RAP iEX Exam Answers Copyright Violation Duplication or reproduction of this document is against the Federal Copyright Laws of United States Advanced Medical Publishing, Ine (ary Pat: AdeMtearn@notcom PO Box 5046, Madison, WI 53705 (P: 608-833-2599, F: 608-833-2255 ‘Web site: hup:/Jwerw advmedpub com The New York Chapter of the American Association of Physicists in Medicine‘The RAPHEX 1998 answer booklet provides a short explanation of why each answer is correct, along with worked calculations where appropriate. An in-depth review of che exam with the physics instructor is encouraged. In cases where more than one answer might be considered correct, the most appropriate answer is used. Although one exam cannot cover every topic in the syllabus, a review of three consecutive years’ RAPHEX should cover most topics. ‘We hope that residents will find these exams useful in reviewing their radiological physics course. RAPHEX 1998 CommitteeGi. G2. GB. g Gi. Gio, on, Gi2, GENERAL Answers 1998 Dose equivalent reflects the biological damage produced by che interaction of radiation. Al ofthe listed factors influence linear energy transtier, and thus dose equivalence. Exposure (X) is defined as ionization in air per unit mass produced by x- or y-rays. Dose (D) is defined as energy absorbed per unit mass by ionizing radiation, Exposure is limited to ionizing photons. Ionization produced directly by high energy particles is excluded. Dose is limited only to ionizing radiation, It may be produced by photons, ‘energetic charged or uncharged particles. The rad and the gray (Gy) are both units of dose. | rad = 107 joulesfkg. 1 Gy = toule/kg. 1 Gy = 100 rad. Hertz (Hz) or cycles/see is une unit of frequency. The “wave equation,” where cis the speed of light, is c= wavelength x frequency. ‘When radiation energy is stated for particulate radiation, it refers to the kinetic energy of the Particle, For equal kinetic energies, the speeds of heavier particles are less than those of lighter particles. ‘Neutrons are not charged particles, and generally interact with matter by transferring their energy to protons or other light nuclei, which then produce dense ionization tracks. Most elements can have several stable and radioactive forms; an element (and its isotopes) can occupy only one row and column of the periodic table, governed by Z., All isotopes of hydrogen have one proton and one electron, so the atomic number is one. The mass ‘number (A) is 3, so there are 2 neutrons. ‘There can never be more than 8 electrons in the outes shel! ofan atom, Thus, there are 8 groups in the periodic table; elements with the same number of electrons in the outer shelJ are found in the same group. Shells other than the outer shell can contain twice the square of the shel’s principal quantum no. (n) up to n= 4 (i.e.,2 forthe K-sbell, 8 forthe L-shell, 18 for the M-shell, 32 forthe N-shell). Raphex 1998.© Answers © Page 1GB. Gl4. Gis. G6. Gi7. G18 G19 G2. G2. G23. Gu. Gas. G27. ‘The decay equation, A = A, ¢™ is used, where ( = -2 days. Deriving the decay constant 2 form the the half-life, A = 0.693/T » = 0,693/14 = 0.0495, Therefore e° 9 #2) = 1.10, ‘Thus the vial contains 10% more activity than it will have atthe time the calibration is valid ‘To deliver the same patient dose, 10% less volume is injected resulting in: 4mV/1.1 = 3.6 ml ‘The decay constant, A represents the probability of a decay in unit time. In this case 4. = 0.693/28d =(0.693)/(28 x 1) =0.025 or 2.5% W0gq= WT, + IT, ‘The mass number decrease of 4 indicates the ejection of an alpha particle only, ‘A beta minus decay is always accompanied by an antineutrino, which shares the total beta-ray energy of the emission, In beta decay, electrons are always emitted with a spectrum of energies. As in the case of cobalt-60, this decay may be accompanied by the emission of one or more monoenergetic photons. In positron emission, a proton is converted into a neutron and a positron, The daughter nucleus may achieve stability by emitting a gamma ray. The positron may annihilate with an orbital electron ‘producing annihilation photons. The resulting electron vacancy can lead to characteristic x-ray emission, ‘Gamma emissions can be 2.16, o 3.75 - 2.16 = 1.59 MeV. Beta minus spectra have maximum ‘energies of 1.11, 1.11 + 1.59 = 2.70, or 1.11 + 3.75 = 4.86 MeV. Anti-neutrinos will also be emitted ‘with maximum energies equal tothe betas. Characteristic x-rays may also be emitted, but we cannot tell from the diagram what their energies will be, Positron emission an¢ electron capture often occur in competition in the same isotope, when the ‘number of neutrons is too low for stability. In electron capture, an electron, usually from the K- shell, combines with a proton to create a neutron and emitted neutrino, In filling the resulting K- shell vacancy, characteristic x-rays and Auger electrons are emitted. Positron emitters are required. These are usually short lived and proton rich. They are not easily ‘made in a nuclear reactor, and an on-site cyclotron is usually used for production, ‘The activity of the sample increases exponentially with time (the curve is the inverse ofthe decay curve). After one half-life, half the maximum activity (A,,,,) is achieved; after two half-lives, 0.75, Aggy is achieved, and so on, After n half-lives the activity is (1 -0.5%) A... Thus four half-lives sive 94% A... 1 Bis equal to one disintegration per second (dps). 1 Ci is equal to 3.7 x 10* dps, (74x 109 Bq)/G.7 x 108 pCi) = 2x 10? = 200 pCi, Raphex 1998 © Answers © Page 2G29, Gl. G32, 633, G34, G35, G36. G37. G38. G39. Gal. G42. Ga. ‘The detection efficiency means tha the actual Jecay rate is (1/03) x 120,000 cpm = 400, 000 cpm, 400, 000/60 = 6, 666 vecays per second. Therefore (6, 666)(3.7 x 10" per Ci) = 0.18 wCi ‘The effective energy of an x-ray beam is approximately 1/3 to 1/2 of the kVp. This may be increased by additional filtration. X-ray energy produced by bremsstrahlung, is independent of the atomic number (Z) of the target materia! and of the mAs. Subject contrast is a function of x-ray energy. ‘Choices 1-4 allow for an increase in the area over which the electrons bombard the anode, thus spreading the heat over a larger area ‘The characteristic K x-rays at about 17.5 and 19 keV are desirable for maximum. calcium and soft tissue contrast. “The energy of characteristic radiation is determined by the differences in binding energies of the target atom’s orbital electrons. Their intensity is about 20% of the total spectrum at this accelerating potential, Thus they do contribute tothe imaging process. A,B, and E affect the shape of the spectrum, but not the maximum photon energy. ‘The value of the HVL depends on bot che kVp and the amount of filtration in the beam, and is ‘ore easily measured than either of those. Filtration requirements are specified in terms of ‘minimum HVLs for Various KVps. Sound waves of any frequency are not ionizing, Electromagnetic and particulate radiation with sufficiem energy to remove an electron from an atom are classified as ionizing radiation, Neutrons are indirectly ionizing, as they release “knock on” protons. Using the inverse square law: I{75] = 1[50] x (50/75)? = 4.4 mR/mnin, Absorption normally decreases with increasing photon energy, and increases with increasing atomic number, The intensity of the transmitted x-ray beam is given by: 1,51, exp (-0.693 /HVL) and 1, = 1, exp (1x), therefore, HVE = 0.693 /j. and if = HVL: I, =I, exp (0.93) = 1/2. Photoelectric absorption is proportional to YE, 1cm=2HYL, Therefore the probability of transmission equals 50% x 50% = 25%. ‘Adding filtration to a beam selectively filters out the lower energy photons, leaving a more penetrating beam with a yreater HVL (but ower intensity) A photoelectron is released from the absorber leaving a vacancy which is filled by the electron from another shel, liberating characteristic x-ray in the process. ‘A photon disappears following a photoelectric imeraction, Following a Compton interaction, the scattered photon may interact again, The photon aso disappears following pair production, aphex 19980 Answers © Page3G50, Gi. G52. G53, G54, G55, G56, ‘The absorption of x-rays (Jose) can be calculated by multiplying the exposure by the f-factor which isa function of the ratio of the mass attenuation coelficients of the material and air, The mass attenuation coefficient is @ fanction of the atomic number (Z) of the material and the energy of the incident photon, Jodine has a higher Z than bone and will absorb more than bone. ectr(eGyhoentgen) ‘or OF 10 70 Proton ery MV) In the photoelectric interaction, if the incident photon energy is greater than the binding energy of the electron, characteristic x-rays may be produced. ‘Compton is the most probable interaction between 25 keV and 25 MeV. ‘A Compton electron acquires its maximum energy when the photon is backscattered; in this case the photon retains about 250 keV. Coherent interaction: scatter but no absorption, ‘Compton: scatter and absorption. In the compton process, part of the photon energy is used to overcome the eleciron binding energy. ‘A very small amount causes nuclear recoil. The remainder is given as kinetic energy to the released. electron. The maximum energy transfer occurs for “backscatter” i.e. a scattering angle of 180°, Jn a compton interaction the photon loses some of its energy to the electron, which is then emitted at an angle of between 0° and 90° tothe direction of the incident photon, The photon with reduced energy can be emitted at any angle, although the angles involved are related tothe inital and final photon energies. Secondary photons can be backscattered, but secondary electrons cannot ‘A photon with a minimum energy of 1,02 MeV is absorbed and contributes all ofits energy to the ‘reation ofthe pair with the remainder given as kinetic energy. The annihilation photons have an ‘energy equal to the mass-equivalent of the elecizon and positron that are destroyed, ‘The energy of the initial photon, less 1.02 MeV (the rest mass of the two electrons created) is, shared between the electron and positron. When the positron stops, it annihilates with another electron, producing a pair of 511 keV photons. Rapher 1998.0 Answers © Page #657-61. EDCAB G62. Gos. G67, G70, Gn. Gn. GB. ‘Curve #5 (pair production) is zero below 1,02 MeV, and increases more rapidly in lead (because of lead’s higher Z) than in water. Curve #4 (Compton) is almost equal in water and lead (when ‘measured per gram, as opposed to per cm), The lead (curve #1) cross section is higher than that of water (curve 2) at low energies because the photoelectric effect is proportional to Z, and at high ‘energies because pair production is proportional to Z. At intermediate energies where the Compton effect dominates, the two curves are almost equal. The photoelectric effect in water (curve 3) decreases very rapidly as energy increases, ‘The iodine K-edge is at 33.2 keV. X-rays with energy just above the K-edge are ‘most likely to undergo a photoelectric interaction. Alpha particfes have ranges in microns; for 8 MeV, about 95 jun. A2 MeV beta particle has a maximum range of about 1 em. ‘When a neutron is absorbed, the resulting nuclear instability can cause the release of energy in many forms, including all of processes listed. Coltimating the beam reduces the amount of scattered radiation reaching the imaging plane. It also lessens the volume of patient which is iradiated. A seasitometer is used as part ofa quality control program for film developing. It pus a particular pattern of exposure onto the film which, when processed, should lead to predictable density steps. ‘The first four choices all influence the ability of the screen to absorb the incident quanta. Choice E describes the amplification of quanta as the energy is converted to a different part of the E.M. spectrum. H &D cave: optical density of film versus dose. Optical density isthe logarithm of the incident intensity divided by the transmitted intensity. Optical density can only be related to dose if the H & D curve is known. ‘There is 69% probability that he measured count is within one standard deviation of the true count. Since ¢ = N!, any counts between 2, 450 and 2, 550 will be in this range. ‘Asa reflection of a binary process, (bit on - bit off), she actual numerical values associated with ‘Computer memory or storage Can be generally expressed as 2°, In this example, 2° = 1, 048, $76. ‘The mainframe is a physical (hardware) device that contains the CPU and main memory. All other ‘hardware (terminal, inpuVoutput, digitizer, printer, plouer) are peripheral devices. A typical 3.5” disk stores about 1,4 MB when formatted. Thus a 9 GB disk has about 6, 100 times as much data, Raphex 19980 Answers © Page SGi, G75. GI. G7. G78, G79, G80. Gal, G82, G83, Ge, Gas, Report No. 94 of the NCRP estimates an effective dose equivalent of 200 mrem (2 mSv) yer year from radon, compared to 100 mrem (1 mSv) per year from all other natural sources, The Wose equivalents from man-made sources are: From NCRP Report #93: mrem/year —mSv/year Diagnostic raliology 39 039 Nuclear medicine 4 od Nuclear power 0.05 0.0005 ‘The effective dose equivalent from nuclear weapons testing has always been estimated at less than I mrem (0,01 mSv) and is decreasing yearly. Radon decays through a chain of daughter products which may be inhaled, some of which decay by alpha emission, ‘The average annual natural background radiation inthe United States is about 100 mrem (excluding radon). About 40 mrem/yr is contributed by radioactive material within the body, mostly “°K, The restis about equally divided between contributions from cosmic rays and radioactive materials in the earth, The other answers are examples of artificially produced radiation, ‘TLD can measure over several orders of magnitude, the others are limited to much smaller ranges. ‘The minimal reading is 10 mrem = 100 pSv. ‘The law requires that no special accommodations be required for a worker unless the pregnancy is declared. If, s0 the limit on exposure for the pregnancy is 0.5 mSv per month, 10. CFR Part 20 recommends that personnel monitoring shall be performed for occupationally ‘exposed individuals for whom there is a reasonable possibility of receiving a dose exceeding one- tenth of the applicable MPD. It specifically excludes the use of monitors when the indivi “exposed as a patient for medical or dental reasons.” Selective filters are used in film badge holders in order to crudely distinguish between. types and energies of radiation. An open window (no filter i used for betaray detection, Film badge reports should be considered with caution because ofthe difficulty of interpreting mixed-radiation exposures. 5 mSv (0.5 rem) is MPD for infrequert exposure of the general public. The limit for frequent exposure is 1 mS. 10 Sv = 100 rem Exposure rate = (Exp, rate const) x activity x (Vd?) = 12.9 10x 1/1000 R/br = 12.9 mRMhr, To reduce 12.9 to 2 requires 3 HVLs. ‘Three TVLs will reduce the exposure by a factor of 1000 (10°). Ten HVLs will reduce the exposure by a factor of 1024 (2!) (700 mA-min)/(10 mA) = 70 min total beaun-on time. The use factor U = 1/4 means the barrier receives 70 min x 0.25 = 17.5 min (0.29 hr) of direct exposure. Raphex 1998 Answers © Page 6a7. G88, G89. al. oo. G93. G94, G95, G97. G98, G99, G100, Boron is a very effective material for capturing low-energy neutrons. After such a capture, it emits a relatively low-energy photon which can be stopped by a small thickness of lead or steel. ‘The maximum permissible dose recommended by NCRP #116 for non radiation workers is 0.1 rem per year, if ths is continuous exposure, Adding one tenth-value layer of shielding will reduce the dose from 1 rem to 0.1 rem, Because it is sealed, the volume of air is held constant, Pressurizing allows for a greater sensitivity since there are more air molecules per unit volumne available to be ionized. ‘A Nal well counter is an efficient measuring device for low-level yamma detection. also provides discrimination for gamma-ray analysis AA liquid scintillation counter allows 50% 70% efficiency for measuring small Quantities of the low energy beta-rays from tritium. AGM counter has a fast response and the ability to detect low levels of gamma-rays. Radon is a radioactive gas emited primarily from rocky soils and/or building materials which contain uace amounts of uranium and radium ores. Radon concentrations in the air can reach ‘hazardous levels in poorly ventilated basements and ground floors, particularly in certain parts of the country where soil and rocks contain large ainounts of these ores, ‘See NCRP Report #116. Electron equilibrium is reached at approximately the d,,, dent or where the kerma and the dose are exactly equal. {the collection voltage is not high enough in an ionization chamber, recombination ‘of ions can occur, resulting in a low reading, ‘Very low concentrations of radioactive materials when ingested cian produce high localized radiation doses to intemal organs. Ina controlled area, workers wear personnel monitors, such as film badges. If members of the public might occasionally be present, then the dose they might receive must not exceed 20 wSv (2 rem) in any one hour, Note: this does not mean that the instantaneous dose ate cannot exceed 2 maenvVhr; the dose rate of the unit, the use factor and the workload must all be considered. ‘An exempt quantity means that its use, possession, and shipment are exempt trom the laws and ‘regulations governing greater amounts of radioactive material. Depending on the chemical form and half-life of the material, exempt quantities of sorne radionuclides may be as much as 1 mCi. For typical medical isotopes, the value is usually 1 Ci, All shipments of radioactive material must be leak ested prior to opening since surface contamination might reveal a potentially hazardous spill inside the container, The dose stated by the vendor must be independently veritied in a suitable dose calibrator, Measuring the activity left following the dose administration and subtracting this amount from the inital calibrated value gives the true amount of material that was administrated, and the amount left Raphex 19980 Answers © Page 7Di. D3. Di. gz DIAGNOSTIC RADIOLOGY Answers 1998 Characteristic x-rays are emitted only when the energy of the electrons impinging on the target exceeds the binding energy of the target material electrons. The K-shell binding energy for tungsten atoms is 69.5 keV. Therefore, as the accelerating voltage is raised above 70 kVp the ‘number of characteristic x-rays produced will increase, From 80 kVp to 100 kVp the characteristic percentage of the x-ray spectrum goes from 10% to 20%. ‘Aluminum filtration reduces the number of x-ray photons in the beam, but more importantly, it effectively removes the photons below 20 keV. These photons aud only to the dose of the patient and not tothe image, since very few will reach the image receptor. ‘The heel effect of an x-ray tube is due to the angle of the anode. So, the effective focal spot will increase from zero at the “heel” of the tube anode to a maximum at the other extreme of the field of view, Power is defined as voltage tines current and Energy is Power times time, Heat units are energy ‘units compared to an old-style, single phase x-ray generator, Since the CT scanner uses a constant potential generator, there is an extra factor of 14 times the energy to account forthe change in waveform, 1.4(140 kVp)(200 mAX(10 sec) = 392,000 HU. ‘The effective focal spot size will naturally depend on which one is selected, (e.g., 0.6 mm verses 1.2:mm), The electrons from the cathoue are focused better as the vollage of the anode is increased, The effective focal spot size is calculated by multiplying the target size on the anode by the sine of the anode angle. To understand the variation of effective focal spot size with position, ‘imagine using a pinhole camera to view the projection of the tube filament to the anode and onto: the imaging plane, ‘The density control setting causes an incremental change in the exposure which is determined by the automatic exposure control system. ‘The settings usually vary the exposure by about 10% per step. ‘A larger effective focal spot causes greater focal spot blurring which results in diminished image spatial resolution. ‘The problem is more pronounced at higher magnifications. A larger effective focal spot, however, allows higher tube power rating and the selection of shorter exposure times ‘needed when motion blurring is a concem, Lower patient doses cannot be obtained by changing the focal spot size. ‘The tube current (in milliamperes, mA) is controlled by the generator filament circuit. ‘Constant potential generators produce a high- voltage wave form with essentially no voltage ripple (less than 2%). Three phase 12 pulse generators produce 3% - 10% voltage ripple. Raphex 19980 Answers © Page 8Dio. Du. D2, DI3.A Dis. DIS. DI6. p17. Dis, p19. At tube potentials below 40 kVp, such as in screen-film mammography, space change- limited ‘operation occurs; that is, dhe accumulated electron cloud surrounding the heated filament does not instantaneously accelerate to the anode in the x-ray tube. This causes a non-linear relationship ‘between filament current and tube current, Compensation circuits are implemented to adjust the filament current so that an accurately known tube current can be derived. ‘An ideal transformer has the same amount of power at the output (secondary) relative to the input (primary). IF Y, and V, are the primary and secondary voltages, and I, and I, are the primary and secondary currents, then Power (primary) = Power (secondary) Vi f ‘Tous, an increase in voltage of the secondary (output) of the step- up transformer will be accompanied by a decrease in the secondary (output) current, relative to the primary. The secondary voltage V, in a transformer is given by the product of the input voltage (primary) V, times the secondary- to - primary tums ratio: V,=V,QYND, NaN, = Hof coil tus in secondary & primary coils. A step up transformer has more secondary coil tums relative tothe primary. Molybdenum filters remove the high- energy bremsstmablung radiation, this improves subject contrast, Italso removes the very low energy x-rays in the spectrum that would only contribute to patient dase, ‘Molybdenum is used as target material in mammography because it produces characteristic x-ray radiation at optimal energy levels. ‘Aluminum is the filter materia used in general radiography x-ray equipment, CT, fluorascopy and ‘other special procedure systems (angiography, tomography). HVL is the thickness of material that attenuates an x-ray beam by 50%, TVL is the thickness of ‘material that attenuates the beam by 90%. If the beam HVL is 3 cm in muscle, the TVL, in muscle, must be greater than 3 cm, The HVL decreases for higher atomic number materials compared with muscle, Bone and lead HVLs should be less than 3 cm, The linear attenuation coefficient = 0,693/HVL = 0.231 cin’ By definition. Thinner objects produce less scater, hence, lower potential for contrast improvement, At the entrance point to the patient, and before being attenuated, the beam has the highest number of x-ray photons, ‘The highest amount of scatter radiation wit! be immediately after the beam exits the patient and before it enters she anti- scatter grid, Due to beam attenuation inthe patient and the grid, lower energy photons will be removed leaving behind a beam with the highest mean energy atthe exit point from the grid. Hence, ube half valve layer will be the highest forthe beam exiting the grid. Note thatthe maximum energy in any of the three beams will be the same, Maximum beam Raphex 1998 © Answers © Page 9pal. D2. DZ, 2s. Dz. D2. D2, ‘energy is determined by the tube kVp and voltage wave form, Beam titcation through the patient ‘or te grid will not change the maximum energy. ‘The number of scattered photons increases with field size and patient thickness. As ue scatering volume changes from 10 10x 10 cm? to 30 x 30x 30 cm? the scatter to primary ratio varies from 0.7 to 4, respectively. The number of scattered x-rays varies primarily with breast thickness. As the breast thickness changes from 2 to 6 cm, the scatter to primary ratio varies from 0:3 10 08, respectively. Film grains are sensitized by only a few x-ray interactions and then all of te silver in a grain is precipitated in the development process, Large grain sizes are used for fast films and small sizes ‘are used for detail films. By using a range of grain sizes, one can produce wider latitude films, A crossover is done when changing the control box of film used forthe sensitometry of the processor. This is because film speed and contrast often change from batch to batch. The Procedure isto flash (with sensitometer) several films from the old box and several from the new box, and determine new control imits from the change in speed and contrast from the old batch to ‘the new batch, Sensitometry Joes not insure optimization, only consistency. It must be done daily forall processors, including those attached to hard-copy devices. PM’s must be done monthly to maintain good processor performance, Subject contrast is reduced as kVp is increased. A developer temperature lower than the recommended setting will cause lowered film contrast. The use of grids will cause improved contrast due to decreased scatter reaching the film, wA has no effect on contrast, provided the mAs was correct, Fixer chemistry does not affect film contras, but this would have been true if the question referred to developer chemistry. Film speed is defined as: one over the exposure in Roentgens required to produce an optical density of 1.0 above base fog. In the question, SmR produces a density of 1.0 above base fog (1.2-02), therefore the speed = 1/ (5x 10°R) = 1000/ (5 R) = 200 R*. Film gamma = optical density difference between the two areas on film / log relative exposure 1.6= D,- D,MlogEyE,) = (DyD,)/ (log 10) 1.6=(D,-D,V/.0 DD =16 Since D, =0.6 D,=16+06=22 Screens with higher conversion efficiency produce more light photons for each x-ray photon absorbed in the screen , hence lower patient exposure to produce a given film density, and highet screen speed. High -speed screens awe generally thicker and have decreased spatial resolution, Detail screens are thinner with less light diffusion, tence better spatial esolution but slower. Slow, detail screens are recommended for extremity examinations, Rare- earth screens are faster than calcium tungstate screens because of their higher absorption elficiency at diagnostic energies. Raphex 1998.0 Answers © Page 10Dw. p31. 32. 033. Dé. 35. 36. The level of sereen noise is mainly detennined by the number of x-ray photons used by the screen to produce the same blackening on the film. A screen that aceds more x-rays to produce certain film density produces a less noisy image. if screens are made thicker or wi igher absorption efficiency, the resultant image noise Joes not change because the xame number of x-ray photons myst be used to produce the same fin blackening. Screens with bigher x-ray to light conversion efficiency, such as rare-earth screens, require fewer x-ray photons to be absorbed i the screen to produce the required film density, Slow screens produce less noisy images because they use more x-ray photons to produce the same density 00 the film. ‘Thin single sorens are associated with better sharpness providing that motion and geometric ‘unsharpness are not significant, In extremities, the exposure time required to produce the appropriate density is usually short, hence movement unsharpness may not be a problem and one can use @ thin single screen, In abdominal angiography with thicker body parts higher mAs values are needed and motion unsbarpness becoines a major issue. Ifa thin single screen is used sharpness will decrease. Three phase generators have higher radiation output efficiency, hence shorter exposure times and less motion unsharpness. A smaller focal spot size means less geometric unsharpness. Moving the x-ray tube away from the patient at 2 given patient wo receiver distance reduces the effect of geometric unsharpness because of reduced magnification , ‘The most frequent target ¢ype in extremity radiography is linear and high in subject contrast. Line targets in extremity radiography are best demonstrated on high-contrast, high-sharpness images. ‘Very sharp images can be obtained because geometric effects can be minimized and because ‘concer about radiation exposure is low . Unlike chest radiography, the background pater in extremity radiography is usually relatively simple in tems of detail and gray scale. Hence, different radiographic strategies are used in ese techniques. Ref: Radiographics March 1977 P479. ‘Unsharpness causes the image of the target to appear larger than the zarget itself due to blurring and the contrast of small targets is less than would be seen in a perfectly sharp image. Although Uunsharpness does not increase the avise level in a radiograph, the combined effect of unsharpness and noise may cause images of tiny targets to become invisible. The gray-scale appearance of a radiograph is determined by three main factors: the properties of the anatomic area being radiograpbed (dimensions & differential attenuation), the amount of radiation exposure and the sensitometric characteristics ofthe recording system, Scene complexity in chest radiography is caused by increasing image sharpness. For filrt processor QC, six items should be checked if corrective action is required. They should be done in the following order, developer temperature, developer immersion tie, replenishment rate, soluion level, replenishment tank level, and water temperature, I all these are correct, the only thing lft to dois to change the developer solution, A sensitometer is used lo expose a step ‘weilge on a piece of film for QC purposes. ‘To operate at the 95% confidence level requires a count rite of + 26 where = (3600? = 60, The range is 3600 # 2 x 60 = 3480 - 3720. ‘The mean CT No. = (58+60458+62+62) / 5 = 60 Measured values = 58 60 58 62 62 Deviation from mean 2-2 0 2 42 42 (Deviation)? 240 44 4 oof (Deviation)? = 16 6 = [(Z of (Deviation)? /(N-1)] ! = (16/4) "2 =22 Raphex 1998© Answers © Page 11a7, 38. 39, Dal, Da2, a3, Das. a7, RAM, Random Access Memory, is used only for temporary storage of images, ‘To produce 512 shades of gray, a total of 9 bits is required: 2°=512. Binary # format: 0001001 BB pW 2 w Decimal equiv: 43216 8 4 21 04+0+048+04+041=9 ‘The range of the A/D converter is from 0 to 1023 since it uses 10-bit resolution, 2 = 1024, Since the images are in digital form, the processing, storage and transmission will be simpler, Film images are limited in gray scale by the H-D curve of the film, whereas digital image receptors have a linear response over a greater range of exposures, ‘The high-contrast resolution in digital systems is limited by the finite size of the detectors or the pixels. ‘The noise level in the final image in DSA [Post contrast image - Pre contrast (mask) image] will be higher than the noise in either the post contrast image or the mask image, Image subtraction is associated with decreased signal to noise ratio. ‘Temporal resolution depends on frame rate. Spatial and contrast resolution will be worse at higher frame rates since both are limited by the ability to collect a large matrix of values and to encode them precisely in the available acyuisition time. Motion artifacts are caused by patient movement ‘between the time the mask image is obtained and the time the contrast appears, which is longer than the time between the frames. Bdge enhancement emphasizes high frequency information in an image, This can achieve better ‘spatial resolution, and compensates for image blur. Other high frequencies such as high frequency noise and artifacts will also be emphasized causing image quality deterioration, ‘The magnification factor, M, is equal to (focus-film distance/focus-object distance) Ms (2448924 = 473 ‘The penumbra = (magnification - 1) x focal spt size = (4/3 - 1) x 1.0mm = 0.33 mm, Lag is due to persistence of a previous image on the monitor when a new image appears. It occurs because it takes a certain amount of time forthe image to build up and decay on the pick up camera target. Lag is associated with resolution degradation, A plumbicon camera isa vidicon camera with a lead monoxide phoroconductor for its target (vidicon targets are made of antimony trisulfate), Plumbicons are associated with low lag, but high noise, Photospot films record the image output of an image intensifier onto 70 and 105 mm roll film, or ‘on 100 mm cut film, Up to 12 frames per second are possible in photospot imaging. Photospot films require one third of the radiation exposure used for conventional film/screen combination, Photospot films can achieve a resolution of 4 Ip/inm, which is the resolution obtained from the image intensifier output. ‘The HVL of the fluoroscopy beam in tissue is about 5 em, Ifthe fetus is at 9cm depth, then the {etal Jose will be about 25% of the skin exposure. ‘Typical skin exposures in fluoroscopy for an average patient thickness of 10 inches are about 2-4 R/imin, The maximum legal limit for entrance skin exposure is 10 R/min, This is generally the case except in some limited special high dose ‘operations. During “last image hold” there is no radiation, so patient dose is zero, The exposure Raphex 1998.0 Answers © Page 12DSO. psi. Ds2, Ds3, Ds4, DSS. DS6. ps7. Ds8. Ds9. per frame in DSA is about 3 times higher Uian that in Cine angiography. ‘A belical scan “interpolates” the projection data from couch table positions both within and ‘outside of the desired reconstructed slice location, The interpolation process effectively “smears” information in the z-direction, ‘The 360 interpolation uses data from 2 routions of the x-ray tube usually 2 seconds of couch movement), while the 180 interpolation uses datz from 1 rotation of the x-ray tube (usually 1 second of couch movement), Clearly the information will be “smeared” more in the slice thickness (2) direction for the 360. ‘The collimator setting determines the slice width. The reconstruction cannot change the slice width to thinner slices. There are some machines however which can add adjacent slices to make ‘THICKER slices in the process, Helical slices can be reconstructed at any position and any distance interval within the data acquisition volume. Since the effective slice width is wider for helical, the noise will normally be slighty Jess for the same mAs per slice compared to non-helical, ‘There is no need to increase the mAs. In fact, the MAS is often decreased because of tube heat-loading considerations. Image noise is a function of the number of x-rays per Voxel used fo create the image, It does not depend directly on focal spot size, Increasing kVp while keeping other parameters fixed results in increased photon ffux atthe detectors, which reduces quantum noise, thus improving low contrast sensitivity, ‘The dynamic range of CR is much greater than film-screen, Over- and underexposed images can be “windowed” to give useable images, whereas film-screen images which are t00 light oF too dark are unusable, Most CR systems have a spatial resolution of about 4 Ip/mm, while that of most film-screen systems is greater than 6 Ip/mm. Although a useable image can be made at 50% of the exposure needed fora film screen image by windowing the image, it will be noisier. Most CR systems are designed to give comparable noise to 2 400 speed film-screen system when ‘exposed identically. CR readers are yeneralfy slower than automatic film processors, both in the time to obtain a diagnostic image and in the number of images per hour processed per processor. ‘Typical average doses in head and boy CT are 5 rads (50 mGy) and 2.5 rads (25 mGy), respectively. Re %- ZFC, +ZP where Z, and 2, are the tissue ieipedances and R is the reflection coefficient. ‘The ultrasound attenuation in muscle is approximately 1 UB/cmvMHz, Therefore, the attenuation for a 3 MHz ultrasonic pulse will be 3 0B/cm. ‘The half-value thickness is the distance required to reduce te intensity by a factor of 2. This is by definition the 3 UB point, since (relative intensity)JB = 10 log(1/1), or in this ease 10 log (2) = 3 2B. Shadowing isa low ultrasound signal caused by high attenuation, strong reflection or refraction of the beam, Reverberation arises froin multiple echoes from closely spaced surfaces which yields a “ring-lown artifact”, Side lobes are off-shoots of the sonic beam which produce mispositioned ‘echoes. Multipath reflections and refractions cause signals to be geometrically misplaced. Frequency modulation (FM) is one of the means of producing radio broadcasts, Raphex 1998.0 Answers © Page 13Dél. De7. Di. frequency shift = 2f, v cos(@)/¢ where f, is the incident frequency, v isthe speed of blood tow, @ isthe angle between the incident wave and the direction of blood flow aw c isthe sped of ultrasound in tissue. The resonant frequency is the natural frequency of oscillaion, Transducer crystal thickness is equal to one- half the wave length of the US wave produced, Changing the thickness of the crystal changes the frequency. Diagnostic ultrasound beams are generally in the range 1-20 MHz. As the beam frequency increases, attenuation increases. Ultrasound waves need a supporting medium, therefore they can't travel through empty space. Airhissue interfaces reflect almost all ofthe incident beam. To remove the air trapped between the skin and transducer and minimize skin reflection, gel is applied at the skin during imaging. TGC is necessary to compensate for increased signal atenuation with depth, TGC causes the signal gain to increase asthe echo-retur time increases. High frequency transducers (8-20 MHz) produce high- resolution, shallow penetration beams suitable for ophthalmology. Brightness (B) mode displays a static image of a two dimensional tissue section. It is the common display mode in ultrasound imaging, Frequency shift (Af) in Doppler ultrasound increases with increasing incident beam frequency ‘and the speed of the moving object (blood tlow). At, however, decreases with increasing velocity ‘of sound in blood and the beam angle with the direction of the moving blood. High Q transducers, are desirable in Doppler Images because they produce a narrow range of ultrasound frequencies. In continuous Doppler two transducers are needed, one to continuously transmit, and the other is to continuously receive. Frequency shifts for moving blood will vary depending on the factors mentioned earlier. Typical shifts are usually less than 1 kHz ‘The phase encode gradient is applied prior to refocusing. The gradient amplitude is varied from ‘one TR interval to the next o completely sample the imaging volume, During the imaging time the phase encode gradient is stepped through 128 - 256 values. ‘The frequency encode gradient is tamed on during data readout to impose frequency dependence as a function of position. ‘The slice select gradient is used in synchrony wit the RF pulses to selectively excite a group of spins. Itis used in conjunction with a narrow frequency bund for the RF pulse to excite a slab in the imaging volume. ‘The most significant artifacts in MRI are caused by motion. Due to the long acquisition times and the numerous changes in the phase encode gradient required to obtain an image, ghost images are produced in the phase encode direction, ‘Typical T, values for tissue are 500-1000 mSec. Typical T, values are 50-100 mSec. The hydrogen Larmor frequency is 42.6 MHZ/Tesla = 63.9 MHz for the 1.5 T field. The approximate value of the earth's field is 1 Gauss. Nuclides with even numbers of protons and neutrons, such as C and #60, have no net nuclear magnetic moment and cannot be imaged using MRI. Raphex 1998.0 Answers © Page 14Dn. Dn. Di. DIS. DI6. p71. D2. Dn. Dal. D2. D8. De. Das. Gadolinium is paramagnetic: each atom is strongly inagnetic because of 7 unpaired electrons in its outer electron shells, Gadolinium chelated to diethlene trianine penta-acetic acid (Gu-DTPA) reduces T, in an aqueous solution giving a strong MRI signal ina T, weighted image, ‘The resolution of parallel hole collimators is best at the collimator surface. The sensitivity is independent of the distance between the source and the collimator. ‘This seems to contradict the inverse square law, but remember that each hole in the collimator “sees” a larger area ata greater distance from the collimator, i.e. more holes see the same source if it is further away from the collimator. ‘The total time per study is the product ofthe number of angular stops and the time per stop. An altemate method uses the total counts in the study as the cull Organ dose isa function of the amount of raliophanmaceutica jected, the distance from the source to the target organ and the effective half- life of the injected isotope. Dose(rads)=SxA, where A= 144A, xT Sis obtained from standard tables 1 mGy=100 mrads Cobalt-57 (122keV) is used to check the low energy isotope range "Te - 140keV), Barium-133(356ke) is used to simulate inedium energy isotopes (iodine-131, indium-113m). Cesiumn-137(62keV) is used to check the response in the range appropriate for Molybdenum-99 (160;780keV) Intrinsic testing is performed with the collimator off and using a point source usually of technecium-99m, SPECT utiizes a Nal crystal asthe detector. It is optimized to detect gammas in the 140 keV range. PET uses a ring of detectors which surrounds the patient and simultaneously detects the #0 511keV annihilation photons. Heavy collimation is one method being explored to allow the detection of PET radiopharmaceuticals with SPECT instrumentation Cracked crystals produce linear image defects. PMT tubes can appear as either hot or cold spots. Drops of isotope or patient's sweat on linens oF table can appear misleading on the image, ‘Also known as oll:peak images, 1 niscentered PHA window would contain an excess amount of image scatter. R(system) = (102 + 42)!2= 10.8 mm Reoll)? + (Rind? |! Bar phantoms are used to approximate te spatial resolution of an imaging system, which is required to be checked on a weekly basis. ‘Well counters use a Nal erystal with a hole eut out for insertion of a source(tst tube) which should not exceed 1 Ci. They have high geometric efficiency due tothe shape ofthe crystal. Energy discrimination is achieved using a ratemeter with window and levelling capability. Raphex 1998 Answers © Page 1586. De7. 89, Do, g g Deadhime losses will be encountered if large aunounts of activity are placed in the well Dose calibrators can be used to assay large ainounts of activity, but they lack energy iscrimination capability due to the detection method (ionization), The ionization current is converted, by the use of an isotope specific calibration factor, toa display in units of activity (Bq. Ci.) 32 stops (views) at about 20-25 seconds of acquisition time per stop. A higher number of stops will improve temporal resolution but it will increase total acquisition time per study. 128 x 128 matrix there are less counts per pixel; therefore in order to maintain the same noise level in the image one must either increase the dose to the patient or increase the imaging time. A longer acquisition time means a greater risk of patient motion. Computer time is becoming less of ‘an issue. Resolution is increased. Prior to back projection - 2D filtering. Post reconstructions - 3D filtering Filtered back projection is used to eliminate the starburst artifact. Hanning, Shepp-logan and Butterworth are all modified RAMP filters. ‘The sensitivity(etficiency) is the percentage of incidem gunma rays that are detected, As the crystal thickness is increased more of the incident gamma rays can interact with the iodide ions of the crystal causing them to lose electrons. These electrons then interact with the crystal lattice and. produce scintillations, which are detected by the PMT's. Thicker crystals allow for a greater spreading of the scintillation light before it reaches the PM tubes, therefore degrading resolution, ‘A.20% window range represents + 10% around the 140 keV "Te peak, This translates to a window of 140 + 14 keV. Daily surveys using a GM survey meter must be performed in all rooms in which radioactive ‘materials are used. Removable contamination should be checked using wipes every week, Controlled areas must be supervised by a radiation safety olficer, ‘The fraction of radiation transmitted through the Jouble shield is: (1- 0.95)? = 0.0025. ‘The radiologist’s weekly exposure after the shield will be : 100 x 0.0025 = 0.25mnR. Raphex 1998 Answers © Page 161. TS. TS. 16. To. Tu. TI. 713. TH, TIS. 16. TH. RADIATION THERAPY Answers 1998 TMRs and FDDs both account for tissue attenuation, but only FDDs include the inverse square effect This is the definition of exposure, TMR at U,q is 1.0 by definition for any photon energy. ‘The simplest formula wo calculate timer setting fora single field at SSD is: {= dose at depth/[(Dose rate at d,,.., SSD) x PDD (equ. s4., 0) Other formulae involving dose rat in air, BSF, inverse square corrections and TAR can be used to arrive at the same answer, but hey are less direct. The other formulae in the question are incomplete. ‘The beam-On time can be found by dividing the prescribed dose of 150 Gy by the dose rate times the PDD. = 150/(100 x 0.65) = 2.3 min ‘The dose at d,., for an SSD calculation can be found by dividing the prescribed dose of 150 cGy by the PDD. D= 1500.65 = 231 cGy By similar triangle geometry with at 87 cm equals 10 x (87/80 = 10.9 em ‘The lowest dose to points between midplane and the surface results from using the highest energy and largest SSD, to maximize PDD. The inverse square component for d= 10 cm at 100 em SSD is (100/110)? = 0.826, whereas that at 200 cm SSD is (200/210)? = 0.907. Thus the PDD, which includes this inverse square factor, is farger at greater SSD. ‘The equivalent square field is always smaller than the geometric square, as it is the field which has the equivalent contribution due to scatter. The importance of scatter decreases with increasing distance from the beam axis, Increasing the wedge angle would attenuate the anterior portions of the lateral fields, which would decrease the dose gradient, B and C would have the oppewite effect. Ina “wedged pair,” the thick ends of the wedges are always together. Raphex 1980 Answers © Page 17TB. 719. 120. Ta. 722, 123. 725. 721. 728. ‘129, ‘Surface dose decreases as photon energy increases. The reverse is tue for electrons. The general formula or calculating a gap is: (Feld size/2) (depth atthe junction/S AD) Field £: (20/2) x (12/100) Field II: (30/2) x (12/80) Total gap = 1.2+2.25 = 3 Depths of maximum build-up for common clinical accelerator energies (10 cm x 10 om, Field Size) are 1.2.cm, 1.5.cm, 2.3 em, and 3.0 em for 4, 6, 10, and 15 MV respectively. Geomeie Pecans colina 0 Consider a point on the dose axis just below the maximum (where both curves meet); the curve for Plan B represents a larger volume than the curve for plan 3 cis point, As any object placed in the path of the beam is moved further from the patient, its effect on the surface dose decreases since the electrons produced in the object have a greater chance of scattering out ofthe beam. Selection B is incorrect since increasing the spoiler thickness would increase the surface dose, Selection C would be correct only ifthe spoiler ‘was in contact with the patient’s skin. Beam spoilers are not generally necessary for treating Hodgkin's disease with energies below 10 MV since the buildup characteristics of the Jower energy beams adequately treat the superficial nodes, ‘As photon energy increases the contribution due to scatter (and hence the effect of blocking) decreases, Fields which require an “irreg” calculation for low energy photons can often be calculated with open field data for energies above 15 MY, for accuracy within 2%. By similar triangle geometry: geometric penumbra/ collimator-isocenter dist, = focal spot diameter/ focus-collimator dist. geometric penumbra (cm)= (100-34) x (0.3/34) MU = 100 cGy/f 1.0 cGy/MU x 0.6 x (100/420) S, x S,] Ignoring S, and S, (collimator and photon scatter respectively), as they will be about 10%, gives 2940 MU. In TBI calculations, the most important factor isthe inverse square factor, and the second most important is the TMR, is undesirable ‘The beam spoiler acts as bolus or build-up material for TBI treatments. Skin spy because the entire blood volume is part of the target. iB ‘MU calculation accuracy and choice of beam energy are important for all treatments, The tighter ‘margins in conformal therapy require more care in set-up and repositioning accuracy. The low density of lung tissue results in less bean attenuation and thus higher dose compared to the same depth in unit density tissue. Areas of thin separation, such as the neck. head and lower Raphex 1998 Answers © Page 18730. TBI 732. 733, 735. 137. 18. 139. 740, TAI. legs receive higher doses than thicker regions, These thickness differences are more dramatic for ‘treatment with lateral fields than for AP/PA fields. Compensators and high energy photons ‘would tend to reduce dose inhomogeneity ‘To produce sharp dose gradients in all directions requires: 1) small fields, and 2) beams incident froma large number of directions (eg., as in 3-D) R (cm) is the practical range of an electron beam. It is the depth at which the falling part of the depth dose curve meets the x-ray (bremsstrahlung) background. R is approximately E(MeV)/2. The depth of the 90% isodose is approximately E(MeV)/3, e.g.,2 12 MeV electron beam treats tissue up to about 4 cm depth and spares tissue beyond 6 em, The surface dose as a % of dy, is influenced by the spread of electron energies in the beam and their incident angles. Electrons scattered from the collimator and the foil(s) affect the surface dose. A.6 MeV electron beam typical has a surface dose of about 75 00 95%. A 6 MV photon bearm has a much smaller surface dose, typically 20 10 25%, depending on the field size, Scanned electron beams have less low energy scartered electrons compared to electron beams that passthrough scattering foils. Onthovoltage beams have surface doses of approximately 100%. Surface dase increases as energy increases. ‘The 80 and 90% isodose curves decrease in width with depth, so the field size on the skin must always be wider than the voluine width at depth, Also the cut-out size matches the 50% isodose at d,..- ‘Low energy x-rays deliver a higher dose to bone than tissue because of the Z? dependence of the photoelectric effect, In the electron beam zbsorbed dose is proportional to the mass stopping power, which is similar in bone and tissue, ‘Options 2 and 4 will result in greater hot spots. is important to measure the output and PDD for small electron fields, as these factotrs ‘can change dramatically. PDD and beam energy are not signiticantly affected by relatively small changes in SSD. (Note, this does not apply to the SSDs used for total skin electrons). MU = Prescribed dose/(output x PDD) = 2004(0.954 x 0.90) = 233 MU. ‘The dose fall-off beyond the tumor will be steeper with the lower energy technique. ‘The rule of thumb for electron range is E/2 cm. IF de cord lies beyond the range for ‘both beams, iis expected to get fess than 10% of the prescribed dose, The 9 MeV technigue witl have a higher surface dose because ofthe bolus. The rule of thumb for the depth of the 80-90% isodose is E/3 cm, Therefore the tumor would be adequately treated with either technique. ‘Situations in which increase or decrease in scatter oocurs are not well modeled by this algorithm. With inhomogeneities or sloping surfaces, itis very important to be able to take account of scatter in calculating an electron beam dose distribution, A encil-beam algorithm is generally better at modeling these situations; however, any Ruphex 1998.0 Answers © Page 19742, 743, Ta, TAS, 746. 747. TAB, 749, . TSL. 752, 753. 755. algorithm must be thoroughly evaluated by comparison with measured data, before reliance can be placed on treatment plans generated ‘The half-life of cobalt-60 is 5.26 yrs. Final dose rate = Initial dose rate x exp ~@9*"/Tia) 100 = 210 x exp 19693 *¥5.26) t= 5.63 yrs ‘The half-life of iodine-125 is 60.0 days,. Therefore; A(l) = A (initial) x exp -(0.693 x U60) = 0.48 mCi x exp {0.693 x 7/60) = 0.44 mCi Exposure rate = Exposure rate const x activity x (1/12) = 8.25 (R-cin*/mg- br) x100 mg x (110,000 cm?) = 82.5 mR/hr. Perpendicular distance (for each source) = 1.5 cm. Longitudinal distance from center ‘of source to calculation point = 2 cm, Om, 2cm respectively. Total dose rate = sum ‘of (cGy per mg-br x mg-Ra eq.) for all sources = (1.3 x 20) + (3 x 20) + (1.3 x 20) = 112cGyhhr, ‘The dose rate is lower along the seed axis than in a direction perpendicular tothe axis, ‘To acoount for random seed orientation inthe tissue, a Jose rate averaged around the seed is used for calculation purposes. Todine-125 has an average energy of about 28 keV, whereas Iridium-192 has an average energy of about 380 keV. ‘Total dose = Initial dose rate x Ty... = 7.7 (1.44 x 60 x 24) = 15967 cGy. (Note: half-life is converted to hrs). ‘A.Baq isthe SI unit of activity and is equal to one disintegration per second. 55 mg-Ra eq. = 55 x (8.25/3.26) = 139.2 mCi of Cesium-137. ‘Amg-Ra eq, of another isotope will have the same exposure rate as a mg of radium, ‘The magnification ring should be placed in the same plane as the applicator for both films. The magnification factor of the film is then (diam of ring on film)/(actual diam). Dimensions measured on the film are then divided by this magnification factor to give actual dimensions inthe plane ofthe applicator. ‘The Patterson-Parker (Manchester) system uses a non-uniform distribution of sources to achieve a uniform dose ata given distance from the plane of the implant. Radon-222 has a half-life of just 3.83 days. Therefore, the radon reaches equilibrium just a few ‘weeks after being encapsulated. This is the maximum amount of radon that will ever be in that source. Al! of the decays in the radium source are either alpha or beta. The alpha particles will remain in the tube and become helium gas. Since the helium is stable, the amount of helium gas and, therefore, the internal pressure will increase linearly with time, eventually causing the failure of the source. Thus helium gas pressure causes the source to break, but itis the leakage of radon ‘gas which isa hazard, ‘One mg Ra-eq. of any radionuclide "X” has an activity in mCi of Gamma(Ra)/Gamma(X). ‘The absorption of a neutron into the nucleus makes it unstable, since it has too few positive Raphex 1998.0 Answers © Page 20156. 757. 758, 759. 61. 762. 163. 165. ‘167. 168. 709. 770. ™. ™. 773. charges. Balance restored when the neuizon decays to a proton uid an electron, which is emitted as a beta minus particle In beta decay, the available energy is divided between the beta pasticle and the neutrino, giving each a spectrum of energy. T=CEn,xE,, where nis the fractional abundance and E is the gamma-ray energy. Cis constant. The two gamma-rays of coball-60 are emitted in cascade during every Cobalt-60 disintegration. n, and n, are both equal to 1, The one gamma-ray of Cesium-137 is emitted in every disintegration of eesium-137 and also has an n of 1. ‘The two gamma-rays of cobali-60 are both approximately twice as energetic as the one gamma-ray of cesium-137, Therefore, Pg, is approximately four tines Tg, Ragium-226 has aT,» of 1600 years and devays <1% per year, Cobalt-60 has a Tp of 5.26 years and decays about 1% per month, Cesium-137 has a Ty 0f 30 years and decays 2.3% per year Iridium-192 has a Ty of 742 days and decays 1% per day. Although there can be great variation in dose rate to point A depending upon differences and internal anatomy and therefore relative positioning of the tandem and ovoids, a reasonable “rule of thumb” approximately is that the dose rate to point A in eGy/hr = the total mg Ra eq. in the tandem plus 1 ovoid x 1.08. Thus (15+ 10+ 10 +18) x 1.05 = 53. By the inverse square law, che largest diauneter will give the lowest surface dose for the same dose at depth. Sealed sources must be leak-tested every 6 months. The weekly dose discrepancy that constitutes a misadministration is 30%. The total dase discrepancy, for treatments invotving more than 3 fractions, is 20%. Flatening filters are only used in photon beams; electrons use scattering foils to obtain a large field size. Separate chambers with separate ci of radiation output, its are used in the accelerator 10 assure zeliable monitoring. ‘The electron beam leaves the accelerator waveguide and is tuned through 90° or 270° before striking the target for une x-ray mode. (X-rays cannot be bent by magnetic fields). Sections of the monitor cha AAs energy increases x-1 transmission tages amber at equal distances from the center are used to monitor symmetry. yy production tends towards the forward direction; thus linacs use ‘The HVL will be about 2-2.5 min Al. HVL is specitied in Pb for megavoltage beams. ‘A “full calibration” is required annually but a monthly spot check of ousput is also required. Answers A through D are required by NRC Part 35 for a source change and a report is Raphex 19980 Answers © Page 2174, 775. 716. ™. 778. Tal. 783. 785. sent within 30 days to the licensing agency. Modification of shielding is almost never needed; the old, decayed source is replaced with one with a similar activity to the ‘previous source when new, fur which the shielding was designed ‘Changes in the shielding and location of the teletherapy unit can result in unacceptable dose rate levels outside the room. These changes must be approved. When the physicist or the radiation safety officer on the license is changed, the ‘qualifications of the new person must be checked and approval given by the licensing agency. ‘Neutrons are most effectively slowed down by striking (and sharing their energy with) particles ofa similar mass, ie., protons. The hydrogen nucleus is a proton, so bydrogenous materials are effective neutron moderators. If the patient is 2 cm closer to the source than intended, they will receive a greater dose. By the inverse square law, the dose will be (100/98)? = 1.04 of the dose intended, i.¢., 4% more. ‘This coincidence can be checked by exposing 2 {itm perpendicular to the beam axis at days Al the isocenter. The light field edges are marked on the filin (e.g., with pin holes or coins). After ‘processing, the film can be scanned in a densitometer to determine the location of points which received 50% of the central axis dose. These points should coincide with the light field edges. ‘The Bragg-Gray relationship describes gas cavity interactions With x-rays. Exposure is the charge collected per unit mass of air and the mass of air in the chamber will decrease when the pressure decreases or the lemperature increase. Therefore, the charge reading will Jecrease when the pressure decreases, Humidity has some effect on the reading but is uscaily less than 1% and is negligible. The temperature would have to be higher in city A than city B to decrease the reading. The stem effect is not relevant to this question ‘Aso for linear accelerators. ‘The maximum permissible fetal dose is $0 mrem per month, The maximum head leakage from a cobalt-60 unit is 10 mremv/hr (the average over the whole head must not exceed 2 mrem/br). ‘Therefore the maximum time is 5 firs. In practice, dose rates received by radiation therapists are far lower, because of the lower average dose rate and increased distance from the head. The best sources of data on typical doses received are the filin badge records of the radiation therapists themselves. Due to the size of the source, rays from the cobalt-60 source converge al the point to be imaged, then diverge as they travel towards the film, Moving dhe film closer 10 the patient minimizes this effect, although it increases patient scatter reaching the film, which reduces contrast, Magnification over these distances is not a factor, and air scatter is negligible. A plot of net optical density as a function of the log of radiation dose is termed the HD curve. ‘The energy absorbed by a TLD (LiF) is stored by electrons trapped in the crystal. When the crystals are heated the electrons drop back to lower energy levels, releasing visible light which is detected and measured by a photomultiplier. Raphex 1998 © Answers © Page 22786. 87. 2 g TSS. 197. T100. ‘An ideal phantom used as a substitute for muscle should have approximately the same. density and effective atomic number as muscle so that photoelectric absorption is the same. Electron density should be the sae to obtain sitnitar Compton attenuation in the phantom, These three factors are very situilar for water and muscle, making water ‘an ideal phantom material, Viscosity is radiologically irrelevant, ‘The % of the initial energy given tothe scattered photon decreases as the ‘scattering angle increases, ‘The dose will be approximately 1% of the central axis Jose due to internal scatter, collimator scatter, and bead Jeakage, but this depends on distance from field edge to fetus, and the actual value of the head leakage (0.1% maxiinum), Cobalt-60 emits two 7-rays of 1.33 and 1.17 MeV. The maximum photon energy is 1.33 MeV. ‘The occupancy factor depends only on the fraction of the working Jay that the area could be occupied; itis always 1.0 for treatment consoles. ‘The design of a protective barrier must include contributions from primary, scattered ‘and leakage radiation, In this case, the primary radiation is not a factor and the maximum scattered radiation is only about 0.5 MeV. However, the leakage radiation through the tube housing is the sane energy as the primary, 15 MeV. (Qhas changed from 10 10 20 based on “the information now available on the RBE for ‘neutrons for a variety of cellular effects in vitro" — see NCRP 91, p. 12. ‘The patient should not be placed in the saune room as another patient, Film badges have various types of filters in order to obtain some information about the beam quality. However, flm has an energy dependence and cannot measure dose or exposure very accurately. AmSv (or 100 mrem) ‘See NCRP 116 for recommended values. Note, however, th values are set by state regulations, ‘Afterloading systems always deliver far less dose to staf than implanting active sources inthe operating room, APHEX 1998 © Answers © Page 23