(1)
University of Miami Sylvester Cancer Center, Miami, Florida, USA
Like radiotherapy, radiation safety is also based on radiobiology but focuses more on the practical application of radiobiology in any environment with radioactive material. Any medical center or institution that uses radioactive material will have a radiation safety program led by a radiation safety officer (RSO).
CMD or ABR candidates need to remember a lot of detailed information about radiation safety but learning this information can help to keep you safe. Much of radiation safety is common sense, but the more you know about the rules and regulations, the less you are at risk of having an accident happen.
7.1 Maximum Permissible Dose Equivalent (Questions)
Quiz 1 (Level 2)
1.
The biological effects of radiation depend on:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Organ
II.
Dose received
III.
Tissue
IV.
Type of radiation received
2.
Which of the following is the dose equivalent formula?
A.
H = D × Q
B.
H1/H2 = d 2 2/d 1 2
C.
X = Γ × A × t/d 2
D.
H = D/Q
3.
What is the SI unit for both dose and dose equivalent?
A.
Becquerel (Bq)
B.
Joules per kilogram
C.
Rem
D.
Gray
4.
What does the quality factor used to calculate dose equivalent depend on?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Organ
II.
Tissue
III.
Biologic endpoint under consideration
IV.
Type of radiation
5.
Match the following radiation type with its quality factor:
A.
X-ray, γ-rays, and electrons
B.
Thermal neutrons
C.
Neutrons and heavy particles (α)
I.
Q = 5
II.
Q = 20
III.
Q = 1
6.
The effective dose equivalent is defined as:
A.
The energy absorbed from an ionizing radiation beam per unit mass of absorber
B.
The sum of the weighted dose equivalents for irradiated tissues or organs
C.
The dose modified by quality or weighting factor
D.
A graph of dose distribution produced by passing a dosimeter across the beam
7.
Which of the following organization is a US group of radiation experts who make recommendations in the area of ionization radiation and develop standards for the use of radiation in this country?
A.
International Commission on Radiological Protection (ICRP)
B.
US Nuclear Regulatory Commission (USNRC)
C.
National Council on Radiation Protection and Measurements (NCRP)
D.
Individual states
8.
What is an “agreement state”?
A.
A state that has entered into an agreement with the USNRC in which they assume responsibility for enforcing the regulations specific to the by-product material as well as accelerator-produced nuclides
B.
An independent group of experts from a wide range of disciplines who have a vested interest in the safe use of all types of radiation sources
C.
The federal agency charged with the regulation of radioactive materials produced in nuclear reactors
D.
A state that has entered into an agreement not to use radioactive material in excess so that radiation incidents are kept below average
9.
Which of the following statements is not true?
A.
The weighting factor represents the different risk of each tissue to mortality from cancer and hereditary effects in the first two generations.
B.
The effective dose equivalent is the sum of the weighted dose equivalents for all irradiated tissues.
C.
Different types of radiation (photons, neutrons, protons) have different biological effectiveness for equal absorbed doses.
D.
Different types of radiation (photons, neutrons, protons) have equal biological effectiveness for equal absorbed doses.
10.
What is the dose equivalent to a person who receives an average whole body dose of 150 mrem from thermal neutrons?
A.
30 mrem
B.
750 mrem
C.
145 mrem
D.
155 mrem
11.
As per NCRP recommendations, what is the maximum accumulated dose a 50-year-old occupational worker can have?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
500 mSv
II.
10 mSv
III.
50 rem
IV.
1 mSv
12.
A deterministic effect is defined as an effect in which:
A.
The probability of occurrence of an effect is higher for higher doses, but the severity of the effect is independent of dose.
B.
The severity of a particular effect in an exposed individual increases with dose above the threshold for the occurrence of the effect.
C.
The specific dose equivalent an individual is permitted to receive annually from working with radiation on the job.
D.
The probability of occurrence of the effect is the same for any dose received.
13.
Determine if the following are deterministic or stochastic effects (answers can be used more than once):
A.
Deterministic effect
B.
Stochastic effects
I.
Nausea
II.
Reddening of the skin
III.
Hereditary effects
IV.
Leukemia
V.
Congenital malformations of the embryo
14.
Which of the following are considered background radiation?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Terrestrial radiation
II.
Cosmic radiation
III.
Radioactive elements in our bodies
IV.
Medical procedures
15.
Which of the following statements is not true?
A.
Terrestrial radiation varies over the earth.
B.
Cosmic radiation levels change with elevation.
C.
The internal irradiation arises mainly from 40K in our body.
D.
Background radiation is contributed by terrestrial, cosmic, medical, and radioactive elements in our body.
16.
Which of the following is the most common hazardous naturally occurring radioactive material?
A.
Lead
B.
Uranium
C.
Radon
D.
Thorium
17.
Which of the following statements are true?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Large doses of radiation produce identifiable effects within a relatively short period.
II.
Large doses of radiation produce identifiable effects within a relatively long period.
III.
Low doses of radiation effects are difficult to ascertain due to low frequency with which these effects might occur.
IV.
Low doses of radiation are easy to measure.
18.
Exposures to low-level radiation may produce:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Genetic effects
II.
Neoplastic diseases
III.
Effects on growth and development
IV.
Effects on life span and cataracts
19.
The harmful effects of radiation may be classified into:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Stochastic effects
II.
Occupational factor
III.
Nonstochastic effects
IV.
Use factor
20.
A stochastic effect is defined as:
A.
The probability of occurrence increases with increasing absorbed dose, but the severity in affected individuals does not depend on the magnitude of the absorbed dose.
B.
The probability increases in severity with increasing absorbed dose in affected individuals.
C.
The probability of occurrence decreases with increasing absorbed dose, but the severity in affected individuals does not depend on the magnitude of the absorbed dose.
D.
The probability of occurrence increases with decreases in absorbed dose as well as severity in affected individuals.
21.
Examples of nonstochastic effects are:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Organ atrophy
II.
Fibrosis
III.
Cataracts
IV.
Blood changes
22.
NCRP recommendations on exposure limits of radiation workers are based on:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
At low radiation levels the nonstochastic effects are essentially avoided.
II.
The predicted risk for stochastic effects should not be greater than the average risk of accidental death among workers in industries.
III.
The ALARA principle should be followed.
IV.
At any radiation level, all effects must be avoided.
23.
Occupational and public dose limits include:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Exposure received from medical procedures
II.
Exposure received by a worker pursuing his/her occupation
III.
Natural background radiation
IV.
Exposure received by a member of the public
24.
The ALARA principle states:
A.
Keep radiation exposure as low as reasonably achievable, considering the economic and social factors.
B.
Maximum permissible levels should be kept low.
C.
A level of average annual excess risk of fatal health effects can be attributed to irradiation.
D.
Keep radiation exposure as low as reasonably achievable outside the work area.
25.
Exposure incurred by patients as part of their own medical or dental diagnosis or treatment is the definition of?
A.
Occupational exposure
B.
Medical exposure
C.
Public exposure
D.
Volunteers’ exposure
26.
Which of the following are the main physical quantities used in safety standards?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Activity
II.
Equivalent dose
III.
Absorbed dose
IV.
Effective dose
27.
What is the definition of organ dose?
A.
The sum of the weighted dose equivalents for all irradiated tissues
B.
The mean dose in a specified tissue or organ of the human body
C.
Total dose received throughout the period of time during which the radionuclide remains in the body
D.
The summation of the product of the mean dose in the various groups of exposed people and the number of individuals in each group
28.
How often should a personnel radiation monitoring device be changed?
A.
Biweekly
B.
Monthly
C.
Biannually
D.
Yearly
29.
What is the yearly occupational maximum permissible dose (MPD) for the whole body?
A.
50 mSv or 5 rem/year
B.
1 mSv or 0.1 rem/year
C.
5 mSv or 0.5 rem/year
D.
500 mSv or 50 rem/year
30.
The lifetime or cumulative occupational limit exposure is:
A.
10 mSv or 0.1 rem × age (years)
B.
5 mSv or 0.5 rem × age (years)
C.
10 mSv or 1 rem × age (years)
D.
1 mSv or 0.1 rem × age (years)
31.
What is the annual occupational maximum permissible dose (MPD) for the lens of the eye?
A.
50 mSv or 5 rem
B.
15 mSv or 150 rem
C.
5 mSv or 0.5 rem
D.
150 mSv or 15 rem
32.
What is the monthly maximum permissible dose (MPD) for a pregnant woman worker?
A.
0.01 mSv or 0.001 rem
B.
0.5 mSv or 0.05 rem
C.
5 mSv or 0.5 rem
D.
1 mSv or 15 rem
33.
The occupational effective dose limit in any year based on the NCRP recommendations should not exceed:
A.
50 mSv (5 rem)
B.
5 mSv (0.5 rem)
C.
1 mSv (0.1 rem)
D.
10 mSv × age
34.
The nonoccupational (public) effective dose to the extremities, skin, and lens in any year based on the NCRP recommendations should not exceed:
A.
500 mSv (50 rem)
B.
150 mSv (15 rem)
C.
50 mSv (5 rem)
D.
15 mSv (1.5 rem) education and training exposure lens
35.
Which of the following statements are true?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Dose limits are subject to the concept of ALARA.
II.
Since radiation is potentially harmful, exposure to it should be monitored continually and controlled.
III.
Exposure of personnel and the public should be kept to a minimum.
IV.
The reduction in exposure to personnel is considered reasonable based on the expense used to reduce the exposure.
36.
Once a pregnancy is declared, the NCRP recommends a monthly limit to the embryo or fetus of:
A.
1 mSv (0.1 rem)
B.
0.5 mSv (0.05 rem)
C.
15 mSv (1.5 rem)
D.
0.1 mSv (0.01 rem)
7.2 Time, Distance, and Shielding (Questions)
Quiz 1 (Level 2)
1.
Which of the following statements are true?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Maximizing the distance will reduce the dose to a greater degree than minimizing time for equal changes.
II.
Radiation dose is proportional to time.
III.
Dose is inversely related to the distance squared.
IV.
Time, distance, and shielding are not considered in radiation protection.
2.
Which of the following laws is used to calculate dose versus distance?
A.
Equivalent square field
B.
Direct square law
C.
Inverse square law
D.
Half-value layer
3.
ALARA stands for:
A.
As low as radiation association
B.
At lower absolute radiation achievable
C.
As low as reasonably achievable
D.
As longer as radiation acquired
4.
Which of the following is the best method to use for radiation protection?
A.
Using the appropriate radiation monitor
B.
Using the personnel monitoring device at all times on the collar
C.
Using a lead apron around radioactive patients
D.
Maximizing distance from the source
5.
Radiation exposure to employees can be reduced by:
A.
I, II, III, and IV.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Reducing the time around radioactive patients or procedures
II.
Increasing distance from the source of radiation
III.
Using appropriate shielding
IV.
Using personnel monitoring devices (film badge)
6.
Why is a long forceps used in handling LDR sources?
A.
To increase time of exposure
B.
To extend the distance from the source
C.
To keep the source aseptic
D.
To keep the hands clean
7.
What actions are taken to reduce the exposure to the environment while shipping a radioactive source?
A.
Use a shielded container.
B.
Try to reduce the exposure time to the public while shipping.
C.
Put exposure rate warning on package surface to reduce the distance to the public.
D.
All of the above.
8.
What is level 1 of ALARA?
A.
10 % of the exposure limit
B.
30 % of the exposure limit
C.
50 % of the exposure limit
D.
70 % of the exposure limit
9.
What actions are normally taken to reach level 1 ALARA?
A.
Reduce time
B.
Increase shielding
C.
Extend distance
D.
All of the above
10.
Which of the following items should a radiographer use for protection against scattered radiation?
A.
Gloves
B.
Lead apron
C.
Thyroid shield
D.
All of the above
7.3 Brachytherapy Source Handling and Storage (Questions)
Quiz 1 (Level 2)
1.
Which of the following are considered safety systems on an HDR unit?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Interlocks prevent initiation of treatment if the door is open.
II.
Backup batteries are provided to take over operation in case of power failure.
III.
A manual source retraction mechanism is available to withdraw the source into the storage safe if it gets stuck.
IV.
The treatment is aborted if the system detects blockage or excessive friction during source transit.
2.
The shielding and safety requirements for the HDR room are mandated by:
A.
International Commission on Radiation Protection (ICRP)
B.
Nuclear Regulatory Commission (NRC)
C.
National Council on Radiation Protection and Measurements (NCRP)
D.
Committee on Biologic Effects of Ionizing Radiation (BEIR)
3.
Which of the following safety features must be present on an HDR room to comply with NRC mandate?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Electrical interlock system
II.
Inaccessibility of console keys to unauthorized persons
III.
A permanent radiation monitor and continuous viewing and intercom systems
IV.
Restricted area controls
4.
Restricted area controls include:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Signs and door warning lights indicating “Radiation ON”
II.
Locks
III.
Visible/audible alarms
IV.
Radiation safety officer present to avoid unauthorized personnel to be around the HDR unit
5.
In order to be licensed for HDR according to NCR, the applicant requirements are:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Source description
II.
Manufacturer’s name and model of the HDR unit
III.
Intended use and authorized users
IV.
Quality assurance program
6.
A high-dose rate (HDR) quality management program must include:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
A written directive
II.
Patient identification
III.
Treatment plan verification
IV.
Documentation
7.
The identity of the patient must be verified by:
A.
Asking the patient his/her name
B.
Checking the patient’s identification bracelet or hospital identification card
C.
Two independent methods
D.
Asking your coworker
8.
HDR pretreatment safety checks must be performed:
A.
Once a week
B.
On any day that the HDR procedure is scheduled
C.
Once a month
D.
Before each patient’s treatment
9.
Prior to the initiation of HDR treatment, the authorized operator must verify:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Name of the patient under treatment
II.
Dose to be delivered to a patient
III.
Site of administration
IV.
Times for each dwell location
10.
Which of the following statement(s) is not true about the quality management program for HDR?
A.
Immediately after each treatment, a survey of the afterloading device and the patient must be performed.
B.
Calibration of the source must be performed by an authorized physicist before the first patient treatment.
C.
Records for each treatment along with a completed checklist will be maintained in an auditable form for a minimum of 3 years.
D.
During all patient treatments, both the authorized physician user and the authorized medical physicist must be in any satellite clinic to be called if needed.
11.
Brachytherapy cases will be reviewed by an authorized physician and/or physicist at intervals:
A.
No greater than 24 months
B.
No greater than 12 months
C.
Of 3 years
D.
No greater than 2 weeks
12.
If a recordable event or misadministration is uncovered during the periodic review:
A.
The HDR unit will be locked in the off position and not used until further notice.
B.
All personnel involved in the treatment are liable.
C.
The number of cases to be reviewed will be expanded to include all cases for that calendar year.
D.
One recordable event or misadministration is not of great concern.
13.
Which of the following statements is true about the quality management program review for an HDR machine?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
The quality management program will be reviewed on an annual basis.
II.
A written summary of the review must be submitted to the RSO and the radiation safety committee.
III.
Any modification made to the program must be reported to the NRC regional office or state if governed by an agreement state within 30 days after modification has been made.
IV.
The quality management program will be reviewed every 2 years if the committee had more than 10 HDR units to review.
14.
Immediately after each use of the HDR device, the physicist will ensure the source has been returned to the full-shielded position by:
A.
Survey of the device only
B.
Survey of the connectors only
C.
Survey of the afterloader and the patient
D.
Survey of the HDR room door
15.
Full calibration measurements of a teletherapy unit must be done:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Before the first medical use of the unit
II.
If the spot check measurements indicate that the output differs more than 5 % from the output obtained at the last full calibration
III.
Following replacement of source or relocation of the unit
IV.
Following repair of the unit
16.
Periodic spot checks for teletherapy units must be done:
A.
Once a year
B.
Once in each calendar month
C.
Every 2 years
D.
Every 5 years
17.
Radiation surveys for teletherapy units must be done:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Before medical use
II.
After each installation of a teletherapy source
III.
After making any change for which an amendment is required
IV.
When the room is built, before placement of the teletherapy machine
18.
What is the leakage limit from the source head with the beam in the off position?
A.
2 mrem/h on average and 10 mrem/h maximum at a distance of 1 m from the source
B.
4 mrem/h on average and 20 mrem/h maximum at a distance of 1 m from the source
C.
2 mrem/h on average and 10 mrem/h maximum at a distance of 5 m from the source
D.
4 mrem/h on average and 10 mrem/h maximum at a distance of 1 m from the source
19.
How often must a teletherapy unit be fully inspected?
A.
During teletherapy source replacement or at intervals not to exceed 3 years, whichever comes first
B.
During teletherapy source replacement or at intervals not to exceed 5 years, whichever comes first
C.
At intervals not to exceed 5 years only
D.
During teletherapy source replacement or whenever major upgrades are complete
20.
Which of the following must be included as the appropriate emergency equipment on an HDR unit?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Two pairs of long-handled forceps and a pair of long-handled scissors
II.
A shielded container
III.
Stopwatch or timer
IV.
Portable survey meter
21.
HDR simulation films must include:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Patient name and date
II.
Catheter identification and length
III.
Magnification factor and marker seeds consecutively from the distal end of each catheter
IV.
Anatomical structures where dose contribution is to be calculated
22.
Some methods used to calculate dose distribution around a linear 192Ir source are:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
TG-43 formalism
II.
Monte Carlo
III.
Sievert integral
IV.
Triple A (AAA)
23.
Which of the following are reports published by AAPM for HDR quality assurance irradiation therapy?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
TG-59
II.
TG-56
III.
TG-40
IV.
TG-43
24.
When choosing lead-lined safes with lead-filled drawers for storing brachytherapy sources, the physicist in charge must consider:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Adequacy of shielding
II.
Distribution of sources
III.
Time required for personnel to remove sources from, and return sources to, the safe
IV.
Person who handles the sources
25.
The storage area for radium, encapsulated powdered sources, or sources containing microspheres:
A.
Should be ventilated by the main air conditioning of the hospital or building
B.
Should be ventilated by a direct filtered exhaust to the outdoors
C.
Should be ventilated by a direct filtered exhaust to the hall
D.
Should be hermetically closed to the outdoors
26.
Which of the following appliances is usually provided in the storage room?
A.
A refrigerator to freeze the radionuclides
B.
A washing machine to wash the cloths used by the physicist who remove the radionuclides
C.
A sink to clean source applicators
D.
A purifier to sterilize the return sources
27.
Which of the following should be included in the storage room for source preparation?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
A source preparation bench close to the safe
II.
A protective L-block barrier constructed of lead
III.
A lead glass viewing window
IV.
Suitably short forceps
28.
Which of the following actions must be taken by the operator working with a brachytherapy source?
A.
Minimize the time in the vicinity of the sources, as well as minimize the distance from the sources.
B.
Maximize the time in the vicinity of the sources and minimize the distance from the sources.
C.
Minimize the time in the vicinity of the sources and maximize the distance from the sources.
D.
Time and distance are not effective since there are various kinds of protective shielding available in the vicinity of the source.
29.
A source is considered to be leaking if a presence of:
A.
0.5 μCi or more of removable contamination is measured.
B.
0.05 μCi or more of removable contamination is measured.
C.
0.005 μCi or more of removable contamination is measured.
D.
0.0005 μCi or more of removable contamination is measured.
30.
As per NRC rules, how often must the source be leak tested?
A.
Once a year
B.
Every 6 months
C.
Every month
D.
Quarterly
31.
According to applicable state or federal regulations, how often should the brachytherapy storage area be surveyed?
A.
Every week
B.
Every 6–12 months
C.
Every month
D.
Every day
32.
The Nuclear Regulatory Commission (NRC) requires that:
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Immediately after implanting and removing sealed sources from a patient, the patient and the area must be surveyed.
II.
Safety instructions must be provided to all personnel caring for the implanted patient.
III.
An inventory describing the number of sources removed and number of sources returned to the safe must be performed.
IV.
The patient can share a room with another patient as long as both use the same radioactive source.
33.
Which of the following is a “violation” of NRC regulations for housing a patient with radioactive sources?
A.
Signs posted indicating the presence of radioactive materials in the room.
B.
Permitted visiting times posted in the room.
C.
Visitors must stand at least 6 ft from the patient.
D.
Items leaving the room do not need to be surveyed.
34.
Which of the following devices should be used when handling radioactive sources?
A.
Any kind of gloves.
B.
It can be touched with the hands if 2 mrem/h or less is detected.
C.
Long forceps.
D.
Lead apron and special gowns.
35.
Which of the following statements are true about safety features for the storage and preparation of radioactive sealed sources for manual brachytherapy?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
E.
All are correct.
I.
Rooms should be used only for source storage.
II.
Rooms should be provided with a locked door.
III.
A radiation sign should be posted on the door.
IV.
There should be shielded storage (safe) available for all sources.
36.
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Which of following are correct about brachytherapy patient treatment rooms?
A.
I, II, and III.
B.
I and III only.
C.
II and IV only.
D.
IV only.
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