Practice Exam 4 Flashcards

1
Q

Which machine components are located within the gantry?
(Select all that apply)
A
Electron gun
B
Klystron
C
Accelerator structure
D
Bending magnet

A

A
Electron gun
C
Accelerator structure

The electron gun and accelerator structure are located in the gantry. The klystron is in the drive stand and the bending magnet is in the treatment head.

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2
Q

List the order of machine parts in the linac head for a photon treatment:
A
Target, flattening filter, ion chamber, primary collimators, secondary collimators, MLCs
B
Target, ion chamber, primary collimators, flattening filter, secondary collimators, MLCs
C
Target, flattening filter, primary collimators, ion chambers, secondary collimators, MLCs
D
Target, primary collimators, flattening filter, ion chamber, secondary collimators, MLCs

A

D
Target, primary collimators, flattening filter, ion chamber, secondary collimators, MLCs

The order of machine parts for photon beam treatments = target, primary collimators, flattening filter, ion chamber, secondary collimators, MLCs. When an electron beam is needed, the target and flattening filter are removed. Instead of the flattening filter, we see the scattering foil.

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3
Q

Which agency is responsible for regulating the manufacturing of linear accelerators?
A
The U.S. Environmental Protection Agency (EPA)
B
The U.S. Nuclear Regulatory Commission
C
The Food and Drug Administration (FDA)
D
State Governments

A

C
The Food and Drug Administration (FDA)

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4
Q
  1. Flattening filters are made of high z# (atomic number) materials, in a cone shape (with the thicker section in the center) and helps to reduce the intensity in the center of the beam in efforts to make it more
    uniform or homogenous

(PBI) has become more widely used for the treatment of early stage breast cancer in selected women

A

image is rt breast treatment

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5
Q

The study of the number of people with a disease
A
Epidemiology
B
Etiology
C
Entomology
D
Ethology

A

A
Epidemiology

Epidemiology = the study how many people have a dise

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6
Q

This device creates an even dose distribution and the thickest portion of this device is located centrally.
A
Flattening filter
B
Wedge
C
Compensating filter
D
Scattering foil

A

A
Flattening filter

Flattening filters are made of high z# (atomic number) materials, in a cone shape (with the thicker section in the center) and helps to reduce the intensity in the center of the beam in efforts to make it more uniform or homogenous.

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7
Q

PPD is affected by:
(Select all that apply)
A
Energy
B
Depth
C
SSD
D
SAD

A

D
SAD

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8
Q

Which agency is responsible for protecting the health and safety of the public against radioactive materials?
A
The U.S. Environmental Protection Agency (EPA)
B
The U.S. Nuclear Regulatory Commission
C
The Food and Drug Administration (FDA)
D
State Governments

A

B
The U.S. Nuclear Regulatory Commission

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9
Q

Which of the following techniques could be used to reduce tumor motion?
(Select all that apply)
A
DIBH
B
Gating
C
Abdominal compression
D
4D CT

A

A
DIBH
B
Gating
C
Abdominal compression

Tumor motion can be reduced using DIBH, gating, and abdominal compression techniques. 4D CTs do not reduce tumor motion, but rather track the motion during the scan to show the full motion of the tumor on all breathing phases.

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10
Q

Which organ does NOT have a tolerance dose of 4500 cGy?
A
Colon
B
Heart
C
Eye retina
D
Brain

A

B
Heart

Colon, eye retina and brain have a tolerance dose of 4500 cGy for the whole organ. The heart has a tolerance dose of 4000 cGy for the whole organ.

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11
Q

Tumor differentiation also determines:
A
Grade
B
Stage
C
Metastasis
D
Size

A

A
Grade

Tumor grade is determined by examining how a cell looks under a microscope. If it resembles normal cells, it is said to be “well-differentiated” and less aggressive. If it does not resemble normal cells, it is “undifferentiated” and is more aggressive.

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12
Q

Which machine components are located within the drive stand?
(Select all that apply)
A
Klystron
B
Circulator
C
Power supply
D
Accelerator structure

A

A
Klystron
B
Circulator

The drive stand contains the klystron and circulator. The power supply is a separate component. The accelerator structure is located in the gantry.

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13
Q

The occupational exposure limits are ______ than public exposure limits.
A
2x more
B
2x less
C
10x more
D
10x less

A

C
10x more

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14
Q

Which of the following are NOT considered sterile
A
Areas from the waist level and up
B
Areas from the knee level and up
C
Passing another person front to front
D
Passing another person back to back

A

B
Areas from the knee level and up

C
Passing another person front to front

There are specific rules to be followed for sterile techniques. Sterile fields occur at the level of the tabletop and waist level and up (below this level is not sterile). No one should lean over the sterile field. Once sterile item becomes wet, it is no longer sterile. Contact between sterile objects and non-sterile objects should be avoided. When two sterile people are passing each other, they must pass back-to-back.

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15
Q

When viewing an axial image, which directions can the patient be moved in?
(Select all that apply)
A
Anterior and posterior
B
Left and right
C
Superior and Inferior
D
The patient can only be adjusted in 1 of the above

A

A
Anterior and posterior
B
Left and right

Axial images allow matching to occur in the anterior and posterior direction as well as the left to right direction. The superior and inferior directions are not visualized on an axial image.

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16
Q

This image represents a 3D or complex treatment plan to the rectum. The treatment fields are “boxier” in appearance and less conformal than IMRT or SBRT would be.

A

3D is Boxier

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17
Q

The stage of acute radiation syndromes that is also called NVD due to nausea, vomiting and diarrhea is called:
A
Prodromal
B
Manifest
C
Latent
D
Recovery

A

A
Prodromal

Prodromal stage of ARS: Symptoms include nausea, vomiting, anorexia, and/or diarrhea and can appear within minutes to days of radiation exposure.

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18
Q

Which structure is located around the vertebral level of T4-T5?
A
Hyoid bone
B
Xiphoid
C
GE junction
D
Carina

A

D
Carina

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19
Q

Which type of breast surgery removes chest wall muscles?
A
Radical mastectomy
B
Total mastectomy
C
Simple mastectomy
D
Lumpectomy

A

A
Radical mastectomy

Simple mastectomy: involves removing the breast along with an ellipse of skin that encompasses the nipple-areola complex.

Lumpectomy: is a type of breast cancer surgery in which the tumor and a small amount of surrounding tissue called the margin is removed

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20
Q

What is the proper order of machine parts for a photon beam?
A
Electron gun, accelerator structure, bending magnet, target
B
Accelerator structure, electron gun, target, bending magnet
C
Electron gun, accelerator structure, target, bending magnet
D
Electron gun, target, accelerator structure, bending magnet

A

A
Electron gun, accelerator structure, bending magnet, target

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21
Q

What is the typical gantry angle used for supraclavicular fields?
A
0 degrees
B
5 - 10 degrees
C
10 - 15 degrees
D
15 - 20 degrees

A

C
10-15 degrees for a supraclavicular field of 3 field breast techniques. This angle avoids the spinal cord.

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22
Q

Which machine components are located within the treatment head?
(Select all that apply)
A
Electron gun
B
Target
C
Ion chambers
D
Water cooling system

A

B & C
The target and ion chambers are located in the treatment head. The electron gun is within the gantry. The water-cooling system is within the drive stand.

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23
Q

When viewing sagittal images, which directions can the patient be moved in?
(Select all that apply)
A
Anterior and posterior
B
Left and right
C
Superior and inferior
D
The patient can only be adjusted in 1 of the above

A

A & C
Sagittal images allow matching to occur in the anterior and posterior direction as well as the superior to inferior directions. The left and right directions are not visualized on an Sagittal image.

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24
Q

Which of the following does NOT need to be on a consent form?
A
Treatment site
B
Laterality and body part
C
Risks and benefits of treatments
D
Treatment dose

A

D
Treatment dose

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25
Q

Which acute radiation syndrome has the shortest latent stage?
A
Bone marrow syndrome
B
GI syndrome
C
CNS syndrome

A
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26
Q

Which of the following couch adjustments can be made with a 6 DoF couch?
A
Pitch
B
Roll
C
Rotation
D
All of the above

A

(D) All of the above

6 DoF (6 degrees of freedom) couches allow for adjustments in the pitch, roll and rotational directions.

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27
Q

Which organ is most susceptible to damage from contrast media use?
A
Heart
B
Kidneys
C
Liver
D
Bladder

A

(B) Kidney

Kidneys are most susceptible to damage during contrast media use in CT simulation. This is why BUN, creatinine and eGFR levels are checked prior to use.

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28
Q

Compared to machines that only treat complex treatments, machines that treat SBRT treatments have:
A
A smaller laser tolerance
B
A larger laser tolerance
C
The same laser tolerance
D
No laser tolerance

A

A
A smaller laser tolerance

  1. Laser tolerances is specific to machine type and are stricter for machines treating SBRT treatments (1 mm) compared to machines treating only complex, non-SBRT treatments (2mm) and IMRT treatments (1.5 mm).
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29
Q

Decisions such as CPR, ventilation devices, palliative care options, etc. should be outlined on this document:
A
Bill of Rights
B
Living will
C
Consent form
D
Healthcare proxy

A

B
Living will

Living wills are legal documents that state the patient’s choice for their health care when they become terminally sick.

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30
Q

The patient is prescribed 180 cGy and is to be treated at 100 SSD. What does did the patient receive if they were accidentally treated at 90 SSD?
A
162 cGy
B
200 cGy
C
222 cGy
D
267 cGy

A

C
222 cGy

Inverse square law factor to find overdose: (100/90)^2 x 180 =222 cGy

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31
Q

Prostate seeds are considered which type of brachytherapy?
A
Intracavitary
B
Interstitial
C
External applicator
D
Intraluminal

A

B
Interstitial

Interstitial brachytherapy = radioactive sources placed with needles, wires, or seeds directly into malignant tissues (Palladium - 103)

Intracavitary = implants are performed by placing the radioactive material into body cavity (cervical or endometrium)

Intraluminal brachytherapy = placement source of radiation within body tubes (such as esophagus, trachea, and bronchus via catheters

Intrathecal = occurring within or administered into spinal theca

32
Q

What is the main difference between VMAT (Volumetric Modulated Arc Therapy) and IMRT (Intensity Modulated Arc Therapy)?
A
Gantry & MLCs move during VMAT and only MLCs move during IMRT
B
Gantry & MLCs move during IMRT and only MLCs move during VMAT
C
VMAT is the same as IMRT
D
MLCs are stationary during VMAT and moving during IMRT.

A

A
Gantry & MLCs move during VMAT and only MLCs move during IMRT

IMRT treatments have fixed gantry angles while MLCs move to create modulated beams. VMAT uses the MLC movement along with gantry motion during treatment (arc therapy).

33
Q

The most common pathology for tumors in the urethra are?
A
Adenocarcinomas
B
Transitional cell carcinomas
C
Sarcomas
D
Squamous cell carcinomas

A

D
Squamous cell carcinomas

34
Q

Which device is MR safe?
A
Implanted neurostimulators
B
Cochlear implants
C
Breast tissue expanders
D
Aneurysm clip

A
  1. Aneurysm clips are considered MR-safe. (non magnetic can get MRI
35
Q

What is the last step when donning PPE?
A
Gown
B
Gloves
C
Goggles
D
Mask

A

B
Gloves

The proper order for donning (putting on) PPE per CDC guidelines: first put on gown, then mask or respirator, then goggles or face shield, and last put on gloves.

36
Q

What is the purpose of imaging studies before brachytherapy?
(Select all that apply)
A
To identify the location and size of the tumor
B
To ensure that the radioactive source is placed in the correct location
C
To minimize the damage to healthy tissue
D
To ensure the proper source is being used

A

A
To identify the location and size of the tumor
B
To ensure that the radioactive source is placed in the correct location
C
To minimize the damage to healthy tissue

37
Q

Which of the following would be a reason why supraclavicular fields are included in breast treatments?
(Select all that apply)
A
Stage N2-N3
B
Tumor is located in superior aspect of breast
C
Routine following whole breast
D
4+ positive axillary lymph nodes

A

A
Stage N2-N3
or
D
4+ positive axillary lymph nodes

38
Q
  1. This treatment technique is VMAT. This is more conformal than 3D or complex treatments. IMRT would appear with a “star-fish” appearance because we can see each beam entrance and exit, while VMAT looks smoother
A

more conformal

39
Q

What is a product of pair production?
(Select all that apply)
A
Electron
B
Neutron
C
Positron
D
Isotope

A

A
Electron
C
Positron (positive electron)

Pair production = incoming photon disappears and then reappears as an electron positron pair.

40
Q

The staging system associated with Hodgkin’s lymphoma is?
A
Ann Arbor
B
FIGO
C
Dukes
D
Gleason

A

A
Ann Arbor

41
Q

Which of the following indicates that nodal spread has not been assessed?
A
TXN1M0
B
T1N1M0
C
T2NXM0
D
T4N3MX

A

C
T2NXM0

The “N” in staging represents involvement in regional lymph nodes. N1-N3 refers to the number and location of lymph nodes involved. NX refers to instances when cancer involved in lymph cannot be measured or assessed.

42
Q

Which of the following is a common side effect of radiation therapy for head and neck cancer?
A
Weight gain
B
Hair loss
C
Nausea and vomiting
D
Dry mouth

A

D
Dry mouth

Dry mouth is a common side effect when irradiating head and neck cancers due to the involvement of parotid gland in treatment fields (xerostomia)

43
Q

Photoelectric effect would be most predominant in which imaging techniques?
(Select all that apply)
A
Portal imaging
B
KV pairs
C
kV-CBCT
D
MV-CBCT

A

B
KV pairs
C
kV-CBCT

Photoelectric effect is predominant in kV ranges. Imaging in kV ranges includes, KV pairs and kV-CBCTs. MV imaging typically involved more Compton effects.

44
Q

What is the most common type of brachytherapy used for prostate cancer?
A
High-dose rate (HDR) brachytherapy
B
Low-dose rate (LDR) brachytherapy
C
Interoperative brachytherapy
D
Intracavitary brachytherapy

A

B
Low-dose rate (LDR) brachytherapy

45
Q

What is the percent error if the patient was prescribed 300 cGy at 80 cm SSD if they were accidentally treated at 90 cm SSD?
A
21% underdose
B
21% overdose
C
27% underdose
D
27% overdose

A

D
27% underdose
Inverse square law factor to find overdose: (90/80)^2 x 100%=127% aka 27% over intended dose of 100%.

46
Q

What is the purpose of the waveguide in a linear accelerator?
A
To accelerate the electrons to high energies
B
To focus the electron beam
C
To generate high-energy photons
D
To cool the electron beam

A

A
To accelerate the electrons to high energies

47
Q

Which of the following can impact the interpretation of nonverbal communication?
A
Cultural differences
B
Personal biases
C
Emotional state
D
All of the above

A

D
All of the above

48
Q

What is the relationship between wavelength and frequency of electromagnetic radiation?
A
The longer the wavelength, the higher the frequency
B
The shorter the wavelength, the higher the frequency
C
There is no relationship between wavelength and frequency
D
The relationship is inverse: the shorter the wavelength, the lower the frequency

A

B
The shorter the wavelength, the higher the frequency

Wavelength and frequency have an inverse relationship. The shorter the wavelength, the higher the frequency.

49
Q

Which factor has an inverse relationship with PDD?
A
Depth
B
SSD
C
Field size
D
Beam quality

A

A
Depth

PDD has an inverse relationship with the depth past dmax. As the depth past dmax increases, the amount of dose available lessens.

50
Q

What is negligence?
A
A healthcare professional intentionally caused harm to the patient
B
A healthcare professional did not follow the standard of care, resulting in harm to a patient
C
Side effects caused because a patient refused to follow the treatment plan recommended by a healthcare professional
D
Side effects caused from radiation therapy, despite the healthcare professional’s best efforts to prevent them

A

A
A healthcare professional intentionally caused harm to the patient

51
Q

Which material would have the highest stopping power for electrons?
A
Air
B
Water
C
Lead
D
Bone

A

C
Lead

52
Q

How is field size related to PDD?
A
As field size increases, PDD decreases due to scatter
B
Field size has no effect on PDD
C
As field size decreases, PDD increases due to scatter
D
As field size increases, PDD increases due to scatter

A

D
As field size increases, PDD increases due to scatter

53
Q

The stage of acute radiation syndromes where the patient looks and feels healthy, although cells are rapidly dying is called
A
Prodromal
B
Manifest
C
Latent
D
Recovery

A

C
Latent

54
Q

The patient is positioned head first prone for a PA treatment. The patient is accidentally treated with a posterior isoshift of 3 cm. How does this affect the dose to the planned isocenter?
A
No effect
B
Planned iso is underdosed
C
Planned iso is overdosed

A

B
Planned iso is underdosed

55
Q

Which of the following cancers is associated with HPV?
A
Oral cavity
B
Salivary glands
C
Astrocytoma
D
Papillary thyroid

A

A
Oral cavity

56
Q

Atomic nuclei with differing Z numbers, but the same Atomic mass number?
A
Isobar
B
Isomer
C
Isotone
D
Isotope

A

A
Isobar

Isotope: Same number protons

Isotone: same number neutrons different number protons

Isomer: each of two or more atomic nuclei that have the same atomic number and the same mass number but different energy states.

57
Q

Which QA tests should be performed at least daily?
(Select all that apply)
A
Lasers
B
Output
C
Emergency off buttons
D
Light field/Radiation field coincidence

A

A
Lasers
B
Output

Lasers and output are checked daily. Emergency off buttons and the light and radiation field coincidence tests are checked monthly.

58
Q

Vaginal cylinders are considered:
(Select all that apply)
A
Intraluminal
B
Intracavitary
C
HDR
D
LDR

A

B
Intracavitary
C
HDR

59
Q

Which of the following is an example of a late effect of radiation therapy?
A
Nausea and vomiting
B
Skin irritation
C
Fibrosis
D
All of the above

A

C
Fibrosis

Fibrosis is a late effect of radiation therapy while nausea, vomiting and skin irritations are early effects.

60
Q

Which of the following factors can affect the shape of the isodose distribution in radiation therapy?
A
Patient anatomy
B
Treatment machine parameters
C
Treatment field size
D
All of the above

A

D
All of the above

Factors that can change the isodose distribution are patient anatomy, treatment machine parameters, beam energy, beam type, source-to-surface distance, field weighting, beam modifiers, and field size.

Machine parameters monitored include meterset (e.g., monitor units [MU] or time), gantry position, collimator and aperture 􏰂􏰇􏰃􏰃􏰋􏰉􏰔􏰂􏰎 􏰃􏰌􏰘􏰍􏰇 􏰒􏰁􏰂􏰋􏰃􏰋􏰁􏰉􏰎 􏰌􏰐􏰈 􏰊􏰇􏰐􏰂􏰓􏰂 􏰞􏰖􏰇􏰏 􏰃􏰐􏰇􏰌􏰃􏰑􏰇􏰉􏰃􏰎 􏰌􏰉􏰏 􏰃􏰆􏰇 􏰓􏰂􏰇 􏰁􏰅 􏰘􏰇􏰌􏰑 􏰑􏰁􏰏􏰋􏰞􏰇􏰐􏰂􏰚

61
Q

Which type of imaging will cause the MOST compton scatter?
A
Portal images
B
KV-KV pair
C
CBCT
D
CT simulation

A

A
Portal images

MV sources create the most Compton scatter. Portal imaging occurs from the MV source.

62
Q

The scattering foil is used to:
A
Reduce “horns” in beam
B
Reduce dose to the center of the beam
C
Accelerate electrons
D
Spread out electron beam

A

D
Spread out electron beam

63
Q

The term “in situ” means:
A
Tumor has not invaded basement membrane
B
Tumor has spread to local organs
C
Tumor has seeded throughout cavity
D
Tumor cannot be assessed

A

A
Tumor has not invaded basement membrane

64
Q

Define a “tort”
A
A type of cancer that can be treated using radiation therapy
B
A legal term used in malpractice lawsuits to describe harm caused by a healthcare professional
C
A form of verbal permission to proceed with radiation treatments
D
The process of payment of radiation services

A

B
A legal term used in malpractice lawsuits to describe harm caused by a healthcare professional

65
Q

Which of the following particles has the highest ionizing power?
A
Alpha particles
B
Beta particles
C
Gamma rays
D
X-rays

A

A
Alpha particles have the highest LET and highest ionizing power.

66
Q

Which of the following types of radiation can be detected using a Geiger-Muller counter?
A
Alpha particles
B
Beta particles
C
Gamma rays
D
Neutrons

A

C
Gamma rays

GM counters can detect gamma rays and x-rays.

67
Q

Which of the following is a risk factor for developing head and neck cancer?
A
Exercise
B
Low alcohol consumption
C
Human papilloma virus (HPV) infection
D
High fiber diet

A

C
Human papilloma virus (HPV) infection

68
Q

What is low-dose rate (LDR) brachytherapy?
A
A type of brachytherapy in which a high dose of radiation is delivered over a short period of time
B
A type of brachytherapy in which a low dose of radiation is delivered continuously over a longer period of time
C
A type of external beam radiation therapy
D
A concomitant chemo treatment

A

B
A type of brachytherapy in which a low dose of radiation is delivered continuously over a longer period of tim

69
Q

What is an isodose line in radiation therapy?
A
A line representing the boundary of the treatment field
B
A line representing the location of the tumor
C
A line representing the level of radiation dose in a patient
D
A line representing the location of the radiation source

A

C
A line representing the level of radiation dose in a patient

70
Q

How does IMRT deliver varying radiation doses to different parts of the tumor?
A
By using a single beam of radiation that is modulated during treatment
B
By using a single beam of radiation that is fixed during treatment
C
By using multiple beams of radiation that are modulated during treatment
D
By using multiple beams of radiation that are fixed during treatment

A

C
By using multiple beams of radiation that are modulated during treatment

IMRT uses multiple beams (beamlets) of radiation that are modulated during treatment to create a non-uniform beam.

71
Q

What does CPT stand for in medical billing and coding?
A
Clinical Payment Terminology
B
Current Procedural Terminology
C
Certified Professional Therapy
D
Clinical Procedure Tracking

A

B
Current Procedural Terminology

72
Q

What is the standard fractionation scheme for whole brain radiation therapy?
A
10 Gy x 3 fractions
B
20 Gy x 5 fractions
C
30 Gy x 10 fractions
D
40 Gy x 20 fractions

A

C
30 Gy x 10 fractions

73
Q

What is a sentinel lymph node?
A
The largest lymph node in the body
B
The first lymph node to receive drainage from a tumor
C
A type of lymphocyte involved in the immune response
D
The lymph node closest to the heart

A

B
A sentinel lymph node is the first lymph node to receive drainage from a tumor and is often checked for spread of cancer.

74
Q

Which of the following is NOT a common classification of chemotherapy drugs?
A
Alkylating agents
B
Antimetabolites
C
Anticoagulants
D
Topoisomerase inhibitors

A

C
Anticoagulant is not a chemotherapy, but rather a blood thinner.

Topoisomerase inhibitors: interferes w/ enzymes n DNA replication (topotecan, etoposide etc)

Antimetabolites: disturbs formation of nuclei n cell reproduction S phase.

Alkylating agent: stops cell division by damaging DNA.

Corticosteroids: hormone like drug (prednisone n dexamethasone)

Nitrosoureas: Hinders DNA synthesis n crosses BBB (carmustine, lomustine, streptozocin)

Antitumor Antibiotics: stops DNA/RNA transcription, does not treat infection. Not specific more effective S n G2. (Adriamycon (can cause cardiac toxicity) (Bleomycin (can cause lung toxicity)

75
Q

What type of photon interaction creates majority of scattered radiation on a port film?
A
Photoelectric effect
B
Compton scattering
C
Pair production
D
Photodisintegration

A

B
Compton scatteringis primarily responsible for scatter in MV ranges (port films).