Exam 2 Poll Questions & Self Assessment

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***The tolerance for annual output calibration is what?

1% absolute

For LDR treatments, radiation surveys are performed: (Select all that apply) 1. After implantation of the sources 2. After removal of the sources 3. To ensure protection of adjoining rooms or hallways 4. On the remote afterloader unit

1. After implantation of the sources 2. After removal of the sources 3. To ensure protection of adjoining rooms or hallways

Departments should prepare an annual QA report including various aspects of treatment planning including: (Select all that apply) 1. Dosimetry 2. Mechanical 3. Spatial Devices & Procedures 4. Safety 5. Imaging 6. Annual Summary of Patient Diagnoses

1. Dosimetry 2. Mechanical 3. Spatial Devices & Procedures 4. Safety 5. Imaging

***Which of the following are daily testing completed on the linear accelerator - as recommended by the AAPM. (Select all that apply) 1. Laser location 2. Photon & Electron Output Constancy 3. X-ray beam and flatness 4. Light/ Radiation Field Coincidence 5. Collimator Size Indicator 6. Distance Indicator (ODI)

1. Laser Localization 2. Photon and Electron Output Constancy 5. Collimator Size Indicator 6. Distance Indicator (ODI)

***(asked to select which statement wouldn't be on the sign on one of these patient's doors and I chose no visitor under 5) Which of the following are safety requirements for inpatient LDR brachytherapy procedures? (Select all that apply) 1. No visitors under 18 years of age are permitted 2. Pregnant women are limited to 30 min visits 3. Visitors are instructed to stand at least 6 feet away from the patient 4. All visitors must check with hospital staff before entering the room

1. No visitors under 18 years of age are permitted 3. Visitors are instructed to stand at least 6 feet from the patient 4. All visitors must check with hospital staff before entering the room

Which of the following are true regarding monthly output constancy? (Select all that apply) 1. Performed with the use of a solid water phantom or water bath, ion chamber, and an electrometer 2.Tolerance is more strict than daily output checks 3. When testing photon output, the ion chamber should be placed at 10 cm depth 4. Reference setup is 20x20cm field size, 100cm 5. The depth of the ion chamber varies depending on the electron energy

1. Performed with the use of a solid water phantom or water bath, ion chamber, and an electrometer 2. Tolerance is more strict than daily output checks 3. When testing photon output, the ion chamber should be placed at 10 cm depth 5. The depth of the ion chamber varies depending on the electron energy

Which of the following statements are true regarding Proton quality control? 1. The functionality of door interlocks and proton beam on light must be checked 2. Mechanical components of the couch movement and imaging panel positioning must be checked - Tolerance of 2mm. 3. Beam output must be checked - Tolerance less than 3% 4. Beam symmetry must be checked - Tolerance less than 3%

1. The functionality of door interlocks and proton beam on light must be checked 3. Beam output must be checked- Tolerance less than 3% 4. Beam symmetry must be checked - Tolerance less than 3%

***The AAPM recommends hardware and software testing to be done to ensure image input and hardcopy output fall within a _____ tolerance.

1mm

***Which of the following are true regarding the "picket fence test?" (Select all that apply.) 1. Performed to verify radiation isocenter 2. Performed on a weekly basis for any machine that treats IMRT or Arc Therapy 3. It is a Qualitative test 4. Performed to verify the effectiveness of the MLC and ensure no excess radiation beam is transmitted through the leafs

2. Performed on a weekly basis for any machine that treats IMRT or Arc Therapy 3. It is a Qualitative test 4. Performed to verify the effectiveness of the MLC and ensure no excess radiation beam is transmitted through the leafs

***The tolerance for the daily Cobalt-60 checks of Laser Alignment & ODI should be what?

2mm

Unrestricted areas must not exceed ______ in any one hour or ______ in a year. A. 2rem; 100rem B. 2mrem; 100mrem C. 2mSv; 100mSv D. 100mrem; 200mrem

2mrem; 100mrem

Remote afterloadersource positioning should be within: A.+/-1mm B.+/-2mm C.+/-1cm D.+/-2cm

A. +/- 1 mm

***Spatial integrity is verified in the x or y direction on a daily basis, and both are verified on a monthly basis. The tolerance for spatial integrity is _______ in the entire scan field. A. +/- 1mm B. +/- 1.5mm C. +/- 2mm D. +/- 3mm

A. +/- 1mm

Low dose rate (LDR) brachytherapy delivers a dose between __ -__ Gy/h. a.0.4 -2 b.0.2 -2 c.0.4 -4 d.0.2 -4

A. 0.4-2 Gy

The tolerance for remote after loader source positioning should be within +/- ______mm A. 1 B. 2 C. 3 D. 5

A. 1

***Collimator Size Indicator has a tolerance of ________ for IMRT Treatments. A.2 mm B.1.5 mm C.1 mm D.1.5 cm

A. 2 mm

***The distance indicator (ODI) has a tolerance of: A. 2mm B. 2 degrees C. 1mm D. 1 degree

A. 2mm

Intracavitaryimplants are... a.Always temporary. b.Only used to treat cervical cancers. c.The same thing as interstitial brachytherapy d.All of the above.

A. Always temporary

Which of the following monthly respiratory gating tests does not have a tolerance of Functional/Non-functional? A. Beam Output Constancy B. Phase, Amplitude Beam Control C. In-Room Respiratory Monitoring System D. Gating Interlock

A. Beam output constancy

***Which of the following accurately matches the CT Simulator QC test with the frequency that is recommended by the AAPM? A.Contrast Resolution-Annually | CT Gantry Laser Alignment-Daily | Imaging Noise-Daily B.Contrast Resolution-Daily | CT Gantry Laser Alignment-Daily | Imaging Noise-Annually C.Contrast Resolution-Monthly | CT Gantry Laser Alignment-Monthly | Imaging Noise-Monthly D.Contrast Resolution-Monthly | CT Gantry Laser Alignment-Daily | Imaging Noise-Daily

A. Contrast Resolution-Annually CT Gantry Laser Alignment- Daily Imaging Noise- Daily

***(know cross hair and then there were others but I can't remember them, it's matching) Misalignment or warping of mylar is an influencing factor for which of the following monthly tests? A. Cross Hair Centering B. Jaw Symmetry C. Linear Scales of Treatment Table D. Light/Radiation Field Coincidence

A. Cross Hair Centering

*** (the question was for temp and pressure and it asks what happens to both if they're decreased) If the temperature in the room increases, the ionizations will ______________. A.Decrease B.Increase C.Remain the same

A. Decrease

***Variation of dose relative to the central axis over the central 80% of the field size (reference region) at a 10cm depth in a plane perpendicular to the central axis is referring to beam ______________. A.Flatness B.Symmetry C.Distribution D.Delivery

A. Flatness

Which of the following is NOT an influencing factor for testing linear scales of the treatment table? A.Jaw Misalignment B.Set up Error C.Table Sag D.Electrical Failure

A. Jaw Misalignment

The collimator size indicator is checked daily - Tolerances are: A. Non-IMRT: 2mm IMRT: 2mm SRS/SBRT: 1mm B. Non-IMRT: 2mm IMRT: 1mm SRS/SBRT: 1mm C. Non-IMRT: 2mm IMRT: 1.5mm SRS/SBRT: 1mm D. Non-IMRT: 2mm IMRT: 2mm SRS/SBRT: 2mm

A. Non-IMRT: 2mm IMRT: 2mm SRS/SBRT: 1mm

***Misalignment of the ________ could cause photon beam flatness to be out of tolerance. A.Target B.Scattering Foil C.Monitoring Chamber D.Table

A. Target

***An autoradiograph is taken to verify the source's _____________. A. Uniformity & Symmetry B. Activity C. Half-Life D. Applicator Length

A. Uniformity & Symmetry

The picket fence test is used for: A.Verifying Calibration and Accuracy of MLC Leaves B.Verifying Radiation Isocenter C.Verifying Gantry/Couch/Collimator Rotation D.Verifying Speed of MLC Leaves

A. Verifying Calibration and Accuracy of MLC Leaves

Which fo the following is incorrect regarding Beam Flatness and Symmetry? A. When considering beam flatness, the tolerance for photon Non-IMRT is 3% B. When considering beam flatness, the tolerance for electron Non-IMRT is 3% C. When considering beam symmetry, the tolerance for photon and electron Non-IMRT is 3% D. When considering BOTH beam flatness and symmetry, the tolerance for photon and electron IMRT & SRS/SBRT is 1 %

A. When considering beam flatness, the tolerance for photon Non-IMRT is 3%

Which of the following are true regarding Quality Assurance tests for Image Noise? 1. Performed Daily 2. A region of interest is used to perform the calculation 3. Tolerance is manufacturer specific 4. Use same phantom slice that was used to evaluate CT number accuracy

All of them

Which of the following are true regarding daily output constancy checks? (Select all that apply) 1. Verified with the use of a multidetector array 2. 20x 20cm field size is set 3. Performed at a distance of 100 cm 4. Measures beam energy to ensure accuracy of the radiation beam

All of them

Which of the following statements regarding laser alignment are true? (Select all that apply) 1. The orientation of the gantry and wall lasers should be parallel and orthogonal to the imaging plane 2. Gantry lasers should align with the center of the imaging plane 3. The ceiling lasers should be orthogonal to the imaging plane 4. The positioning of the gantry lasers should be checked daily 5. The tolerance for all required laser alignment checks is +/- 2mm

All of them

Which of the statements are true regard the light/radiation field coincidence test? (Select all that apply) 1. The purpose is to ensure the light field shown on the patient matches the actual radiation field being treated 2. Tolerance is 2mm or 1% on a side 3. Performed with varying field sizes 4. Equipment required: Film or OBI 5. Possible influencing factors include setup error, mirror misalignment, light bulb misalignment, light bulb failure, and jaw misalignment

All of them

***How often is spatial resolution verified?

Annually

***The daily gantry laser alignment should have a tolerance of... A.+/-1mm B.+/-2mm C.+/-1 degree D.+/-2 degrees E.None of the above, it is not recommended that gantry lasers are checked daily.

B. +/- 2 mm

***Laser alignment should be within: A. +/- 1mm B. +/- 2mm C. +/- 2cm D. +/- 1cm

B. +/- 2mm

The tolerance for the linear scale of the treatment table is: A.1mm B.2mm C.1 degree D.2 degree

B. 2 mm

***Distance Indicator (ODI) has a tolerance of ________ for IMRT Treatments. A.3mm tolerance B.2 mm tolerance C.1.5 mm tolerance D.1 mm tolerance

B. 2 mm tolerance

Unrestricted areas cannot exceed: A.2 rem/hour B.2mrem/hour C.20 mrem/hour D.Unrestricted areas are not surveyed

B. 2mrem/hour

***Intracavitary and interstitial sources are individually calibrated to verify source strength - The strength should fall within +/- ______mm of the manufacturer's value. A. 2 B. 3 C. 1 D. 5

B. 3

***(it was in a question asking what wasn't a true statement for brachy and it said you keep it for 12 years) Documentation must be kept for A.2 Years B.3 Years C.4 Years D.6 Months

B. 3 Years

The daily CT number test is verifying the CT number for water, but the monthly test will verify the accuracy of the CT numbers for different materials such as..... A.Air, Bone, Sucrose, and Polyethylene B.Air, Bone, Acrylic, and Polyethylene C.Air, Bone, Bowel, and Tissue D.Air, Bone, Tissue, and Polyethylene

B. Air, Bone, Acrylic, and Polyethylene

Which of the following is not true regarding contrast resolution? a)Also known as Low contrast resolution b)Also known as High contrast resolution c)The ability to discriminate between similar tissue densities d)Performed annually

B. Also known as High contrast resolution

All of the following are monthly tests for respiratory gating except: A.Beam Output Constancy B.Beam Energy Constancy C.Phase, Amplitude Beam Control D.In-Room Respiratory Monitoring System

B. Beam Energy Constancy

*** (Not necessarily this but a picture of a split field test you have to identify) A split field test is performed to verify: A.Linear Scales of the Treatment Table B.Multiple Beam Alignment C.Field Size Indicator D.Light/ Radiation Field Coincidence

B. Multiple Beam Alignment

*** (this but with a visual of SSD and SAD set up, 10cm depth SAD is the pic I chose) An SAD or SSD setup is used with a standard calibration distance of 100cm for which output calibration? A.Electron B.Photon

B. Photon

*** (this but the other spatial res photo in the slides) The images below show examples of CT slices of 2 different phantoms used to complete which of the following CT simulator QC tests. a.Monthly CT number accuracy b.Spatial resolution c.Contrast resolution d.Field uniformity

B. Spatial Resolution

***(know the tolerance for ct flatness)CT number Flatness test determines the _____________ of the beam. A. Noise B. Uniformity C. Linearity D. Contrast

B. Uniformity

***Which of the following are considered to be treatment planning uncertainties: 1-Beam Geometry 2-Definition of Anatomy 3-Misalignment of patient immobilization device 4-Dose Calculation a.1 and 2 only b.1, 3, and 4 only c.1, 2, and 4 only d.All of the above

C. 1, 2, and 4 only

****The treatment plan should be reviewed by the physician and physicist prior to what percentage of the treatment dose being delivered? A.0% B.5% C.10% D.15%

C. 10%

***High dose rate (HDR) brachytherapy delivers a dose at greater than or equal to _____Gy/h. a.5 b.10 c.12 d.15

C. 12

***High Dose Rose (HDR) Brachytherapy delivers the dose at a rate of: A..4-2Gy/hr B.10 Gy/hr C.12 Gy/hr D.15 Gy/hr

C. 12 Gy/hr

When verifying jaw symmetry, the tolerance should be __________ for symmetric jaws and ___________ for asymmetric jaws. A.1.5 mm, 1 mm B.1 mm, 2 mm C.2 mm, 1 mm D.1 mm, 1.5 mm

C. 2 mm, 1.0 mm

***All sealed brachytherapy sources must be leak tested every _______ months and all sealed sources are physically inventoried ________. A. 3; Monthly B. 3; Annually C. 6; Quarterly D. 6; Annually

C. 6; Quarterly

****Photon beam symmetry is defined as the "maximum point-to-point difference in the central ____ of the profile." A.70% B.70cm C.80% D.80cm

C. 80%

Beam flatness is defined as the variation of dose relative to the central axis over the central __________% of the reference region at a ____ cm depth in a plane perpendicular to the central axis. A. 70; 10 B. 75; 5 C. 80; 10 D. 90; 5

C. 80;10

***Which of the following annual tests does NOT have a tolerance of 2? A. Non-SRS/SBRT Radiation isocenter B. Table top sag C. Annual Output Check D. Annual respiratory gating beam energy constancy

C. Annual output check

CT indexing tests determines how accurately the patient moves during the CT scan - This is completed on a(n) ________ basis with a _______mm tolerance. A. Annual, +/- 2 B. Monthly, +/- 1 C. Annual, +/- 1 D. Daily, +/- 1

C. Annual; +/- 1

Which of the following monthly tests does not have a 2mm tolerance? A. Field Size Indicators B. Cross Hair Centering (Non-IMRT) C. Collimator angle indicator D. Linear scales of the treatment table

C. Collimator angle indicator

***If electronic wedges are installed, it is recommended by the AAPM that a minimum of one electronic wedge should be checked to ensure it is functional on a ____ basis. A.Weekly B.Monthly C.Daily D.Annual

C. Daily

***According to the AAPM TG- 142 report, monthly dosimetry checks for the linac include all of the following EXCEPT: A.X-ray output constancy B.Photon and electron beam profile constancy C.Gantry/collimator angle indicators D.Electron

C. Gantry/collimator angle indicators

***The _________ is the regulating agency that is responsible for setting brachytherapy program standards. A. ASRT B. AAPM C. NRC D. TJC

C. NRC

Which of the following daily imaging tests does NOT have a tolerance of less than or equal to 1 mm? A. SRS/SBRT Planar KV and MV imaging positioning/repositioning B. Non-SRS/SBRT CBCT Positioning/Repositioning C. Non-SRS/SBRT CBCT Imaging and Treatment Coordinate Coincidence D. CBCT SRS/SBRT Positioning/Repositioning

C. Non-DRS/SBRT CBCT Imaging and Treatment Coordinate Coincidence

***The linear accelerator laser alignment is checked daily - the tolerance values are: A. All Linear Accelerator Laser Tolerances are 2mm B. Non-IMRT: 2mm IMRT: 2mm SRS/SBRT: 1mm C. Non-IMRT: 2mm IMRT: 1.5 mm SRS/SBRT: 1mm D. Non-IMRT: 2mm IMRT: 1mm SRS/SBRT: 1mm

C. Non-IMRT: 2mm IMRT: 1.5 mm SRS/SBRT: 1mm

****Accurate reproduction of patient dimensions and shape in CT images refers to: A.Contrast Resolution B.Spatial Resolution C.Spatial Integrity D.Electron Density Conversion

C. Spatial Integrity

***The CT number for water should be checked daily and the tolerance should be within ________ of zero. A. +/- 2HU B. +/- 4HU C. +/- 3HU D. +/- 5HU

D. +/- 5HU

Laser alignment has a tolerance of ________ for IMRT Treatments. A.2 mm B.1.5cm C.1 mm D.1.5 mm

D. 1.5 mm

***According to the AAPM TG-142 report, the tolerance for photon and electron output constancy is ____ for monthly checks and ____ for daily checks. A.3%, 3% B.2%, 2% C.3%, 2% D.2%, 3%

D. 2%, 3%

****It is recommended that the brachytherapy source strength be within __ of the manufacturer value & when completing the QC test, it is recommended that the source positioning be within __ tolerance. a.1% & +/-1mm b.3% & +/-2mm c.2% & +/-2mm d.3% & +/-1mm

D. 3% & +/-1mm

The gantry angle is verified at _____ angles. A.1 B.2 C.3 D.4

D. 4

****Which of the following are examples of safety features associated with an HDR remote afterloaderunit? 1-Backup battery 2-Treatment aborts if blockage is detected 3-Availability of manual source retraction 4-Inability to activate source if connectors are improperly attached a.1 and 3 only b.1, 3, and 4 only c.1, 2, and 4 only d.All of the above

D. All of the above

***The star pattern quality control test is typically used to check the linear accelerator radiation isocenter on a(n) _____ basis. A.Daily B.Weekly C.Monthly D.Annual

D. Annual

Electron density to CT number conversion is checked on a(n) _______ basis and the tolerance is manufacturer specific and consistent to the results obtained during commissioning. A. Daily B. Monthly C. Quarterly D. Annual

D. Annual

***Contrast Resolution (Low contrast) is checked on a(n) ________ basis. A. Daily B. Weekly C. Monthly D. Annually

D. Annually

Spatial resolution (High Contrast Resolution) is check on a(n) ______ basis. A. Daily B. Weekly C. Monthly D. Annually

D. Annually

The tolerance for the daily test of electronic wedges is: A. 1.5% B. 1% C. 2% D. Functional

D. Functional

***Which of the following is not an influencing factor for beam output, beam flatness, AND beam symmetry? A.Set-up Error B.Damage to target or Scattering Foil C.Environmental Influences D.Gantry flex/sag

D. Gantry flex/sag

***A(n) ____ and ____ are commonly used when preforming the annual photon and electron output calibration on the linac. A.Electrometer, graph paper B.Multidectorarray, spirit level C.Ruler, wiggler D.Ion chamber, electrometer

D. Ion chaber, electrometer

Orientation of CT Tabletop with respect to the imaging plane is checked _____ with a tolerance of ________ mm. A. Daily, +/- 2 B. Monthly, +/- 1 C. Daily, +/- 2 D. Monthly, +/- 2

D. Monthly, +/- 2

***Brachytherapy programs are licensed through.... a.OSHA b.CDC c.AAPM d.NRC

D. NRC

_***__________ refers to accurate reproduction of patient dimensions and shape in the CT images. A. Spatial Resolution B. Electron Density C. DRR Reconstruction Accuracy D. Spatial Integrity

D. Spatial Integrity

***(know the actual number)T or F: CT number flatness is performed daily and the tolerance is within +/- 5Hu.

False

***(know the tolerance amount it should be within) T or F: Vertical, Longitudinal, and Lateral CT Table movements should be assessed for accuracy. The movement of the table is checked daily and should be within +/- 2mm.

False

***T or F: The tolerance for photon and electron beam output for daily and monthly is 3%.

False

T or F: All records of brachytherapy sources must be kept for two years.

False

T or F: Image noise should be checked on a monthly basis.

False

T or F: Imaging and treatment coincidence is checked by four cardinal angles for daily and monthly QA.

False

T or F: Leaf position accuracy is verified on a monthly basis and is checked at 4 cardinal gantry angles. The tolerance is 1mm for IMRT and Non-IMRT treatments.

False

T or F: The monthly checks for collimator angle and gantry angle indicator requires the gantry to be at zero degrees for the readout.

False

T or F: The tolerance for symmetric and asymmetric jaws is 2mm.

False

T or F: When completing the monthly check for CT number accuracy, it is suggested that two different materials are verified rather than the daily check of one (water.)

False

T or F: When considering respiratory gating quality control tests, the beam energy constancy is more strict for annual tests than it is for the monthly beam output constancy check.

False

***It is recommended by the AAPM that the alignment of the CT simulator wall and overhead lasers be checked how often?

Monthly

Which annual test results in a star pattern?

Radiation Isocenter

****T or F: Defining patient contours and planning target volumes is considered one of the largest sources of uncertainty in the treatment planning process.

True

***T or F: Environmental influences can influence the outcome of the linacoutput constancy.

True

T or F: Accuracy of the CT numbers is checked daily as well as monthly.

True

T or F: Monthly MLC tests include verification of the MLC setting versus the radiation field and leaf position accuracy.

True

T or F: Personnel handling brachytherapy sources must wear a ring badge.

True

T or F: The monthly imaging and treatment coordinate coincidence is checked at four cardinal angles whereas the daily check involves one angle.

True


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