Treatment Planning Chapter 10
3:161
1. The caudal margin of the target volume in patients with endometrial carcinoma is: A. Anterior superioriliac spine
B. Brim of true pelvIs
C. Midobturator foramen
D. Widest point of the bony pelvis
2. Which of the following tissue will most likely require a homogeneity correction factor of .25 gmcc?
A. Uver B. Lung
C. Breast tissue
D. Bone tissue
3:203
3. The target volume for malignancies of the nasopharynx must include all or part of:
1. Base of the skull
3. Suproc/oIJicol lymph nodes
2. Cervical lymph nodes
A. 1 & 2 only B. 1 & 3 only
3;242
C. 2 & 3 only
D. 1.2, & 3
4. During rotation therapies with an arc angle of 100 degrees, the point of maximum dose is normally located:
A. On the isocenter B. Displaced toward the irradiated sector
C. Displaced away from the irradiated sectoB:228
D. At ~epth of Dmax
5. During radiotherapy of the rectum custom shield blocks for the lateral wedged field are designed to reduce
irradiation of the:
3: 190
1. Sacrum
A.
8.
. 2. Urinary bladder
1 & 2 only 1 & 3 only C.
D.
3. Prostate gland
2 & 3 only
1. 2. & 3
6. Preservation of reproductive function when high pelvic irradiation
1. External organ shields
2. Internal organ shields
IS
unavoidable can be accomplished by:
3. Surgical relocation of the gonads
C. 3 only
D. 1. 2. & 3
A. 1 only B. 2 only
3320
7. The mass attenuation coeffiCient for a 10 MeV photon beam will be highest lor: A. Water 8:72
C. Bone
D. Soft tissue
B. Blood
8. What is the geometric penumbra for a 2.0cm diameter source at a 80cm source-to-surface distance (SSD)
and a 40cm source diaphragm distance (SDD) at a depth of 10 cm?
8:64
A. 1.09 B. 1.25 C. 2.50
D. 3.75
9. The amount of geometric penumbra is not effected by the: A. Source skin distance 8:64
C. Field size
D. Source size
B. Source diaphragm distance
10. Tumors that are limited to the upper cervical esophagus are best treated with: A single field treatment B. AP/PA opposed port
A.
C. Three field technique with posterior obliques
D. 360 degree rotation
...
Chapter 10 2:185
56
i..
Treatment Planning
3: 161
11. Target volume lor carcinfJIna 01 the uterine cervix and endometrium includes the_______
1. Uterus 2
3. Regiollal nodes
Upper vagina
A. 1 & 2 only
C.
2 & 3 only
B. 1 & 3 only
D.
1. 2. & 3
8:218
12. Which of the following are advantages of parallel opposed fields:
1. Homogeneous tlmlor dose
2. Setup reproducibility
3. Less chance of geometric miss
C. 2 & 3 only
A. 1 & 2 olily
B. 1 & 3 only
D.
1. 2. & 3
13. In order to maximize tUll10r dose alld lIlinil11ize dose 10 the sllrloullding tissue. which of the following can
be considered.
8: 223
J.
1J5P
0"1""1"'0/1" /11"1111'017.1"
2.
,,,t:lp'I~P ",,,,,I>pf
A. 1 only
B. 2 only
0/ 1"" /1115
C.
3 ollly
D.
1.2. & 3
.1. 11:<01" npprnprlotp "1"0111 p/lprgy
14. The half value layer thickness lor a I UMeV photon energy is about:
11 :61
A.
III 111 AI C.
13 mmPb
S.
IlIIIICU D.
13 1111111120
15. The lise 01 shielding blocks will require dose calculations involving:
1. Depth
2. Blocked field
18:267
3. U"blocked field
A. 1 & 2 only
B. 1 & 301lly
C.
D.
2 & 3 only
1.2. & 3
16. A treatment in which the source·axis distmlce (SAD) remains constant at all limes is referred to as a/an:
A. Split lield technique
B. Mangle technique
17. Which 01 the 101l0wIIIg
1. Ellergv of unit
C. Hypobaric technique
D. Isocentric technique
l1IilV
2.
8:57
3:3
lead to treatment erron. Incorrect dilta concerning
Tumor depth
3. Tumor dose
A. 1 & 2 only
2 & 3 only
D. I. 2. & 3
C.
B. 1 & 3 only
8:213
18. The lilting of an isodose curve Irol1l its normal position Is best accomplished by the use 01:
A. Flallening filters
B. Wedge lilters C.
0
Bolus materials
Build up blocks
19. What is the hinge angle lor a 30 degree wedge?
A. 60 degrees
B. 100 degrees
8:231
C.
D.
120 degrees
150 degrees
20. Calculate the equivalent square lor a 10cm x 15cm rectangular field.
A. 11.1crn x 11.1cIll
S. 121':11I)(] 2clll
8: 165
C. 13cm x Ixm
D
Il\clII x
)1\1"111
21. An area outside the target l'rea which receives a Iligher dose than the specilled target does is termed a:
A. Tolerance sport C
B.
o
Hot spot Cold spot
Threshold
8:235
'I""I
..
Treatment Plannin'g
57 r
Chapter 10
3:3
22. Which of the following may lead to errors in treatment?
1. meg/hie handwriting
2. Miscalculation
01 time
3. Not noting prescriptiOn change
C. 2. & 3 only
A. 1 & 2 only
B. 1 & 3 only
D.
1. 2. & 3
23. In order to obtain accurate measurements of patient dosimetry, which of the following factors must be
considered?
8: 239
1. Target depth
3. Tissue density
2. Body contours
C. 2 & 3 only
1,2. & 3
A. 1 & 2 only
B. 1 & 3 only
D.
3:3
24. The prescription for treatment should include all of the following EXCEPT:
C. Monitor units given
D. Depth of tumor
A. Energy of the unit
B. Total dose planned
25. To maintain a surface dose of less than 50% with a Cobalt beam. an air gap of at least
reqUired.
A. 3cm
is
9:6i
C. 12cm
D. 15cm
B. Scm
26. The dose distribution data measured by a water phantom closely approximates the radiation absorption
and scattering properties. of:
8: 157
1. Bone tissue .' 3. Solt tissue
2. Muscle tissue
A. 1 & 2 only
B. 1 & 3 only
C. 2 & 3 only
D. 1. 2. & 3
27. The most desirable feature of a wedge pair technique is a
1. Rapid dose build-up
2. Rapid dose lall 011
A. 1 only
beyond the overlap region.
8:231
3. Uniform dose distribution
C. 3 only
D. 1.2. & 3
B. 2 only
28. Radiotherapy treatment Simulation is used for:
9:27
1. Determination of po tlent position
2. Checking accuracy 01 bloclc placement
3. Delineate of treatment field
A- I & 2 only
. B. 1 & 3 only
C. 2 & 3 only D. 1.2. & 3 8:268
29. Whenever possible. patient Immobilization should be performed in the:
A. Prone position
B. Supine position C. Lateral position
D. Oblique position
30. The optimum hinge angle for a 60 degree wedge pair is:
A. 30 degrees
8:231
C. 60 degrees
D. 90 degrees
B. 45 degrees
31. The proe.ess that converts ultrasou'nd energy from electrical energy and vice-versa is the:
A. Auger effect
B. Modulation transfer effect
Chapter 10 8:246
C. Piezoelectric effect
D. Van de Graf effect
58
...
"
Treatment Planning
32. The ralionale behind using lower Ihan the 100 percenl isodose curve lor irradiation 01 the chesl wall using
en eleclron beam Is:
8:323
1. Increased skIn sporIng
2. Lower lung exposure
A.
] only
C.
B.
2 only
D.
3. Reduced bolus use
3 only
1. 2, & 3
8:180
33. Irregular fields dose calculations can be done by using the _ _ _ _ __ melhod.
1. SSD
A.
B.
2. Clarkson
3. TMR
1 only
2 only
C.
3 only
D.
1, 2, & 3
8:267
34. One of the weakesl links in the trealment planning process is:
A.
Palient positioning
B.
Isocenlric technique
C. Simulation
D. Localizalion
35. For a Cobalt 60 unit, as the prescriplio;,deplh increases:
1. Tile surface dose Increases
A.
B.
2. The tumor dose Increases
3. The applied dose Increases
C. 2 & 3 only
D. 1. 2, & 3
1 & 2 only
1 & 3 only
8: 129
36. Direct calculation of absorbed dose from a given exposure may nol be used:
,
1. For plloton energies aboup 3 MpV
2. Where electronIc equIlIbrIum does not exIst
3. For electron beams
A.
& 2 ollly
C
2 & 3 only
B.
& 301lly
D.
I, 2, & 3
37. Whal is Ihe principal advafll""I" nflsoccnlric lechnique over SSD techniquE' for a Irealmenl with multiple
ports?
8: 267
A.
Deplh of lumor is known
B.
Laser lights are eesilv used
C.
D
Palienl is nol moved
Field size is defined on Ihe skin
38. The lumor, presumed lurnor lIfld normal surrounding tissues enclosed by IhE' minimum largel dose isodose
surface is called I he:
8: 235
A.
MaximulII larg<,1 volume
C
T reallllenl volumE'
B.
Mean largel volulll<'
D
Miniflllllll I<lIg<'1 volulIlf'
39. One or more serious problelllh) when
1. Underdose to normal
t;SSIl~
1'1
2. Abnormal beam profile
1 only
C
3 ollly
B. 2 only
o
1. 2, & 3
A.
14 :81
Irealmenl field is inaccuralelv alrQfleci is(are)
3
Failure to treat entire tumor
40. Ultrasound provides useful Information fOl patient contours of the follOWing structures, except:
A.
Retroperitoneurn
C
Chest wall
B.
Lung tissue
o
Breast
41. What is the angle between the cent rill lIxis of two beams call('(j?
A.
Hinge allgle
C
Block i'Il1gle
B.
Overlap ollgle
D.
Wedge lingle
Treatment Planning
59
8:245
8:228
...
Chapter 10
52. When treating to
III
8:228
depth 01 5 em using partial are therapy the isoeenter should be:
A. 1.5cm
B. 2.5 cm 5.0 em
7.0 cm
C.
D.
3:3
53. A record of treatment is contained within the:
A. Flow chart B. Patient log book C. Treatment chart
D. Simulation chart
54. For a sloping skin surlace. isodose curves are not perpendicular to the direction of the beam. The skin
sparing effeci call be maintained and the slluallon corrected by using (8):
8: 266
A.
B.
Bolus MllltHield teclll1iques C. Shielding blocks
D. Compensaling wedge filler
55. DUring III givelltrealllleni. a ]U gralll \tllilor receives a uniform dose of 400 rruls. Tile tolal energy absorbed
by this tissue is:
8:122
A. 4 x 10.1 ergs B. 6 x ]O~ ergs 8 x 103 ergs
C.
D.
I)
l<
10II ergs
9:272
56. The use of lymphangiography is an important part 01 a diagnostic workup for:
A.
Vaginal tumors C.
B. Testicular tumors Breast tumors
Brain tumors
D.
57. The strongesl amount of ectlO reflection in an ultrasonic imaging system occurs for which tissue interlace?
2 S<lf' /Issue
1. Muscle - jnl
3. Sof' /Issue - bOlle
jal
8:245
A. 1 only
C.
3 only
B. 2 only D
1.2, & 3
8:52
58. Which 01 the follOWing is a cOllImonly elllploved method 01 tumor localization"
L Pa/pallon
2
C. T. scanning
3.
A. 1 & 2 only
B.
1 & 3 ollly 59. When using
A.
~hieldillg
Radfogrophv
C
2 & 3 onlv
[)
1. 2, & 3
8 187
blocks. whIch 01 lin' lollowing is effected?
Equivalellt square B. S.S.D. C
S TD
[)
SAD
8
60. The wedge used dllliflg Ihe external beam irradiatioll olthe larynx is elllplQI.'4'd to
A.
Increase skin dost' C
Rt'ducp skill dost'
B. Evenly distribult' dOlt' D
Reduce bM:kscalh'rmg
61. The II eatmellt chart contains illlorlllalloll
1. TypE' of cancer
2
lU
33
to
n,corrl of lrE'n'me'I'
gUH'FI
A. 1 & 20llly
C
D
B. 1 & 3 only
62. Determine the equivalenl sqll.:.re lor
C'I
3
pf ,.,,,, ,."n' posllfon
2 & 3 onlv
1. 2. &. 3
rectangul.:.r held wilt. a Width 01 Jelll o'I'Ki ... I""glh 01 J7cm 8165
A. 9.1 C
109
B. 9.9 o
II 6
Trei'lmenl Planlling
[)P.~rlpflO"
6J ...
Chllpt~r
10
63. Determine the equivalent square for a rectangular field With a Width of 8cm and a length of 15cm. 8: 165
C. 9.5
O. 10.4
A. 8.2
B. 8.5
8:166
64. The intensity of a high energy photon beam at any given distance for source is:
A. Directly proportional to the distance
B. Inversely proportional to the square of the distance
C. Directly proportional to the square of the distance
D: Inversely proportional to the distance
65. Air and contrast mix.ture may be introduced into the urinary bladder to:
A. Help minimize the effects of irradiations
B. Provide an internal bolus
3:185
C. Assist in the localization of the bladder
D. Increase the target dose
66. Which of the following Iypes ollreatment machines use a source to the skin distance of 50cm or more?
1. Super/lela I 3. Megavoltage
2. Orthovoltage
C. 3 only
D. 1. 2. & 3
A. 1 only
B. 2 only
67. Which of the following is used to localize the targel volume 01 the prostate?
1. Ultrasound
3. Stereoradiography
2. Orthogonal radiography
A. 1 only
B. 2 only
3;178
C. 30n!y
D. 1. 2. & 3
68. The treatment prescription should define the:
1. Treatment volume
3:3
2. Tumor dose
A. 1 & 2 only
B. 1 & 3 only
3. Number of treatments
C. 2 & 3 only
D. 1. 2. & 3
69. One of the principal reasons that the treatment volume must be larger than the tumor volume is related
to:
1. Movement due to reSp'ratIon
2. Swe11lng caused by prevIous treatments
3. Poss/blle microscopIc j!xtenslons
A. 1 & 2 only
B. 1 & 3 only
C.
2 & 3 only
O.
1. 2. & 3
70. In the
range of photon energies film has been used
accuracy of ± 3%.
10
A. 100 kV
C. 500 kV
B. 250 kV
D. 4 MV
3:6
measure Isodose curves with acceptable
8: 155
71. The use of -negative" shu!ld blocks are mosl commonly employed for treating tumors of the:
A. Lung
B. Abdomen
8:279
C. Head and neck
O. Shoulder
72. Calculate the equivalent lQUare for 8x12cm rectangular field:
A. 8.4cm x 8.4 em
B. 9.6cm x 9.6 cm
Chapter 10 C.
O.
62
8:165
10.2cm x 102 em
11.6cm x. 11.6 cm
,..
'­
Treatment Planning
8:287·
73. Hot and cold spots are common problems associated with:
1. Isocel1t ric fields
3. Four field leclmique
2. Abbuttlng fields
C. 3 only
D. 1, 2, & 3
A. 1 only
B. 2 only
74. Which of the following devices can be used to provide lor cross-section image localization of Internal
8:241
structures?
3. Computed lomography
2. Transverse lomograp/lY
1. Conventional tomograpllY
A. 1 & 2 only
C. 2 & 3 only
D. 1, 2, & 3
B. 1 & 3 only
8:249
7S. The advantages of trealment simulations include:
1. Unforeseen problems catl be solved
2. Increased treatment room 'up' time
3. Improved radiographic qua Illy
A. 1 & 2 only
C. 2 & 3 only
D. 1,2. & 3
B. 1 & 3 only
3:3
76: Which of the following MUST be noted in the trealment chart:
A. Set·up sketch
C. Patient position
D. Patient photograph
B. Dose calculation 77. A lesion is being treated using a 100 degree angle of arc rotalion. The midpoint of the tumor volume Is
Scm. The isocenler should be placed at:
8:228
A. O.5CIII
C. 5cm
D. 7.Scl1l
B. 2.5crn
78. Two treatrll{,llt fil'ld~ on a patient with c:anC'l'r of maxillary sinm have a hingl' ('\lIgle of gO degrees. Calculate
the wedge angle.
8:231
C. 60 degrees
D. 90 degrees
A. 0 degrees
B. 45 degrees 79. During a 4 mV treatment. a sloping skin surface is corrected by a _ _ _ shift toward the skin surface
3: 125
of the isodose curve.
A. 3/4
C.
D
B. 2/3
1/2
1/4
80.. The major advantages 01 megl'lvoltage Irradlallon compared
1. Higher depth dose
2. Less side scalier
10
orlhovoltt'lgc lechnlque Incl\lde:
3
3: I)
Skin sparing
A. 1 & 2 only
C. 2 & 3 only
B. 1 & 3 only
D.
1. 2. & 3
81. The best method for reproducing tire large irregular field required in the radiotherapy of a bronchopulmonary
lesion is best achieved through the use of:
3:208
A. Wedged fields
B. Customized divergent blocks Treatment Planning
C. Customized nOIl·divergent blocks
D Shaped bolus blocks
63 Chapler ]0
B2. When prepering a treatment chart, Which of tke following may lead to treatment errors? Incorrect data
3;3
concerning:
1. Energy of unit
3. MicroscopiC extensions
2. Patient respiration
A. 1 only
B. 2 only C. 3 only
1. 2. & 3
O.
83. A 4 MV pkoton beam is being used at 100cm SAD to treat a lesion using an arc angle of 110 degrees. If
tke midpoint of tke tumor volume is at 5cm. the isocenter should be placed at:
8:228
C. icm
D. 15cm
A. 2cm
B. Scm 84. II the exposure rate of tke Colbalt treatment machine is increased by 30%. which of the lollowing will
increase?
A. Percentage depth dose
B. Tumor dose C. Backscatter factor
D. All of the above
11:349
85. Tumors that are limited to the upper cervical esophagus are first best treated with
spare the cord. oblique parallel opposed technique can be used:
1. A single field treatment
2. Parallel
3
opposed ports
A. 1 only
C. 3 only
B.
D.
2 only then to
360 degree rotation
1. 2. & 3
86. Side and ceiling lasers should intersect at a point in the arc ¢orresponding to the:
1. Rotational axIs
2. SAD of the machine
A. 1 only
B.
22:82
3. /socenrer of the unit
C. 3 only
D. 2. 2. & 3
2 only 3:208
87. The target volume for a bronchopulmonary leSIon should include.
1. Primary leSion
2. MediastInum
C. 2 & 3 on II.
D 1. 2. & 3
A. 1 & 2 only
B.
Hdar nodes
3
1 & 3 only 88. During localization of the target volume 01 the prostrate.
the bladder and the courU! of the urethra distal to Ihe bladder
contrast
IS
C. Iodine contras: media
D Radium
Air B. Nitrogen A.
8:45
89. The penetrating power of an x-ray beam can be increased by
A. Increasing the HVL B.
often used to locate
3: 178
C
D
DecreaSing the kVp DecreaSing tube flltratlon
IncreaSing the tube current
90. The best non-invasive procedure for the evaluation of tumor response or recurrence alter surgery and
irradiation for a brlUn tumor is:
18:267
C
D
A. Computed tomography B. Cerebral angiography Cllrasonography
Radlonuchde scanning
91. The demonstrated tumor and other tissue with presumed tumor
IS
comldered the
Target volume C
IrradIated volume
B. Treatment volume D
MaxImum target volume
A.
Chapter 10 64
.. 8:234
T reatmen! Planning
92. A patient is treated willi two adjacent photon beam fields. 10cm and 12cm in length respectively, at 80
SSD. Calculate tl.e gap on the skin necessary to give a uniform junction at a depth of 13cm.
A. 0.5 cm
B. 1.2
3: 150
C. 1.8 cm
D. 2.4 cm
COl
93. A computer-based svstem tltat compares the treatment that has been set up with a record of the intended
treatment is called a:
A. Closed-circuit system B. Record and verify system C. AFC system
D. Vacuum system
3:3
94. The prescription includes notation of all of the following EXCEPT: A. Daily dose
B. Time or minutes C. Treatment plan
D. Total dose to date
95. Which type of trealrnent will be used for a 2cm source-to-skin distance? 1. Orthouoltage
8:48
3. Superficial
2. Contact A. 1 only
B. 2 only
C.
3 olily
D.
1.2. & 3
8:183
96. Why does the exposure rate Increase as field size Increases? A. Filter flattening B. Block transmission C. Collimator scattering
D. Phantom scattering
97. Spectral energies of a heterogeneolls beam can best be measured with a:
A. Scintillation spectrometer
B. Calorimeter C.
D.
8:120
Point source plotter
Dose rate calibrator
98. The lI1agnitude of higl~ d05(~ regions produced in wedge pair techniques will increase as:
1. Field size Illcrf'oses
2. Wedge angle Increases
A. 1 & 2 only
C.
B. 1 & 3 Dilly
[). 1. 2. & 3
8:231
3. Depth Increases
2 & 3 only
99. The geometriC penumbra 01 a 2 5cm dialllelel source al a 10Ucm 550 and 40cITl source-Io-dlaphragm
distance 1Ucm below the skill surface is:
8:64
2.75
D. 2.34
A. 4.38 C.
B. 3.45 100. The ICRU considers the minimum accuracy of the delivered dose to be
C.
[)
A. 20%
B. 18%
Treatment Planning 65
of the prescribed dose:
9:94
5%
Any of Ih(> lIbovl"
i"
Chapler 10