
C. Maximum Intensity Projection (MIP) CT
D. Minimum Intensity Projection (MinIP) CT
D. Minimum Intensity Projection (MinIP) CT
Because the lesion is hypodense within the liver, the MinIP will best represent the ITV of the lesion. The average CT will blur the edges of the lesion and will make it difficult to clearly delineate. The 50% phase will solely show the lesion in one phase of motion, and the MIP will erroneously show the lesion much smaller than it actually is.
When a therapeutic electron beam interacts with tissue, how do the electrons predominantly lose their energy?
A. Inelastic collisions with atomic electrons
B. Inelastic collisions with nuclei
C. Elastic collisions with atomic electrons
D. Elastic collisions with nuclei
A. Inelastic collisions with atomic electrons
In low atomic number media such as water or tissues, electrons lose energy predominantly through ionizing events (inelastic collisions) with atomic electrons.
Which ionization chamber minimizes cavity perturbation effects in a radiation field?
A. Parallel-plate chamber
B. Farmer chamber
C. Vented thimble chamber
D. Unvented thimble chamber
A. Parallel-plate chamber
The small electrode spacing in a parallel-plate chamber minimizes cavity perturbations in a radiation field. Farmer and thimble shaped chambers typically produce significant perturbations in the radiation field that require corrections.
What depth, in water, is the beam flatness typically specified for a clinical photon beam?
A. dmax
B. 5 cm
C. 10 cm
D. 15 cm
C. 10 cm
For a clinical photon beam, the beam flatness is typically specified at 10 cm depth in water for all photon beam energies. The depth is important as the flattening filter shape is designed to ensure a flat beam profile at 10 cm.
An Ir-192 HDR source is exchanged while a patient is undergoing a three-fraction vaginal cylinder course. If the first fraction was delivered in 375 seconds with a source strength of 5.8Ci, what is the expected treatment time for the second fraction if the new source strength is 9.9Ci?
A. 220 seconds
B. 290 seconds
C. 375 seconds
D. 450 seconds
A. 220 seconds
The treatment time is inversely proportional to the source strength if the dose is kept constant. If the source strength increased, the treatment time will decrease accordingly by the same proportion.
Generally, respiratory motion management techniques are recommended if the target motion, in any given direction, is larger than:
A. 3 mm.
B. 5 mm.
C. 10 mm.
D. 15 mm.
B. 5 mm
To ensure the dose is accurately delivered, AAPM Task Group 76 recommends that a 5mm motion limit criterion should be used as this level of motion can cause significant imaging artifacts and systematic errors during imaging procedures.
Compared to x-ray based IMRT/VMAT treatment plans, why is the high dose conformity of proton therapy to the target volume generally worse?
A. Need to use higher energy (100-200 MeV) protons
B. Enhanced biological effects of higher LET
C. Proton range uncertainty
D. Dosimetric contributions of neutrons
C. Proton range uncertainty
For the same target, the high dose conformity is generally worse for proton therapy delivery primarily due to the proton range uncertainty.
What is the activity on the 100th day for an Ir-192 source (T1/2 = 78.4 days) with an initial activity of 10 Ci?
A. 2.8 Ci
B. 4.1 Ci
C. 5.1 Ci
D. 7.8 Ci
B. 4.1 Ci
The equation to determine activity at a point in time is A(t) = A0*exp(-λt). The decay constant λ is related to the half-life by λ = ln(2)/T1/2.
What is the role of a magnetron or klystron in a linear accelerator during photon beam production?
A. Generates radiofrequency power for acceleration
B. Transfers radiofrequency power to an electron beam
C. Redirects an electron beam toward machine isocenter
D. Creates photons from an accelerated electron beam
A. Generates radiofrequency power for acceleration
The magnetron or klystron (depending on accelerator design) acts as a radiofrequency power source for a medical linear accelerator. Power from the magnetron or klystron is transferred to electrons within an accelerating waveguide. Bending and focusing magnets act on the accelerated electron beam to redirect it toward a tungsten target in line with machine isocenter. Interactions in the target convert the electron beam energy to Bremsstrahlung photons directed toward the patient.
Which electron beam energy is MOST appropriate when treating a target at 4 cm depth that is prescribed to the 80% isodose line?
A. 6 MeV
B. 9 MeV
C. 12 MeV
D. 15 MeV
C. 12 MeV
R80, the depth where dose from an electron beam falls off to 80% of the maximum, is approximated (in centimeters) by the nominal beam energy (in MeV) divided by 3. Therefore, to achieve prescription dose at 4 cm depth prescribed using the 80% isodose level, the appropriate beam energy is 4 cm * 3 = 12 MeV.
What dosimeter should be used when performing an absolute dose output calibration of a linear accelerator?
A. Geiger counter
B. Ionization chamber
C. Radiochromic film
D. Thermoluminescent dosimeter (TLD)
B. Ionization chamber
Ionization chambers are most appropriate as they can be calibrated accurately with methods traceable to primary standards laboratories to provide direct absolute dose measurements. Geiger counters are much less accurate and typically only calibrated for exposure. Film is a relative dosimeter, requiring a separate calibration to be used as an absolute dosimeter. Thermoluminescent dosimeters (TLDs) are capable of absolute dosimetry with careful pre- and post-processing, however this requires special equipment not commonly available in a clinic and still results in measurements with less accuracy and precision than an ionization chamber.
What does “UID” denote in the DICOM standard? A. Underlying dataset B. Uninterruptable data stream C. Unique identifier D. Universal indicator
C. Unique identifier
A DICOM unique identifier (UID) is structured yet unique number that allows an aspect of a DICOM- compliant dataset to be reliably referenced to other DICOM-compliant datasets. Some areas where UIDs are necessary include establishing a common UID among all slices in an image volume, matching a UID to a frame of reference for registered image volumes, and maintaining study/series and subject/object relationships, among others. Enforcing concordance of UIDs keeps relationships structured and predictable in the presence of large amounts of data.
Voxel values in a computed tomography (CT) image set are MOST closely related to which property of the object being imaged?
A. Metabolic activity
B. Nuclear spin
C. Photon attenuation
D. Physical density
C. Photon attenuation
Computed tomography (CT) images are formed by the mathematical reconstruction of the relative attenuation of a photon beam passing through the subject being imaged. It is possible to create a mapping between CT image values and physical density using specialized phantoms, but physical density is not the fundamental material property responsible for creating the image. Positron emission tomography (PET) images are most used to evaluate metabolic activity, and magnetic resonance (MR) images are formed using properties of nuclear spin.
What factor principally contributes to the reduced soft tissue contrast in MV portal images as compared to diagnostic radiographs?
A. Photon beam energy
B. Radiation field size
C. Source-to-detector distance
D. Source-to-subject distance
A. Photon beam energy
The higher beam energy in portal images leads to reduced contrast, as the dominant attenuation mechanism is the Compton interaction (independent of atomic number) for a megavoltage beam as opposed to the photoelectric effect (varies exponentially with atomic number) for a kilovoltage beam. While differences in acquisition geometry may affect the magnification or signal, detector response for a given acquisition is relatively uniform across the panel and therefore image contrast is independent of the geometry.
In general, which set of treatment techniques is correctly ordered from least MU to most MU when treating a given target to the same dose prescription?
A. 3D CRT, fixed-gantry IMRT, VMAT
B. 3D CRT, VMAT, fixed-gantry IMRT
C. VMAT, fixed-gantry IMRT, 3D CRT
D. VMAT, 3D CRT, fixed-gantry IMRT
B. 3D CRT, VMAT, fixed-gantry IMRT
While there are variations among treatment sites and planning approaches, estimates in literature suggest that fixed gantry IMRT treatment plans generally require 2-3 times more MU as compared to a 3D conformal technique to deliver equivalent dose to a given target. Arc-based IMRT is more time- and MU-efficient than fixed gantry IMRT, but as an intensity-modulated technique still requires more MU than for an equivalent 3D conformal plan.
There are two types of accelerating waveguides for medical linear accelerators: standing wave and traveling wave. Standing wave linac waveguides are _____ in length than traveling wave but both employ ______to increase the energy of electrons.
A. Shorter; magnetic fields
B. Shorter; microwaves
C. Longer; magnetic fields
D. Longer; microwaves
B. Shorter; microwaves
Linac standing wave waveguides are approximately half the length of traveling wave waveguides because they employ side cavity coupling. In both types of waveguide, the electrons are
accelerated by the electric field of the microwaves that are fed into the waveguide. A magnetic field cannot do work on charged particles and thus cannot increase their energy.
The AAPM Task Group 51 report for linac beam calibration requires that the absolute dose output calibration be performed at least ______with a dosimeter placed in a _________ phantom.
A. Monthly, water
B. Monthly, tissue equivalent solid
C. Annually, water
D. Annually, tissue equivalent solid
C. Annually, water
The TG51 report requires that calibration be performed at least annually in a water phantom. Solid phantoms are not permitted.
The absorbed dose, D1, in a linac beam is measured using an ion chamber placed at depth, d1, within a large water phantom. Water is added to the phantom without moving the ion chamber, and as a result, the ion chamber is now at a depth, d2. With no change in the linac configuration, what is the dose at d2?
A. D1 x TMR(d2)/TMR(d1)
B. D1 x TMR(d1)/TMR(d2)
C. D1 x PDD(d2)/PDD(d1)
D. D1 x PDD(d1)/PDD(d2)
A. D1 x TMR(d2)/TMR(d1)
This is based on the definition of TMR as the ratio of two doses measured at different depths but at the same distance from the source.
An 8-bit gray scale image has __________ shades of gray.
A. 8
B. 16
C. 64
D. 256
D. 256
An 8 bit gray scale contains 28 = 256 shades of gray.
What is the approximate average annual effective dose received by individuals in the US population, including background, medical and consumer exposure?
A. 5 mSv
B. 50 mSv
C. 150 mSv
D. 500 mSv
A. 5 mSv
The average effective dose received annually by a member of the US population is 6.2 mSv. This includes exposure from background, medical exams and consumer products.
In magnetic resonance imaging (MRI), what is “relaxation”?
A. The magnetic susceptibility of the tissue reaching saturation
B. The magnetization of the protons returning to equilibrium
C. The detection of an echo from the tissue voxels
D. A magnetic pulse that flips the spin of the protons
B. The magnetization of the protons returning to equilibrium
In MRI, “relaxation” refers to the return of proton magnetization to its equilibrium value with time- scales T1 and T2.
Why does ICRU 83 define “near minimum” and “near maximum” dose parameters of a target volume?
A. The absolute minimum and maximum dose are difficult to determine
B. The absolute maximum dose is always 100% of the prescribed dose
C. Single voxels may have extreme values
D. The absolute minimum dose is always zero
C. Single voxels may have extreme values
The absolute minimum and maximum dose can be deceiving because they may only occur in a single small voxel and represent an extreme outlier.
What is a difference between pencil beam scanning (PBS) and passive scattering delivery techniques for proton therapy?
A. Dose delivery interplay due to organ motion is less of a problem for PBS
B. Neutron contamination is higher for PBS
C. PBS requires no patient specific beam modifiers
D. Passive scattering does not use a spread-out Bragg peak approach
C. PBS requires no patient specific beam modifiers
Interplay is more problematic when an organ is moving while it is being scanned by the pencil beam. Passive scattering relies on a spread out Bragg peak for target coverage along the beam axis. For passive scattering, distal conformity is achieved with a physical compensator but proximal conformity is more difficult to achieve due to the fixed extent of the spread out Bragg peak.
As compared to a flattened 6 MV photon beam, how does the x-ray energy spectrum of a 6 MV flattening filter free (FFF) beam differ?
A. Lower maximum photon energy
B. Higher maximum photon energy
C. Larger percentage of lower energy photons
D. Larger percentage of higher energy photons
C. Larger percentage of lower energy photons
The maximum photon energy will not change between a flattened 6 MV beam and a 6 MV FFF beam. However, since there is no flattening filter to filter the 6 MV FFF beam, the 6 MV FFF beam will have a higher percentage of lower energy photons as compared to the flattened 6 MV beam due to beam hardening attributed to the flattening filter.
What is the purpose of a scattering foil in a linear accelerator? A. Increase electron energy B. Eliminate photon contamination C. Flatten photon beam profile D. Broaden the electron field
D. Broaden the electron field
The scattering foil is located inside of the treatment head, and it broadens the electron beam to enable delivery of large field sizes.
What is the MOST probable interaction of a 6 MV photon with water?
A. Compton
B. Pair production
C. Photo electric
D. Nuclear interaction
A. Compton
From about 150 KeV to 10 MV photon energies, Compton effect is the most dominant interaction in water.
When using a vented ion chamber, why is it necessary to correct the ion chamber reading for ambient air temperature and pressure?
A. To account for the mass of air within the ion chamber active volume
B. To account for the change in linac dose output with atmosphere
C. To account for polarity effects of the ion chamber
D. To account for ion recombination within the ion chamber
A. To account for the mass of air within the ion chamber active volume
An unsealed ion chamber is affected by both air temperature and pressure because the density of air depends on temperature and pressure. The output of the linac, chamber polarity and ion recombination are not affected by temperature and pressure.
Geometric penumbra is independent of which of the following parameters?
A. Beam energy
B. Beam focal spot size
C. Source to Surface Distance (SSD)
D. Source to Collimator Distance (SCD)
A. Beam energy
Geometric penumbra is cause by the finite size of the focal spot and is dependent on the distance from the source and the distance the collimator is from the source. The beam energy influences the radiative and transmission penumbra due to the lateral scattering range of the secondary electrons and the transmission through the jaw/MLC with higher energies.
For a remote afterloading HDR unit, what is the source positioning accuracy tolerance for daily QA?
A. 0.5 mm
B. 1.0 mm
C. 2.0 mm
D. 3.0 mm
B. 1.0 mm
According to TG-59 and NRC regulations, the required accuracy in source positioning for a remote afterloading HDR Ir-192 source is 1.0 mm.
What is the planning target volume (PTV)?
A. Volume accounting for uncertainties in treatment setup
B. Volume accounting for changes in target shape over treatment course
C. Volume defining the beam block margins to ensure target dose coverage
D. Volume defining the GTV motion during physiological movements
A. Volume accounting for uncertainties in treatment setup
The PTV is created to account for patient movement and set up uncertainties.
Which process is responsible for the generation of photons in the target of a linear accelerator?
A. Photoelectric effect
B. Bremsstrahlung interaction
C. Compton scattering
D. Elastic scattering
B. Bremsstrahlung interaction
Bremsstrahlung is the interaction by which electrons interact very closely with nuclei in the target and are strongly accelerated while irradiating their energy in the form of x-ray
photons. The photoelectric effect and Compton scattering are both photon interactions, not electron interactions. Elastic scattering is when the total kinetic energy is conserved, which is not the case in the production of photons.
When a 6 MeV electron beam strikes a target to produce a photon beam, what is the maximum possible energy of the photon beam?
A. 2 MV
B. 4 MV
C. 6 MV
D. 8 MV
C. 6 MV
The spectrum of a photon beam produced by the Bremsstrahlung interaction is polyenergetic with any energy equal to or less than the initial energy of the electron possible. In this case, the photons in the beam can have any energy less than or equal to 6 MV.
For AP/PA photon fields, when is treating with a higher energy beam preferable to a lower beam energy?
A. Patient with a pacemaker
B. IMRT
C. Superficial target
D. Large treatment area separation
D. Large treatment area separation
The tissue lateral effect demonstrates that a higher beam energy results in a more homogeneous dose than a lower beam energy, an advantage particularly apparent as the patient thickness increases. A higher beam energy is not preferred for either a pacemaker or for IMRT due to neutron dose. A higher beam energy is also not preferred when treating a superficial target since it will have more skin sparing than a lower energy beam.
Which of the following approaches increases the skin dose of an electron beam?
A. Decreasing the electron beam energy
B. Placing a bolus on the patient surface
C. Ensuring the electron beam is perpendicular to the patient surface
D. Mixing a photon beam with the electron beam
B. Placing a bolus on the patient surface
A bolus will move the skin to a deeper portion of the percent depth dose curve, thereby increasing the skin dose. Decreasing the beam energy will decrease surface dose.
Orthogonal beam angles will decrease surface dose as compared to oblique incidence. Adding a photon beam will lower the skin dose since photon beams have more skin sparing.
A full, absolute dose calibration of a megavoltage photon beam using the TG-51 calibration protocol is recommended on what temporal basis?
A. Daily
B. Weekly
C. Monthly
D. Annually
D. Annually
Calibration is recommended (and required by many regulations) on an annual basis by Task Group 142. Verification of the output via spot checks should be performed on a more frequent basis.
For a HDR vaginal cylinder treatment with a dose prescription point 5mm from the cylinder surface, how does the choice of cylinder diameter influence the surface dose?
A. Diameter size does not affect the surface dose
B. Smaller diameter cylinder will lead to a lower surface dose
C. Larger diameter cylinder will lead to a lower surface dose
D. Depends on the HDR radioisotope being used
C. Larger diameter cylinder will lead to a lower surface dose
With a larger diameter cylinder, the surface and prescription points are farther from the source. The inverse square effect becomes less severe with increased distance from the source resulting in less variation between the surface and prescription point. Since in either case the prescription point is getting the same dose, the only difference will be that in the case of a larger diameter, the surface point is not as increased as it would be for a smaller diameter. This physics principle also applies to other radioisotopes and is not exclusive for Ir-192.
What type of image is a port film compared to, in order to quantify patient setup offsets?
A. Digitally reconstructed radiograph (DRR)
B. Treatment planning CT
C. Scout image taken at CT simulation
D. Cone-beam CT (CBCT) taken prior to treatment
A. Digitally reconstructed radiograph (DRR)
A port film is a 2D image and must be compared with a radiographic representation of the patient’s anatomy at the time of simulation which is typically digitally reconstructed in the treatment planning system.
Why does an IMRT treatment require higher confidence in both delivery accuracy and patient setup reproducibility?
A. Uses higher doses per fraction thereby increasing the severity of a geometrical miss
B. Treatment is less susceptible to patient anatomy changes
C. Treatment uses a lower photon beam energy resulting in different effects on surface dose
D. Creates dose distributions with high conformity and sharp dose gradients
D. Creates dose distributions with high conformity and sharp dose gradients
The high dose gradients in IMRT are less forgiving to setup errors than those of open fields with margins in the beam aperture typical of 3D radiation therapy.
If a linac is programmed (i.e. moded up) to generate a photon beam, but the hardware incorrectly configures itself to generate an electron beam, how will the dose rate detected at the monitor chambers change?
A. Increase slightly
B. Increase significantly
C. Decrease slightly
D. Decrease significantly
B. Increase significantly
Due to inefficiencies in x-ray production, the linac operates at a significantly higher dose rate for photon beams compared to electron beams. Furthermore, in this situation, the flattening filter would not have been in place for the photon beam, which also would increase the dose rate incident on the monitor chambers.
When a 10 MV photon beam interacts with a metal prosthesis, why is there an increase in the dose at the proximal edge of the metal interface?
A. Backscatter
B. Attenuation
C. Pair production
D. Photoelectric absorption
A. Backscatter
The increased dose is due to an increase in backscatter at the metal-tissue interface. Attenuation within the metal causes decreased dose downstream. Pair production and photoelectric absorption do not cause increased dose at the interface.
Compared to a hospital EMR, what is a unique feature of a radiation oncology record and verify system?
A. Supplies information that controls radiation treatment delivery
B. Stores medical notes and billing codes
C. Has modules for patient data entry
D. Has settings required to maintain patient security
A. Supplies information that controls radiation treatment delivery
The RO EMR and EMRs for other clinics both contain medical notes and billing codes. There are different vendors for RO EMR’s and EMR’s. Both types of EMR’s require multiple tasks and settings to maintain security. What makes the RO EMR unique is that it contains technical parameters that are used by treatment machines to deliver radiation.
What happens if the applicator treatment length of an HDR treatment channel is entered incorrectly in the treatment plan?
A. The source will dwell at times that are different than intended
B. The source will move to a location different than intended
C. The source step size will be different than the plan
D. The source activity will be different than the plan
B. The source will move to a location different than intended
The applicator treatment length in the HDR plan communicates to the afterloader the maximum distance the source can move to. Source dwell positions are then relative to this maximum distance. If the treatment length in the plan does not match the actual length of the applicator and transfer guide tube system, then the source will move to a position that doesn’t match the intended anatomical treatment position.
What anatomical structure appears larger in a deep inspiration breath hold (DIBH) CT compared with a free breathing CT?
A. Heart
B. Lung
C. Esophagus
D. Trachea
B. Lung
In a deep inspiration breath hold CT, the lung tidal volume is maximized, thus resulting in an increased lung volume in the image. The volume of the heart, esophagus, and trachea aren’t affected by the breath hold.
For the opposed, lateral brain fields of a 3D CRT craniospinal treatment, what limits the maximum extent of the inferior beam edge?
A. Jaw position limits
B. MLC interdigitization limits
C. Mandible position
D. Shoulder position
D. Shoulder position
When the inferior edges of the CSI brain fields are too low, they enter through the shoulders, resulting in an inacceptable dose distribution and unnecessary doses in the shoulders. Jaw position limits, while factor affecting spine fields, do not affect the brain fields. MLC interdigitization limits are not factors for CSI treatments. The maximum extent of the superior edge of the spine field will be limited by the field exiting through the face.
A patient treated for a lung tumor using protons experiences fluid filling around the tumor. Assuming the tumor location does not change, how will the location of the Bragg peaks for each treatment field change relative to their original positions?
A. Peaks will be more distal
B. Peaks will be more proximal
C. Peaks will not change location
D. Peaks will change selectively based on beam energy
B. Peaks will be more proximal
There would be a higher density tissue surrounding the periphery of the lung tumor as compared to the original treatment plan. The increased density would cause the Bragg Peaks to be located more proximal to the original peak location.
