MISC Board Review Notes
General
1. Bremstrahlung can be called photon contamination, Dx, inelastic collision
with atomic nuclei
2. Teff = (Tb * Tp) / (Tb + Tp) → Note Teff will be < Tb and Tp
3. 1 TVL = 3.32 HVL → then 1 HVL = 0.3 TVL
4. CS electron angle → 0 to 90 → as angle increases, E goes down to electron
5. CS photon angle → 0 to 180 → as angle increases, E goes down to photon
6. Photon in at 6 MeV → PP → energy to e-/e+ pair is 4.978 (subtract 1.022)
7. Fluence = number / cm2
8. Fluence rate = number / cm2-sec
9. Energy fluence = MeV / cm2
10. Energy fluence rate = MeV / cm2-sec
11. Build up region of a PDD, there is NO CPE.
Imaging
1. AEC can modify mAs and kV
2. Optical Density = log10 (Io/I)
3. PACs systems →> transfer data, store data, view data
4. DICOM requires → 1) IP address 2) port number 3) AE title
5. AE = application entity
6. If pixel size is reduced → better spatial resolution
7. Smaller focal spot → better resolution
8. Large focal spot → if you need high technique (high mAs)
9. T1 relaxation times > T2 relaxation times in MRI
10. Fusion of images → easier to register if same modality; example CT to CT,
MRI to MRI
11. OBI fluoro used to monitor internal motion
12.
Linac and QA
1. Some 6MV linacs do not have Bending Magnets → guide is short
2. No neutron at 6MV
3. Neutron threshold at 10MV….not many made
4. As X energy goes up, number of neutrons goes up and energy increases
slightly (2MeV to 2.2MeV)
5. Neutrons produced by photo-disintegration process
6. Steering coils keep beam steered and aligned → to maintain symmetry
7. MLC rounded leaf edges help keep constant penumbra with change in field
size
8. TG51 reading is corrected for: temp, ion collection, polarity, electrometer
9. Penumbra → use 80/20 (vendors may use 90/10 or 90/20)
10. TG-142 list tolerance per modality (3D, IMRT, SRS, SBRT, etc)
11. TG-142 coincidence test for imaging and treatment should be checked
daily.
12. TG-142 SRS accuracy should be less than 1mm.
13. TG-142 SRS isocenter → 1.0 mm
14. TG-142 SRS isocenter → 1.5 mm
Algorithms and Planning and Treatment
1. MC is more accurate that superposition and convolution.
2. MC is especially good for 1) small field sizes 2) inhomogeneous areas
3. Electron therapeutic range use E/4
4. Electron d90 use E/3.2
5. Best energy to treat lesion that is depth 1.5-2.5 is 9E…..throughout that
depth dose > 90%
6. Electron cutout factor (output) → minor deviation from cone factor is the
equivalent field size is > practical range (E/2)
7. Random errors are random, not dependent patient to patient, Example:
SSD set wrong on 1 patient
8. Systematic errors are errors that would cause errors to every patient:
Examples: linac miscalibrated, linac QA tolerance off, tps not modeled
correctly.
9. SRS dose fall off depends on: Energy, Collimation, Prescribed Isodose Line
10. End to End testing should be done for SRS at least Annually
11. SRS, single isocenter, multiple mets → be careful with distance from CAX →
greater distance is more sensitive
Radiation Safety
1. Wipe tests in areas should be performed → weekly, if suspect
contamination, after a spill
2. For HDR, Gamma Knife → physicians must be listed on NRC license as
authorized users
Protons
1. Patient motion will create largest errors with protons (range issues)
2. IMPT = intensity modulated proton therapy
3. IMPT → typically yields least integral dose and spares critical structures
better than 3D, IMRT, VMAT
4. Proton range depends on 1) density and 2) atomic number
5. Dual Energy CT → provides better information for the algorithms to predict
the proton range
6. Pencil beam scanning protons have a lower entrance dose than double
scattering protons → anything in beam path will create higher surface dose
and also introduce more neutrons
7. Penumbra of Protons: depth, energy, air gap
Brachy
1. Ra-223 decays by alpha
2. Ra-223 dose based on weight of patient
3. Y-90 used to treat liver (hepatocellular carcinoma)
4. Y-90 decays by B-
5. *** HDR source activity accuracy *** 3% (use to be 10%, then 5%, use 3%)
6. Larger the vaginal cylinder, the less the surface dose on applicator (less
mucosal dose)
