| Question 1: The Reference Point Air Kerma (Ka,r): |
| Reference: | NCRP. NCRP Report No. 168, Radiation dose management for fluoroscopically-guided interventional medical procedures; 2010 |
| Choice A: | Represents the patient’s peak skin dose |
| Choice B: | Is irrespective of primary or secondary gantry rotations |
| Choice C: | Is a good surrogate for the patient effective dose |
| Choice D: | Accuracy required to be within 15% |
| Question 2: The Anode Heel Effect: |
| Reference: | Fluoroscopic X-ray Beam Profiles for Spectra Incorporating Copper Filtration. Wunderle K, Godely A, Shen Z, Rakowski J, Dong F. – AAPM, Washington D.C., Aug 2016 |
| Choice A: | Doesn’t affect skin dose |
| Choice B: | Increases the dose on the cathode side of the X-ray field |
| Choice C: | Reduces the effective dose by increasing the beam quality |
| Choice D: | Only occurs at the skin entrance and is not observed at depth |
| Question 3: The relative biological effectiveness (RBE) for DSB induction and reproductive cell survival of filtered diagnostic kV x-rays relative to unfiltered MV x-rays is about |
| Reference: | Stewart RD, Streitmatter SW, Argento DC, Kirkby C, Goorley JT, Moffitt G, Jevremovic T, Sandison GA. Rapid MCNP simulation of DNA double strand break (DSB) relative biological effectiveness (RBE) for photons, neutrons, and light ions. Phys Med Biol. 2015 Nov 7;60(21):8249-74. doi: 10.1088/0031-9155/60/21/8249. Epub 2015 Oct 9.
Streitmatter SW, Stewart RD, Jenkins PA, Jevremovic T. DNA double strand break (DSB) induction and cell survival in iodine-enhanced computed tomography (CT). Phys Med Biol. 2017 Jul 13;62(15):6164-6184. doi: 10.1088/1361-6560/aa772d. |
| Choice A: | 0.9 to 1.0 |
| Choice B: | 1.1 to 1.3 |
| Choice C: | 1.4 to 1.8 |
| Choice D: | 2.0 to 3.0 |
| Question 4: Which of the following are the least relevant factor or factors to consider when evaluating the potential for early skin reactions after an FGI procedure? |
| Reference: | Dörr W. Radiobiology of tissue reactions. Ann ICRP. 2015 Jun;44(1 Suppl):58-68. doi: 10.1177/0146645314560686. Epub 2015 Mar 5. Int J Radiat Biol. 1990 Apr;57(4):751-73.
Hopewell JW. The skin: its structure and response to ionizing radiation. Int J Radiat Biol. 1990 Apr;57(4):751-73. |
| Choice A: | Hypoxia |
| Choice B: | Intrinsic radiation sensitivity of the basal cell layer |
| Choice C: | Volume of irradiated skin |
| Choice D: | DNA damage repair |
| Choice E: | a and b |
| Question 5: For early skin reactions, the most significant factor to consider when evaluating the time interval for safe re-irradiation of the skin after a previous FGI procedures is |
| Reference: | Turesson I, Thames HD. Repair capacity and kinetics of human skin during fractionated radiotherapy: erythema, desquamation, and telangiectasia after 3 and 5 year's follow-up. Radiother Oncol. 1989 Jun;15(2):169-88 (and references therein). |
| Choice A: | Extent and kinetics of DNA damage repair |
| Choice B: | Dose rate or time interval required to complete the FGI procedure |
| Choice C: | kV x-ray voltage and amount of filtration |
| Choice D: | Kinetics of cell migration and repopulation in the basal layer of the skin |
| Question 6: All of the following complicate dose estimates for patients who have undergone both fluoroscopically-guided interventions and external beam radiation therapy EXCEPT: |
| Reference: | The Physics of Radiology. 4th ed. Johns HE, Cunningham JR. CC Thomas. Springfield, Il. 1983 |
| Choice A: | The differences in calibration processes generally means the fluoro doses are more accurate |
| Choice B: | The organ(s) at risk (OARs) are generally different |
| Choice C: | The term “the patient dose†has very different meanings |
| Choice D: | The depth of maximum dose differs drastically for MV and kV x-rays depending on voltage and filtration |
