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Which of the following processes is most likely to be associated with apoptosis? A. B. C. D. Nucleosomal DNA laddering Loss of plasma membrane integrity Swelling of the nucleus Endoreduplication
Correct answer is A. RATIONALE: Apoptosis is a type of programmed cell death involving orderly, well-defined, controlled processes. One of the most prominent of these processes involves the cleavage of chromatin at specific intervals defined by nucleosomal units. While it is possible to have apoptosis without DNA laddering, the remaining choices do not imply "controlled" processes at all. 2. Which of the following terms is defined as the net energy transferred to charged particles per unit mass, at a point of interest, excluding radioactive energy loss and excluding energy passed from one charged particle to another for photons? A. B. C. D. Exposure Collision kerma Mass energy absorption coefficient Absorbed dose
Correct answer is B. RATIONALE: This item requires knowledge of the definitions and distinctions between four common physics terms. 3. The purpose of a phase II clinical trial is to: A. B. C. D. estimate the toxicity of treatment to be tested. estimate the efficacy of treatment to be tested. estimate the preclinical toxicity of an experimental agent. determine a safe starting dose of an experimental agent.
Correct answer is B. RATIONALE: A Phase II trial is performed to determine if a drug or treatment has activity against a specific type of tumor. 4. Which of the following chemotherapy agents is most effective against soft tissue sarcoma? A. B. C. D. Thiotepa Cyclophosphamide Dactinomycin Doxorubicin
Correct answer is D. RATIONALE: Doxorubicin has been a mainstay of chemotherapy for advanced soft tissue sarcomas, with a 20-30% response rate. More recent studies also have demonstrated the efficacy of ifosfamide.
Radiation Oncology In-Training Exam 2007
What number of axillary lymph nodes removed for sampling during a level I / II node dissection for breast cancer most likely would require postoperative radiation therapy to the axilla? A. B. C. D. 02 06 08 10
Correct answer A. RATIONALE: The number of chest wall recurrences increased in cases where the number of axillary lymph nodes removed for sampling was less than 6. The minimum number of axillary lymph nodes to be removed in a level I/II node dissection is 6. Reference: Recht A, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. Journal of Clinical Oncology. 1991;9(6):988-996. 6. Which of the following types of cancer was associated with a statistically significant improvement in survival for patients who had one to three solitary brain metastases and received whole brain radiation therapy with the addition of stereotactic radiosurgery, according to results of the RTOG 9508 phase III trial? A. B. C. D. Breast cancer Renal cell cancer Non-small cell lung cancer Melanoma
Correct answer is C. RATIONALE: Based on the RTOG 9508 phase III trial results, patients with non-small cell lung cancer (NSCLC)/small cell cancer (SCC) had improved median survival with the addition of stereotactic radiosurgery (SRS) to whole brain radiation therapy (WBRT) on subset analysis. This is the basis for the ongoing RTOG 0320 phase III trial. 7. In RTOG 8501, what was the 5-year overall survival rate for patients who had esophageal cancer and received radiation therapy alone? A. B. C. D. 00% 10% 25% 35%
Correct answer is A. RATIONALE: This is a landmark study that established the superiority of combined chemoradiation therapy to radiation therapy alone for esophageal cancer. Reference: Herskovic. New England Journal of Medicine (NEJM). 1992;326:1593.
American College of Radiology
Which of the following tumor stages is correctly matched to the appropriate prostate cancer involvement or invasion? A. Stage T2b is associated with tumor involvement of more than one half of one lobe but not both lobes of the prostate. B. Stage T2c is associated with nonpalpable tumor involvement of both lobes of the prostate via needle biopsy. C. Stage T3a is associated with tumor invasion of the prostate apex. D. Stage T4 is associated with tumor invasion of the seminal vesicles.
Correct answer is A. RATIONALE: The correct answer for option B is T1c (not T2c), option C is T2 (not T3a), and option D is T3b (not T4). Reference: AJCC Cancer Staging Manual (6th edition). 9. According to GOG 122 (Randall), the survival rate of patients who have surgical stage III-IV endometrial cancer and receive adjuvant abdominopelvic irradiation compared to adjuvant chemotherapy is: A. B. C. D. worse. similar. improved. not able to be analyzed.
Correct answer is A. RATIONALE: In the GOG 122 trial, patients treated with adjuvant abdominopelvic irradiation had a worse survival (42% vs. 55%, p < 0.01) compared to patients treated with adjuvant chemotherapy. Reference: Randall, et al. Journal of Clinical Oncology. 2006;24:36-44. 10. A well-lateralized, stage T3N0 squamous cell carcinoma of the nasopharynx has at least a 15% risk of metastasis to the: A. B. C. D. ipsilateral parotid lymph nodes. ipsilateral submandibular lymph nodes. posterior triangle lymph nodes bilaterally. occipital lymph nodes bilaterally.
Correct answer is C. RATIONALE: An important concept in the management of nasopharyngeal cancer is the need for elective irradiation of the level V nodes bilaterally, regardless of the status of the neck. The lymph nodes in the other areas are not routinely treated in a patient with a stage N0 neck. 11. What is the second leading cause of lung cancer? A. B. C. D. Exposure to arsenic Exposure to asbestos Exposure to benzene Exposure to radon
Correct answer is D. RATIONALE: Radon is the second leading single agent responsible for causing lung cancer; asbestos is responsible for only 3% to 4% of cases.
Radiation Oncology In-Training Exam 2007
resulting in alopecia. What is the most common secondary malignant neoplasm inside the radiation field for patients with retinoblastoma? A. Apoptosis is most likely to be involved in which of the following normal biological/developmental processes? A. not fertility.14) t(14. RATIONALE: It is important to know that common secondary malignant neoplasms inside the radiation field for patients with retinoblastoma are osteosarcoma. RATIONALE: Hair growth is due to continuous cycles of cell division and programmed cell death. Which of the following chromosomal translocations is most commonly associated with Burkitt lymphoma? A. which may be disrupted by radiation or chemotherapy.. B.14) t(9. and option D is for follicular lymphoma. C. Which of the following terms is defined as the energy absorbed per unit mass for photons? A. C. B.e. The balance of cell division and controlled apoptosis results in lengthening of hair. B. with osteosarcoma being the most common. 6 American College of Radiology . Apoptosis of eggs would result in infertility. Squamous cell carcinoma Non-Hodgkin lymphoma Fibrosarcoma Osteosarcoma Correct answer is D. i.22) t(11. Fertility Hair growth Muscle hypertrophy Tooth formation THIS ITEM WAS NOT SCORED. D. D. The collection of epithelial cells is often interspersed with melanocytes. apoptosis. 14. fibrosarcoma. C. RATIONALE: This item requires knowledge of the definitions and distinctions between four common physics terms. RATIONALE: Option B is the correct answer for chronic myelogenous leukemia (CML). which give rise to hair color. 15. or spindle cell sarcoma. 13. D. C. in specialized epithelial cells at the root of the hair follicle. B. Exposure Collision kerma Mass energy absorption coefficient Absorbed dose Correct answer is D. option C is for mantle cell lymphoma. D. t(8.18) Correct answer is A.12.
B. Which of the following neurological cognitive tests is most appropriate for measuring a patient's memory? A. RATIONALE: Endoscopic ultrasound (EUS) is the most useful diagnostic test for determining the tumor (T) stage of esophageal cancer. et al. C. 1999. Part A Grooved Pegboard Test Correct answer is A. 2000. C. D. RATIONALE: The objective of a phase I trial is to determine an appropriate dose for use in a phase II or phase III trial. Hopkins Verbal Learning Test (HVLT) Controlled Oral Word Association (COWA) Test Trail Making Test. Reference: Fitzgibbons. Which of the following factors is the most important predictor of disease-free survival and overall survival in patients with breast cancer? A. C. Tumor size Mitotic index Axillary lymph node status Histopathologic tumor grade Correct answer is C. B. C. 18. College of American Pathologists Consensus Statement. D. PL. Which of the following diagnostic tests is most useful for determining the tumor stage of esophageal cancer? A. B. Prognostic factors in breast cancer. axillary lymph node status is the most powerful predictor of these factors. 19. Three different lung cancer radiation treatments are being assessed for maximum-tolerated dose. 17. Esophagogastroduodenoscopy Endoscopic ultrasound PET scan CT scan Correct answer is B. RATIONALE: All of these factors are shown to be prognostic for diseasefree survival (DFS) and overall survival (OS) by multivariate analysis. RATIONALE: Memory is measured by the Hopkins Verbal Learning Test (HVLT).16. Radiation Oncology In-Training Exam 2007 7 . D.124:966-978. D. Archives of Pathology and Laboratory Medicine. This study is an example of what type of clinical trial? A. However. B. Phase I Phase II Phase III Pilot Correct answer is A.
It decreases the risk of intraoperative bleeding. B. 8 American College of Radiology . It is a viable alternative to thoracotomy in patients who are frail. the sole trial to require pelvic lymphadenectomy was the GOG 99 trial. C. RATIONALE: Deviation of the tongue to the ipsilateral side is the major finding in a patient with loss of function of cranial nerve XII. GOG 99 (Keys) GOG 33 (Morrow) PORTEC (Creutzberg) Norwegian (Aalders) Correct answer is A. RATIONALE: The regional recurrence and long-term survival with video-assisted thoracic surgery (VATS) and lymph node dissection are equal to open lung resection.52(1):6-13. more like late-responding normal tissues. The postoperative period is shorter. <3 Gy 3 Gy to 5 Gy 6 Gy to 8 Gy >8 Gy Correct answer is A. 2002 (Jan 1). Correct answer is D. Physics. D. In the Norwegian and PORTEC trials. C. all patients underwent hysterectomy alone without surgical evaluation of the pelvic and/or paraaortic lymph nodes. 2004. Reference: Keys. D. Biology.20. RATIONALE: Of the 3 published trials. B. Locoregional recurrence is increased. 23. Deviation of the tongue to the left side with protrusion Deviation of the tongue to the right side with protrusion Loss of sweet taste on the right side of the tongue Loss of salty taste on the right side of the tongue Correct answer is B. et al. et al. Which of the following studies compared surgery alone versus surgery plus external-beam pelvic irradiation in patients with early-stage endometrial cancer and required all patients to undergo surgical staging with pelvic lymphadenectomy? A. References: Brenner.92:744-51. D. D. International Journal of Radiation Oncology. 22. Gynecologic Oncology. B. RATIONALE: Both preclinical and clinical evidence suggests that prostate cancer has a low alpha/beta (α/β) ratio. Which of the following findings is most likely to be caused by loss of function of right cranial nerve XII? A. 21. C. C. DJ. What is the best estimate of the α/β ratio for prostate cancer? A. B. Which of the following statements about video-assisted thoracic surgery for patients with lung cancer is FALSE? A. GOG 33 investigated the relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium.
the non-orbit head and neck sites (8%). B.92:744-51. RATIONALE: Insulin-like growth factor-1 (IGF-1) is a better test than growth hormone (GH). of these failures. the most common site of failure in the surgery alone arm was in the pelvis. According to the IRS-I and IRS-II data analyses. D. Lymph node metastasis has prognostic significance. the prostate had a 42% risk of lymph node metastasis compared to other sites. 2004. C. C. B. C. 26.24. Orbit Prostate Lower extremity Parameningeal THIS ITEM WAS NOT SCORED. B. nearly three fourths were in the vaginal vault. which of the following primary sites of rhabdomyosarcoma is associated with the highest risk of lymph node metastasis? A. 25. 77 Ir + 0 → ( 77 Ir ) → 1 192 0 191 192 n Os + γ (Electron capture) decay) 77 Ir + 0 → ( 77 Ir + −1 β) → 76 1 192 78 Pt + 0 −1 β +γ (Beta Radiation Oncology In-Training Exam 2007 9 . However. RATIONALE: This item requires knowledge of balancing 191 192 n nuclear reaction equations for this reaction. 27. What is the daughter product associated with electron capture from A. and the lower extremity (9%). Reference: Keys. Gynecologic Oncology. Which of the following laboratory tests is most appropriate for determining if a patient with acromegaly has responded favorably to radiation therapy? A. which of the following sites is most likely to be associated with cancer recurrence in a patient who has early-stage endometrial cancer and undergoes TAH-BSO without adjuvant irradiation? A. According to GOG 99 (Keys). RATIONALE: In the GOG 99 trial comparing surgery alone with surgery plus adjuvant pelvic irradiation in patients with stage I-II endometrial cancer. et al. Liver Vaginal vault Pelvic lymph nodes Paraaortic lymph nodes Correct answer is B. B. 192 76 192 78 192 77 Ir ? Os Os Pt Pt 192 76 192 78 THIS ITEM WAS NOT SCORED. such as the orbit (0%). D. D. C. Serum glucose level Growth hormone (GH) Thyroid stimulating hormone (TSH) Insulin-like growth factor-1 (IGF-1) Correct answer is D. RATIONALE: Analysis of IRS-I and IRS-II data revealed that among all of the sites listed. D.
B. C.tamoxifen) without radiation: results from five NSABP randomized trials. International Journal of Radiation Oncology.3 months Correct answer is C.28. RK. B. D. Perez. et al. Cancer Principles and Practice of Oncology. Which of the following survival times is most likely to be associated with a patient who has a class II brain metastasis. p 1411. Philadelphia: Lippincott Williams & Wilkins Publishers. RATIONALE: The number of regional failures increases as does the tumor size and the number of positive axillary nodes found. According to an NSABP cumulative analysis.1 months 04. Patients with the same tumor size but an increase in the number of positive lymph nodes will not have an increased risk of local failure. D. Halperin. Reference: DeVita. EC.2 months is the correct answer. 2004. C. AG. Principles and Practice of Radiation Oncology. 29.2 months 02. RATIONALE: Approximately 5% of patients with neurofibromatosis will develop malignant peripheral nerve sheath tumor. D. CA. 10. which of the following scenarios about the risk of locoregional breast cancer recurrence after treatment with mastectomy. 4th edition. based on the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA)? A. Sarcomas of the soft tissue and bone. chemotherapy and no chest wall irradiation is true? A. 2001. C. Brady. Reference: Taghain.2 months 07. 4. 30. The rate of isolated regional failure is 3% in patients with one to three positive lymph nodes and a tumor size of <2 cm. 10 American College of Radiology . LW. Physics. RATIONALE: Based on the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) for brain metastases. eds. Schmidt-Ullrich. The number of lymph nodes examined was not predictive of regional cancer recurrence. A higher risk of local failure is associated with patients who have one to three positive lymph nodes and an increased tumor size. et al. Biology. THIS ITEM WAS NOT SCORED. B. Liposarcoma Fibrosarcoma Leiomyosarcoma Malignant peripheral nerve sheath tumor Correct answer is D. type 1? A. 5th edition.51(1):106. Which of the following soft tissue sarcomas is most likely to be found in a patient with neurofibromatosis. Pattern of locoregional and distant failure in patients with breast cancer treated with mastectomy and chemotherapy (+/.
4 Gy Correct answer is B. 103 125 Pd I 131 Cs 198 Au Correct answer is B. Reference: Pollack. A radiobiological model suggests that HDR brachytherapy may achieve higher biologically effective doses.011628 per day. which then leads to nondisjunction. 32. according to the Intergroup 0123 study? A. 45 Gy 50. unequal distribution of chromosomes to daughter cells.011628 per day? A. D. At 5 years. patients were randomized to 64 vs. C.20:1167–74. Which of the following radionuclides has a decay constant (λ) of 0. Physics. 34.7 Gy per fraction was well tolerated acutely. What is the recommended dose for definitive radiation treatment of esophageal cancer. RATIONALE: Hypofractionated radiation therapy at 2. C. et al. D. 2002. According to a randomized trial comparing standard fractionation versus hypofractionation." The treated cancer cells go into mitosis with damaged DNA/chromosomes. C. RATIONALE: 125I has a decay constant (λ) of 0. 2006 (Feb 1). B. The lower dose arm had a higher median survival of 17.64(2):518-26. RATIONALE: The primary mode of cell death in most epithelial malignancies and the cell lines derived from such tumors after exposure to radiation doses in the therapeutic range is either "mitotic catastrophe" or "postmitotic death. Biology.4 Gy. The slow growth rate of prostate cancer is associated with high sensitivity to increased fraction size. B.5 Gy per fraction produced excellent local control. Reference: Journal of Clinical Oncology. and numerous translocations or chromosomal loss. The doomed cell either dies without successfully completing mitosis or soon after the aberrant mitosis. D. Correct answer is A. 12.4 Gy 54 Gy 59.9 months. B. Which of the following statements about hypofractionated radiation therapy for prostate cancer is FALSE? A. RATIONALE: In the Intergroup 0123 study. hypofractionation using 70 Gy at 2. 50. B. International Journal of Radiation Oncology.5 months vs. G0 G1 G2 M Correct answer is D. C. hypofractionation results in more severe acute GI and GU toxicity. Radiation Oncology In-Training Exam 2007 11 . D. The implication is that non-cycling cells tend to be more radioresistant. 33.31. Radiation-induced cell death in carcinomas typically occurs immediately after attempting to traverse which phase of the cell cycle? A.
0 mm Correct answer is B. CD7 CD20 CD30 CD40 THIS ITEM WAS NOT SCORED. C. Correct answer is A. It is less likely to metastasize to the brain than other histologies. C. B. and CD7).0 mm 03. RATIONALE: National Comprehensive Cancer Network (NCCN) guidelines specify 30 Gy to 36 Gy or 40 Gy in the case of bulky disease.0 mm 10. It is the most common histologic subtype. D. D. D. 38. 37. 36. D. RATIONALE: T-cell lineage is evident from the presence of T-cell markers (CD3. Which of the following antigens is a T-cell marker? A. C. 01. 10 Gy to 15 Gy 30 Gy to 40 Gy 50 Gy to 55 Gy 60 Gy to 70 Gy Correct answer is B. RATIONALE: Adenocarcinoma has surpassed squamous cell carcinoma of the lung as the most common histological subtype. RATIONALE: A large number of studies recommend a threshold value of 2 mm to 5 mm depth of invasion for elective treatment of the regional lymph nodes in this setting. It is treated differently than squamous cell carcinoma. which of the following radiation dose ranges would be most appropriate for treatment of intermediate-grade non-Hodgkin lymphoma? A. CD2. B. B. Which of the following statements about adenocarcinoma of the lung is true? A.35.0 mm 15. B. According to the National Comprehensive Cancer Network (NCCN) guidelines. 12 American College of Radiology . C. Which of the following depths of invasion is considered to be the threshold for elective irradiation of the regional lymph nodes in a patient with squamous cell carcinoma of the oral tongue? A. It is rarely associated with TTF-1.
B. in turn. Hypoxia adversely affects the treatment and management of cancers because it: A. RATIONALE: The aim of randomization is to minimize bias. impedes adequate blood flow to the tumor. This. A 9-month-old infant has a mass in the left flank. Tumors often show aberrant perfusion patterns and do not respond to physiological cues to the same degree as normal tissues. 42. which of the following radionuclides yields the greatest absorbed dose to tissue? A. Biopsy results are consistent with neuroblastoma. 40. D. Randomization Patient stratification Univariate analysis of prognostic factors Multivariate analysis of prognostic factors Correct answer is A. RATIONALE: Absorbed dose is directly proportional to the half-life of the radionuclide. the majority of which contribute to cancer cell survival. activates molecular pathways contributing to resistance. D. and treatment is entirely different. What is the best method for minimizing bias in a national trial comparing two radiation therapy regimens? A. C. Correct answer is C. Radiation Oncology In-Training Exam 2007 13 . C. D. periorbital ecchymosis. D. such as HIF-1. RATIONALE: Hypoxia leads to activation of potent transcription factors. However.39. bone involvement (not bone marrow) upstages the infant to cancer stage 4. B. 103 125 Pd I 131 Cs 198 Au Correct answer is B. B. causes dyspnea and tachypnea in the patient. B. Stage 2 Stage 3 Stage 4 Stage 4S Correct answer is C. activates numerous downstream targets. 41. C. RATIONALE: If there were no presence of bone metastases. C. Hypoxia within the tumors is detectable even when blood oxygen levels remain normal. For permanent implants with the same activity. and bone metastasis to the right femur. this infant’s disease would be classified as cancer stage 4S. What cancer stage would be most appropriate for this patient's condition? A. increases blood flow to the tumor.
14 American College of Radiology . RATIONALE: Osteosarcoma is the most common malignant primary bone tumor (excluding multiple myeloma). For the following trials. D. which has not yet been able to be explained. D. 1. D. 46. trial. BC. B.5 3. 1998. according to the RTOG 9005 trial treatment parameters? A. there has been a very dramatic increase in esophageal adenocarcinoma in Caucasian men. the PIV/TV ratio should be <2. 35% Vancouver. 24% Danish trial (82b).5 Correct answer is A. B. B.0 to minimize complications. 38% Correct answer is B. 30% IBCSG. Reference: Devesa. C. 13% for the NSABP trials. and 20% for the IBCSG trial.5 2.5 4. D. RATIONALE: The 10-year published results are as follows: 33% for the Vancouver. C. Cancer. C. 45.83:2049-53. C.43. Which of the following primary bone tumors is most common? A. NSABP (5-study analysis). RATIONALE: Over the past 40 years. what is the correct isolated locoregional failure rate over a 10-year period for a premenopausal patient with one to three positive lymph nodes who receives postmastectomy chemotherapy and tamoxifen with no radiation therapy? A. Ewing sarcoma Malignant giant cell tumor Chondrosarcoma Osteosarcoma Correct answer is D. Which of the following PIV/TV ratios (conformality indexes) would be most appropriate when using conformal stereotactic radiosurgery to treat a patient with meningioma. Squamous cell carcinoma in Caucasian men Squamous cell carcinoma in African American men Adenocarcinoma in Caucasian men Adenocarcinoma in African American men Correct answer is C. B. Which of the following types of esophageal cancer has had the greatest increase in incidence over the past 40 years? A. 44. BC trial. RATIONALE: Extrapolating from the treatment parameters used in the RTOG 9005 trial. et al.
RATIONALE: According to the current FIGO staging system for uterine tumors. 48. Age Gender Performance status Weight loss THIS ITEM WAS NOT SCORED. Proctitis Erectile dysfunction Urinary incontinence Anastomotic stricture Correct answer is A. RATIONALE: Proctitis is a known complication of radiation therapy. B. D. There is a greater risk of metastasis to the superior jugular nodes than to the submandibular nodes. There is a similar risk of metastasis to the submandibular nodes as to the mid-jugular nodes. What is the risk of metastasis to the lymph nodes in a patient with stage T2N0 squamous cell carcinoma of the lateral aspect of the oral tongue? A. Which of the following complications is NOT associated with a radical prostatectomy? A. RATIONALE: An important concept in both surgical and radiotherapeutic management of oral tongue cancer is parallel first echelon drainage to the submandibular (level I) and mid-jugular lymph nodes. Radiation Oncology In-Training Exam 2007 15 . C. C. Which of the following factors is NOT an independent prognostic indicator of non-small cell carcinoma of the lung? A. IC IIA IIB IIIA Correct answer is C. B. There is a similar risk of metastasis to the retropharyngeal nodes as to the mid-jugular nodes. Extension to the cervical glands only is classified as stage IIA. B. D. Which of the following FIGO stages is associated with a patient who has endometrial cancer with extension to the cervical stroma? A. D. C. B. 49. D. 50. There is a greater risk of metastasis to the retropharyngeal nodes than to the mid-jugular nodes. Correct answer is D. extension to the cervical stroma is classified as stage IIB. C.47.
C. RATIONALE: This item requires knowledge of the Bragg Peak. Unlike herpesvirus or HIV infections. RATIONALE: Continued tobacco use by a patient undergoing radiation therapy for head and neck malignancies is well-documented to be associated with poorer tumor control rates. LDH. 60% of patients with neuroblastoma have metastases at diagnosis. 54. What percent of patients with neuroblastoma have metastases at diagnosis? A. Which of the following factors is included in the international prognostic index (IPI) for non-Hodgkin lymphoma? A. B. D. RATIONALE: The international prognostic index (IPI) consists of stage.51. 53. 52. B. 10% 25% 60% 80% Correct answer is C. The knowledge of this percentage is important because it justifies the need for routine metastatic workup of patients with the disease. Concurrent HPV infection Concurrent tobacco use Gender of the patient Grade of the cancer Correct answer is B. Histology Weight loss Lactate dehydrogenase (LDH) level Erythrocyte sedimentation rate (ESR) Correct answer is C. Which of the following factors most adversely affects patients receiving radiation therapy for squamous cell carcinoma of the head and neck? A. C. human papilloma virus (HPV) infections have not been shown to be associated with increased treatment-related toxicities. Protons Gamma–rays Neutrons Electrons Correct answer is A. and increased need for treatment breaks. age. B. 16 American College of Radiology . and number of extranodal sites. B. RATIONALE: Overall. C. C. D. Which of the following forms of radiation demonstrates a Bragg peak in matter? A. increased side effects. D. D. performance status.
Which of the following statements about post-prostatectomy radiation therapy used in the EORTC 22911 Trial is true? A. Hormone therapy was added to the treatment regimen for patients with positive lymph nodes. 58. Verocay bodies Psammoma bodies Small. be most beneficial after D2 lymph node dissections. RATIONALE: Psammoma bodies are associated with meningiomas. Spleen colony D. RATIONALE: There is no overall survival benefit yet. are non-clonogenic. According to Intergroup Trial 0116. biochemical progression-free survival. D. C. Correct answer is A. D. round blue cells Flexner-Wintersteiner rosettes Correct answer is B.345(10):725-30. 56. C. 57. and hormonal therapy was not added. result in a statistically significant decrease in the rate of distant metastases. with a significant p value. and thus. result in an unacceptable level of toxicity in the majority of patients. LD50 B. D. RATIONALE: Only the spleen colony assay of Till and McCulloch depends on the colony-forming ability of individual bone marrow stem cells.55. Which of the following pathological findings is associated with patients who have meningioma? A. Radiation Oncology In-Training Exam 2007 17 . result in a statistically significant improvement in overall patient survival. RATIONALE: Overall survival increased from 41% to 50%. Patients with positive lymph nodes were not included. It was beneficial for patients who had prostate cancer with positive lymph nodes. Which of the following assays of normal tissue radiation response directly depends on the clonogenicity of individual cells? A. It improved local control. All of the other assays depend on measuring a tissue structural or functional endpoint as a surrogate marker for cell survival. Reference: New England Journal of Medicine (NEJM). Pig skin reaction C. adjuvant chemotherapy and radiation therapy after gastrectomy were more likely than gastrectomy alone to: A. B. It resulted in more frequent grade 2 or grade 3 late effects. 2002. Correct answer is C. and overall patient survival. B. B. 51Cr clearance Correct answer is C. C.
For 137Cs. Correct answer is A.635 cm) will transmit about what fraction of the incident radiation striking it? A. 03% 06% 12% 25% Correct answer is B.5)*(. Other symptoms. (.5) = 0. B. are signs of more advanced disease and are uncommon at initial presentation. RATIONALE: There are now multiple papers documenting a less than 5% recurrence rate in the contralateral lymph nodes following radiation therapy to the ipsilateral nodes (no treatment to the contralateral nodes) in patients with T1-T2. Normal lung cells do not take up amifostine. T2N1 with the primary tumor confined to the tonsillar fossa T1N1 involving the most lateral section of the soft palate T1N1 confined to the glossal-tonsillar sulcus T1N0 involving the lateral aspect of the base of tongue Correct answer is A. including pain and hematuria. C. B. D.0625 or 6. C. 18 American College of Radiology . N0-N2b stage small cell carcinoma that is confined to the tonsillar fossa. Pelvic pain Low back pain Vaginal bleeding Hematuria Correct answer is C. a 1-inch-thick lead filter (HVL = 0. Which of the following stages of oropharyngeal squamous cell carcinoma is associated with the lowest risk of contralateral cervical lymph node metastases? A.25%. Pneumonitis is decreased. The other answers describe situations where the risk of contralateral neck disease is clearly greater than 15%. D. C.5)*(. RATIONALE: Amifostine treatment before lung irradiation protects the lung alveolocapillary integrity and has been found to have a protective effect in the acute phase of radiation lung injury. 60.5)*(.59. Xerostomia and mucositis are increased. Which of the following statements about the use of amifostine concurrently with thoracic external-beam radiation therapy is true? A. C. B. RATIONALE: The most common presenting symptom in patients with endometrial cancer is painless vaginal bleeding. Which of the following symptoms is most common in patients who present with endometrial cancer? A. Esophagitis is increased. RATIONALE: The 1-inch-thick shield constitutes four half-value layers. D. B. D. Hence. 61. 62.
and then remain unchanged. the total dose that yields a 5% probability of a normal tissue complication would be expected to: A. Vinblastine Hydroxyurea Prednisone Carmustine Correct answer is C. The median age at diagnosis of neuroblastoma is about 2 years of age. B. followed closely by neuroblastoma. a table is required that converts Hounsfield units to which of the following physical properties of the medium imaged? A. 65. Correct answer is D. doxorubicin. Radiation Oncology In-Training Exam 2007 19 . increase to a point. D. RATIONALE: In the absence of cell cycle effects and/or cell proliferation.63. Oncovin. the loss of additional sparing with increasing fractionation of the total dose is a reflection of the fact that tissue dose response curves have non-zero initial slopes. B. C. D. C. RATIONALE: Wilms tumor is the most common abdominal tumor that occurs during childhood. and prednisone. Neuroblastoma Rhabdomyosarcoma Non-Hodgkin lymphoma Wilms tumor THIS ITEM WAS PARTIALLY SCORED (BOTH OPTIONS A & D SCORED CORRECT). CHOP chemotherapy contains which of the following drugs? A. and then remain unchanged. as the dose per fraction of x-rays is reduced from approximately 2 Gy to 0.5 years of age. C. RATIONALE: CHOP chemotherapy includes cyclophosphamide. remain unchanged. Mass number Atomic number Electron density Physical density Correct answer is C. continue to increase. decrease to a point. For absorbed dose from heterogeneity corrections calculated from CT images. and the median age at diagnosis of Wilms tumor is 3. In the absence of cell cycle effects and proliferation. C. B. D.2 Gy. B. RATIONALE: Absorbed dose is directly proportional to electron density. 66. D. Which of the following types of abdominal tumor most commonly occurs in a 2-year-old child? A. 64.
the positive predictive value is true positive / true + false positives. In EORTC 10853.24(21):3381-3387. In NSABP B-17. a radiation dose of 59. B. Journal of Clinical Oncology. C. breast irradiation reduced the risk of breast cancer recurrence in all subgroups except for the patients with positive surgical margins. True positive / (True positive + false negative) True positive / (True positive + false positive) True negative / (True negative + false negative) True negative / (True negative + false positive) Correct answer is B. 2006. RATIONALE: In NSABP B-17. I n NSABP B-24. 20 American College of Radiology . 68. et al. RATIONALE: Since this is a malignant tumor. In NSABP B-17. Ductal carcinoma in situ of the breast. New England Journal of Medicine (NEJM).4 Gy/28 fractions 54 Gy/30 fractions 59. the actuarial rate of breast cancer recurrence after 12 years in patients who received surgery plus breast irradiation was 16%. clinging/micropapillary subtypes (RR 2. D. EORTC reported the relative risk of recurrence was higher for cribriform and solid histologic subtypes (RR 2. Which of the following equations is used to determine a positive predictive value? A. 2004.67.39) vs. Correct answer is B. D. C. Which of the following radiation doses per fraction would be most appropriate for a patient with malignant meningioma? A. Bjker N.4 Gy/33 fractions Correct answer is D. Which of the following treatment outcomes is associated with patients who have DCIS. the actuarial rate of breast cancer recurrence after 12 years in patients who received surgery only was 24%. RATIONALE: By definition. the actuarial rate of breast recurrence was 32% in the group not receiving radiation therapy. HJ.25). 69. including the group with positive surgical margins. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten year results of European Organization for Research and Treatment of Cancer Randomized Phase III Trial 10853 – A study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. B. the subtype of DCIS histology had no effect on patients' risk for breast cancer recurrence. C.4 Gy would be appropriate.350:1430-144. References: Burstein. In NSABP B-24. et al. D. B. according to prospective randomized trials? A. radiation reduced the risk of breast recurrence in all subgroups. 45 Gy/25 fractions 50.
D. IC IIB IIIA IIIC Correct answer is C. TD50 limiting dilution TCD50 tumor control Clonogenic survival MTT Correct answer is C.70. extension to the uterine serosa is classified as stage IIIA. C. Which of the following assays measures the reproductive capacity of individual cells? A. increase by a factor of 2. Stage IIIA also includes involvement of the adnexa and/or positive peritoneal cytology. Which of the following FIGO stages is associated with a patient who has endometrial cancer with extension through the entire myometrium and involvement of the surface of the uterine serosa? A. The other assays measure viability but not reproductive capability. D. Correct answer is B. D. 71. nx4 photons would have a standard deviation of the sqrt (nx4) or sqrt(n)x2. 73. Inguinal External iliac Presacral Obturator Correct answer is A. C. B. It is argued that reducing the reproductive capability of cancer cells is more clinically meaningful than achieving a specific degree of cell killing. RATIONALE: According to the current FIGO staging system for uterine tumors.e. then the signal-to-noise ratio (value divided by the standard deviation) of the number of photons in the group of similar voxels will: A. If the number of photons in a typical voxel increases by a factor of 4. RATIONALE: In Poisson statistics. RATIONALE: Only clonogenic survival assay measures the long-term reproductive capability of cells (i.. Radiation Oncology In-Training Exam 2007 21 . B. decrease by a factor of 4. Which of the following lymph nodes is NOT commonly associated with prostate cancer metastases? A. Thus. the ability to divide enough times to form colonies). RATIONALE: Inguinal lymph node metastasis from prostate cancer is not common. increase by a factor of 4. decrease by a factor of 2. The SNR = (nx4)/(sqrt(n)x2) = sqrt (n)x2 versus n/sqrt(n) = sqrt(n) for the original photon counts. C. B. D. Image intensity in a uniform region of a nuclear medicine image follows Poisson statistics. the standard deviation is proportional to the square root of the number of counted events. 72. C. B.
Endobronchial stent placement Correct answer is B. Of these. B. decreasing the fraction size would result in LENGTHENED overall treatment times. 125I LDR therapy C. Photodynamic therapy B. Which of the following treatment techniques is NOT an effective method for providing expedient palliation for an endobronchial lesion? A. D. RATIONALE: For a given prescribed overall dose. Which of the following represents an advantage of hyperfractionation? A. 22 American College of Radiology . Reduced acute toxicity Reduced late effects to normal tissue Decreased overall treatment time Increased patient convenience Correct answer is B. C.74. 76. B. D. Which of the following histologies is most likely to be associated with primary CNS lymphoma? A. With a smaller fraction size. but the management would remain the same. 77. 75. alveolar histology has the worst survival. Burkitt Follicular Hodgkin disease Diffuse large B-cell Correct answer is D. The difference in monitor units needed to deliver each fraction would be overshadowed by the increased number of visits required of the patient. RATIONALE: Most primary CNS lymphomas are diffuse large B-cell. immunoblastic or lymphoblastic lymphomas. D. C. the probability of late complications may be lower. RATIONALE: 125I LDR therapy is not an effective method for providing expedient palliation for an endobronchial lesion. Alveolar Embryonal Spindle cell Botryoid Correct answer is A. RATIONALE: Data from the literature showed that histologic subtype bears prognostic significance for rhabdomyosarcoma. B. 192Ir HDR therapy D. Which of the following histologic subtypes of rhabdomyosarcoma has the worst prognosis? A. C.
50%. RATIONALE: Surgical ablation including amputation alone resulted in long-term survival in approximately 20% of patients. RATIONALE: LCIS is not associated with any gross clinical or mammographic features. the photoelectric effect. Architectural distortion is the most common finding on mammography. Typically. 70%. 2004. D. D. Reference: Harris. LCIS is an incidental finding when biopsy of the breast tissue is completed for another reason. B. 80. Only one third to one half of cases may present with invasive lobular histology.78. It is associated with diffuse and bilateral proliferative activity in the breast tissue. 05%. the Compton effect. pp 497-505. C. bremsstrahlung radiation. characteristic x-rays from the tungsten target. The majority of x-ray production in a typical diagnostic x-ray tube operating at 60 kVp results from: A. Prior to the advent of chemotherapy. Diseases of the Breast. C. D. It may present in the setting of fibrocystic changes. B. et al. 20%. Which of the following statements about LCIS is true? A. Correct answer is B. 79. THIS ITEM WAS NOT SCORED. Radiation Oncology In-Training Exam 2007 23 . Most invasive cancers seen in association with LCIS are ductal. 3rd edition. the overall survival rate for patients with osteosarcoma treated with surgery alone was: A. J. B. Median age is 40 to 50 years and is seen more commonly in premenopausal women than in postmenopausal women. C. A lobular histology is associated with subsequent development of invasive cancer in 75% of patients. Correct answer is C. The median age of diagnosis is 50 to 60 years. RATIONALE: This item requires differentiation of x-ray production mechanisms.
D. and in the ongoing Intergroup trial. RATIONALE: Epidemiologic studies suggest that the routine use of refrigeration and the consequent avoidance of smoking and salting for food preservation is the major reason behind the decline in gastric cancer in the United States. 83. ionization chambers Correct answer is A. D. B. RATIONALE: Epirubicin. B. scattering foil. C. cisplatin. and 5-FU (ECF) comprise the chemotherapy regimen used in the MAGIC trial. which showed a benefit to perioperative chemotherapy. 84. D. ionization chambers High Z target. and 5-FU Cyclosphosphamide. and 5-FU Correct answer is C. ionization chambers High Z target. Cisplatin and VP-16 Gemcitabine and capecitabine Epirubicin. C. which randomizes ECF to 5-FU/LV as given in Intergroup 0116. cisplatin. flattening filter. C. Scattering foil. 04 Gy 06 Gy 08 Gy 14 Gy Correct answer is C. C. RATIONALE: A radiation dose of 8 Gy is the recommended upper limit (14 Gy is too high). Which of the following radiation doses should NOT be exceeded when stereotactic radiosurgery is administered to the optic chiasm? A. B. ionization chambers Flattening filter. RATIONALE: Requires knowledge of the linac's production of x-rays and electrons. D. 82. B. scattering foil. Which of the following factors has contributed most to the decline in incidence of distal gastric cancers in the United States? A. Which of the following chemotherapy regimens is most appropriate in the treatment of gastric cancer? A. 24 American College of Radiology . Which of the following sequences of items in a beam path would be most appropriate for delivery of 6-MeV electron-beam therapy? A.81. methotrexate. Use of proton pump inhibitors Improved food storage and preservation Improved detection of Helicobacter pylori Routine upper endoscopy screening of patients at 50 years of age Correct answer is B.
D. B. B. 88. C. RATIONALE: An endorectal balloon has not been shown to cause hypoxia in prostate cancer. Stage T1N0 of the oropharyngeal portion of the posterior pharyngeal wall Stage T1N0 of the floor of mouth Stage T1N0 of the soft palate Stage T2N0 of the base of tongue Correct answer is B. 87. the irradiated patients had a significantly worse local (inguinal) control and worse overall survival than patients treated with surgery alone. C.24:380-96. however. RATIONALE: In the GOG 88 trial. B. due to the fact that the groin irradiation was prescribed only to 3 cm below the anterior skin surface significantly underdosing many women's inguinal lymph nodes. C. 1992. C. This trial has been criticized. cause hypoxia. each in conjunction with a radical vulvectomy? A. Biology. Radiation Oncology In-Training Exam 2007 25 . Physics. Even experts who recommend primary surgery for oropharynx primaries would agree that the added benefit from surgery is greatest for answer B. which of the following outcomes is associated with patients who undergo definitive groin irradiation compared to groin dissection alone. According to the GOG 88 (Stehman) trial for vulvar cancer. B. 86. be practical for target localization during daily treatment. Increases TLC Increases DLCO if chemotherapy is added Decreases FEV1/VC ratio Decreases DLCO Correct answer is D. Reference: Stehman. D. Primary surgery is most appropriate for patients with which of the following types of squamous cell carcinoma? A. Correct answer is A. International Journal of Radiation Oncology. The use of an endorectal balloon and radiation therapy for prostate cancer has NOT been shown to: A. while radiation therapy is preferable to surgery for most tumors of the oropharynx. RATIONALE: Both radiation therapy alone and in combination with chemotherapy cause an immediate decline in DLCO (corrected or uncorrected) starting within 1 month after radiation therapy with a nadir at 9 months. RATIONALE: Primary surgery is the recommended therapy for most tumors of the oral cavity. et al. D. Worse local control and worse survival rates Similar local control and similar survival rates Improved local control and improved survival rates Improved local control and similar survival rates Correct answer is A.85. What effect does external-beam radiation therapy have on lung function? A. reduce prostate motion. D. improve high-dose rectal wall sparing.
25% of neuroblastomas exhibit N-myc amplification.5 cm Within +/-1% over 80% of the maximum field size at a depth of 10 cm Within +/-3% over 50% of the maximum field size at a depth of 10 cm Within +/-3% over 80% of the maximum field size at a depth of 10 cm Correct answer is D.89. The emphasis therefore is on prevention. What percent of neuroblastomas exhibit N-myc amplification? A. C. 90. RATIONALE: B symptoms occur very infrequently in non-Hodgkin lymphoma and usually are associated with stage III or IV disease. Approximately what percent of patients who have follicular non-Hodgkin lymphomas present with B symptoms? A. C. Within +/-1% over 50% of the maximum field size at a depth of 1. RATIONALE: Overall. 26 American College of Radiology . D. C. 05% 25% 50% 75% Correct answer is B. B. 75% 50% 25% 05% Correct answer is D. 91. B. C. The severity is reduced with concurrent chemotherapy. 92. Correct answer is A. what is the most appropriate specification for flatness in the radial and transverse directions? A. It can be easily managed by surgical excision. Which of the following statements about radiation-induced fibrosis is true? A. D. RATIONALE: Requires knowledge of the common definition of beam flatness. Surgical manipulation of irradiated tissues should only be performed by experienced operators. It can be effectively treated using hyperbaric oxygen. B. D. It is usually irreversible. D. B. RATIONALE: Radiation-induced fibrosis is generally irreversible. For a 6-MV x-ray beam.
B. What is the stage of a 5-cm gastric tumor that extends into. Which of the following statements about the biological characteristics of DCIS is true? A. HJ. D. High-grade lesions tend to be histologically continuous.350:1430-1441. it is quite possible to have apoptosis and caspase activation in the absence of p53 or EGFR. HER-2/neu is positive in 55% of cases. B. RATIONALE: The median survival time is the time at which half the subjects have died and half are still alive. I II III IV Correct answer is D. In contrast. B. involvement of >15 lymph nodes is classified as N3. B. 96. It is the low-grade tumors that tend to be more multifocal/multicentric. Reference: Burstein.g. In other words. caspase 3 or 7). the muscularis propria with 16 of 23 positive lymph nodes? A. C. but not through. Which of the following molecular events is required during apoptosis? A. The activated caspase then cleaves other intracellular targets such as PARP. D. D. resulting in apoptosis. et al. mean of the survival-time intervals. D. Ductal carcinoma in situ of the breast. Positive estrogen receptors are found in 90% of cases. New England Journal of Medicine (NEJM). point in time a survival probability on a Kaplan-Meier curve is 50%.93. which corresponds to stage IV. Cell cycle checkpoint inhibition Epidermal growth factor receptor (EGFR) inhibition Caspase activation p21 activation Correct answer is C. RATIONALE: The biochemical definition of apoptosis includes the activation of executioner caspases (e. cancer cells lacking p53 or EGFR may still be susceptible to having caspase activated through other pathways. C. It is easy to derive the median survival time from the survival curve by drawing a horizontal line at 50% survival and seeing where it crosses the curve. Median survival is defined as the: A. 2004. median of the survival-time intervals. most prevalent time to death in the sample population. The HER-2/neu gene is overexpressed in 25% of cases. 95. THIS ITEM WAS NOT SCORED.. Correct answer is B. Low-grade lesions are histologically continuous (with ≤5-mm gaps). Radiation Oncology In-Training Exam 2007 27 . The BRCA1 or BRCA2 germline mutation is found in 5% of patients. RATIONALE: DCIS tumors are ER-positive in 70% of cases. C. C. RATIONALE: In gastric cancer. 94.
99.g. Radiobiology for the Radiologist. Chapter 15. B. B. what is the most appropriate specification for symmetry in the radial and transverse directions? A. RATIONALE: Docetaxel has been shown to be more effective than the traditional chemotherapy (e. and prednisone). Which of the following chemotherapy agents recently has been shown to be effective in treating hormone-refractory prostate cancer? A. Docetaxel Gemcitabine Oxaliplatin Topotecan Correct answer is A. 28 American College of Radiology . 98. The collective effective dose is the product of the average equivalent dose to a population and the number of persons of reproductive age. C. After the correction is made. C. such as carcinogenesis or mutagenesis.” The appropriate use of WR values is for estimating the probability of stochastic late effects.97. D. Within +/-1% over 80% of the maximum field size at a depth of 1. B. The committed equivalent dose is the product of the absorbed dose and a tissue-specific weighting factor. following low-dose or low-dose-rate irradiation. D. mitoxantrone. 6th edition. Correct answer is A. estramustine. The radiation-weighting factor is a unit-less multiplier that corrects the absorbed dose by a factor related to the RBE of the type of radiation. C. 2006. The NCRP is a committee appointed by Congress that is charged with enforcement of radiation-protection standards in the workplace. and although based on experimentally measured values of RBE. For a 6-MV x-ray beam. RATIONALE: This item requires an understanding of an important linac parameter — beam symmetry. The radiation-weighting factors for different types of radiation are determined by the ICRP. pp 226-227.. Reference: Hall and Giaccia. RATIONALE: The radiation-weighting factor (WR) is a unit-less multiplier that corrects absorbed dose (in Gy) by a factor that takes into account the relative biological effectiveness (RBE) of different types of radiation to which an individual may be exposed. are often averaged or subject to other “judgment calls.5 cm Within +/-1% over 50% of the maximum field size at a depth of 10 cm Within +/-1% over 80% of the maximum field size at a depth of 10 cm Within +/-2% over 80% of the maximum field size at a depth of 10 cm Correct answer is D. Which of the following radiation protection terms is defined correctly? A. “dose equivalent” can be expressed on a common scale using sieverts (Sv) as the unit of measure. D.
102. D. PET scanning has replaced mediastinoscopy for determining cancer staging. Radiation Oncology In-Training Exam 2007 29 . 103. C. What two emission products of 131I are used to manage patients with papillary thyroid carcinoma? A. Which of the following tumor stages is associated with a patient who has vulvar cancer arising on the labia minora with involvement of the lower urethra? A. Calcium level of >12 mg/dL Hemoglobin level of 8. An electron for radiation therapy and an electron for diagnostic imaging An electron for radiation therapy and a photon for diagnostic imaging A photon for radiation therapy and an electron for diagnostic imaging A photon for radiation therapy and a photon for diagnostic imaging Correct answer is B. RATIONALE: According to the AJCC Cancer Staging Manual. B. Iodine-131 is used to image thyroid cancer because a second emission product is a kilovoltage-range photon that exits the body. C. C. RATIONALE: Iodine-131 is able to ablate thyroid tissue and tumor cells because it emits a relatively low-energy electron that deposits energy within a few millimeters. and elevated monoclonal globulin spike on serum electrophoresis above a defined level.100. bone marrow plasmacytoses of >30% plasma cells. B. What is a major criterion for the diagnosis of multiple myeloma? A. Correct answer is D. vulvar tumors involving the lower urethra and/or vagina and anus are classified as stage T3. T1 T2 T3 T4 Correct answer is C. 101. Positive PET scan findings require pathological confirmation. RATIONALE: Major criteria are plasmacytoma on tissue biopsy. Upper-urethral involvement is classified as stage T4. RATIONALE: Mediastinoscopy is still considered the gold standard for staging. CT scan provides approximately 95% sensitivity and specificity. Which of the following statements about staging for non-small cell carcinoma of the lung is true? A. D. D. D.5 g/dL Plasmacytoma on tissue biopsy Lytic bone lesions on skeletal survey Correct answer is C. B. C. Screening tests have reduced the mortality rate for high-risk patients. B.
B. 105. The effect itself however is “all or none. D. and carcinogenesis are stochastic effects. but that otherwise occurs by chance for a given individual. 106.” and it does not increase in severity with increasing dose. Radiobiology for the Radiologist. Which of the following chemotherapy agents is most effective for desmoid tumors? A. The risk of the effect increases linearly with dose. with that probability increasing with increasing dose. C. 30 American College of Radiology . D. Continuously move all primary collimators and MLC leaves. 6th edition.” Early and late effects in normal tissues following radiation therapy and radiation-induced cataracts are examples of deterministic radiation effects. Which of the following processes best explains how a radiation beam is delivered during segmented IMRT? A. with no dose threshold. RATIONALE: In segmental IMRT. pp 135-136. B. Which of the following characteristics is NOT associated with a stochastic radiation effect? A. Radiation effects that show dose thresholds and increase in severity with increasing dose are termed non-stochastic or “deterministic. 2006. Approximately 40% of rhabdomyosarcomas occur in the head and neck region. Which of the following body sites is most commonly involved in patients with rhabdomyosarcoma? A. The risk of the effect is probabilistic and occurs by chance for a given individual. the beam is "Off" when the MLC leaves are moving to their positions. RATIONALE: This item is based on epidemiological data. Reference: Hall and Giaccia. Move all MLC leaves in one direction only. C. there is no dose below which there is not some probability of a negative consequence resulting from exposure.104. B. mutagenesis. the beam is constantly "On" when the leaves are moving. In dynamic IMRT. RATIONALE: A stochastic radiation effect is one that does not exhibit a dose threshold. Only deliver radiation while the MLC is stopped. C. Chapter 10. that is. Correct answer is B. B." An increase in dose will increase the severity of the effect. D. Vincristine Vinblastine Cyclophosphamide Etoposide THIS ITEM WAS NOT SCORED. C. D. The effect is "all or none. 107. Thorax Extremities Head and neck Genitourinary tract Correct answer is C. Correct answer is A. Leave the radiation beam on during the entire delivery sequence. Radiation-induced cell killing.
What percent of pituitary adenomas are secretory tumors? A. C. Dexamethasone is given in 4 divided doses. pp 1207-1208. C. 110. Sarcoma Carcinoid Lymphoma Adenocarcinoma Correct answer is B. RATIONALE: Carcinoid is the most common histology of tumors involving the terminal ileum. C. JR. Williams and Wilkins. 10% 30% 45% 65% Correct answer is D. Vecht. B. Neurological Complications of Cancer. 109. fluid retention. Marcel Dekker. Radiation Oncology In-Training Exam 2007 31 . B. and the presence of a hypersecretory state is the most common mode of presentation. et al (Wiley R. hyperglycemia. CJ. Symptomatic improvement is expected between 24 to 72 hours after initiation of therapy. Lippincott. Diseases of the Breast.108. B. New York. 1995. Which of the following statements about the management of brain metastases secondary to breast cancer is true? A. RATIONALE: As many as 70% of pituitary adenomas are endocrinologically active. D. What is the most common histology of tumors involving the terminal ileum? A. but its biologic half-life could allow bid administration. Treatment is more effective for focal neurological deficits than for headaches. 2004. ed). gastritis. Correct answer is B. D. References: Harris. Prednisone therapy should be initiated with a loading dose of 20 mg. A loading dose of 10 mg is given with 4 mg qid. D. 3rd edition. The frequency and severity of these symptoms can be modified by using the lowest dose possible. and immunosuppression. Use of glucosteroids in neuron-oncology. RATIONALE: Corticosteroids are associated with multiple side effects including myopathy. Most patients are started on dexamethasone because of relatively little corticosteroid. Dexamethasone must be administered four times daily because of its half-life properties. insomnia. followed by 10 mg four times daily. decreasing the risk of fluid retention and providing a lower risk of infection and cognitive impairment. weight gain.
RATIONALE: Pathologic tumor size: Stage T2 tumor is more than 2 cm but not more than 5 cm in greatest dimension. C.2 Gy) radiation therapy using a combination of conformal photon and proton beams for clinically localized prostate cancer is true? A. Obstetrics Gynecology. 73% versus 72%. the 2-year survival rate of patients who have vulvar cancer with positive inguinal lymph nodes and undergo adjuvant pelvic-inguinal irradiation compared to pelvic lymphadenectomy alone is: A.03). B. Springer Press. B. patients with vulvar cancer and positive groin lymph nodes after radical vulvectomy and bilateral groin dissection were randomized to pelvic-inguinal irradiation or pelvic lymphadenectomy. Correct answer is C. Correct answer is B. D.and high-risk patients. RATIONALE: The advantage is seen in both low. Reference: Homesley. Stage T3 tumor is more than 5 cm in greatest dimension. 1986. Reference: AJCC Cancer Staging Manual. D. 112. p = 0. 113. 2002. Which of the following statements about the randomized trial comparing conventional-dose (70. 68% versus 54%. There is increased acute or late rectal toxicity in the high-dose group. Patients undergoing irradiation had a significantly improved survival compared to patients undergoing surgery alone (2-year survival of 68% vs.0-cm primary tumor and 12/15 positive. Stage N2 involves metastases to 4 to 9 axillary lymph nodes (at least one tumor deposit greater than 2.68:733-40.0 mm).111. RATIONALE: In GOG 37. According to GOG 37 (Homesley). There is increased acute or late urinary toxicity in the high-dose group.2 Gy) versus high-dose (79. (6th edition). pT3N2 pT3N3 pT2N1 pT2N3 Correct answer is D. D. 54%. C. 1 to 3 positive and/or IM nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent via CT or PE. High-dose radiation therapy does not improve biochemical outcome. et al. Stage N3 involves metastases to 10 or more axillary lymph nodes or infraclavicular lymph nodes or clinically apparent ipsilateral IM nodes with 1 or more positive axillary lymph nodes or more than 3 axillary lymph nodes with microscopic metastases in IM nodes or positive ipsilateral supraclavicular lymph nodes. Which of the following pathological stages of breast cancer is associated with a patient who has a 5. 44% versus 50%. non-fixed lymph nodes? A. 54% versus 68%. pp 227-228. 32 American College of Radiology . B. The advantage of high-dose radiation therapy is observed in both high-risk and low-risk patient groups. C. American Joint Committee on Cancer. Lymph nodal stage: Stage N1 involves metastases to the ipsilateral axillary lymph nodes.
1997. and the Intergroup Rhabdomyosarcoma Study Group Statistical Center. Factors that influence treatment decisions in childhood rhabdomyosarcoma. Radiation Oncology In-Training Exam 2007 33 . D. It predicts tumor response to chemoradiation. B. B. Which of the following radiation dose ranges is most commonly used to treat solitary plasmacytoma? A. C. Reference: Donaldson. and a 2-cm nodule in the right lower lobe of the lung? A. RATIONALE: AJCC Cancer Staging Manual. Radiology. D. C. What is the most common group classification of rhabdomyosarcoma at initial diagnosis? A.203:17-22. It standardizes assessments of the severity of acute effects. 117. It standardizes assessments of the severity of late effects. RATIONALE: Dose response data indicate that 40 Gy to 50 Gy will control most solitary plasmacytomas. 15 Gy to 20 Gy 24 Gy to 30 Gy 40 Gy to 50 Gy 60 Gy to 70 Gy Correct answer is C. mediastinal adenopathy. It predicts the probability of late effects. J. the Pediatric Oncology Group. The most common presentation is Group III disease. C. What stage of non-small cell lung cancer is most appropriate for a patient who has a 3-cm mass in the right upper lobe. Objective. 116. Correct answer is D. 115. Intergroup Rhabdomyosarcoma Study Group of the Children's Cancer Group. Analytic (SOMA) scale is intended to standardize the assessments of the incidence and severity of late radiation effects. Stage IIB Stage IIIA Stage IIIB Stage IV Correct answer is D. RATIONALE: This item is based on epidemiological data.114. D. SS. C. B. Management. Which of the following best describes the LENT/SOMA scoring system? A. RATIONALE: The Late Effects Normal Tissue (LENT) Task Force Subjective. B. and Anderson. Group I Group II Group III Group IV Correct answer is C. D.
C.001 Tamoxifen + XRT 36% 45% . Which of the following statements associated with the postmastectomy Danish trials investigating the use of radiation therapy is true? A. D. Pilocytic Fibrillary Protoplasmic Gemistocytic Correct answer is B. C. The Danish trial was completed with CMF chemotherapy. 120. The trials studied the use of anthracycline chemotherapy for all premenopausal patients. B. M. The trials found that the favorable association of radiation therapy with improved 10-year overall survival was lost after 15 years of follow-up. D. Tamoxifen is administered to postmenopausal patients for 1 year. 1999. RATIONALE: Earache is a common symptom at diagnosis of carcinoma of the base of tongue or supraglottic larynx. RATIONALE: Postoperative radiation therapy in high-risk postmenopausal breast cancer patients were given adjuvant tamoxifen. C. Which of the following pathologic subtypes is most commonly associated with diffuse astrocytoma in adults? A. Which of the following disadvantages is associated with intensity-modulated radiation therapy (IMRT) versus conformal radiation therapy? A. Correct answer is D. B. Which of the following lesions is most likely to be associated with otalgia? A. B. 121. 34 American College of Radiology . 119. The trials studied the use of tamoxifen over a 5-year period for all postmenopausal patients.353:1641-1648. et al: Lancet. The trials found an association between the use of radiation therapy and reduced rates of subsequent development of metastatic disease. Stage T1N1 of the base of tongue Stage T1N1 of the posterior pharyngeal wall of the hypopharynx Stage T2N0 of the middle section of the hard palate Stage T2N1 of the true vocal cord Correct answer is A. The mechanism for ear pain in this setting is referred pain along the nerves of Jacobson and Arnold. D. The 15-year analysis has upheld the 10-year findings: Disease-free survival Overall survival P Tamoxifen alone 24% 36% <. B. RATIONALE: Fibrillary astrocytoma is the most common subtype.118. RATIONALE: Intensity-modulated radiation therapy (IMRT) generally requires a large number of monitor units for the amount of absorbed dose delivered. D. C.03 Reference: Overgaard. Decreased leakage radiation to the entire body of the patient Decreased absorbed dose to normal tissues and critical structures Decreased monitor unit to dose efficiency Decreased "beam-on" times per field Correct answer is C.
Reference: Hall and Giaccia. are added to the spontaneous incidence of that type of cancer. The relative risk model is best described by the excess incidence of radiation-induced leukemia in Japanese A-bomb survivors. most of whom are now at or approaching old age (when the greatest number of radiation-induced solid tumors are to be expected). all contribute to the excess cancer risk. The absolute risk model predicts that radiation exposure induces a discrete "crop" of excess cancers that. are added to the spontaneous incidence of that type of cancer. D. these excess cancers appear and are added to the natural incidence. Colon Rectal Esophageal Gastric Correct answer is A.56:106-130. 124.S. D. Correct answer is C. age at exposure. gender. On the other hand. The relative risk model predicts that radiation exposure induces a discrete "crop" of excess cancers that. 2006.122. Which of the following statements about the absolute and relative risk models of radiation carcinogenesis is true? A. Which of the following types of cancer most commonly occurs in the GI tract in the U. C. and accelerators and x-ray machines are not considered materials. Chapter 10. RATIONALE: The NRC only regulates byproduct material. the dose squared. RATIONALE: There are approximately 150. C. Uranium is naturally occurring. significantly more than the other choices. The absolute risk model is best described by the excess incidence of radiation-induced solid tumor in Japanese A-bomb survivors. population? A. pp 138-139. C. After the appropriate latency period. D. Reference: CA: A Cancer Journal for Clinicians. and in some cases. after the appropriate latency period. 2006. after the appropriate latency period. B. Radiobiology for the Radiologist. B. the relative risk model predicts that radiation exposure of a population causes a multiplicative increase in the natural cancer incidence for each cancer type and at all ages.) 123. a modified version of the relative risk model is favored by the BEIR committee. 6th edition. Which radiation source is governed by the Nuclear Regulatory Commission (NRC)? A. B.000 cases of colon cancer per year. Radiation Oncology In-Training Exam 2007 35 . RATIONALE: The absolute risk model of radiation carcinogenesis assumes that radiation exposure of a population induces a discrete “crop” of excess cancers over and above the natural cancer incidence and unrelated to it. most of the radiation-induced excess cancers would be expected later in the lives of the irradiated cohort. Cobalt Radium Linear accelerators Therapeutic x-ray machines Correct answer is A. the cancer incidence returns to baseline. The time-dependent relative risk model assumes that the radiation dose. For the Japanese A-bomb survivors. but thereafter. and because cancer tends to be a disease of older age in general. time elapsed since exposure. such as cobalt.
the only conceivable indication for external-beam radiation therapy is recurrent disease following I-131 therapy. Which of the following radiation therapy plans is most appropriate? A. followed by a 150-mCi dose of 131I C. 127. low-grade tumors. followed by external-beam radiation therapy to a dose of 50 Gy at 2 Gy per fraction B. RATIONALE: Most vulvar cancers arise on the labia majora or minora. Patient outcome after brachytherapy alone has not been shown to be equivalent to radical prostatectomy and external-beam radiation therapy in patients with localized prostate cancer. Which of the following statements about brachytherapy for prostate cancer is true? A. External-beam radiation therapy to a dose of 50 Gy at 2 Gy per fraction.125. and 103Pd is preferred for high-grade tumors. The second most common site is the clitoris. D. A 150-mCi dose of 131I. The addition of androgen deprivation to external-beam radiation therapy is not useful in patients with high-risk factors. A 35-year-old woman who has follicular thyroid carcinoma undergoes thyroidectomy and neck dissection. A 150-mCi dose of 131I only Correct answer is D. B. which reveals positive margins and lymph nodes. RATIONALE: In a young adult. Differences in half-life and dose rate suggest that 125I is preferred for slow-growing. Where is vulvar carcinoma most commonly located? A. differences in half-life and dose rate suggest that I-125 is better suited for slow-growing. The mons pubis and vaginal vestibule are uncommon sites. C. Correct answer is C. B. 126. C. Brachytherapy alone is best for patients who have stage T1 to stage T2a prostate cancer with a Gleason score of ≤8 and a prostate-specific antigen (PSA) level of <10 ng/mL. This patient does not have an indication for external-beam radiation therapy. D. Clitoris Mons pubis Vaginal vestibule Labia Correct answer is D. 36 American College of Radiology . low-grade tumors. External-beam radiation therapy to a dose of 70 Gy at 2 Gy per fraction only D. RATIONALE: Although there are no clinical data demonstrating an advantage. whereas Pd-103 is better for high-grade disease.
B. 129. both trained in HDR emergency procedures. Working adults exhibit longer latency periods for radiation-induced cancers. The adult working population contains fewer elderly persons who demonstrate the greatest excess of radiation-induced cancers. The risk estimate for excess cancer mortality due to chronic. the ICRP recommends slightly higher risk estimates than for the adult working population because of the increased susceptibility of the young. Extrapleural pneumonectomy. low-level radiation exposure is approximately 4% per sievert (Sv) for the working population. C. Radiation Oncology In-Training Exam 2007 37 . Only an authorized physician Only a qualified medical physicist Both an authorized physician and a qualified medical physicist Both the licensee and an authorized user Correct answer is C. Correct answer is C. 131.128. Alcohol use Tobacco use Mustard gas exposure Ionizing radiation exposure Correct answer is D. Which of the following factors is most strongly linked to an increased risk for the development of multiple myeloma? A. D. Pleurodesis. RATIONALE: Ionizing radiation exposure is a risk factor for multiple myeloma. RATIONALE: For the general population. Children in the general population are more sensitive to radiation-induced cancer. RATIONALE: Once an HDR treatment begins. B. IMRT to a localized positive margin to a radiation dose of 70 Gy D. as shown by a marked increase of this tumor in Hiroshima survivors. the best results have been achieved with trimodality therapy. compared to 5% per Sv for the general population. RATIONALE: For healthy patients with malignant mesothelioma. What is the most likely explanation for this difference? A. followed by chemotherapy and adjuvant radiation therapy to a dose of 50 Gy to 60 Gy B. IMRT to the entire lung to a radiation dose of 45 Gy Correct answer is A. What is the best treatment for malignant mesothelioma? A. B. D. which predicts a larger number of excess cancers than the absolute risk model. must be present for the entire treatment. both an authorized physician and an authorized medical physicist. The incidence of radiation-induced cancer among children in the general population follows the relative risk model. 130. D. C. C. Which of the following personnel must be present during a high-dose-rate (HDR) procedure after the procedure begins? A. followed by systemic chemotherapy with subsequent external-beam radiation therapy to a dose of 60 Gy in 20 fractions C.
RATIONALE: The Bcl-2 gene codes for an anti-apoptosis protein. Brachytherapy is effective for both low-grade and high-grade sarcomas. WW. Most are the pre-B cell type. Which of the following cancer genotypes is NOT correctly matched with the resulting phenotype? A. B. Overexpression of the ras oncogene → growth in the absence of "go" signals D. 38 American College of Radiology . 135. C. D. B. C. D. Which of the following statements about postoperative brachytherapy for fibrosarcoma of an extremity is true? A. Scientific American. 133. RATIONALE: This item is based on the epidemiology of childhood leukemia. B. not down-regulated. RATIONALE: Catheters are loaded 5 days after surgery to prevent wound-healing complications. Activation of telomerase → cellular immortality Correct answer is A. Correct answer is B. will allow cells to evade apoptosis when up-regulated. and as such. Down-regulation of the Bcl-2 gene → evasion of apoptosis B. 001 mrem 0010 mrem 0100 mrem 1000 mrem Correct answer is D.132. D. C. Acute lymphocytic leukemia (ALL) comprises 80% of all acute leukemias in childhood. Brachytherapy gives better local control than external-beam radiation therapy. Up-regulation of vascular endothelial growth factor (VEGF) gene → tumor angiogenesis C. Pre-B cell lymphocytic Mature B-cell lymphocytic Mature T-cell lymphocytic Monocytic myelogenous Correct answer is A. Catheters are loaded with radioactive sources approximately 5 days after surgery.289: 56-65. Reference: Gibbs. How many mrem equal 10 mSv? A. 2003. 134. Which of the following types of acute leukemia occurs most commonly during childhood? A. The entire muscle compartment including the tumor bed should be irradiated. RATIONALE: There is a direct conversion from conventional units (mrem) to SI units (mSv).
Stage T4N0 tumor of the sigmoid colon with invasion into the pelvic sidewall Stage T3N2 tumor of the transverse colon Stage T2N1 tumor of the descending colon Stage T2N0 tumor of the appendix Correct answer is A.. C. through reduced ligand binding or the ability to signal to downstream pathways even in the absence of a ligand). growth factors. Which of the following statements about receptor/ligand interactions is most accurate? A. Which of the following results is associated with concurrent chemoradiation therapy versus radiation therapy alone for patients with locally advanced laryngeal cancer. several retrospective studies and first principles of radiation suggest a T4 tumor with clear invasion into adjacent organs would be the most likely of the above choices to benefit from adjuvant therapy. C. B. B. based on the RTOG 91-11 study? A. C. D. Their effect is mediated by down-stream pathways. Same rate of distant metastases Improved swallowing function Improved overall survival Improved local control Correct answer is D. B.136. D. B. RATIONALE: Although the only randomized trial of radiation therapy vs. THIS ITEM WAS NOT SCORED. which is 5000 mRem. Which of the following stages of colon cancer is most likely to benefit from adjuvant radiation therapy? A. The initial receptor/ ligand interaction is at the cell surface. or synthetically designed small molecules. They usually occur first at the nucleus. hormones. The ligand is an antibody that targets the receptor with specificity.g. 137. work in the clinic. might receive at least 50 mR/year. C. Body monitors must be provided to radiation oncology personnel who: A. 139. might receive at least 100 mR/year. D. Mutation of the ligand causes resistance to receptor-targeted therapy. Mutations in the receptor may lead to altered signaling (e. Correct answer is B. RATIONALE: Based on results of the RTOG 91-11 study. might receive at least 250 mR/year. RATIONALE: Regulations require monitoring of anyone who is at risk of receiving at least 10% of the annual occupational exposure limit. 138. no radiation therapy for colon cancer did not demonstrate an advantage to treatment. RATIONALE: Ligands can be antibodies. Radiation Oncology In-Training Exam 2007 39 . D.
C. Decreased sexual libido and hot flashes Osteoporosis and muscle weakness Increased late GU toxicity Increased late GI toxicity Correct answer is C. C. 141. What is the most common genetic abnormality associated with low-grade gliomas? A. B. 40 American College of Radiology . B.140. D. The second most common histology is melanoma. Activation of oncogenes Inactivation of tumor suppressor genes Hypermethylation of histone proteins Initiation of apoptosis Correct answer is B. 142. D. In addition. comprising about 10% of all cases. and 5 late GI toxicities. RATIONALE: Gene conversion secondary to a loss of heterozygosity is a recognized mechanism for the inactivation of tumor suppressor genes. What is the second most common histology associated with vulvar cancers? A. D. 2003 (Nov 1). Adenocarcinoma Adenosquamous carcinoma Squamous cell carcinoma Melanoma Correct answer is D. 1p 10q 17p 19q Correct answer is C. 143. B. D. RATIONALE: Options A and B are obvious side effects of long-term hormonal uses. C. RTOG 92-02 showed there was a small but significantly increased incidence of grade 3. B. Other histologies are significantly less common (<5%). Reference: Journal of Clinical Oncology. 4. C. Which of the following processes is associated with the loss of heterozygosity? A. RATIONALE: Deletion of chromosome 17p contains the p53 gene. Which of the following side effects is NOT associated with long-term hormonal therapy combined with radiation therapy for prostate cancer? A. RATIONALE: The most common tumor histology for vulvar cancers is squamous cell (85%).21(21):3972-8.
146. RATIONALE: This item is based on the epidemiology of childhood leukemia. Sec. The carcinogenic effects appear to result from its physical properties rather than its chemical structure. RATIONALE: Extramedullary plasmacytomas arise most frequently in the head and neck and upper respiratory tract. VT. B. C. 145. Back Pelvis Lower extremity Head and neck Correct answer is D. S. Pre-B cell lymphocytic Mature B-cell lymphocytic Mature T-cell lymphocytic Monocytic myelogenous Correct answer is C. Hellman. C. RATIONALE: Neutrons are best absorbed by materials that are either hydrogenous (concrete) or have a larger nuclear cross section (boron). Reference: Devita. Rosenberg. Which of the following types of acute leukemia is most likely to be associated with a 12-year-old boy who presents with a large mediastinal mass and lymphoblasts in his blood? A. 2. soft tissue plasmacytomas? A. SA. C. Which of the following materials would be best suited for neutron shielding? A. This is a classic presentation of mature T-cell lymphocytic leukemia (older boy with a mediastinal mass). Which of the following anatomical sites is most commonly associated with extraosseous. Mesothelioma cell lines appear to be less sensitive than non-small cell lung cancer cell lines to radiation. Chapter 40. Cancer Principles and Practice of Oncology. Which of the following statements about asbestos exposure and mesothelioma is true? A. D. B. It is rare for mesothelioma to be misdiagnosed. 6th edition. Walls Iron Steel Lead Concrete Door Lead Concrete Borated polyethylene Borated polyethylene Correct answer is D. D. B. 147. D. Screening of asbestos workers for mesothelioma is an effective way to improve the cure rate of this disease.144. Radiation Oncology In-Training Exam 2007 41 . D. B. Correct answer is A. C.
CD30+ CD15-. It is performed by assessing the binding of total RNA from tumor cells to microchips containing an array of probes. Incorrect geometric lateral shift of 4 cm Incorrect photon energy (6 MV vs. D. and the incorrect energy would create an error of approximately 15%. but it always requires confirmation by reverse-transcriptase. RATIONALE: Expression profiling is generally performed in core facilities or specialized labs. B. D. A is the only possible answer. Correct answer is C. Fewer control samples are required to confirm the results.148. It is performed by comparing DNA sequences of normal cells with tumor cells. CD15+. C. 150. B. D. and can be CD20+ or CD20-. C. CD30+. CD30CD15-. RT-PCR or Northern blotting is not required to confirm the results. Which of the following statements about gene expression profiling of tumor cells is true? A. or realtime PCR. C. or Northern blotting to validate that the mRNA levels of specific genes are truly increased or decreased. 149. B. CD30- Correct answer is A. RATIONALE: A missing 15° wedge would create approximately a 20% error. 18 MV) prescribed to 10-cm depth Miscalculation of monitor units by 15% Missing a 15° wedge Correct answer is A. CD30+ CD15+. RATIONALE: Classical Hodgkin lymphoma has cell markers CD15+. Which of the following errors would have the most serious consequences for a target dose to a 10-cm-wide volume treated with an AP field? A. Which of the following cell markers is most commonly associated with classic Hodgkin lymphoma? A. 42 American College of Radiology .
Miller. site of the primary tumor or the number of positive lymph nodes.17:449-453. JR. RATIONALE: Subependymal giant cell astrocytomas occur in 5% of patients with tuberous sclerosis. Brain metastases are most likely to involve a solitary site. predictive factors and impact on overall survival. pp 1205-1218. References: Harris. 14. Clinical Oncology. Breast cancer is the most common cause of brain metastases in women.4:1972-1977. Which of the following statements about brain metastases secondary to breast cancer is true? A.8% of patients had clinically occult CNS metastases. et al. ER-negative tumors are more likely to metastasize to the brain than are ER-positive tumors. D. Of these patients. B. widely metastatic disease. Fibrillary Gemistocytic Protoplasmic Subependymal giant cell Correct answer is D. RATIONALE: The most common cause of brain metastases in women is lung cancer. Lippincott. Breast cancer is the second leading cause. et al. JF. Increased tumor size and number of positive lymph nodes are associated with an increased risk of brain metastases. Estrogen receptors. THIS ITEM WAS PARTIALLY SCORED (BOTH OPTIONS C & D SCORED CORRECT). tumors with HER-2/neu gene overexpression and the number of metastatic sites were significant predictors for CNS involvement by multivariate analysis. Diseases of the Breast. Occult central nervous system involvement in patients with metastatic breast cancer: prevalence. B. Sparrow. and the subsequent development of brain metastases. C.151.7:291-301. There is no relationship among the size. Annals of Oncology. C. Which of the following types of astrocytoma is associated with tuberous sclerosis? A. Brain metastases from breast cancer: clinical course. 1981. 152. Brain metastases are more likely to present in premenopausal women with aggressive. In patients who have breast cancer and are screened for enrollment in clinical trials of systemic therapy. D. Williams and Wilkins. 3rd edition. et al. European Journal of Cancer. 1981. K. 2004. Breast cancer rarely presents with brain metastases before detection of the primary cancer. sites of metastatic disease and survival in recurrent breast cancer. prognosis and influence of treatment. Radiation Oncology In-Training Exam 2007 43 . Stewart. 2003. GE. HER-2/neu gene overexpression is not associated with an increased risk of brain metastases.
154. that most cells in the adult body don’t divide. B. (Epigenetic changes. 44 American College of Radiology . pp 1255-1262.) References: Tannock. D. gene expression. Untangling the roots of cancer. and that even those that do have a limited replicative lifespan (for the most part). Hill. This hypermutability is usually referred to as “genomic instability. Lewis et al. 3rd edition.5% 1. D. 2005. 01% 05% 15% 25% Correct answer is B..289: 56-65.0% Correct answer is B. it would seem highly unlikely that all of these required mutations would ever accumulate in a single cell over the organism’s lifetime. Chapter 24. whether the actual initiating mutation(s) are instead in as yet unidentified “master genes” that supervise DNA replication and repair. which is specified in many regulations. 2003. What remains to be seen is whether these genetic changes are themselves the cause of genomic instability or early indicators of it. Gibbs. or both. the activation of oncogenes. B. assuming that the spontaneous mutation rate of a normal human cell is in the range of 10-6 mutations per gene per cell division. and Harrington. Approximately what percent of colorectal cancers are due to hereditary nonpolyposis colorectal cancer (HNPCC)? A. approximately 40% of people are diagnosed with cancer during their lifetimes. Alberts. Up-regulation of telomerase Decreased immunosurveillance at the tumor site Hypermutability of cells during the early stages of carcinogenesis Alternate splicing of oncogenes and tumor suppressor genes during transcription Correct answer is C. Bristow.1% 0. Which of the following factors is most likely responsible for the development of cancer.153. 4th edition. and some 20% to 25% of patients die from their disease. 0. 1994. Bray. However. The most prevalent explanation for this apparent paradox is that cells that acquire one or two of the prerequisite carcinogenic mutations become hypermutable and can more readily accumulate the additional mutations that allow them to progress to full malignancy in relatively short order. Nevertheless. RATIONALE: An average of 3 to 7 different gene mutations is necessary to convert a normal cell into a cancerous one capable of unlimited proliferation and invasive and/or metastatic behavior.g. WW. and therefore. e. can also contribute to genomic instability. D. C. Scientific American. What is the maximum transmission allowed through collimating jaws? A.0% 2. Reference: Gastroenterology. RATIONALE: It is suggested that "up to 6%" of colorectal cancers are due to hereditary nonpolyposis colorectal cancer (HNPCC). Chapter 5. post-translational modifications of chromatin that alter its structure or activity.5%. RATIONALE: The maximum jaw transmission allowed is 0. The Basic Science of Oncology.104(5):1535-49. C. or coordinated cell division. 155. B. given the very low frequency of spontaneous mutations characteristic of human cells? A. Molecular Biology of the Cell. 1993 (May).” and it is thought to occur secondary to the inactivation of tumor suppressor genes. that is. C.
not the MRE11 gene. Electrons lose energy in water by approximately how many million electron volts (MeV) per centimeter? A. Radiation Oncology In-Training Exam 2007 45 . C. D. not the RB gene.0 5. D. 0. What percent of patients diagnosed with testicular seminoma have elevated α-fetoprotein serum levels? A. C. 158. 157. Nijmegen breakage syndrome is caused by a mutation in the NBS1 gene.156. B. RATIONALE: The primary pattern of spread of fallopian tube cancers closely resembles that seen in cancers of the ovary.0 Correct answer is C. RATIONALE: An elevation of serum α-fetoprotein (AFP) is diagnostic for testicular non-seminoma. Nijmegen breakage syndrome → mutation in the MRE11 gene (DNA damage response) C. D. it can be derived that electrons lose approximately 2 MeV per centimeter. B. Which of the following genetic diseases characterized by radiation sensitivity and/or increased cancer predisposition is correctly matched to the gene mutation and molecular defect? A. 159. 00% 10% 20% 30% Correct answer is A. C. Li-Fraumeni syndrome → germline mutation in the RB gene (cell cycle regulator) B. Cockayne syndrome → mutation in the BLM gene (DNA helicase) Correct answer is C. Lynch syndrome → mutation in the hMSH2 and/or hMLH1 genes (mismatch repair components) D.5 1. with local extension to adjacent pelvic structures and involvement of the peritoneum and omentum. Cockayne syndrome is caused by a mutation in the CS gene. Vulvar Ovarian Endometrial Cervical Correct answer is B. B. Which of the following types of gynecologic cancer has a similar pattern of tumor spread as that associated with fallopian tube cancer? A. RATIONALE: Li-Fraumeni syndrome is caused by a germline mutation in the TP53 gene. RATIONALE: By mass stopping power ratios. not the BLM gene.0 2.
It commonly spreads along the biopsy tract. B. 162. Which of the following factors is most important in establishing a favorable prognosis for a child with posterior fossa ependymoma? A. D. RATIONALE: The extent of surgical resection has been the single most important prognostic factor in patients over 18 months of age. RATIONALE: Hodgkin lymphoma has been found to be related to the level of maternal education for younger patients. 163. Jude. What is the probability of being within two standard deviations of the mean for data with an exactly normal distribution? A. RATIONALE: The probability of being within 2 SD of the mean is 95%. RATIONALE: It is important to know where malignant mesothelioma spreads since these tracts have to be covered by a radiation port.160. Early birth order Increased number of siblings Increased number of playmates as child Chronic immunosuppressant treatment Correct answer is A. Which of the following statements about malignant mesothelioma is true? A. B. Excellent response to induction chemotherapy Achievement of a gross total resection Absence of p53 gene deletion Patient age >8 years Correct answer is B. CCG). D. Most patients have bilateral disease at presentation. 161. 50% 68% 95% 99% Correct answer is C. Which of the following factors is associated with a higher risk for the development of Hodgkin lymphoma in economically developed countries? A. D. C. Correct answer is D. C. decreased number of siblings. B. D. C. 46 American College of Radiology . C. and early birth order in economically developed countries. decreased number of playmates. Diagnosis is most commonly established via cytology of pleural effusions. (St. The median patient survival time is 24 months. B.
A contrast-enhanced CT scan is best for establishing the diagnosis. Li-Fraumeni syndrome) are prone to increased malignancies. "gamma-H2AX") is often considered a marker of the DNA damage response. but longer survival times are associated with breast cancer. B. Radiation therapy should be administered to the entire CNS axis. p53. Limb weakness with paresthesias and pain occur in the affected limb. Which of the following statements about leptomeningeal metastases secondary to breast cancer is true? A. D. B. Reference: Harris. pp 1231-1240. B. ATM. HER-2/neu. C. The median survival rate is 4 months. 165. Options A and C occur in Ewing sarcoma. RATIONALE: Spinal symptoms are the most common presentation of leptomeningeal disease. Clinical radiation sensitivity is consistently associated with the absence of: A. C. It rarely occurs in African Americans. 3rd edition. gamma-H2AX. Patients deficient for p53 (e. RATIONALE: The amount of tumor necrosis at resection is a prognostic indicator and surgery is the local treatment of choice.e. Diseases of the Breast. C. 2004. 25% 40% 90% 99% Correct answer is C. Gadolinium-enhanced MRI is the modality of choice for both cranial and spinal sites. B. 167. Radiation Oncology In-Training Exam 2007 47 . D. Correct answer is D.g. Correct answer is B. The addition of ifosfamide and etoposide to standard VACA-based chemotherapy improves survival for patients with nonmetastatic disease. Radiation therapy is the preferred treatment for local control. Which of the following statements about osteosarcoma is true? A. JR. RATIONALE: While phosphorylation of H2AX (i. CT is less sensitive and is not useful for spinal imaging unless a contrast agent is used in the subarachnoid space. D. C. Lippincott. Radiation is the best treatment for focal leptomeningeal nodules. A proper rule of thumb for electron percent depth dose (PDD) is energy divided by 4 is approximately equal to the 90% depth. Radiation therapy should be given to symptomatic areas and to sites of bulky disease. D. RATIONALE: Electrons have a much higher surface dose than photons and increase with increasing energy. What is the percent dose at the surface for 20-MeV electrons? A.164. Correct answer is D. A headache is the most common symptom in patients at presentation. but have not been reported to show unusual toxicities after radiation therapy. The amount of tumor necrosis at resection is an important prognostic factor. Williams & Wilkins. humans deficient for H2AX have not been described. 166. Focal radiation can help restore normal CNS flow and facilitate effectiveness of intrathecal therapies. Diplopia is the most common cranial nerve symptom. Headaches are the most common symptom of cerebral disease.
Oligodendrogliomas most commonly exhibit which of the following types of pathological pattern? A. B. C. D. Necrosis Fried egg appearance Rosenthal fibers Globoid cells
Correct answer is B. RATIONALE: The “fried egg appearance” is secondary to prominent nuclei surrounded by a cytoplasmic halo. 169. Which of the following microenvironmental or treatment-related conditions would inhibit sublethal damage recovery? A. B. C. D. Maintenance of cells at or below 5°C Maintenance of cells at an oxygen concentration of 20 mm Hg Maintenance of cells in a contact-inhibited, quiescent state Preexposure of cells to an initial dose of 2 Gy
Correct answer is A. RATIONALE: Sublethal damage recovery is a fairly robust process that, of the choices given, is only inhibited under conditions of extreme temperature (maintenance of cells below about 5oC or above about 40oC) or severe hypoxia (oxygen concentration below about 3 mm Hg). Repair occurs for both proliferating and quiescent cells and does not diminish in the face of repeated doses. 170. Increasing the source-to-surface distance (SSD) for electrons will NOT affect the: A. B. C. D. output. penumbra. treatment time. percent depth dose.
THIS ITEM WAS PARTIALLY SCORED (BOTH OPTIONS A & D SCORED CORRECT). RATIONALE: Since electrons are not deeply penetrating, there is a minimal inverse square component. Therefore, percent depth dose (PDD) does not change with increasing source-tosurface distance (SSD). 171. Which of the following types of colonic polyp is most likely to progress to carcinoma? A. B. C. D. Hyperplastic polyp Tubular adenoma Tubulovillous adenoma Villous adenoma
Correct answer is D. RATIONALE: Villous adenomas have a 15% to 25% chance of progressing to carcinoma.
American College of Radiology
According to the MRC trial by Fossa, et al, what was the local recurrence rate in the pelvis in patients with stage I testicular seminoma who received radiation therapy to the paraaortic lymph nodes only? A. B. C. D. <2% 03% to 5% 07% to 9% 10% to 15%
THIS ITEM WAS PARTIALLY SCORED (BOTH OPTIONS A & B SCORED CORRECT). RATIONALE: There were eighteen relapses, nine in each treatment group. Among these, four (out of 236 patients randomized to the paraaortic radiation therapy group) were pelvic relapses, all occurring after radiation therapy to the paraaortic lymph nodes. 173. According to RTOG 79-20 (Rotman), which of the following outcomes at 10 years is most likely to be associated with prophylactic extended-field irradiation of the paraaortic lymph nodes in patients with stage IIB and bulky stages IB and IIA cervical cancer? A. There was a statistically significant difference in overall survival but no difference in disease-free survival for the arm that received pelvic and paraaortic irradiation. B. Survival following first failure was significantly higher in the pelvic radiation only arm. C. A higher percentage of local failures were salvaged long-term in the pelvic radiation only arm. D. The cumulative incidence of death due to cervical cancer was significantly higher in the arm that received pelvic and paraaortic irradiation. Correct answer is A. RATIONALE: A statistically significant difference in overall survival was found at 10 years for the pelvic and paraaortic irradiation arm, without a difference in diseasefree survival. The conclusion was that this could be explained by a lower incidence of distant failure in complete responders and a better salvage in the complete responders who later failed locally. Reference: Journal of the American Medical Association (JAMA). 1995 (2 Aug);274(5):387-393.
Radiation Oncology In-Training Exam 2007
Which of the following statements most appropriately justifies the minimum 6-hour interfraction interval for hyperfractionated radiation therapy? A. Shorter interfraction intervals maximize cell cycle redistribution effects. B. Shorter interfraction intervals minimize the potential for tumor cell repopulation. C. Acutely hypoxic cells reoxygenate more quickly and completely when dose fractions are closely spaced. D. The potential for complete repair of DNA damage is maximized in normal tissues at risk.
Correct answer is D. RATIONALE: In radiation therapy treatments involving more than one dose fraction per day (hyperfractionation or accelerated fractionation), it is critical to ensure that the fractions are delivered far enough apart in time to allow all (or most, at a minimum) of the sublethal DNA damage registered by the first dose to be repaired before the second dose is given. Otherwise, the tolerance dose for the normal tissue(s) at risk of a radiation-induced complication may be lower than expected. Although the half-times of repair for mammalian cells maintained in culture tend to be short (about 0.5 to 1.0 hours, on average, although this is somewhat variable), they are much longer in normal human tissues in vivo and may be especially long – several hours – in late-responding normal tissues. During the 1990’s, both EORTC Trial #22851 and the CHART clinical trials were designed to test multiple-dose-per-day hyperfractionation and accelerated fractionation compared to conventional fractionation in advanced head and neck cancer. Subsets of patients enrolled in these trials received their multiple daily doses delivered at 4-hour intervals, and it soon became clear that the incidence of spinal cord myelopathy was significantly worse than expected. When the interfraction interval was increased to 6 hours, the incidence of late effects decreased, although arguably, it was still higher than predicted based on the linear-quadratic model with its underlying assumption of complete repair of sublethal damage between doses. These trials helped to establish today’s standard of care of making sure that the time between fractions in any hyperfractionated or accelerated fractionation regimen involving multiple doses per day is at least 6 hours. References: Hall and Giaccia. Radiobiology for the Radiologist. 6th edition. 2006; Chapter 22, p 388. Dische, et al. Radiotherapy Oncology. 1997;44:123; Horiot, et al. Radiotherapy Oncology. 1997;44:111.) 175. What is the best photon energy for total-body irradiation? A. B. C. D. 01.25 MV 06 MV 15 MV 18 MV
Correct answer is B. RATIONALE: Cobalt would require high dmax doses, 15 MV would introduce neutrons, and 18 MV would require bolus or thick spoilers.
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4530. C. Correct answer is D. 177. 4550. the following 11 absorbed doses in water points (in centigray) represent the prescribed absorbed dose in water: 4500. Correct answer is C. The overall survival at 5 years revealed a significant improvement associated with chemotherapy. Which of the following statements about TNM staging for lung cancer is FALSE? A. Reference: AJCC Cancer Staging Manual. Which of the following statements about the EORTC hypopharynx preservation trial is true? A. D. Patients with palpable adenopathy were required to undergo neck dissections following completion of radiation therapy. Stage N3 involves the contralateral hilar and mediastinal lymph nodes. 4520. 4540. and 4500. RATIONALE: This is one of the fundamental differences between this trial and the VA laryngeal preservation study. The difference between the mean target volume and the modal target volume of the absorbed dose in water is approximately how many centigray (cGy)? A. Fifty percent of the patients had primary tumors involving the pyriform sinus. 4540. followed by radiation therapy. Stage N2 involves the ipsilateral mediastinal lymph nodes. RATIONALE: Requires the resident to distinguish mean target volume from modal target volume of absorbed dose in water. Stage M1 involves the contralateral supraclavicular lymph nodes. Stage N1 involves lymph node stations 10-14. 178. C. B. 04 cGy 10 cGy 14 cGy 20 cGy Correct answer is C. 4540. D. B. Only patients with a complete clinical response after induction chemotherapy were eligible for definitive radiation therapy. Within a target volume.176. C. D. B. Radiation Oncology In-Training Exam 2007 51 . 4540. Patients were required to have achieved a clinical complete response to induction chemotherapy prior to undergoing radiation therapy. 4520. 4510.
while the lens and fingernails are often protected. C.4 Gy and 55. tend to be less fatal. A dicentric chromosome is a type of asymmetrical chromosomal aberration. Scalp Soles of the feet Lens of the eye Fingernails Correct answer is B. 52 American College of Radiology . Concurrent chemotherapy with craniospinal irradiation to 36 Gy and 55. RATIONALE: The scalp often has higher doses due to the tangential effect. RATIONALE: Standard of care in North America currently is concurrent Vincristine with craniospinal irradiation (CSI) to a dose of 23. RATIONALE: An asymmetrical chromosomal aberration results in the formation of an acentric fragment that is often lost from the cell at the subsequent mitosis. Symmetrical aberrations result in an even exchange of chromosomal material with nothing lost.8-Gy boost dose to the posterior fossa. Induction chemotherapy.8-Gy boost dose to the posterior fossa B. Craniospinal irradiation to a dose of 23. Concurrent chemotherapy with craniospinal irradiation to 23.8-Gy boost dose to the posterior fossa. longer-lived.4 Gy and 55. B. What is the most appropriate therapy for a 6-year-old child with a completely resected medulloblastoma with no evidence of metastasis? A. Which of the following statements about asymmetrical versus symmetrical chromosomal aberrations is FALSE? A. usually leading to cell death. and potentially more carcinogenic. and as such. D. This question is asking the examinee about risk groups (standard versus high risk) and the appropriate treatment of standard-risk patients.8-Gy boost dose to the posterior fossa. Correct answer is A. followed by additional chemotherapy Correct answer is B.4 Gy and a boost to the posterior fossa followed by additional chemotherapy for standard risk patients. C. craniospinal irradiation to a dose of 36 Gy and 55. Which of the following regions of the body would require a boost field for total skin electron therapy using a 6-field.179. A chromosome inversion is a type of symmetrical chromosomal aberration. followed by additional chemotherapy C. D. 181. Symmetrical chromosomal aberrations tend to be longer-lived than asymmetrical ones. modified Stanford technique? A. Asymmetrical chromosomal aberrations are more likely to be carcinogenic than fatal. B. followed by additional chemotherapy D. 180.
50% of tumors have extended beyond the laryngeal structures. 183. C. What is the minimum percentage of oligodendroglioma cells required for a tumor to be classified as a mixed oligoastrocytoma? A. 2004. Locally Advanced Breast Cancer. B. at least 25% of the tumor has to consist of oligodendroglioma cells. D. C. Radiation Oncology In-Training Exam 2007 53 . Which of the following statements about squamous cell carcinoma of the larynx is true? A. there is a 20% chance that patients with stage T3 and T4 glottic cancers will have clinically involved lymph nodes at initial presentation. D. Correct answer is C. Subglottic tumors tend to present with early lesions that are easily managed with primary surgical resection. 184. B. At the time of diagnosis. Chapter 50 (Marie Taylor.182. C. Primary tumors more commonly arise from the supraglottic laryngeal structures than from the glottic region. The tumor is most commonly ER-positive. Which of the following statements about breast cancer in men is true? A. Correct answer is A. Reference: Perez and Brady. 05% 15% 25% 50% Correct answer is C. Management of breast cancer in men parallels that of breast cancer in women. RATIONALE: Approximately 80% to 90% of breast cancers in men are ER-positive. The majority of patients who undergo genetic screening will be found to have a BRCA1 germline mutation. D. Approximately 5% of men with breast cancer have noninvasive disease at diagnosis. pp 1541-1543. The BRCA2 germline mutation is most frequently found in men who have breast cancer. et al). B. Supraglottic tumors are more likely to present with palpable lymphadenopathy than glottic lesions. In fact. The disease should be treated with cisplatin-based chemotherapy. whereas. because the true vocal cords have essentially no capillary lymphatics. Approximately 25% of patients will have noninvasive disease at diagnosis. there is a 55% chance that patients with stage T1-T4 supraglottic cancer will have clinically positive lymph nodes at diagnosis. RATIONALE: For a tumor to be classified as a mixed oligoastrocytoma. RATIONALE: Glottic lesions have a lower chance than supraglottic lesions of spreading to the lymph nodes. MD.
188. 187. Custom cerrobend shielding in an applicator Custom lead shielding on the skin Conventional multileaf collimators Collimating jaws Correct answer is B. B. exchange-type chromosomal aberrations was both steeper and more linear for Hiroshima versus Nagasaki survivors because the Hiroshima bomb produced more high-LET radiation (neutrons).185. Correct answer is C. Stage IB Stage IIB Stage IIC Stage IIIA Correct answer is B. the sharper the penumbra.to 5-cm paraaortic lymph nodes? A. B. In addition. The atomic bomb dropped on Hiroshima produced more neutrons than the bomb dropped on Nagasaki. skin shielding moves with the patient. D. the closer the field shaping is to the patient. D. HAART has been shown to reduce the severity and incidence of cancer-related toxicity. exchange-type chromosomal aberrations in lymphocytes than the A-bomb survivors from Nagasaki? A. B. Correct answer is A. D. Patients with HIV are at increased risk for the development of anal intraepithelial neoplasia and squamous cell carcinoma of the anal canal. Which stage is most appropriate for a patient who has testicular seminoma involving the spermatic cord with multiple 2. Why did the A-bomb survivors from Hiroshima show a higher yield per gray of stable. The median age of the Japanese survivors in Hiroshima was approximately half that of those in Nagasaki. The source of drinking water contained higher concentrations of naturally occurring antioxidants in Nagasaki than in Hiroshima. C. A disproportionately higher number of Japanese survivors were located closer to the epicenter of the explosion in Hiroshima than in Nagasaki. The risk of increased toxicity with chemotherapy and radiation therapy is greater in patients with CD4 cell counts that are less than 200. C. Which of the following statements about patients who have HIV and anal cancer is FALSE? A. D. How is optimal field definition accomplished for electron arc therapy? A. RATIONALE: The radiation dose response curve for the induction of stable. B. 54 American College of Radiology . RATIONALE: For electron treatments. Reference: AJCC Cancer Staging Manual. Patients with HIV are at increased risk for toxicity associated with chemotherapy and radiation therapy. C. RATIONALE: HAART has not been shown to reduce the severity and incidence of cancer-related toxicity. C. 186. 6th edition.
Which of the following statements about malignant mesothelioma is true? A. et al. RATIONALE: Postcricoid region tumors are not very common. Chemoradiation therapy alone offers promising results.11:1172-1178. Pyriform sinus cancers are more common than posterior pharyngeal tumors. Biology. Most patients die of metastatic disease and not of local recurrence. posterior pharyngeal wall. B. Second Third Fourth Fifth Correct answer is B. D. C. Correct answer is C.65(1):169-176. pyriform sinus Correct answer is D. B. B. postcricoid region. It was beneficial for patients with invasion of the deep third of the cervical stroma and lymphovascular space invasion. 2006. Pyriform sinus. According to GOG 92 (Sedlis). though. D. D. International Journal of Radiation Oncology. Patients who have the epithelial subtype have a worse prognosis. et al. Correct answer is D. Physics. which of the following statements about the addition of postoperative adjuvant pelvic radiation therapy for patients with stage IB cervical carcinoma with poor prognostic features is true? A. Sedlis. D. posterior pharyngeal wall.73:177-183. Which of the following subsites of the hypopharynx is correctly ordered from the least to the most commonly involved sites? A. C. 1993. with a second peak in incidence (although much smaller) after 50 years of age or in the sixth decade onward. 192. 191. pyriform sinus. Gynecologic Oncology. B. C. References: Rotman. 190. postcricoid region Posterior pharyngeal wall. It did not improve the progression-free survival rate. Mediastinal lymph node involvement affects the prognosis. Hodgkin lymphoma most commonly occurs during which decade of life? A. pyriform sinus Posterior pharyngeal wall. The incidence is bimodal. It significantly reduced the risk of recurrence by 80%. 1999. It did not benefit patients with adenocarcinoma. postcricoid region Postcricoid region. C.189. Radiation Oncology In-Training Exam 2007 55 . RATIONALE: The majority of Hodgkin lymphoma cases occur during the third decade (20 to 30 years of age). Reference: Journal of Clinical Oncology (JCO).
Correct answer is B.15. 56 American College of Radiology . As the LET of the type of radiation increases. B. C. For neutrons of intermediate LET. with SF2 values ranging from as high as 0. RATIONALE: Pure germinomas have the lowest risk for dissemination to the spine and can be treated with whole ventricular irradiation only. Which of the following statements about the RBE for neutrons is true? A. D. although not all. Much. survival curves become steeper and the width of the shoulder region becomes narrower. exhibit a relatively broad range of radiosensitivities to low-LET radiations (such as X-rays) when assayed in vitro. C. requiring craniospinal axis irradiation. Chapter 19. pp 209-211. Because of this. RATIONALE: Different mammalian cell types. 195. Steel. apparently normal in their capacity to detect and repair DNA damage. Neutron irradiation reduces the natural variability in radiation sensitivity among different mammalian cell types.193. the RBE is higher for single radiation doses than for fractionated doses. References: Hall and Giaccia. The RBE is higher for a severe endpoint (low level of cell survival) than for a milder endpoint (high level of cell survival). 6th edition. the oxygen enhancement ratio (OER) equals 1. 2006. For a given endpoint. D. Prescriptions for radiosurgery are made to what percent of maximum dose for the listed modalities? A. The other tumors have a much higher risk of spread through the cerebrospinal fluid (CSF). 194. until the shoulder region is eliminated completely for radiations characterized by LET radiations in the range of 100 keV/µm. of this difference can be accounted for by differences in the width of the shoulder region of the radiation survival curve. Pineoblastoma Ependymoblastoma Nongerminomatous germ cell tumor Pure germinoma Correct answer is D. B. Chapter 7.8 to as low as 0. Which of the following tumors is LEAST likely to be treated with craniospinal irradiation? A. pp 110-111. Radiobiology for the Radiologist. and the survival curve as a whole becomes an exponential function of dose. D. the natural variability in radiation sensitivity between different mammalian cell types characteristic of their X-ray dose response is “dampened” (although not completely eliminated) for higher-LET radiations. 3rd edition. RATIONALE: The cobalt Gamma Knife sources provide a wider penumbra than the sharply collimated linac beams. 2002.0. C. Gamma Knife 100% 080% 050% 050% Linac Beam 100% 050% 080% 050% Correct answer is C. such as neutrons. B. Basic Clinical Radiobiology.
D. RATIONALE: By far. four cycles of AC with concurrent trastuzumab. but it is not scheduled to be administered with doxorubicin due to the potential for additive cardiac toxicity. four cycles of paclitaxel with concurrent trastuzumab. D. C. 2006. p 113. Four cycles of AC. and continuation of trastuzumab for 1 year. Four cycles of dose-dense doxorubicin and cyclophosphamide (AC) in conjunction with four cycles of paclitaxel. Reference. D. Head and neck rhabdomyosarcoma accounts for ≤10% of cases in most series.196. 197. RATIONALE: Trastuzumab has been shown to improve disease-free survival/overall survival for women with HER-2/neu-positive breast cancer and is now recommended for use as adjuvant therapy. Which of the following cell types would produce the highest neutron RBE. Correct answer is B. Radiation Oncology In-Training Exam 2007 57 . Head and neck Retroperitoneum Lower extremity Upper extremity Correct answer is C. 198. Soft tissue sarcoma most commonly arises from what site? A. Which of the following adjuvant systemic therapies would be most appropriate to recommend for an otherwise healthy patient who has HER-2/neu-positive (FISH) ER/PR-negative breast cancer with positive axillary lymph nodes? A. B. B. C. 199. B. Hall and Giaccia. Six cycles of docetaxel. What is the purpose of a circulator in a linear accelerator? A. Chapter 7. doxorubicin. the most common location is the lower extremity. C. and cyclophosphamide. and continuation of trastuzumab for 1 year. Absorb reflected microwaves Adjust the frequency of microwaves Adjust the frequency of electron injection Regulate the flow rate of cooling water Correct answer is A. Radiobiology for the Radiologist. D. 6th edition. relative biological effectiveness (RBE) values are high for tissues that accumulate and repair a great deal of sublethal damage and low for those that do not. RATIONALE: This item requires knowledge of the purpose of a circulator in a linear accelerator. Trastuzumab is generally combined with chemotherapy. Melanoma Bone marrow Mammary epithelium Germinal cells Correct answer is A. Four cycles of paclitaxel. B. which is more prevalent than the upper extremity. C. RATIONALE: In general. assuming otherwise identical irradiation and physiological conditions? A.
C. RATIONALE: The MRI sequence and margin T2 + 2 cm are the most appropriate for delineation of a low-grade oligodendroglioma that has been used in the RTOG trials. T1 T2 T3 T4 Correct answer is B. Which histology is most likely in men older than 60 years with testicular cancer? A. AJCC Cancer Staging Manual. D. 201. D. Reference. RATIONALE: Lymphoma is the most common histology for a testicular mass in men older than 60 years of age. T1 + 1. D.5 cm T1 + 3 cm T2 + 2 cm FLAIR + 3 cm Correct answer is C. C. 6th edition. C. 58 American College of Radiology . 202.200. B. Which of the following tumor stages is most likely to be associated with a patient who has a 3-cm squamous cell cancer of the anus with direct rectal wall invasion? A. B. Yolk sac tumor Classical seminoma Choriocarcinoma Lymphoma Correct answer is D. B. Which of the following MRI sequences and margins would be most appropriate for target delineation of a low-grade oligodendroglioma? A.
Which of the following conditions should be treated like small cell lung cancer? A. Which of the following eye tumors should be diagnosed clinically without a biopsy? A. C. Reference: Whitney. Which of the following statements about CNS germinomas is true? A. RATIONALE: A biopsy of retinoblastoma can result in vitreous seeding. Patients in the CF arm had fewer pelvic recurrences. Radiation Oncology In-Training Exam 2007 59 . Correct answer is B. D. D. D. Reference. 207. Which of the following outcomes is most likely to be associated with the GOG 85/SWOG 8695 Intergroup protocol study (Whitney) comparing primary radiation therapy with hydroxyurea versus radiation therapy with fluorouracil and cisplatin for patients with locally advanced cervical carcinoma? A. B. Note that a pelvic lymphadenectomy was not required. Radiation doses of >50 Gy Complete resection of the involved lymph nodes Subsequent presentation of the primary tumor Stage N1 versus stage N2 lymph node involvement Correct answer is C. B. C. Journal of the National Comprehensive Cancer Network (JNCCN). Patients with positive paraaortic lymph nodes at the time of lymphadenectomy achieved the greatest benefit in overall survival rates. B. Severe or life-threatening leukopenia was more common in the group receiving fluorouracil with cisplatin. 205. Patients in the hydroxyurea treatment arm experienced fewer pelvic recurrences. C. C.4:614. Patients in the fluorouracil with cisplatin treatment arm had better overall and progression-free survival rates. D. 2006. Which of the following factors is NOT typically associated with improved overall survival for patients who present with unknown primary tumors of the head and neck region? A. The suprasellar region is the most common site of origin. et al: Journal of Clinical Oncology (JCO). They most commonly occur during the second and third decade of life. Patients with metastases were excluded from participation in the trial. 204. Retinoblastoma Orbital rhabdomyosarcoma Conjunctival lymphoma Pseudolymphoma Correct answer is A. Patients underwent staging paraaortic lymphadenectomies. B. RATIONALE: The combination of 5-FU and cisplatin with radiation therapy offers patients better progression-free survival and overall survival than treatment with hydroxyurea (HU).17(5):1339-48. 1999 (May). RATIONALE: The subsequent development of a primary tumor in a patient who has undergone postoperative radiation therapy portends a worse prognosis. Combined small cell lung cancer and non-small cell lung cancer Non-small cell lung cancer with neuroendocrine features Large cell neuroendocrine tumors Atypical carcinoid tumors Correct answer is A.203. B. 206.
voltage magnitude. 1000 keV/µm. Correct answer is B. voltage polarity. D. Chi-square test Fisher exact test Log-rank test Student t test Correct answer is C. When used to calibrate a linear accelerator. The pineal region is the most common site of origin. followed by a boost dose to the primary tumor. 209. the linear energy transfer (LET) at which the relative biological effectiveness (RBE) reaches its highest value is: A.C. B. For many biological endpoints. the Pion factor refers to ion collection efficiency as a function of ion chamber: A. Alpha-fetoprotein serum levels are elevated in patients with pure germinoma. but elevated alpha-fetoprotein serum levels will exclude that diagnosis. 0100 keV/µm. Beta-HCG can sometimes be slightly elevated in patients with pure germinoma. D. RATIONALE: Patients with CNS germinomas most commonly present in their 2nd decade of life. 0001 keV/µm. C. The best treatment is craniospinal axis irradiation. Because the predominant risk for its dissemination is in the ventricles. patients can be treated with whole ventricle radiation therapy. B. the average density of ionization events along an incident particle's track roughly corresponds to the diameter of the DNA double helix. B. RATIONALE: The log-rank test is the most common method of comparing independent groups of survival times. wall material. C. Correct answer is C. followed by primary tumor boost avoiding full craniospinal axis irradiation. 0010 keV/µm. Correct answer is A. Which of the following tests is used to determine the difference in survival between two treatment regimens? A. C. RATIONALE: At a LET of approximately 100 keV/µm. D. D. 210. radius. meaning a higher probability of a double-strand break being produced than at either lower or higher LET. RATIONALE: Requires knowledge of calibration protocol. 208. 60 American College of Radiology .
the patient has cancer stage IB. 2006. HER-2/neu-negative Luminal B → ER+/PR+. D. Luminal A → ER+/PR+. ER-positive. RATIONALE: The patient has significant weight loss and night sweats. HER-2/neu-negative. Stage IA Stage IB Stage IIA Stage IIB Correct answer is B. The basal molecular phenotype of breast cancer most commonly is: A. HER-2/neu-positive Reference: Race.211. ER-negative. A 22-year-old man with Hodgkin disease has adenopathy of the right cervical and right supraclavicular regions and weight loss of >10% of his baseline body weight. Correct answer is D. C. Radiation Oncology In-Training Exam 2007 61 . PR-negative. RATIONALE: The most common physical finding at initial presentation is jaundice.295:2492-2502. C. breast cancer Subtypes & survival in the Carolina breast cancer study. HER-2/neu-positive. HER-2/neu-negative. The cervical and supraclavicular lymph node chains are considered a unified area for the purpose of staging and management. both of which qualify as "B" symptoms. 213. C. B. PR-positive. PR-positive. Which of the following cancer stages is most likely to be associated with this patient's condition? A. ER-positive. PR-negative. Approximately 10% to 20% of pancreatic cancers are associated with hereditary factors. RATIONALE: DNA microarray analysis has enabled tumor gene expression subtypes for breast cancer that fall into the following categories: Gene profile by hormone receptors and HER-2/neu status enable recommendations regarding treatment programs. Tumors of the pancreatic head arise to the right of the superior mesenteric vein-portal vein confluence and include tumors of uncinate origin. ER-negative. Which of the following statements about pancreatic cancer is FALSE? A. D. HER-2/neu-positive. D. New-onset diabetes mellitus may be the first clinical feature in 10% of patients. Correct answer is C. The most common physical finding at initial presentation is Courvoisier's sign. B. Journal of the American Medical Association (JAMA). HER-2/neu-positive Basal-like → ER/PR and HER-2/neu-negative HER-2/neu-positive → ER/PR-negative. Hence. B. 212.
RATIONALE: Requires knowledge of the bremsstrahlung process. Neutrons are harder to shield than protons. Correct answer is C. D. It is likely to be beneficial for treating slow-growing tumors with sizeable hypoxic fractions. Z2 and V2. D. the proton oxygen enhancement ratio (OER) would still be high. 62 American College of Radiology . Z and V. THIS ITEM WAS NOT SCORED. The efficiency of x-ray production via the bremsstrahlung process is proportional to the product of: A. B. C. As such.214. Z2 and V. D. <5% 5% to 10% 11% to 15% >15% Correct answer is A. B. 215. and hypoxic tumors would not differentially benefit from proton radiation therapy. Which of the following statements about proton radiation therapy is FALSE? A. C. 216. C. RATIONALE: Fewer than 1% of patients undergoing bladder-conserving therapy will require cystectomy for persistent treatment-related symptoms. What percent of patients with bladder cancer will require a cystectomy for radiation-related complications after bladder preservation therapy with concurrent chemoradiation? A. B. RATIONALE: The relative biological effectiveness (RBE) of protons possesses radiobiological properties that are not significantly different from those of traditional X-rays or gamma rays. Z and V2. Its physical dose distributions make it effective for treating tumors close to critical normal tissues. A favorable characteristic is the virtual absence of an exit dose.
Regimens of radiation therapy and chemotherapy that contain cisplatin improve the rates of survival and progression-free survival. RATIONALE: Taxanes. RATIONALE: A tonsillectomy can reveal occult primary tumors in 20% of cases. 1999 ( April). and hydroxyurea was associated with a better local control rate. C. A PET scan is able to detect the primary tumor in approximately 15% to 20% cases only. B. All patients received radiation therapy.217. 218. Radiation Oncology In-Training Exam 2007 63 . Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. Correct answer is C. et al. shift the dynamic equilibrium between tubulin dimers and microtubule assembly. D. Tonsillectomy may reveal the occult primary tumor in 20% of cases. Stabilization of microtubules and prevention of their disassembly Intercalation into DNA and inhibition of DNA replication Inhibition of topoisomerases Inhibition of DNA repair Correct answer is A. PET imaging is able to detect the primary tumor in 60% of cases. B. The three drug regimens had the highest frequency of combined grade 3 and 4 side effects. C. and they actually stabilize the tubulin molecules in microtubles. 219. The overall survival rate was highest in the hydroxyurea only treatment arm. It was a randomized trial of cisplatin alone. RATIONALE: The study evaluated stages IIB-IVA cervical cancer patients without paraaortic lymph node involvement. Random biopsies will reveal the primary lesion in 40% of cases. resulting in the stabilization of microtubules against depolymerization. 5-FU + cisplatin + hydroxyurea. Taxane derivatives elicit cytotoxic effects mainly by which of the following mechanisms? A. D. Correct answer is D. Cisplatin-based chemotherapy improved the survival rate and the progression-free survival rate. Chest imaging will reveal a primary lung tumor in 20% of cases. The three-drug regimen had the lowest combined frequency of grade 3 and grade 4 side effects. Reference: Rose. D. fluorouracil. New England Journal of Medicine (NEJM). C.340(15):1144-1153. and hydroxyurea alone. such as paclitaxel and docetaxel. B. Which of the following findings is most likely to be associated with GOG 120 (Rose) that studied the use of radiation therapy in combination with three concurrent chemotherapy regimens for patients with locally advanced cervical cancer? A. Which of the following statements about unknown primary head and neck tumors is true? A. Stage IB1 cancer treated with cisplatin.
0 Gy per fraction 60 Gy at 2. 64 American College of Radiology . RATIONALE: The randomization of radiation therapy is 20 Gy vs.8 Gy per fraction 50 Gy at 2. 222. High-grade tumors mostly demonstrate intrinsic growth into the brainstem. A permanent implant is removed after 30 days. High-grade tumors display exophytic growth.0 Gy per fraction Correct answer is B. hyperfractionated high-dose irradiation failed to show any benefit from radiation dose escalation. 30 Gy 00 Gy vs. 20 Gy Correct answer is C. The radionuclide used for the implant has a half-life of 6 days. 2% 3% 4% 6% Correct answer is B. 40 Gy 24 Gy vs. There has been no benefit shown from the addition of chemotherapy for brainstem gliomas.220. RATIONALE: The majority of brainstem tumors are high-grade although the exact grade distribution is difficult due to the lack of biopsy information. D. 2006.4:613. What percent of the original planned dose still needs to be delivered? A. B. 36 Gy vs. The addition of chemotherapy has improved overall survival rates. 36 Gy 20 Gy vs. RATIONALE: Requires knowledge of the use of half-life for calculations. Journal of the National Comprehensive Cancer Network (JNCCN). 221. HD 10 trial of patients with early-stage disease? A. Radiation doses greater than 54 Gy have not been shown to improve survival. Reference. B. C. 223. D. The POG randomized trial of conventional vs. B. Which of the following radiation doses were compared in the randomized treatment arms of the German Hodgkin Study Group. C. Which of the following radiation doses administered concurrently with chemotherapy is considered to be the most INAPPROPRIATE treatment for limited-stage small cell lung cancer? A. 45 Gy at 1. Correct answer is C. Which of the following statements about brainstem gliomas is true? A. D.5 Gy per fraction twice daily 45 Gy at 1. 30 Gy. B. C. which followed a randomization of 2 versus 4 cycles of ABVD systemic therapy. C. D. The majority of tumors are low-grade gliomas.
Both stage IIIB and SCLN-positive patients differed significantly in overall survival when compared with stage IV patients. Sulfhydryl-containing compounds. Which of the following statements about patients who are diagnosed with breast cancer and have supraclavicular lymph node involvement is true? A. References: Brito. Over 20% of patients will have lymphedema and brachial plexopathy. Journal of Clinical Oncology (JCO). In this study. Patients with ipsilateral SCLN metastases and no other distant metastases should be classified as having stage N3 rather than stage M1 disease. Correct answer is A. Over 20% of patients will survive 10 years with aggressive trimodality therapy. Correct answer is D. 225. Which of the following sealed radioactive sources has the most anisotropic dose distribution? A. B. the source radiation is absorbed in the source capsule. et al. C. To clarify the significance of stage N3 disease. Long-term results of combined modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastases. MD Anderson Center Experience. B. such as amifostine. are effective dose modifiers because of their ability to: A. 226. D. University of Texas. leading to anisotropy (less dose along the source axis). et al.224. RATIONALE: A study by Brito. without distant metastases. C. surgery. a new category of stage IIIC has been instituted. D. there was no difference in disease-free survival or overall survival in LABC patients with positive SCLN and no other sign of distant metastasis compared with stage IIIB patients without distant metastasis. RA. C. AJCC Cancer Staging Manual.19:628-639. 125 137 I Cs 192 Ir 198 Au Correct answer is A. (6th edition). stage IIIB. post-surgical chemotherapy. because their clinical course and outcomes are similar to patients with stage IIIB LABC. D. bind to caspases and directly inhibit their activation. provides evidence that aggressive treatment of patients with positive supraclavicular lymph nodes (SCLN) results in outcomes comparable to those in patients with locally advanced breast cancer (LABC). B. 2001. RATIONALE: Amifostine is believed to protect cells from ionizing radiation by scavenging free radicals and by facilitating restitution of target radicals through donation of hydrogen. Approximately 30% of patients will have clinically detectable internal mammary lymph nodes on CT scan of the chest. sensitize hypoxic cells regardless of the radiation dose. 2002. and irradiation. At a median follow-up time of 8.5 years. These findings indicate that classifying SCLN as a distant metastasis may be a disservice to patients. scavenge free radicals. The diagnosis should be classified as stage M1 breast cancer. Radiation Oncology In-Training Exam 2007 65 . and thus. 70 patients with SCLN-positive LABC received intensive treatment that included induction chemotherapy. because it implies incurability and may lead to suboptimal therapy. p 233. form free-radical intermediates that interact with DNA. RATIONALE: 125I has a much lower energy.
B. Change in depth of 2 cm Change in source-to-skin distance of 2 cm Maximum tolerable variation in daily output Offset of 0. Which of the following statements about uveal melanomas is true? A. 2. Decreasing field of view has minimal effect on noise. C.5.5 cm along the direction of a 15° wedge Correct answer is A.0. 1. D. such as alpha particles. Systemic metastases are the cause of death in the majority of patients. RATIONALE: COMS showed that both enucleation and plaque brachytherapy produces the same overall survival outcome. but increasing current (mA) more significantly improves photon statistics. since there is no oxygen effect noted with such densely ionizing radiations. B.5. 1. 2. Which of the following procedures will have the greatest effect in decreasing CT image noise? A. 66 American College of Radiology . Preoperative radiation therapy does not improve local control in patients with large tumors. 229. Preoperative radiation therapy before enucleation does not produce better local control compared to enucleation alone. 230. C. C. RATIONALE: The use of 6-MV photons change the radiation dose by approximately 6% per centimeter past dmax due to attenuation and inverse square falloff. This is because most of the damage from high-LET radiation is mediated by direct effects rather than indirect effects. The oxygen enhancement ratio (OER) for high-LET radiations such as alpha particles is approximately: A. 228.0. A biopsy is necessary to establish the diagnosis in the majority of patients. is essentially unity. D. RATIONALE: The oxygen enhancement ratio (OER) for high-LET radiations. B. D. B. Which of the following factors will cause a dose delivery error of >5% for a planned single-field treatment with 6-MV photons at a source-to-skin distance of 100 cm and prescription depth of 5 cm? A. RATIONALE: Increasing kVp increases x-ray production efficiency slightly as well as detected photons due to decreased attenuation. D. Correct answer is C. C. Correct answer is A. Enucleation produces better overall survival than plaque brachytherapy in patients with medium-sized tumors. Increasing the kilovolt peak by 20% Increasing the milliamperes by 20% Decreasing the slice thickness to 1 mm from 3 mm Decreasing the field of view to 30 cm from 48 cm Correct answer is B. Decreasing slice thickness increases noise (fewer detected photons per detector element).227.
D. what is the 3-year disease-free interval following a radical hysterectomy for a patient with pathologic stage IB squamous cell carcinoma of the cervix with invasion of the deep third of the cervical stroma? A. 233. In fractional terms. C.6% for deep third invasion. 232. deep lobe lesion. RATIONALE: Delgado. B. 1990 (September). acinic cell histology. The DFI was strongly correlated with depth of stromal invasion. B. and 73.38(3):352-357. C. Adverse predictors of overall survival for patients with parotid gland malignancies include all of the following factors EXCEPT: A. T2 T3 T4a T4b Correct answer is A. high-grade mucoepidermoid histology. Based on the GOG prospective surgical-pathological study (Delgado). et al.231. RATIONALE: Hydronephrosis does not affect clinical T staging in bladder cancer. D. reported the findings of a GOG prospective surgical-pathological study of disease-free interval (DFI) in patients with stage IB squamous cell carcinoma of the cervix. 94% 85% 74% 53% Correct answer is C.5% for middle third. In what region are cholangiocarcinomas most commonly located? A. C. 84. Correct answer is B. 234. This study laid the ground work for postoperative adjuvant radiation therapy for stage IB cancers of the cervix. D. C.1% for superficial third. Distal Proximal Intrahepatic Hilar Correct answer is D. Reference: Gynecologic Oncology. Radiation Oncology In-Training Exam 2007 67 . RATIONALE: Acinic cell histology is not an adverse factor because it is a low-grade tumor. RATIONALE: Sixty-seven percent of cholangiocarcinomas occur in the hilar region. D. Bladder cancer associated with hydronephrosis and invasion limited to the outer half of the bladder wall corresponds to which T stage? A. facial nerve paralysis. B. the DFI was 94. B.
237. and the risk is presumed to be independent of therapy. Which of the following Hodgkin lymphoma subtypes is most closely associated with the development of non-Hodgkin lymphoma? A. 68 American College of Radiology . C. 2006. Preimplantation Major organogenesis Minor organogenesis Fetal Correct answer is A. RATIONALE: There is no evidence that radiotherapy benefits the patient with a negative mediastinal nodal dissection.8). Which of the following treatment strategies would be best for uniformly treating a target that extends from the skin surface to 1 cm deep while sparing deeper tissue? A. 236. B. C. 238. D. B. Bolus serves to increase the surface dose. D. B.235. Nodular sclerosis Lymphocyte depleted Lymphocyte predominant Lymphocyte rich Correct answer is C. What is the most sensitive gestational period for prenatal death after irradiation? A. RATIONALE: Neonatal death. treatment should be with 90% or greater maximum dose. B. Radiation therapy with positive mediastinal nodal dissection Chemoradiation therapy with negative mediastinal nodal dissection Chemotherapy with negative mediastinal nodal dissection Chemotherapy with negative mediastinal nodal sampling Correct answer is B. D. Reference: Journal of the National Comprehensive Cancer Network (JNCCN). C. 6-MeV electrons with 0. D. there is a documented association between lymphocyte-predominant Hodgkin lymphoma and non-Hodgkin lymphoma. as well as position the edge of steep falloff close to the posterior target edge. found at depth t/4. Which of the following treatments would NOT be appropriate after a lobectomy with negative margins is performed for a patient who has limited-stage small cell lung cancer? A. Higher doses are also required compared to the preimplantation period. rather than prenatal death. RATIONALE: Ideally.4:610.5-cm bolus 6-MeV electrons with 2-cm bolus 9-MeV photons with 1-cm bolus 9-MeV photons with 3-cm bolus Correct answer is A. RATIONALE: Compared to other subtypes. may occur during the fetal period or major organogenesis period. C. The risk is thought to be approximately 3% (relative risk of 1.
C. 241. Correct answer is A. Radiation Oncology In-Training Exam 2007 69 . C. A protocol violation An adverse event occurring in one of the treatment arms Evidence of one treatment arm showing significant superiority during the trial Loss of follow-up of some of the subjects during the trial Correct answer is C. adenoviruses. 242. genes are most commonly transferred into cells by: A. B. C. They commonly metastasize to the lungs. RATIONALE: Based on the CCG 7881/POG 8850 trial. B. C. 06 mg Ra eq 08 mg Ra eq 11 mg Ra eq 14 mg Ra eq Correct answer is B. C. D.239. Which of the following primary sites is most commonly involved in patients who are diagnosed with Ewing sarcoma? A. These tumors rarely metastasize. 75% or higher) for definitive radiation therapy. Surgical excision is the most common treatment of choice. RATIONALE: Retrospective studies show good local control rates (approx. D. D. and herpes viruses are commonly used as vectors in gene therapy. What would be the best reason for early termination of a randomized phase III trial? A. RATIONALE: It is important to know that when one treatment arm shows definite superiority during the trial. the tibia in 10% of patients. Definitive radiation therapy can achieve local control in 25% of cases. bacterial plasmids. The activity of a 20-mCi 137Cs source is approximately how many milligram radium equivalents? A. Involvement of the humerus occurred in 7% of patients. They commonly metastasize to the bones. During gene therapy. B. it is unethical to continue randomization. and the fibula in a lower percentage of patients than those with involvement of the humerus. RATIONALE: Retroviruses. Which of the following statements about desmoid tumors is true? A. Correct answer is C. viral vectors. 243. Surgery is the initial treatment of choice. the primary site of involvement was the pelvis in 24% of patients with Ewing sarcoma. Pelvis Humerus Fibula Tibia Correct answer is A. D. RATIONALE: Requires knowledge of cesium-137 sources and mg Ra eq. D. small-interfering RNA (siRNA). B. B. synthetic oligonucleotide primers. 240.
D. C. 0. 246. will undergo apoptosis after exposure to approximately 0. B. and like lymphocytes. RATIONALE: Approximately 75% to 98% of patients with gallbladder cancer have cholelithiasis. The hypoxic fraction in experimental animal tumors is approximately: A. C. −1% −0. and the lens of the eye is the most radiosensitive of the structures described. 245. RATIONALE: The sclera is most radioresistant. Which of the following conditions is the most common risk factor for gallbladder cancer? A. A measurement is performed using an air ionization chamber. C. 15%. RATIONALE: Oocytes are extremely radiosensitive.3 Gy 0.5% +1% Correct answer is A.12 Gy (12 cGy). 248. D. Cholelithiasis Coledochal cysts Primary sclerosing cholangitis Liver fluke infestation Correct answer is A. D. Lens Retina Lacrimal gland Sclera Correct answer is D. 70%. An increase in 3°C has what effect on percent change in the reading? A.5 Gy 0. C. What is the approximate D0 for oocytes? A. Correct answer is A. 247. 50%. 30%.1 Gy 0. 70 American College of Radiology . D.244. What structure in the eye is most radioresistant to late injury? A. B. B. C.7 Gy Correct answer is A. D.5% +0. RATIONALE: Although the hypoxic fraction may range from 0% to 50%. B. RATIONALE: Requires knowledge of how temperature affects mass of air in ionization chambers. the average obtained from surveys conducted on numerous animal tumor types is approximately 15%. B.
inversely proportional to the photon scattering angle. independent of the initial photon energy. Which of the following chemotherapy agents is most commonly used when administering chemoradiation for bladder preservation? A. a function of the incident photon energy. Correct answer is B. 0.35 0. B. Reference: New England Journal of Medicine (NEJM). C. P-glycoprotein Bcl-2 BAX TP53 Correct answer is A.99 Correct answer is C. C. what is the relative risk of disease progression among the women assigned to receive preoperative radiation therapy and chemotherapy compared to preoperative radiation therapy alone for bulky stage IB cervical cancer? A. C. 251. compared with the group given radiation therapy alone. RATIONALE: Requires knowledge of the Compton process. RATIONALE: The relative risk of recurrence in the combined-therapy group. RATIONALE: P-glycoprotein is a transmembrane protein product of the multiple drug resistance (mdr) gene. 252. RATIONALE: Cisplatin is most commonly used when administering chemoradiation for bladder preservation. For a Compton scattering event. 340(15):1154-1161. D.249. independent of the electron mass.51 0. 1999 (April 15). Radiation Oncology In-Training Exam 2007 71 . 250. B. the difference in wavelength between the incident and scattered photon is: A. D. Adriamycin Melphalan Cisplatin 5-FU Correct answer is C. C. According to GOG 123 (Keys). was 0. D. B. B.26 0.51 (95% confidence interval). D. Multidrug resistance in tumor cells is often attributed to extrusion of drugs mediated by overexpression of which of the following proteins? A.
Only 20% of temporal bone chemodectomas occur in the inferior tympanic canaliculus. Microscopic evaluation of these tumors reveals a high level of disorganization of cellular alignment. 60% direct 10% direct. BE. 0. C. B.32 day-1 0. D. C. The biological half-life of a systemically distributed radionuclide is 8 days. C. RATIONALE: Indirect damage secondary to the ionization of water accounts for approximately two thirds of the total DNA damage produced in cells irradiated with low-LET X. 50% indirect 40% indirect.66 day-1 Correct answer is B. 256. L. The majority occur in the inferior tympanic canaliculus. B. C.46 day-1 0. Reference: Gandhi. 70% indirect. What is the effective decay constant? A. 72 American College of Radiology . 30% direct 50% direct. They are very sensitive to chemotherapy. D. RATIONALE: Requires knowledge of how to combine effects of physical and biological decay. RATIONALE: Chemodectomas look histologically benign and are sensitive to radiation therapy. 2006.rays. 254. Johnson. and the physical half-life is 3 days.4:631-638. They are derived from neural crest tissue of the second branchial arch associated with either cranial nerve IX or X. B. 255. What is the proportion of indirect versus direct damage in cells irradiated with linear-accelerator-produced x-rays? A. Which of the following conditions does NOT belong in the paraneoplastic category of immune-mediated neurological syndromes in small cell lung cancer? A. D. Journal of the National Comprehensive Cancer Network (JNCCN). Correct answer is A. but not to chemotherapy. D. B.253.23 day-1 0. Eaton-Lambert syndrome Cerebellar degeneration Hypernatremia Retinopathy Correct answer is C. 90% indirect Correct answer is A. Which of the following statements about temporal bone chemodectomas is true? A.
257. RATIONALE: Cells synchronized in the G2. Inguinal Paraaortic Mediastinal Cervical Correct answer is D. Total dose in 1 week from a linear accelerator that exceeds 20% of the weekly total prescribed dose B. RATIONALE: Requires knowledge of NRC regulations. RATIONALE: Approximately 60% to 80% of patients with Hodgkin lymphoma present with cervical/supraclavicular adenopathy. Total dose from a low-dose-rate (LDR) procedure that exceeds 20% of the prescribed dose C. C.0 Gy 55. C. Radiation Oncology In-Training Exam 2007 73 . Dose in 1 week from a 60Co teletherapy machine that exceeds 15% of the weekly total prescribed dose D. B. M S G1 G0 Correct answer is A. 260. 259. Which of the following is defined as a medical event by the Nuclear Regulatory Commission (NRC)? A.or M-cell cycle phases by physical (mitotic shake off) or chemical means have been consistently shown to be more clonogenically radiosensitive than other cell cycle phases. 258. B. Which of the following radiation doses is standard definitive radiation therapy for an unresectable Ewing sarcoma? A. C. D. Which of the following lymph node chains is most commonly involved in patients who present with Hodgkin lymphoma? A. Approximately 50% of patients have mediastinal lymph node involvement.2 Gy Correct answer is B. Which of the following cell cycle phases is most radiosensitive? A. D.8 Gy.8 Gy 70. 45. Doses >60 Gy have been associated with high rates of secondary malignancy. B.8 Gy 64. D. RATIONALE: The standard radiation dose is 55. Dose from a Gamma Knife stereotactic machine that exceeds 15% of the prescribed dose Correct answer is B.
B. It has a monophasic histologic pattern. B. The gastrointestinal syndrome is linked to compromised intestinal function secondary to disruption of the normal villus architecture. 264. Stage N3b disease designates axillary lymph node involvement (at any level) in association with ipsilateral IMC node involvement. including those designated as apical. 262. Standard axillary lymph node dissection includes level I and II lymph nodes. RATIONALE: The AJCC Cancer Staging Manual describes level III lymph nodes as those in the axillary apex. RATIONALE: Mesenchymal chondrosarcomas are more aggressive and have a worse prognosis than the more common subtypes. intestinal function. This region is immediately lateral to the infraclavicular fossa. Correct answer is B. Metastases to this region would be classified as stage N3b disease. This includes all lymph nodes medial to the medial margin of the pectoralis minor muscle. C. and ultimately. D. 74 American College of Radiology . C. Correct answer is A. B. What is the primary source of contrast in megavoltage electronic portal images? A. It has a better prognosis than most other forms of chondrosarcoma. They most commonly occur in the spine or non-pelvic flat bones. Which of the following statements about mesenchymal chondrosarcoma is true? A. It occurs most commonly in elderly patients. D. What causes the changes in villi following irradiation? A.261. Which of the following statements about level III involvement of the axillary lymph nodes in a patient with breast cancer is true? A. The lymph nodes are commonly removed by standard axillary lymph node dissection. B. D. It occurs most commonly in the flat bones. Level III lymph nodes are at the superior clinical border of the infraclavicular fossa. 263. C. Killing of crypt cells Migration of Goblet cells Prolonged cell cycle arrest Damage to villus vasculature Correct answer is A. Pair production Compton scattering Photoelectric effect Bremsstrahlung Correct answer is B. The region is superomedial to the pectoralis minor muscle and lateral to the clavicular bone. C. RATIONALE: Compton scattering is the primary source of contrast with portal imaging. The photoelectric effect is the primary source of contrast for diagnostic plain films. RATIONALE: Killing of crypt stem cells that resupply mature epithelial cells to line the surfaces of the villi drives changes in villus structure. D.
D. Correct answer is A. Approximately 30% of patients with ependymomas have cerebrospinal fluid dissemination. 60(1):62-7. They most commonly occur in patients older than 21 years of age. Patient survival is dependent on the degree of tumor resection. Which of the following statements about patients with primary sclerosing cholangitis (PSC) and cholangiocarcinoma is true? A. Correct answer is D. Patients who have both conditions often have a worse prognosis. 43 (TG-43) dose calculation formalism can be applied to which of the following types of treatment? A.265. RATIONALE: AAPM TG43 was designed for small encapsulated sources. C. Reference: Urology. RATIONALE: About two thirds of patients who enter bladder preservation protocols achieve complete response to induction therapy. because they often have multifocal cancer and underlying liver dysfunction. 131I thyroid therapy C. Cholangiocarcinoma tends to occur at an older age in patients who have PSC. Hepatobiliary cancer will develop in 25% to 30% of patients with PSC. 268. 137Cs Fletcher-Suit D. 267. 266. 90Y and 131I are internally distributed throughout tissue and require a different formalism. Radiation Oncology In-Training Exam 2007 75 . What percent of patients with bladder cancer invading the muscles will achieve a complete response to induction chemoradiation administered for bladder preservation? A. Postoperative radiation therapy has no impact on local control in completely resected tumors. C. 137Cs uses more elongated sources and may not be as applicable as HDR therapy. High-dose-rate (HDR) endobronchial therapy THIS ITEM WAS NOT SCORED. 90Y microspheres B. 30% 40% 55% 65% Correct answer is D. Completeness of tumor resection affects patient survival. B. RATIONALE: Patients with primary sclerosing cholangitis and cholangiocarcinoma have a poor prognosis. and the postoperative radiation therapy dose impacts disease control (see Perez textbook). C. 2002 (July). D. B. Which of the following statements about ependymomas is true? A. D. B. The risk of cerebrospinal fluid (CSF) spread is approximately 5% to 10%. RATIONALE: Ependymoma most commonly affects children younger than 5 years of age. Approximately one third of cholangiocarcinomas occur within 10 years of diagnosis of PSC. The American Association of Physicists in Medicine (AAPM) Task Group No.
5-MeV electrons Positrons Correct answer is B. RATIONALE: The 0. C.18(8):1606-1613. 76 American College of Radiology .5-MeV photons 0. Tumor size >5 cm Lymphovascular space invasion Depth of invasion into the deep third of the cervical stroma Microscopic involvement of the parametrium Correct answer is D. B. Compared to radiation therapy. The study concluded that adjuvant chemotherapy and radiation therapy significantly improved progression-free survival and overall survival in this high-risk population. Stage of gestation Body mass Dose rate Dose Correct answer is B. et al: Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation alone as adjuvant therapy after radical surgery in high-risk early stage cancer of the cervix. C. Based on the results of SWOG 8797 (Peters). B. B. Which of the following statements about the role of radiation therapy in the management of paragangliomas is true? A. B. D. D. D. 271.269. Reference: Peters.5-MeV (511 keV) photons are produced from annihilation and thus localize the positron. 272. RATIONALE: The stage of gestation. The radiation dose response increases above 45 Gy for tumor regression. RATIONALE: Surgery or radiation therapy can be used to treat paragangliomas. The local control rate after radiation doses of 45 Gy alone is commonly 90% to 95%. surgery offers improved control and disease-specific survival rates. Surgery followed by radiation therapy is the preferred treatment. Lower-energy photons are from scatter and decrease image quality by producing false coincidence events. and total dose are the principal determinants of pathogenic radiation effects on the embryo or fetus. dose rate. Journal of Clinical Oncology (JCO). C. RATIONALE: This study included patients who had positive pelvic lymph nodes and/or margins and/or microscopic parametrial involvement. Which of the following does NOT affect the response of the developing embryo or fetus to ionizing radiation? A. C. Which of the following types of radiation is detected in PET imaging? A. 2000 (April). D. Correct answer is C. which of the following pathologic findings after a radical hysterectomy and pelvic lymph node dissection is an indication for adjuvant chemotherapy with radiation therapy for patients with high-risk cancers of the cervix? A. 270. A radiation dose of 45 Gy is sufficient to achieve excellent local control (>90%). 140-keV photons 0.
Occupational exposure to benzene Occupational exposure to aluminum Use of mitomycin C Exposure to HPV Correct answer is A. X-rays are more penetrating in tissue. According to the VA Lung Cancer Group's classification.4:615. Doubling the atomic number has what effect on attenuation probability for photoelectric interactions? A. Which of the following factors increases a patient's risk for the development of leukemia? A. Correct answer is B. C. D. Decrease by a factor of 8 Decrease by a factor of 2 Increase by a factor of 8 Increase by a factor of 2 Correct answer is C. C. Radiation Oncology In-Training Exam 2007 77 . smoking. There has been no established relationship to viral exposure with HPV. RATIONALE: The physical source of these radiations is their defining feature. 276. and benzene exposure. B. B.273. Ipsilateral hilar lymph nodes Ipsilateral supraclavicular lymph nodes Contralateral supraclavicular lymph nodes Contralateral mediastinal lymph nodes Correct answer is C. B. C. mitomycin C. D. 275. Which of the following physical or biological features best distinguishes x-rays from gamma rays? A. D. 2006. B. or thalidomide. Gamma rays are less biologically effective. RATIONALE: Risk factors for leukemia include radiation exposure/atomic bomb experience. Gamma rays produce less scatter in tissue. aluminum. C. which of the following sites of lymphadenopathy is associated with extensive-stage small cell lung cancer? A. D. RATIONALE: Attenuation is proportional to Z^3/E^3 for photoelectric interactions. 274. X-rays are produced outside the atomic nucleus. Reference: Journal of the National Comprehensive Cancer Network (JNCCN).
RATIONALE: Requires an understanding of how integral dose is determined. RATIONALE: Rad51C is part of a multi-protein complex that participates in DNA DSB repair by homologous recombination in mammalian cells. and 1p/19q gene deletion in oligodendrogliomas. or p<0. C. <0. LOH-RB in retinoblastoma. The other population has a mean age of 30 years and a standard deviation of 4 years.14) is most commonly seen in Burkitt lymphoma. B. 278.277. One population has a mean age of 40 years and a standard deviation of 3 years. 279. as the means are different by at least 2 standard deviations. What is the likelihood that these two populations are the same in age? A. Which of the following SI units is used to express integral dose? A. Gray Sievert Joule Watt Correct answer is C. C.05% <5% >75% >95% Correct answer is B. D.05. The ages of two populations are sampled. Which of the following genetic abnormalities is most commonly associated with Ewing sarcoma? A. 280. The null hypothesis that population A is the same as population B is rejected at p<0.22) 1p/19q gene deletion Loss of heterozygosity (LOH) of the retinoblastoma gene Correct answer is B. B. Which of the following proteins plays a key role in homologous recombination? A. The translocation t(8. B.05%. Ku80 Rad51C Telomerase XPA Correct answer is B. D. D. RATIONALE: This is a typical t test. C. The separation would have to be far greater to achieve 0. RATIONALE: t(11.0005. D. C. 78 American College of Radiology . B.22) is the classic translocation in Ewing sarcoma.14) t(11. t(8.
Which of the following statements about the diagnosis of inflammatory breast cancer is true? A. RATIONALE: This question requires an understanding of target theory and Poisson statistics. Dermal lymph node involvement must be demonstrated. 282. B. This clinical presentation is due to tumor emboli within dermal lymphatics. On imaging. For a population of 100 cells with a D0 of 2 Gy. D. the skin changes arise quickly in the affected breast. They are used only for controlled access areas.281. Classically.5. 283. They have an average patient attenuation factor. It is important to remember that inflammatory carcinoma is primarily a clinical diagnosis. D. however. There may not be a discrete palpable mass at presentation. It illustrates the random nature of cell killing by radiation. Correct answer is C. They have a use factor of 0. 00 37 50 63 Correct answer is B. The tumor of inflammatory carcinoma is classified T4d. how many cells on average would survive a single dose of 2 Gy (based on use of Poisson statistics)? A. which may or may not be apparent on skin biopsy. RATIONALE: Inflammatory carcinoma is a clinicopathologic entity characterized by diffuse erythema and edema (peau d’orange) of the breast. RATIONALE: This item requires knowledge of shielding variables. In addition to the clinical picture. They have an occupancy factor of 1 for controlled access areas. B. 2002. a patient may report having a longstanding breast mass that developed skin changes over time. there may be a detectable mass and characteristic thickening of the skin over the breast. often without an underlying palpable mass. Involvement of the dermal lymphatics alone does not indicate inflammatory carcinoma in the absence of clinical findings. since the diagnosis is clinically established. C. Thus. These clinical findings should involve the majority of the skin of the breast. the term “inflammatory carcinoma” should not be applied to a patient with neglected locally advanced cancer of the breast presenting late in the course of the disease. pp 225-226. Radiation Oncology In-Training Exam 2007 79 . a biopsy is still necessary to demonstrate cancer either within the dermal lymphatics or in the breast parenchyma itself. B. C. C. 6th edition. Reference: AJCC Cancer Staging Manual. A biopsy is not required. Which of the following statements about primary barriers for shielding calculations is true? A. D. Correct answer is A. At presentation.
C. 287. What is the daughter radionuclide for a 90Sr eye applicator? A. RATIONALE: RTOG recursive partitioning analysis included the following prognostic factors: patient's age. calculating radiation dose through generating transport histories. D. comparing means and standard deviations. 89 91 Sr Sr 89 Y 90 Y Correct answer is D. extrapolating from limited samples to predict endpoints. duration of neurologic symptoms. D. Tumor size Tumor stage Mental status Extent of resection Correct answer is C. B. B. C. D. Bladder preservation therapy with chemoradiation would be most appropriate for bladder cancer associated with: A. G0 → G1 G1 → S G2 → M S → G2 Correct answer is B. C. 285. RATIONALE: Requires knowledge of 90Sr decay.284. Karnofsky performance status. RATIONALE: Bladder preservation therapy is best suited for muscleinvasive bladder cancer without hydronephrosis and multifocal carcinoma in situ. C. Which of the following cell cycle phase transitions is most affected when the TP53 gene is lost or mutated? A. B. D. Which of the following prognostic factors is included in the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA)? A. multifocal carcinoma in situ. invasion of the outer half of the bladder wall. C. invasion of the subepithelial connective tissue. Monte Carlo models are applied to statistical studies by: A. mental status. hydronephrosis. B. randomly sampling a modeled population multiple times. THIS ITEM WAS NOT SCORED. B. Correct answer is D. RATIONALE: Early work by Michael Kastan on the G1→S cell cycle phase transition has unambiguously linked the TP53 gene to this process. D. 286. 80 American College of Radiology . 288.
International Journal of Radiation Oncology. Charles Levenback. RATIONALE: Answer B would be true if the tumor involved the lower third of the vagina. 291. Radiation Oncology In-Training Exam 2007 81 . If the tumor involves the upper third of the vagina. remains constant. Correct answer is B. Answer D is false. For alpha particle decay. 2005 (May). The E7 protein expression inhibits Rb function. Eifel. D. a pelvic examination is performed to determine the method of further radiation therapy delivery. Biology. The E6 protein expression activates c-myc. B. RATIONALE: Some HPV viral genes have specific effects on cell cycle control that directly impact tumor initiation. THIS ITEM WAS PARTIALLY SCORED (BOTH OPTIONS A & C SCORED CORRECT). and Patricia J. Physics. D. Answer C places the inferior border too close to the gross disease. D. The E7 protein expression inactivates p53. After 45 Gy of external-beam radiation therapy. Anuja Jhingran. C. decreases. but would be true if stage I-II disease.289. The inferior border of the fields is placed 1 cm below the most distal extent of the disease. C. Definitive radiation therapy for squamous cell carcinoma of the vagina. Which of the following molecular mechanisms is specifically implicated in the oncogenesis of cervical cancer associated with prior HPV infection? A. which in turn releases the E2F transcription factor to induce cellular DNA synthesis and progression into the S cell cycle phase. B. the neutron/proton (N/P) ratio of the daughter nuclide compared to that of the parent nuclide: A.62(1):138-147. Which of the following statements about definitive radiation therapy for squamous cell carcinoma of the vagina is true? A. 290. Reference: Steven J. has a value closer to 1. RATIONALE: Requires knowledge of alpha particle decay and basic math. B. Radiation therapy achieves pelvic disease control rates of 80% to 90% for patients with stage III to stage IVA disease. C. Correct answer is A. Frank. increases. the medial inguinofemoral lymph nodes should be treated. Specifically. the E7 protein binds to pRB leading to its degradation. The E6 protein expression suppresses G2-M cell cycle arrest.
Superior laryngeal nerve paralysis Spinal accessory nerve injury Hypogossal nerve injury Vagus nerve injury Correct answer is D. 24 Gy in 8 fractions 25 Gy in 10 fractions 30 Gy in 10 fractions 30 Gy in 15 fractions Correct answer is C. B. 294. Reference: Journal of the National Comprehensive Cancer Network (JNCCN). 2006. Beam penumbra width Random variation in patient position Systematic variation in patient position Laser calibration differences between the CT scanner and linear accelerator Correct answer is C. RATIONALE: Laser calibration differences should be within 1 mm to 2 mm. Which of the following neurological complications is most common after surgical resection of paragangliomas? A.8 2. B. Random variation has significantly less impact (by a factor of 3 or more) than systematic position error. D. What is the approximate relative biological effectiveness (RBE) of protons with energies that are commonly used in radiation therapy? A. RATIONALE: Injury to cranial nerves IX and X are the most common neurological complications after surgical resection of paragangliomas. Which of the following radiation doses is LEAST preferred for prophylactic cranial irradiation administered to patients who have limited-stage small cell lung cancer and who experience a complete response to chemotherapy for their lung lesions? A. D. C.7 1. much smaller than position variability. 0. B. Which of the following uncertainties contributes most to the planning target volume expansion? A. D.2 1. B. C. C.6 Correct answer is B. 293. C.2 would be expected for proton beams with energies of approximately 160 MeV used for radiation therapy. RATIONALE: A relative biological effectiveness (RBE) of 1. 82 American College of Radiology .4:619.292. Penumbra is not considered in planning target volume (PTV) definition. D. 295.
is irradiated with low-energy neutrons (0. B. 297. RATIONALE: The most common site of distant spread in patients with Ewing sarcoma is the lungs. C. D. t(5.296.22) Trisomy 8 Trisomy 21 Correct answer is B. B. A point on a cumulative dose volume histogram represents the: A.025 eV) to yield helium nuclei (alpha particles) and 7Li nuclei. 299. RATIONALE: The chromosomal translocation t(9. B. 10B." and translocation of the BCR and ABL genes are present in approximately 90% of chronic myelogenous leukemia (CML) cases. D.17) t(9. volume of an organ that receives a given dose or less. C. 298. Protons Photons Alpha particles High-energy neutrons Correct answer is C. D. Radiation Oncology In-Training Exam 2007 83 . each point on a cumulative dose volume histogram (DVH) represents the definite integral of volume from that dose to the maximum dose in the body. C. D. Lung Bone Bone marrow Lymph nodes Correct answer is A. Which of the following factors is associated with chronic myelogenous leukemia? A. What is the most common site of metastatic disease in patients with Ewing sarcoma? A. Correct answer is C. Which of the following types of ionizing radiation is produced when low-energy (thermal) neutrons bombard a boron-containing compound during boron-neutron capture therapy? A. volume of an organ that receives a given dose or greater. RATIONALE: By definition. location of a given dose in an organ. RATIONALE: During boron-neutron capture therapy. followed closely by the bone. dose received by a given point in an organ. C.22) is called the "Philadelphia (Ph) chromosome. B.
Correct answer is A. Reference: Perez and Brady: Locally Advanced and Recurrent Breast Cancer.5 MeV of kinetic energy and generates two bremsstrahlung photons of 100 keV and 30 keV as it travels. C. B. 0000. RATIONALE: Kc (collision kerma) is the energy transferred to the medium. B. Williams and Wilkins. +/. Chest wall only Chest wall and draining lymph nodes Excision scar and a 5-cm margin No radiation is required if the excision reveals negative margins. JR. C. D. Reference: Harris. 3rd edition. Which of the following radiation treatment sites would be most appropriate for a patient with breast cancer who undergoes postoperative irradiation after successful wide excision for a localized chest wall recurrence 2 years after mastectomy and chemotherapy? A. D.the IMC or axillary lymph nodes. 2004.5 MeV 0002 MeV 0370 keV 1870 keV Correct answer is C. An incident 2-MeV photon undergoes Compton scatter. L1 vertebral lesions is not associated with a referred pain pattern to the bilateral iliac crests or to the bilateral sacroiliac joints. What is the collision kerma of this event? A. 2004. Diseases of the Breast. 84 American College of Radiology . Which of the following statements about metastasis of breast cancer to the bone is true? A. 303. Up-regulation of HIF-1α Down-regulation of TP53 Decreased cell proliferation Decreased free-radical damage Correct answer is D. C. 302. p. Compression of the epidural spinal cord associated with breast cancer most commonly has a single site of vertebral metastasis. Pain from T12. B. minus that lost to bremsstrahlung. Correct answer is B. 301. RATIONALE: A relative lack of free oxygen reduces the probability of fixation of free-radical damage in irradiated DNA. The resulting electron receives 0. Which of the following factors best explains why hypoxic cells are more resistant to the cytotoxic effects of ionizing radiation? A. Radicular pain in the thoracic spine is typically unilateral. pp 1529-1532. 1220. D. D. RATIONALE: Higher rates of locoregional tumor control are reported when radiation field design includes the chest wall and supraclavicular areas. B. C. and therefore. accounts for the reduced cytotoxicity under hypoxic conditions.300. Lippincott. Metastasis to the epidural spine is most commonly associated with worsening back pain in the supine position or with the Valsalva maneuver.
It affects men and women equally. Alpha decay and electron capture Positron decay and isomeric transition Negatron decay and internal conversion Electron capture and internal conversion Correct answer is D. 307. a beta-emitter. B. Tumors most commonly originate from the shaft of the penis. First-echelon lymph nodes include the periaortic lymph nodes. D. Which of the following pairs of processes results in the production of characteristic x-rays? A. Greater than 90% have squamous cell histology. 308. THIS ITEM WAS PARTIALLY SCORED (BOTH OPTIONS A & D SCORED CORRECT). Correct answer is D. Mismatch repair Nucleotide excision repair Non-homologous end joining Base excision repair Correct answer is C. C. It is commonly associated with cirrhosis of the liver. D. 305. B. Correct answer is A. Which of the following statements about the fibrolamellar variant of hepatocellular cancer is true? A. RATIONALE: No clear sex predominance is reported in fibrolamellar hepatocellular cancer. B.304. P-32. RATIONALE: Squamous cell carcinoma is the predominant type of cancer in the penis. RATIONALE: Only two pathways can rejoin DNA DSB: non-homologous end joining (NHEJ) and homologous recombination (HR). Surgery is rarely associated with visual and endocrine complications. D. Radiation Oncology In-Training Exam 2007 85 . Intracavitary diluted β-emitter isotopes can be used to treat cystic lesions with up to 200 Gy prescribed to the cyst wall. Conformal external-beam radiation therapy of 40 Gy delivered to both cystic and solid components with a 0. D. C. Which of the following repair pathways rejoins DNA double-strand breaks? A. Complete surgical resection is possible in approximately 10% to 15% of patients. RATIONALE: The recommended dose for external-beam radiation therapy is about 54 to 55 Gy.5-cm margin will achieve local control. B. It occurs more frequently in elderly persons. Which of the following statements about craniopharyngiomas is true? A. C. RATIONALE: Requires an understanding of radioactive decay pathways. 306. D. Patients are less likely to present with positive lymph nodes. Which of the following statements about penile cancer is true? A. C. Clinically positive lymph nodes are pathologically involved <20% of the time. C. can be used to treat monocystic lesions. B.
What is the 5-year disease-specific survival rate for stage I squamous cell carcinoma of the vagina treated with definitive radiation therapy? A. D. D. Which of the following lymph nodes is at the highest risk for regional metastasis from skin cancer of the forehead? A. it can be used to compare different treatment schedules for approximate biological equivalence (or lack thereof). B. Frank. B. B. 2005 (May). C. RATIONALE: Requires knowledge of AAPM Task Group No. Which of the following units was used for calibration of the brachytherapy source in the report by the American Association of Physicists in Medicine (AAPM) Task Group No. and as such. Predicting tumor-control doses Predicting normal-tissue tolerance doses Comparing different fractionation schedules Optimizing beam energy Correct answer is C. D. It should not be used to predict or assess treatment outcome in individual patients. Kerma rate Collision kerma Air kerma strength Apparent activity Correct answer is C. 43 (TG-43)? A. Parotid Suboccipital Submental Facial Correct answer is A. C. 311. 86 American College of Radiology . and Patricia J. Anuja Jhingran. RATIONALE: The linear quadratic equation is best viewed as a guide to the likely fractionation sensitivity of different tissues. Biology. Which of the following represents the most appropriate application of the linear quadratic model of cell killing? A. C. 312.62(1):138-147. Reference: Steven J. Tumors of the scalp and forehead anterior to a coronal plane through the ear canals spread preferentially to the parotid and upper jugular lymphatic chain. Eifel: Definitive radiation therapy for squamous cell carcinoma of the vagina. B. Charles Levenback. 95% 85% 75% 50% Correct answer is B. International Journal of Radiation Oncology. RATIONALE: Knowledge of the cutaneous lymphatic drainage of the head and neck is important for determining the lymph node groups at risk for regional metastasis. 310. C. Physics. 43 (TG-43) report. D.309.
33:270-298. B. C. RATIONALE: This is a typical presentation of Eaton-Lambert Myasthenic syndrome seen in about 1% to 2% of patients with small cell lung cancer. Which of the following types of leukemia has the highest risk of CNS involvement? A. 314. with the CNS being the most common. Which of the following statements most accurately describes the biological basis for combining heat and radiation for the treatment of malignant disease? A. Which of the following qualities causes film to be useful for analyzing relative dose distributions? A. 2006 (May). An effective Z value equal to water No background corrections required Insensitivity to film-processing conditions Small grain size Correct answer is D. International Journal of Hyperthermia. Seminars in Oncology. C. D. RB. D. 2006. RATIONALE: Requires knowledge of film dosimetry. Reference: Kampinga. Acute lymphocytic Acute myelogenous Chronic myelogenous Chronic lymphocytic Correct answer is A. CNS prophylaxis is often employed. RATIONALE: Heat affects the stability of many nuclear proteins including those involved in DNA repair. A 62-year-old man with limited-stage small cell lung cancer and proximal muscular weakness is most likely to have which of the following conditions? A. Reference: Darnell. RATIONALE: The eye/ocular region. B. Radiation Oncology In-Training Exam 2007 87 . JB. Heat inhibits DNA repair Heat triggers apoptosis Correct answer is C. Because of this. B. and central nervous system (CNS) are common sanctuary sites in acute lymphocytic leukemia (ALL). 315. C. Posner. B.22(3):191-6. SIADH Myasthenia gravis Cerebellar degeneration Eaton-Lambert syndrome Correct answer is D. Heat suppresses radiation-induced checkpoint activation Heat is preferentially toxic to tumor cells. Paraneoplastic syndromes affecting the nervous system. testicles.313. 316. This is thought to be the basis of thermal sensitization. D. D. EMG and antibody testing to P/Q VGCC are diagnostic. C.
C. and dicentrics are generally considered to be lethal types of chromosomal aberrations. D. B. Which of the following types of chromosomal aberrations is most likely to be involved in carcinogenesis? A. D. anaphase bridges. Stage I Stage II Stage III Stage IV Correct answer is C. CT scan of the chest does not reveal any pulmonary nodules. B. a written directive for a brachytherapy procedure requires at least which of the following two pieces of information? A. Rings Dicentrics Anaphase bridges Translocations Correct answer is D. 320. A 3-year-old girl has Wilms tumor with a favorable histology and a positive surgical margin. 319. Which of the following types of cancer is most frequently associated with isolated hepatic metastases at presentation? A. B.317. D. RATIONALE: Cancer stage III is associated with this patient’s condition because of the positive surgical margin. Translocations (and small deletions) are often compatible with continued viability but may lead to cancer. C. B. D. C. 318. Colorectal Esophageal Gastric Lung Correct answer is A. RATIONALE: Colorectal cancer is the most frequent type of malignancy that is associated with isolated hepatic metastasis at presentation. According to the Nuclear Regulatory Commission (NRC). What cancer stage is most appropriate for the patient's condition? A. RATIONALE: Rings. C. RATIONALE: Requires knowledge of written directive requirements. 88 American College of Radiology . Source type and the source serial number Both the authorized user and radiation safety officer signatures Patient name and the source serial number Patient name and number of sources Correct answer is D.
B. B. RATIONALE: In high-incidence regions of the world. What percent of patients with hepatocellular cancer are candidates for curative resection? A. Metaplastic histology A disease-free interval of <2 years Recurrent DCIS in a different quadrant of the breast Concurrent involvement of the supraclavicular lymph nodes Correct answer is C. Which of the following findings is associated with a better outcome for patients who have a local recurrence of breast cancer after breast-conserving surgery? A. D. C. 322. between 15% and 30% of patients are potential candidates for resection. Other options are known to be associated with a poor prognosis after recurrence. RATIONALE: Noninvasive breast cancer in a different quadrant of the breast is suggestive of a new primary lesion. 75% 50% 20% 05% Correct answer is C. Fossa navicularis Bulbomembranous urethra Prostatic urethra Penile urethra Correct answer is B. D. only 10% to 15% of newly diagnosed patients are candidates for standard resection.321. C. B. Which of the following sites is most commonly associated with cancer of the urethra in men? A. C. N1 disease is stage IVB using the FIGO staging system (or stage III using the TNM staging system). What is the FIGO stage of a 3-cm vaginal mass with paravaginal extension and a single metastatic inguinal lymph node? A. 323. Radiation Oncology In-Training Exam 2007 89 . RATIONALE: Urethral tumors in men occur predominantly in the bulbomembranous urethra. C. 324. II III IVA IVB Correct answer is D. D. D. whereas in low incidence areas. The cure rate with salvage mastectomy is nearly 100%. B. RATIONALE: Based on the AJCC Cancer Staging Handbook (6th edition).
C. D. rather than a shave biopsy. B. PDQ. RATIONALE: Excisional biopsy may be inappropriate for certain sites such as the face. without interfering with definitive local therapy. and CD22 are related to B-cell ALL. 3iiiDiii.) 326. D. 90 American College of Radiology . Alkaline elution Northern blotting High-pressure liquid chromatography (HPLC) Pulsed-field gel electrophoresis Correct answer is D. D. 70%. Northern blotting is used for analysis of RNA. 327. palmar surface of the hand. Cell markers CD2. C. Correct answer is B. An excisional biopsy is NOT appropriate for a suspected melanoma in which of the following sites? A. In these instances. Palmar surface of the hand Dorsal surface of the hand Forearm skin Shoulder Correct answer is A. 20%. B. Level of evidence. CD19. Which of the following types of leukemia is associated with myeloperoxidase activity and cell markers CD13 and CD33? A. and CD10. 328. B. (Refer to current NCCN guidelines. 50%.325. Which of the following assays is commonly used for measurement of radiation-induced DNA double-strand breaks? A. RATIONALE: NCI. C. B. a full-thickness incisional or punch biopsy of the clinically thickest portion of the lesion is recommended. It should provide adequate microstaging. sole of the foot. RATIONALE: Myeloperoxidase activity and cell markers CD13 and CD33 are related to acute myelogenous leukemia (AML). and CD7 are related to T-cell acute lymphocytic leukemia (ALL). 90%. or distal digit. inoperable stage III and III invasive thymoma. Invasive thymoma and thymic carcinoma. while HPLC is used to detect base damage. C. Acute lymphocytic Acute myelogenous Chronic myelogenous Chronic lymphocytic Correct answer is B. The 5-year survival for patients who have undergone radiation therapy for inoperable stage III invasive thymoma is approximately: A. D. CD5. Alkaline elution is used for detection of single-strand breaks.
Contralateral breast doses at 4. D. 330. RATIONALE: Adjustment equals arc tangent (half field width/source axis distance). Physics. What adjustment to the gantry angle would be required to make each pair of symmetric. SX. Kelly. which is 2. 10-cm-wide opposed fields tangential at their posterior borders? A. A lower radiation dose is delivered to the contralateral breast with a physical wedge technique than with a multileaf collimated intensity modulation technique. Irradiation using 6-MV photons without any compensation will deliver a 4% radiation dose to the contralateral breast. Conventional medial/lateral tangential breast irradiation using 6-MV photons with a physical wedge technique delivers 3% to 6% of the prescribed dose to the contralateral breast. RATIONALE: Dose to the contralateral breast with 6-MV photons without any compensation is 2%. C.45(5):1305-1314. International Journal of Radiation Oncology. B. Biology. D. CA. Which of the following statements about radiation dose to the contralateral breast is true? A.5% Non-diverging posterior border 3.3% Virtual/dynamic wedge (lat only) 2. Dose to the contralateral breast: a comparison of four primary techniques. et al. C.5% Asymmetric jaw + block + wedge 3.5% Asymmetric jaw 2. Correct answer is A. Physics. A comparison of different intensity modulation treatment techniques for tangential breast irradiation. 1996. International Journal of Radiation Oncology. Biology.5% Non-diverging posterior border + wedge 3.3% Multileaf collimation (med & lat) 2. Radiation Oncology In-Training Exam 2007 91 .9°.329. 1999. A lower radiation dose is delivered to the contralateral breast if a medial wedge is omitted and lateral tangential compensation is made with a physical wedge rather than with a virtual wedge. B.3% Asymmetric jaw + block 2.5 cm from the medial tangential border by treatment technique are: Cerrobend half beam block + wedge 8% Cerrobend half beam block 7% Asymmetric jaw + wedge 3.5% Virtual/dynamic wedge (med & lat) 2. et al.1% Reference: Change. Beams must be angled posteriorly to make the posterior edge match. 10° anterior 10° posterior 03° anterior 03° posterior Correct answer is D.34(3):727-732.
Single-fraction radiation therapy is equally effective for pain relief. D. Correct answer is A. Radiation therapy will achieve partial or complete pain relief within 4 weeks. B. accelerated failure time analysis when the distribution of failure times can be well-characterized by a failure distribution with a single parameter for scale. Hemibody irradiation can be recommended for treatment of pain secondary to widespread metastatic disease. linear regression when the responses are not normally distributed. RATIONALE: Partial relief may be observed within several days or 1 to 2 weeks of radiation therapy. THIS ITEM WAS NOT SCORED. Diseases of the Breast. Lippincott. because localized external-beam irradiation is not beneficial. pp. 333. 1309-1320. Recommended doses are 6 Gy per fraction to the upper hemibody and 8 Gy fractions to the middle and lower hemibody regions. T3N3 T3N2 T2N3 T2N1 THIS ITEM WAS NOT SCORED. since Samarium will have no effect on tumor activity at soft tissue sites. B. and acute toxicities are better with these dose selections. Which of the following statements about the treatment of bone metastases secondary to breast cancer is true? A. An 8-Gy dose of hemibody irradiation should be administered in a single fraction to the upper. D. multiple studies have shown that over time there are higher rates of retreatment. subsequent bone fracture. Kaplan-Meier analysis when there is more than one predictor and/or the predictor is a continuous variable. JR. Williams and Wilkins. or lower hemibody regions for treatment of painful bony metastases. Metastatic sites with extraosseous bone involvement should be treated with 153Sm only. 92 American College of Radiology . D. 332. B. Single-fraction irradiation provides equivalent results to protracted radiation treatment schedules for pain control durability and reduced risk of subsequent fracture. C. Which stage corresponds to a rectal cancer invading through the muscularis propria with metastasis to the perirectal lymph nodes? A. 2004. A Cox analysis is an alternative to: A. Samarium must be used in conjunction with local radiation when there is extraosseous tumor extension. and decreased recalcification seen in single fraction treatment arms. C. Wilcoxon test when the within-strata hazard functions are proportional. but commonly pain responses will be best assessed at the 4-week interval. Duration of response in 14 weeks. Reference: Harris. middle.331. however. 3rd edition. C.
2002. Correct answer is C. D. Individuals who are chronically immunosuppressed have the highest risk to develop multiple skin cancers. RATIONALE: A PET scan is considered a supplementation and not a replacement to CT scanning. B. D. internal or external iliac nodes. T size is established by the depth of the invasion. The significance of regional lymph node metastasis in staging urethral cancer lies in the number and size. Correct answer is B. The use of PET scans for diagnostic staging of small cell lung cancer is undergoing evaluation in clinical trials. RATIONALE: Regional lymph nodes important for staging of urethral cancers include the superficial or deep inguinals. Two left-sided 2-cm metastatic inguinal lymph nodes have a better prognosis than a single 2-cm lymph node in both inguinal regions. Actinic keratosis Chronic immunosuppression Chronic arsenic exposure Bowen's disease Correct answer is B. or periurethral muscle. CT scan of the chest and upper abdomen Brain imaging Bone scan PET scan Correct answer is D. bladder neck. not whether metastasis is unilateral or bilateral. C. Which of the following statements about female urethral carcinoma is true? A. 336. Stage T2 carcinoma of the urethra in men invades the: A. RATIONALE: All of the above factors are known to increase squamous cell carcinoma of the skin. B.334. Reference: AJCC Cancer Staging Handbook (6th edition). corpus cavernosum. B. B. D. Radiation Oncology In-Training Exam 2007 93 . D. 337. corpus spongiosum. subepithelial connective tissue. The T stage is affected by the size of the primary lesion. RATIONALE: Stage T2 carcinoma involves tumor invading any of the following sites: corpus spongiosum. brain imaging. and bone scans. The size of regional lymph node metastases affects the prognosis. common. and pelvic groups. 335. sacral. C. Which of the following diagnostic tests is NOT included in the staging of small cell lung cancer? A. some of which behave in a very aggressive fashion. and presacral. A T2 tumor is associated with anterior vaginal invasion. C. Which of the following conditions places a patient at the highest risk for the development of aggressive multi-focal squamous cell carcinoma of the skin? A. C. prostate.
Which of the following statements about clinical trials is true? A. Unpublished trials should be included in a meta-analysis.000 and 5. C. 05 Gy to 10 Gy 12 Gy to 18 Gy 24 Gy to 30 Gy 36 Gy to 40 Gy Correct answer is B. B. D. 340. the number of single-strand breaks to be approximately 1. B. A phase III trial compares two experimental treatments in a randomized fashion. D. all patients who do not receive the intended treatment should be excluded in the analysis.000. a radiation dose of 12 Gy to 18 Gy is typically recommended. Which of the following radiation dose ranges administered to the cranium would be most appropriate for providing CNS prophylaxis to patients with acute lymphoblastic leukemia? A. Intrathecal methotrexate is commonly used in adults. RATIONALE: Various authors have quoted the amount of damaged bases per gray to be between 1. Subgroup analysis is a reliable way to analyze a subgroup of patients with some particular characteristics. C. Increase it by 10% Increase it by 18% Decrease it by 10% Decrease it by 18% Correct answer is D. C. B. and the number of double-strand breaks to be approximately 40 to 50 per cell. RATIONALE: All unpublished trials also should be included in meta-analysis to minimize the effect of publication bias.338. Which of the following types of DNA damage would be predominant in cells after irradiation with 1 Gy of x-rays? A. In a phase III clinical trial. Single-strand breaks Double-strand breaks Thymine dimers Base damage Correct answer is D. Correct answer is A. RATIONALE: When CNS prophylaxis is provided in the management of acute lymphoblastic leukemia (ALL).000. 339. in this example). 94 American College of Radiology . D. B. RATIONALE: Inverse square law. C. with a minor adjustment as effective source distance for electrons is generally less than 100 cm from isocenter (90 cm. 341. Thymine dimers are typically induced by UV radiation. D. Increasing the source-to-skin distance for a 6-MeV electron field from 100 cm to 110 cm will have what effect on the dose to dmax? A.
342. AK. RATIONALE: Single doses of 6 Gy or 8 Gy have been used to treat the hemibody for palliation of skeletal metastases. B. Symmetrical jaws will give lowest doses to the contralateral breast even when used with a customized cerrobend block. B. compensating filter. largely due to increased scatter as well as an increase in the number of monitor units needed to deliver the correct dose to isocenter. use of beam modifiers (physical wedge. What percent of palpable inguinal nodes in patients with anal cancer are due to reactive hyperplasia? A. SSD technique. Cerrobend half beam block technique gives the highest contralateral breast dose. or contralateral breast in primary breast irradiation using intensity-modulated radiation therapy (IMRT)? American Journal of Clinical Oncology. A posterior nondiverging border (standard collimation) with a customized Cerrobend block compared with an asymmetric jaw to define the posterior tangential border Correct answer is B. RATIONALE: Fifty percent of palpable inguinal lymph nodes in patients with anal cancer are due to reactive hyperplasia. 343. Does breast dose affect the scatter dose to the ipsilateral lung. 10% 25% 50% 66% Correct answer is C. A Cerrobend half-beam block instead of an asymmetric jaw for definition of the posterior tangential border D. regardless of wedge application. SSD technique will increase scatter to the opposite breast relative to isocentric technique. especially for younger patients. Which of the following radiation therapy technique modifications will result in a lower radiation dose to the contralateral breast? A. virtual/dynamic wedges. heart. No medial wedge paired with a 30° lateral wedge compared with a 15° medial and lateral wedge technique C. how the posterior tangential border is defined. and the clinical volume/symmetry of the contralateral breast itself. Radiation Oncology In-Training Exam 2007 95 . Bhatnager describes an average of 11% superficial/skin dose to the opposite breast with IMRT techniques. Non-diverging posterior borders give a smaller dose compared with asymmetrical jaw and cerrobend block techniques. RATIONALE: Fundamental understanding of how radiation technique affects contralateral breast dose is necessary to reduce the potential late effects of treatment. D. References: Bhatnagar. The amount of scatter was proportional to the breast size. regardless of any other technique application. et al. The principal factors affecting dose to the contralateral breast are SAD vs. 2006. A medial wedge will always increase contralateral breast dose. D.29(1):80-84. 04 Gy 06 Gy 10 Gy 30 Gy Correct answer is B. What is the typical single fraction hemibody dose that is used to treat bone metastasis? A. A source-to-axis distance (SAD) instead of a source-to-surface distance (SSD) technique B. C. C. 344. intensity modulated filters).
(References continued for item 344.): Chang, SX, et al. A comparison of different intensity modulation treatment techniques for tangential breast irradiation. International Journal of Radiation Oncology, Biology, Physics. 1999;45(5):1305-1314. Kelly, CA, et al. Dose to the contralateral breast: a comparison of four primary techniques. International Journal of Radiation Oncology, Biology, Physics. 1996;34(3):727-732. Siddon, RL, et al. Three field technique for breast irradiation using tangential field corner blocks. International Journal of Radiation Oncology, Biology, Physics. 1983;9:583-588. 345. Which of the following types of ionizing radiation has similar biological properties to protons? A. B. C. D. Neutrinos Alpha particles Carbon ions X-rays
Correct answer is D. RATIONALE: Protons and 250-kVp x-rays have a similar relative biological effectiveness (RBE) and similar oxygen enhancement ratio (OER). 346. Which of the following statements about male urethral cancer is true? A. B. C. D. Involvement of the lymph nodes is frequently bilateral. Adenocarcinoma is the most common histological type. Distal tumors tend to be more advanced than proximal tumors. Thirty percent of clinically positive lymph nodes are pathologically positive.
Correct answer is A. RATIONALE: Lesions of the entire urethra or posterior urethra in women and in the bulbomembranous urethra in men usually are associated with invasion and a high incidence of pelvic lymph node metastases. 347. What is the stage of a squamous cell carcinoma of the female urethra that extends into the bladder neck with a 2.5-cm left inguinal lymph node metastasis? A. B. C. D. T2N2 T3N1 T3N2 T4N1
Correct answer is C. RATIONALE: Based on the AJCC Cancer Staging Handbook (6th edition, 2002), a stage T2 tumor invades the periurethral muscle. A stage T3 tumor invades the anterior vagina and/or the bladder neck. A stage T4 tumor invades other adjacent organs. Stage N1 involves metastases to a single lymph node 2 cm or less in greatest dimension. Stage N2 involves metastases to a single lymph node more than 2 cm in greatest dimension or in multiple lymph nodes.
American College of Radiology
Which of the following types of radiation is most responsible for the development of skin cancer? A. B. C. D. Cosmic rays Long-wave ultraviolet (UVA) rays Medium-wave ultraviolet (UVB) rays Short-wave ultraviolet (UVC) rays
Correct answer is C. RATIONALE: The knowledge of the risk factors for skin cancers. Medium-wave ultraviolet (UVB) rays are the principal carcinogen for the induction of skin cancers. Long-wave ultraviolet (UVA) rays are primarily responsible for the sun's aging effects, such as loss of skin elasticity. Short-wave ultraviolet (UVC) rays are a potent carcinogen, but play a negligible role in the pathogenesis of skin cancers, because they are filtered out by the atmospheric ozone layer. 349. Which of the following types of cancer is most commonly associated with myasthenia gravis? A. B. C. D. Small cell lung cancer Non-small cell lung cancer Mesothelioma Thymoma
Correct answer is D. Reference: Engels, EA, Pfeiffer, RM. International Journal of Cancer. 2003;105(4):546-551. 350. During evaluation of tumor biopsy specimens, which of the following markers can be used as a histochemical indicator of cell proliferation? A. B. C. D. Ki-67 TP53 c-myc Nuclear/cytoplasmic ratio
Correct answer is A. RATIONALE: Ki-67 is a marker of cells in the S cell cycle phase and is a commonly used clinical indicator of cellular proliferation status. 351. If a typical lung region has an attenuation of 25% relative to water, then a CT scan of this region should have what average Voxel value (in Hounsfield units)? A. B. C. D. 0+25 HU 0–25 HU -250 HU –750 HU
Correct answer is D. RATIONALE: HU = (attenuation of tissue – attenuation of water)/(attenuation of water)*constant. The typical constant is ~1000. Thus, lung has HU = (.25-1)*1000 = –750.
Radiation Oncology In-Training Exam 2007
Which of the following types of leukemia has the highest incidence rate? A. B. C. D. Acute lymphocytic Acute myelogenous Chronic myelogenous Chronic lymphocytic
Correct answer is D. RATIONALE: Chronic lymphocytic leukemia (CLL) is approximately twice as common in men as in women and is more common than other leukemias. 353. What is the correct order of threshold doses, from lowest to highest, for the induction of each of the three forms of the acute radiation syndrome (ARS)? A. B. C. D. Cerebrovascular, Hematopoietic, Gastrointestinal Gastrointestinal, Hematopoietic, Cerebrovascular Hematopoietic, Gastrointestinal, Cerebrovascular Hematopoietic, Cerebrovascular, Gastrointestinal
Correct answer is C. RATIONALE: The acute radiation syndrome is derived from studies on animals (mice, rats) and humans that show a progression of organ failure based on total dose administered. The underlying controlling factors are primarily the rate of stem cell turnover in the first two syndromes with a more complex process at the highest dose levels leading to the cerbrovascular mediated events. 354. Compared to a stable version of an element, an isotope of an element has: A. B. C. D. the same atomic weight, but a different number of protons. the same number of neutrons. a different number of electrons. a different atomic weight.
Correct answer is D. RATIONALE: This is the definition of an isotope, with a different number of neutrons, and hence, a different atomic weight. 355. Which of the following statements about the effectiveness of 131I for treating thyroid cancer is true? A. Medullary carcinoma is treated more effectively than Hürthle cell carcinoma. B. The follicular variant of papillary carcinoma is treated more effectively than Hürthle cell carcinoma. C. Tall cell carcinoma is treated more effectively than the follicular variant of papillary carcinoma. D. Insular carcinoma is treated more effectively than the follicular variant of papillary carcinoma. Correct answer is B. RATIONALE: The follicular variant of papillary carcinoma concentrates radioiodine as well as any other well-differentiated variant. The other variants listed above are unfavorable because they concentrate radioiodine poorly or not at all. Many experts do not recommend the use of radioiodine therapy for Hürthle, tall, insular, or medullary carcinoma.
American College of Radiology
Breast MRI – Diagnosis and Intervention. B. A biopsy is not required if MRI does not confirm a suspicious finding of microcalcification on mammography. and therefore. Reference: E. RATIONALE: MRI has been shown to be more sensitive than mammography in detection of additional sites of invasive and non-invasive breast cancer. T here is much overlap between mammographic appearance and nuclear grade of tumor. 357. Morrison and L. B. Which of the following processes is NOT commonly involved in the development of bone metastases? A. A segmental enhancement pattern on MRI is most commonly associated with a diagnosis of DCIS. Avascular necrosis Activation of osteoclasts Cell adhesion molecules Chemotaxis of metastatic cancer cells Correct answer is A. D. The most common mammographic appearances of calcification caused by DCIS are linear/branching. THIS ITEM WAS NOT SCORED. eds.A. Segmental. coarse granular or fine granular calcifications. are a more aggressive tumor. C. The linear findings represent casts of calcifications in necrotic tumor along the ducts. D. Radiation Oncology In-Training Exam 2007 99 . Which of the following equations is used to determine specificity? A. D. True positive / (True positive + false negative) True positive / (True positive + false positive) True negative / (True negative + false negative) True negative / (True negative + false positive) Correct answer is D. Mammographic patterns of DCIS do not indicate the probable aggressiveness of the tumor. or diffuse enhancements are seen less often. Liberman. C. mammography patterns can indicate the probable aggressiveness of the tumor. RATIONALE: Avascular necrosis is not typically involved in bone metastases. Mammographically evident suspicious microcalcifications without corresponding MRI enhancement should still be biopsied through traditional methods. 358. However. regional. C. B. 2005. Springer Press. specificity is true negative / true negative + false positive. mass. Which of the following statements about imaging findings associated with noninvasive breast cancer is true? A. Mammography cannot predict pathology. Casting calcifications are more commonly associated with necrosis.356. A mammographic mass indicates a higher likelihood of a well-differentiated cancer or a lower grade lesion. RATIONALE: By definition. MRI does not image calcification. MRI is better than mammography in detecting the extent of DCIS. MRI will demonstrate DCIS most commonly as a linear/ductal pattern of enhancement.
Microinvasion of DCIS is most likely to be found in patients with: A.350:1430-1441. 360.5 cm in diameter. 100 American College of Radiology . B. What is the most common site of metastasis for patients with soft tissue sarcoma? A. a clinically palpable mass >2. Ductal carcinoma in situ of the breast. HJ. Reference: Burstein. D. RATIONALE: Most metastases occur in the lung. Regional lymph node involvement occurs in <15% of cases. 2004. Correct answer is D. C. New England Journal of Medicine (NEJM). C. D. RATIONALE: Microinvasion is most likely to be found in patients with DCIS lesions that are greater than 2.359.5 cm. and those with high-grade ductal carcinoma or comedo-necrosis. et al. Regional lymph nodes Bone Lung Liver Correct answer is C. micropapillary histology. DCIS and LCIS mixed histology. those presenting with palpable masses or (bloody) nipple discharge. B. a unilateral clear nipple discharge.
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