Syllabus RadiationBiology 2007

5th
Edition
2007 Syllabus:
Radiation Biology for Diagnostic
and Interventional Radiologists
Wayne R. Hedrick, PhD, Editor
Canton, Ohio
Mahadevappa Mahesh, PhD, Contributor
Baltimore, Maryland

Contents
Instructions
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Radiation Biology Syllabus for Diagnostic and Interventional Radiologists 2007

Preface
F or the fifth edition of the syllabus, the
general format of the fourth edition has
been retained, with various topics updated.
The principal change in format is the addition
of references to support the correct answers.
Informational content has been expanded to
include magnetic resonance (MR) imaging
and ultrasound. Current recommendations
by the American College of Radiology with
respect to safe MR practices are included.
Questions are classified in the following
sections: Radiation Biology/Effects, Radia-
tion Safety/Protection, Magnetic Resonance
Imaging, and Ultrasound. The conversion to
a Web-based instructional publication will
facilitate future and more frequent revisions.
The Radiological Society of North America is a nonprofit organization.

©2007 by the Radiological Society of North America, Inc
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2007 Radiation Biology Syllabus for Diagnostic and Interventional Radiologists

Questions
Instructions for Sample Questions
Each question is one of the following types, as indicated immediately preceding the question:
A Only one answer is correct B Match answers X True/False–any number of answers may be True
I. Radiation Biology/Effects X
5. Which of the following statements concerning
chromosomal aberrations in stimulated
A
peripheral lymphocytes are true?
1. The majority of the energy received by
biologic material from x rays is transferred by A. They can be used to assess whole-body
radiation exposures
A. Electrons
B. They can be used to detect a dose of 1 cGy
B. Degraded gamma photons
C. They can be used to measure a total body
C. Protons
dose of 10 Gy 3 weeks after exposure
D. Spallation products
D. The number of interchange aberrations is a
linear function of dose for x rays
A
2. The percentage of x-ray damage to biologic
X
material mediated by free radicals is closest to
6. Chromosome changes induced by radiation
A. 10% include
B. 20%
A. Acentric fragments
C. 40%
B. Centric fragments
D. 60%
C. Inversions
E. 90%
D. Symmetric translocations
E. Dicentrics
A
3. X-ray–produced chromosomal aberrations,
A
such as dicentrics and rings, are generated as
7. The phase of the cell cycle that is most variable
a consequence of
in length is
A. A single chromosomal break interacting
A. G1
with itself
B. G2
B. Interaction of two separate chromosomal
C. M
breaks
D. S
C. High-dose events caused by a single
electron
D. Misreplication events A
8. If an asynchronous population of cells is
exposed to a single x-ray dose of 10 Gy, the
A
surviving cells are partly synchronized because
4. Cell killing by x rays correlates best with
A. Radiation block occurs in the G1 phase
A. Damage to DNA bases
B. Radiation block occurs in the S phase
B. The initial number of DNA double-strand
C. Most survivors are in the G2 phase
breaks
D. Most survivors are in the late S phase
C. The final number of DNA double-strand
breaks
D. The number of thymine dimers

A X
9. The most radiosensitive portion of the 13. The likelihood of late stochastic effects following
gastrointestinal tract to cell killing is the exposure to radiation is influenced by
A. Esophagus A. Radiation dose
B. Stomach B. Linear energy transfer (LET) of the radiation
C. Small intestine C. Radiation dose rate
D. Large intestine D. Type of tissue exposed
E. Oropharynx
A
A 14. The minimum dose range that results in an
10. The syndrome that is associated with the expected 5%–30% prevalence of nausea
greatest sensitivity to x rays is following acute total-body irradiation is
A. Bloom syndrome A. 0.01–0.1 Gy
B. Ataxia telangiectasia B. 0.1–0.25 Gy
C. Fanconi anemia C. 0.75–1.25 Gy
D. Xeroderma pigmentosum D. More than 10 Gy
A A
11. The shoulder in cell survival curves is MOST 15. The most likely consequence of an acute total
pronounced when cells are irradiated with body exposure to 1 Gy of x rays is
A. 1-MeV neutrons A. Diarrhea
B. 2-MeV alpha particles B. Decrease in lymphocyte count
C. 5-MeV electrons C. Epilation
D. 100-MeV pi mesons D. Sterility in a female
E. Erythema
A
12. For a given total dose of x rays, a protracted B
exposure at a low dose rate is less effective in 16. Match the items (1–4) with the doses (A–D)
killing mammalian cells than an acute exposure (single acute x-ray exposures).
at a high dose rate, primarily because
1. Dose producing the cerebrovascular
A. Fewer free radicals are produced syndrome
B. The mitotic cell cycle is shortened 2. Estimated dose to double the natural
C. Cell division occurs during exposure mutation rate
D. Ion pairs recombine during extended 3. Typical LD 50/5 (ie, gastrointestinal death)
exposure 4. Typical LD 50/60 in humans
E. Repair of sublethal damage occurs during
A. 100 Gy
exposure
B. 10 Gy
C. 4 Gy
D. 1 Gy

X X
17. Which of the following effects would be seen as 21. Which of the following are true concerning
a consequence of a total body exposure to 1.5 radiation-induced sterility?
Gy of x rays?
A. An acute 0.5-Gy dose of gamma rays can
A. Vision-impairing cataracts of the ocular induce temporary sterility in males
lens B. An acute 3.5-Gy or greater dose of
B. Dicentric chromosomes in peripheral gamma rays can induce permanent sterility
lymphocytes in females
C. Skin erythema C. Radiation-induced permanent sterility in
D. Ataxia males leads to a loss of libido
E. Increased carcinogenesis from 25% to 50% D. Radiation-induced sterility in females
produces hormonal changes
X E. An acute 2-Gy dose of gamma rays will
18. An acute whole-body exposure of 1 Gy of low- cause immediate sterility in males (ie, no
LET radiation will cause which of the following latent period)
effects? X
A. Vomiting in 95% of those exposed radiation-induced heritable effects are true?
B. Diarrhea in 95% of those exposed
C. Temporary sterility in males A. Radiation-induced heritable changes are
D. Permanent sterility in females different from those that occur spontaneously
E. Decrease in lymphocyte count B. Humans are much more sensitive to radiation
than mice
C. Risk estimates in humans are based largely
X
on data from mice
D. 10%–20% of heritable changes in the
total body irradiation of humans after an acute
population can be attributed to background
exposure to x rays are true?
radiation
A. The LD 50/60 is between 3 and 5 Gy E. The doubling dose in humans is estimated
B. Seizures are likely if the dose exceeds 3 Gy to be 0.5–2.5 Sv (acute exposure)
C. The nadir in white cell count following a
dose of 2 Gy will occur within 6 days A
D. Bone marrow transplants are likely to save 23. A patient undergoes two CT scans of her abdo-
persons exposed to more than 15 Gy men; the dose was 0.1 Gy. If she subsequently
becomes pregnant within 1 year, what is the
A probability that the child will have a radiation-
20. The earliest clinically detectable effect of induced hereditary defect?
radiation on the skin is
A. Less than 1 in 1,000
A. Epilation B. 1 in 1,000 to 1 in 100
B. Pain C. 1 in 100 to 1 in 10
C. Ulceration D. > 50%
D. Erythema
E. Depigmentation

A B
24. The dose-response relationship for solid 28. Match the type of exposure (1–5) with the type
tumors in the Japanese survivors used by the of radiation-induced cancer (A–E).
BEIR V and UNSCEAR committees has the
1. Patients who are treated with radiation for
form
ankylosing spondylitis
A. Linear with no threshold 2. Patients who undergo fluoroscopy repeatedly
B. Linear with threshold during management of tuberculosis
C. Quadratic with no threshold 3. Uranium workers
D. Exponential 4. Dial painters who work with radium
E. Quadratic with threshold 5. Marshall Island inhabitants
A. Leukemia
A B. Breast cancer
25. Which of the following organs in children is C. Thyroid cancer
most sensitive to the induction of both benign D. Lung cancer
and malignant tumors by x rays? E. Bone cancer
A. Bone marrow
B. Breast B
C. Thyroid 29. For each organ (1–4), select the correct
D. Lung description of cancer incidence in the U.S.
population (A–D).
A 1. Prostate
26. Based on cancer risks in the BEIR V commit- 2. Thyroid
tee report, the number of cancer deaths in the 3. Breast
general public in the United States as a result 4. Kidney
of nuclear power plant accidents is estimated
to be closest to A. Low natural–low radiogenic
B. Low natural–high radiogenic
A. 1 C. High natural–high radiogenic
B. 10 D. High natural–low radiogenic
C. 100
D. 1,000
X
30. A 2-Gy exposure to a developing embryo when
A radiation is administered during
27. The International Commission on Radiological
Protection (ICRP) estimate of the total number A. weeks 8–15 of gestation is likely to induce
of cases of cancer of all types produced by a abortions
total body exposure of a working population to B. weeks 0–2 of gestation usually produces
1 Sv of low-LET radiation at a low dose rate is congenital abnormalities
closest to C. weeks 15–25 can produce mental retardation
D. weeks 2–6 is likely to induce congenital
A. 4 in 100 abnormalities
B. 4 in 1,000
C. 4 in 10,000
D. 4 in 100,000

X X
31. Which of the following statements concerning 34. Which of the following statements concerning
radiation-induced stochastic effects are true? radiation oncogenesis are true?
A. The clinical severity of the effect increases A. Generally, the mean latent period for radia-
with dose tion-induced leukemia is about 20 years
B. The probability that an individual will experi- B. Children are less sensitive than adults to
ence the effect increases with dose the induction of leukemia
C. There is a well-defined threshold in dose C. Benign neoplasms can be induced after
D. The effect may arise from damage to a irradiation
small number of cells D. Solid tumors induced by radiation may
appear 25 years or more after exposure
E. A whole-body dose of 0.1 Gy would be
X
expected to increase the incidence of
32. Which of the following statements regarding
cancer from approximately 20% (the natural
the study of the atomic bomb survivors in
incidence) to approximately 30%
Hiroshima and Nagasaki are true?
A. Less than 2,000 excess radiation-induced
B
malignancies were found
35. Match the consequence (1–3) with the stage
B. There was an increased risk of radiation-
of pregnancy (A–C) when radiation would most
induced breast cancer
likely be the cause.
C. There was an increased incidence of men-
tal retardation in children exposed in utero 1. Congenital malformations (other than in
D. No statistically significant excess heritable the central nervous system)
effects in children of those exposed were 2. Death
found 3. Increased risk of cancer
A. Preimplantation
X B. Organogenesis
33. Risk estimates for radiation-induced cancer in C. Fetal period
humans are based on studies involving
A. Patients treated with I-131 for hyperthyroidism X
B. Survivors of Hiroshima and Nagasaki 36. A therapeutic dose of I-131 to a patient with
C. Women developing breast cancer after Graves disease who is 4 weeks pregnant will
multiple fluoroscopic examinations for
A. Not result in hypothyroidism in the fetus
tuberculosis
B. Cause intrauterine demise with 90%
D. Populations living near nuclear power
probability
plants
C. Result in a 5% risk of leukemia in the
mother
D. Result in a 10% risk of solid tumors in the
mother

X X
37. A woman involved in a traffic accident com- 40. Which of the following statements concerning
plained of lower back pain and underwent radiation-induced cataracts are true?
anteroposterior and lateral lumbosacral spine
A. Cataracts begin in the anterior portion of
radiography. She was subsequently found to be
the lens
10 weeks pregnant. Which of the following are
B. A dose of 1 Gy over 5 years is likely to pro-
true?
duce a cataract
A. The radiographs should not have been C. Prescription eyeglasses protect from 80%
obtained of the dose to the lens from diagnostic
B. A therapeutic abortion should be x rays
recommended D. Vision-impairing cataracts are preceded by
C. If a radiation-induced defect occurs, it will asymptomatic opacities in the lens.
most likely affect the central nervous system
D. The offspring may be at increased risk for a
X
childhood malignancy
E. The fetus probably received an absorbed
radiation-induced cataracts are true?
dose of 0.1–0.15 Gy
A. A cataract is a stochastic effect
X B. The minimum single acute dose of x rays
that will produce a cataract is 2 Gy
38. A woman receives a dose of 50 mGy to the
C. A single dose of radiation is more likely to
abdomen and pelvis and then learns she is 18
induce a cataract than the same amount of
weeks pregnant. There is
radiation administered in 10 fractions
A. An increased risk of intrauterine death D. For a given dose, neutrons are more
B. An increased risk of neonatal death effective than gamma rays in producing
C. A risk of microcephaly in the infant cataracts
D. A risk of leukemia in the child
X
A 42. The explosion of a “dirty bomb” made from
39. A 25-year-old woman undergoes cerebral angi- highly radioactive material, such as a cobalt-60
ography and a CT scan of the brain involving teletherapy source, can result in which of the
2-mm-thick sections that include the orbits. The following?
patient’s lifetime risk probability for radiation-
induced cataracts is estimated to be A. Radiation dose sufficient to cause acute
radiation injury
A. 0% B. Casualties contaminated with radionuclides
B. 0.01% C. Psychologic impact on the victims
C. 0.1% D. Casualties may present a potential hazard
D. 1.0% to medical personnel
E. 10.0%

II. Radiation Safety/Protection A
46. The biggest contributor to the effective dose to
X the U.S. population from natural causes is
43. Which of the following units are SI units? A. Cosmic radiation
A. Rad B. Solar radiation
B. Rem C. Radon
C. Sievert D. Potassium-40 in food
D. Curie E. Gamma ray emitters in building materials
E. Gray
A
X 47. In the United States, the greatest source of
44. A pregnant, occupationally exposed woman exposure to ionizing radiations (collective ef-
working in fluoroscopy shows a reading of fective dose) in the general population due to
4 mSv over 90 days to a badge worn on her human activity is
collar over a lead apron. Which of the following A. Video display terminals
are true? B. Fallout from nuclear weapons testing
A. The Nuclear Regulatory Commission C. Nuclear waste disposal sites
should be called D. Medical and dental diagnostic radiation
B. She should no longer work with fluoroscopy E. Nuclear reactor accidents
C. The dose recorded does not exceed
National Council on Radiation Protection and B
Measurements (NCRP) recommendations 48. Match the quantities (1–4) with the doses
D. A therapeutic abortion is recommended (in millisieverts) (A–D).
1. Average background radiation in the United
A States, including radon
45. Which of the four pie charts (A–D) best de- 2. Dose limit per month (NCRP) to an occupa-
scribes the distribution of effective doses to the tionally exposed worker who has declared
U.S. population as summarized by the NCRP? her pregnancy
3. Dose received in flying across the Atlantic
in a commercial jetliner
4. Genetically significant dose from medical
radiation in the United States
A. 0.05
B. 0.25
C. 0.50
D. 3.0
10 Radiation Biology Syllabus for Diagnostic and Interventional Radiologists 2007

X A
49. Which of the following statements regarding 53. A worker in a nuclear medicine laboratory
radon are true? declares that she is 3 months pregnant. What is
the NCRP recommended limit for the remainder
A. Concentrations are higher in the basement
of the pregnancy?
of a house than outside
B. The BEIR VI committee estimates that A. None
radon is the cause of 10% of lung cancer B. 0.05 mSv/mo
cases in the United States C. 0.5 mSv/mo
C. Decay of radon involves emission of alpha D. 3 mSv total
particles E. 30 mSv total
D. The half-life is 1,600 years
E. The parent is radium X
54. For radiation protection purposes,
X A. the maximum permissible dose for hands
50. Which of the following statements concerning reflects concern for cancer
radon are true? B. a whole-body low-dose-rate exposure has a
A. Radon is a naturally occurring radioactive cancer risk of 4%/Sv
gas C. hands are nearly as radiosensitive as the eye
B. Radon contributes a larger average effec- D. low-dose-rate exposures are associated
tive dose to the U.S. population than do with a lower risk of cancer development
medical x rays than high-dose-rate exposures
C. The action level recommended by the EPA
is 4 pCi/L B
D. The half-life of radon is 1,600 years 55. For each of the following terms related to
E. The effective radiation emitted by radon radiation protection (1–4), select its appropriate
daughters is in the form of gamma rays definition (A–D).
1. Genetically significant dose
A
2. Equivalent dose
51. Which of the following procedures is likely to
3. Effective dose
result in the greatest radiation exposure of
4. Committed equivalent dose
personnel?
A. Dosimetric term used when the source of
A. Chest radiograph obtained with a technolo-
radiation exposure is from radioactive mate-
gist in the room
rial located within the body
B. One CT section obtained with a technolo-
B. The absorbed dose multiplied by a radiation
gist in the room
weighting factor (Wr) appropriate for the
C. Fluoroscopy of the abdomen for 3 minutes
type of radiation
D. Knee examination with MR imaging
C. An index of the presumed effect of gonadal
irradiation on the whole population
X D. The sum of the equivalent doses, weighted
52. A genetically significant dose due to medical for the relative risk of cancer and hereditary
x rays involves the effects, for all irradiated organs and tissues
A. gonad doses
B. age and sex of the patient
C. number of persons exposed
D. time of day at which the exposure is
received

B X
56. For each type of exposure (1–4), select the 59. Which of the following are NCRP recommen-
appropriate current NCRP-recommended dations concerning occupational exposure?
maximum permissible dose (A–D). (The
A. No occupational exposure is allowed before
choices A–D may be used more than once.)
the age of 18 years
1. Annual occupational effective dose limit B. Medical radiation received by radiation work-
2. Annual public equivalent dose limit (frequent ers is included in their maximum permissible
exposure) dose
3. Monthly equivalent dose limit to a fetus C. ALARA (as low as reasonably achievable)
after a pregnancy has been declared does not apply to occupational exposure
4. Annual occupational equivalent dose limit D. The purpose of the occupational maximum
for the lens of the eye dose is to protect against both stochastic
and deterministic effects
A. 0.5 mSv
B. 1 mSv
C. 50 mSv X
D. 150 mSv 60. Which of the following are considered patient
dose-reduction techniques during interventional
B fluoroscopy?
57. Match the quantities (1–4) with the corresponding A. Increased source-to-skin distance
units (A–D). B. Use of last-image hold
1. Absorbed dose C. Variable pulse rate fluoroscopy
2. Activity D. Increased beam filtration
3. Equivalent dose E. Removal of grid
4. Collective effective dose F. Dose spreading
G. Use of electronic magnification
A. Sievert H. Use of geometric magnification
B. Gray
C. Person-sievert
D. Becquerel A
61. Which of the following is (are) considered to
offer minimum protection to the fluoroscopist?
A
58. The NCRP maximum permissible dose for the A. Protective lead aprons
hands of radiation workers is based on B. Thyroid collars
C. Ceiling-mounted lead glass shield
A. estimates for cancer induction of the basal D. Radiation-attenuating surgical gloves
layer of the skin
B. effects anticipated after acute exposures
C. epidemiologic studies of nuclear power
plant employees
D. concern for deterministic effects

A III. Magnetic Resonance Imaging
62. Which potential adverse effect is expected
to occur following a fluoroscopically guided A
interventional procedure in which a skin dose 65. The usage of conventional metal detectors in
of 15 Gy was delivered to a single site? MR environments is NOT recommended by
A. No visible effect the American College of Radiology (ACR). The
B. Temporary hair loss within 24 hours basis for this recommendation considers all of
C. Dry desquamation the following except ________.
D. Damage to vascular structures A. Metal detectors are not necessary because
low fringe fields exist with modern actively
A shielded superconducting magnets
63. Which of the following imaging procedures for B. Metal detectors do not differentiate between
a pregnant patient will deliver the highest ferromagnetic and nonferromagnetic metallic
radiation dose to her 6-week-old fetus? objects/implants/foreign bodies
C. Metal detectors cannot detect a small metal
A. Abdominal ultrasound fragment in the orbit or near the heart
B. Chest radiography (posteroanterior and D. Metal detectors have variable sensitivity
lateral projections) response
C. Head CT (with and without contrast
material)
D. Kidney, ureter, bladder (KUB) radiography A
(four radiographs) 66. What is the ACR recommendation regarding
the pregnant MR imaging technologist or other
health care practitioner working in the MR
A environment?
64. Which of the following work activities is not
recommended for a pregnant radiation worker? A. Permitted to work in and around the MR
environment during the second and third
A. Nuclear medicine imaging trimesters only
B. Radioactive iodine treatments B. Permitted to work in and around the MR
C. Fluoroscopy environment throughout all stages of
D. Portable radiography pregnancy
C. Permitted to remain in the magnet room
during actual data acquisition/imaging
D. Should not enter the magnet room in
response to an emergency

A A
67. What is the ACR guideline regarding the MR 70. What is a quench with respect to the supercon-
imaging of pregnant patients? ducting magnet?
A. Pregnant patients can be accepted to A. Uncontrolled loss of superconductivity
undergo MR imaging at any stage of preg- B. Rapid boil-off of cryogens
nancy C. Requires the immediate evacuation of the
B. Pregnant patients should not undergo MR patient and personnel from the magnet
imaging during the first trimester room
C. Gadolinium-based MR contrast agents D. All of the above
can be routinely administered to pregnant
patients A
D. Fast MR imaging sequences, such as echo- 71. According to the Food and Drug Administration
planar imaging, should be avoided (FDA), a controlled access area must be estab-
lished such that the fringe field outside this
X area does not exceed ________. For the safe
68. Nephrogenic systemic fibrosis (NSF) has been operation of pacemakers, the magnetic field
associated with administration of gadolinium- should be less than this value.
based MR contrast agents to patients with re-
A. 10 G
nal disease. What guidelines are recommended
B. 5 G
by the ACR when considering administering
C. 1 G
gadolinium-based MR contrast agents to a
D. 0.5 G
patient?
A. Hematologic screening for glomerular filtra- X
tion rate (GFR) prior to MR imaging 72. In 1988, the FDA reclassified MR diagnostic
B. No special treatment for patients with stage imagers as class II devices. New devices brought
1 or 2 chronic kidney disease to the market had to demonstrate only that they
C. Refrain from administering gadolinium- were “substantially equivalent” to MR devices
based MR contrast agents to patients with presently on the market. Safety guidelines
stage 3, 4, or 5 renal disease pertaining to clinical MR imaging issued by the
D. Immediate hemodialysis following admin- FDA include which of the following?
istration of gadolinium-based MR contrast
agents should be considered for any patient A. Static magnetic field strength
with severe or end-stage renal disease B. Time-varying magnetic fields
C. Radiofrequency (RF) power deposition
D. Acoustic noise levels
A
69. The presence of all the following metallic objects/
devices is considered a contraindication for MR
imaging examination (meaning performance of
MR imaging is not routine) except ________.
A. Implantable cardioverter-defibrillator
B. Implanted cardiac pacemaker
C. Intracranial aneurysm clips composed of
titanium
D. Ferromagnetic foreign body in the eye
E. Swan-Ganz catheters

A A
73. The specific absorption rate (SAR) in units of 77. What deleterious biologic effects are associ-
watts per kilogram describes ________. ated with chronic exposure to magnetic field
strengths produced by MR imagers (0.2–4 T)?
A. Tissue heating induced by changes in
magnetic field gradients A. Peripheral nerve stimulation
B. Absorption of transmitted RF energy by B. Leukemia
tissue C. Congenital malformations
C. Attenuation of MR imaging signal by the D. None
patient
D. Attenuation of the applied static magnetic IV. Ultrasound
field within the patient
A
A
78. At the point of interest in the ultrasonic field,
74. What is the principal source of MR-generated the instantaneous intensity is directly propor-
acoustic noise during MR imaging? tional to the square of the ________.
A. Cryogen reclamation system A. Acoustic pressure
B. Room air conditioners B. Acoustic velocity
C. Vibrations of the gradient coils C. Frequency
D. Thermoelastic expansion caused by the D. Mass density
absorption of RF energy in the head
A
A
79. Which of the following describes intensity mea-
75. Current MR imagers produce time-varying surements using the unit of the decibel?
magnetic fields (dB/dt), which can result in
________ in some patients. A. Based on a logarithmic scale
B. Measure of relative intensity
A. Induction of intense pain (brain stimulation) C. A factor of two reduction in intensity corre-
B. Cardiac stimulation sponds to a 3-dB change
C. Peripheral nerve stimulation D. Point of interest may be greater or less than
D. All of the above the reference value
E. All of the above
A
76. Local thermal injury to a patient during MR
imaging can be caused by ________.
A. Disconnected surface coil lead left on the
patient
B. Patient contact with the inner bore of the
magnet
C. Patients crossing their arms or legs in the
MR imager
D. Implanted metallic foreign objects in the
patient
E. All of the above

A A
80. In 1992, the American Institute of Ultrasound 83. As the ultrasound beam propagates through
in Medicine (AIUM) and the National Electrical tissue, the intensity decreases as sonic en-
Manufacturers Association (NEMA) adopted ergy is absorbed and converted into heat. The
the voluntary standard for the display of acoustic increased temperature has the potential to
output information called the output display cause irreversible tissue damage. The biologic
standard (ODS). What two acoustic output response is a ________ phenomenon.
parameters, shown in real time on the monitor,
A. Nonthreshold linear
were defined as indicators of the potential for
B. Nonthreshold quadratic
biologic effect?
C. Threshold (temperature only)
A. Derated power and scan time D. Threshold (temperature and time)
B. Acoustic intensity averaged over the focal
area and duty factor A
C. Mechanical index and thermal index 84. Which of the following real-time scanner set-
D. Intensity index and thermal index tings can affect the acoustic output index?
A. Time-gain compensation
A
B. Frame rate
81. In ultrasound, the acoustic output parameter
C. Transmit power
thermal index (TI) indicates ________ for the
D. Frequency
current scanning parameters.
E. Gray-scale mapping
A. Maximum temperature rise in tissue F. All of the above
B. Minutes of exposure time before heating is G. A, C, D
too great H. B, C, D
C. Likelihood of inducing cavitation
D. Acoustic power in milliwatts A
85. The output display standard of mechanical
A index (MI) increases in magnitude as the
82. As the ultrasound beam propagates through ________ is decreased.
tissue, the intensity decreases as sonic energy
A. Acoustic pressure
is absorbed and converted into heat. What
B. Acoustic velocity
factor(s) affect(s) the rate of temperature rise in
C. Frequency
tissue?
D. Peak intensity
A. Temporal average intensity
B. Frequency A
C. Duration of exposure 86. According to the AIUM statement on “Mam-
D. Pulse repetition frequency malian In Vivo Ultrasonic Biological Effects,”
E. All of the above no independently confirmed significant biologic
F. B, D effects have occurred with spatial peak, tem-
poral average intensities below ________ for
mammalian tissues exposed in vivo. Assume
focused ultrasound.
A. 1 W/cm2
B. 100 W/cm2
C. 1 mW/cm2
D. 100 mW/cm2

A A
87. As the ultrasound wave propagates through 90. What is the conclusion of the National Institutes
tissue, regions of compression and rarefaction of Health (NIH) regarding the appropriate use
are created. Thus localized regions are sub- of ultrasound in obstetrics?
jected to increases and decreases in pressure
A. Routine screening is recommended
in an alternating fashion, and these cause gas
B. Ultrasound examination in pregnancy
bubbles to exhibit dynamic behavior. This phe-
should be performed for a specific medical
nomenon is known as ________.
indication
A. Radiation force C. Ultrasound examination performed solely to
B. Cavitation satisfy the family’s desire to obtain a picture
C. Ionization of the fetus should be encouraged to en-
D. Fourier force hance bonding between mother and child
D. None of the above
A
88. Multiple models have been developed for the A
thermal index (TI). These different models are 91. According to recommendations by the NCRP,
necessary because temperature profiles in tissue a risk-benefit decision should be considered
are highly dependent on the presence of a when the mechanical index (MI) exceeds a
strong absorber such as ________. value of ________ and the thermal index (TI)
exceeds a value of ________.
A. Air
B. Bone A. 1.0, 1.0
C. Fluid B. 0.5, 0.5
D. All of the above C. 0.5, 1.0
D. 1.0, 0.5
A E. None of the above; the NCRP makes
89. A number of epidemiologic studies of in utero no recommendations with respect to MIs
ultrasound exposure have been conducted over and TIs
the past 20 years. What is the conclusion of the
NCRP regarding a causal relationship between
diagnostic ultrasound and any adverse effect?
A. Low birth weight is an adverse effect
caused by in utero ultrasound exposure
B. Dyslexia is an adverse effect caused by in
utero ultrasound exposure
C. Delayed speech development is an adverse
effect caused by in utero ultrasound expo-
sure
D. Insufficient justification to warrant the con-
clusion that there is a causal relationship
between diagnostic ultrasound and any
adverse effect

Answers
I. Radiation 17. A-False 30. A-False 40. A-False

Biology/Effects B-True B-False B-False
C-False C-True C-False
1. A D-False D-True D-True
E-False
2. D 31. A-False 41. A-False
18. A-False B-True B-True
3. B B-False C-False C-True
C-True D-True D-True
4. C D-False
E-True 32. A-True 42. A-True
5. A-True B-True B-True
B-False 19. A-True C-True C-True
C-False B-False D-True D-True
D-False C-False
D-False 33. A-False
6. A-True B-True
B-True 20. D C-True
C-True D-False
D-True 21. A-True
E-True B-True 34. A-False
C-False B-False
7. A D-True C-True
E-False D-True
8. D E-False
22. A-False
9. C B-False 35. 1-B
C-True 2-A
10. B D-False 3-C
E-True
11. C 36. A-True
23. A B-False
12. E C-False
24. A D-False
13. A-True
B- True 25. C 37. A-False
C-True B-False
D-True 26. A C-True
D-True
14. C 27. A E-False
15. B 28. 1-A 38. A-False
2-B B-False
16. 1-A 3-D C-True
2-D 4-E D-True
3-B 5-C
4-C 39. A
29. 1-D
2-B
3-C
4-A

II. Radiation Safety/ 55. 1-C III. Magnetic IV. Ultrasound
Protection 2-B Resonance 78. A
3-D Imaging
43. A-False 4-A
B-False 65. A 79. E
C-True 56. 1-C
D-False 66. B 80. C
2-B
E-True 3-A
67. A 81. A
4-D
44. A-False
B-False 68. A-False 82. E
57. 1-B
C-True 2-D B-True
D-False C-True 83. D
3-A
4-C D-True
45. B 84. H
58. D 69. C
46. C 85. C
59. A-True 70. D
47. D 86. A
B-False
C-False 71. B
48. 1-D 87. B
D-True
2-C 72. A-True
3-A B-True 88. B
60. A-True
4-B B-True C-True
D-True 89. D
C-True
49. A-True D-True
B-True 73. B 90. B
E-True
C-True F-True
D-False 74. C 91. C
G-False
E-True H-False
75. C
50. A-True 61. D
B-True 76. E
C-True 62. C
D-False 77. D
E-False 63. D
51. C 64. B
52. A-True
B-True
C-True
D-False
53. C
54. A-False
B-True
C-False
D-True

Explanation of Answers
I. Radiation Biology/Effects Question 5. Lymphocytes from a blood sample can

be stimulated to divide, and chromosomal aberra-
Question 1. When x rays are absorbed in biologic tions can be scored at the first mitosis. The number
material, the photon first interacts with an orbital of aberrations reflects the average effective total
electron of an atom of the material by the photo- body dose. Option A is therefore true (1, pp 25–28;
electric, or Compton, process to produce a fast 3, pp 19–20). The aberrations scored are of the
recoil electron. The energy of this electron is lost exchange type, such as dicentrics, which require
through interactions with other atoms or molecules to breaks in two chromosomes, so that the relation to
produce biomolecular ions. The ensuing biochemi- dose is linear-quadratic. Hence, option D is false
cal events may or may not lead to a biologic effect. (1, pp 25–28). The dose that can be detected de-
Protons and spallation products are formed when pends on how many cells are scored, but for practi-
neutrons are absorbed in tissue. The correct option cal purposes, 25 cGy is the lowest dose that can be
is A (1, pp 9–11; 2, pp 37–43). detected. Option B is therefore false (1, pp 25–28;
3, pp 19–20). Lymphocytes are very radiosensitive,
Question 2. X rays are absorbed in biologic mate- die an interphase death, and disappear quickly after
rial to produce a recoil electron, as described in a large dose. A few days after exposure to 10 Gy,
Question 1. This electron may interact directly with there would be few lymphocytes in circulation, so
DNA to cause a strand break, but this is relatively the system could not be used to assess dose. In any
unlikely because DNA constitutes a small proportion case, the person would have died a gastrointestinal
of the cell. The cell is mostly water, and the electron death before 3 weeks! Option C is therefore false
may ionize a water molecule close to the DNA. This (1, pp 119–120; 3, pp 19–20).
leads to the chemical production of a free hydroxyl
radical (OH•), which diffuses to the DNA and causes Question 6. If a break occurs in two prereplication
a strand break. This accounts for about two-thirds of chromosomes, and pieces of chromatin without
the biologic damage produced by x rays. The correct centromeres are exchanged, this is a symmetric
option is D (1, p 12). translocation and is compatible with life (option D).
If rejoining occurs so that the two pieces with cen-
Question 3. Dicentrics and rings are “exchange tromeres join, this represents a dicentric (option E).
type aberrations”; in other words, they are formed If the two pieces without centromeres join, this forms
by the illicit rejoining of two separate chromosome an acentric fragment (option A). A small piece of
breaks. A dicentric is formed as a consequence of chromatin with a centromere is a centric fragment.
rejoining of breaks in two different chromosomes; What usually happens is that a break occurs on each
a ring forms from the rejoining of breaks in the two side of the centromere, and the two “sticky” ends join
arms of the same chromosome. The correct option to form a ring chromosome; in other words, the centric
is B (1, pp 22–23; 2, p 820). fragment is often a ring (option B). When two breaks
occur in the same piece of chromatin, and the piece
Question 4. Damage to bases may represent isolated reverses and rejoins, this is called an inversion
a mutation, but it does not kill the cell. Thymine (option C). All options are true (1, pp 21–25).
dimers are produced by ultraviolet radiation, not by
ionizing radiations. Double-strand breaks are the Question 7. In most mammalian cells, mitosis itself
most important lesions caused by x rays. Some are (M) lasts about a half hour to an hour. The DNA syn-
quickly and correctly repaired. Those that remain thetic phase (S) has a duration of 6–8 hours in rodent
unrepaired or that rejoin illicitly to form an aberra- cells and about 12 hours in human cells. G2 has a
tion may cause cell death. The correct option is C duration of a few hours. G1 is the phase that is most
(1, pp 28, 35–39, 45). variable in length; it may last only an hour in cells that
are dividing rapidly to repair damaged tissue, or it
may be 10 days to 2 weeks in, for example, the stem
cells of resting skin. The correct option is A (1, p 369).

Question 8. Cells in mitosis (M) or just before, in Question 13. Stochastic effects are effects for which
the G2 phase, are the most radiosensitive, while there is no threshold and for which the severity of
cells in late S are the most radioresistant. G1 cells the effects does not depend on dose, although the
are intermediate in radiosensitivity. When an asynchro- probability that the effects will occur does. Stochastic
nous population of cells is exposed to x rays, most effects include heritable effects and carcinogenesis,
surviving cells will be from the most radioresistant but not cell killing. All biologic effects, stochastic or
moiety of the population, S. The correction option otherwise, depend on all four factors: dose, LET,
is D (1, pp 52–54). dose rate, and type of tissue exposed. All options are
correct (1, pp 135–136, 139–146; 2, p 840).
Question 9. In the few humans who have died a
gastrointestinal death as a consequence of total Question 14. A total body dose in the range of
body irradiation, it is the small intestine that is most 0.75–1.25 Gy results in nausea in 5%–30% of
completely denuded. The correct option is C persons exposed. At higher doses in the range of
(1, pp 119–120; 2, p 835). 1.25–3.00 Gy, the prevalence increases to 20%–70%.
Above 5.3 Gy, moderate to severe nausea is ex-
Question 10. Xeroderma pigmentosum is character- pected in 50%–90% of persons exposed. The correct
ized by sensitivity to ultraviolet radiation but not to option is C (4, p 84).
x rays. Bloom syndrome and Fanconi anemia both
exhibit genomic instability but are not particularly Question 15. The lymphocyte count would be
sensitive to either x rays or ultraviolet radiation. The decreased by a dose of 0.5 Gy. A transient early
characteristic of ataxia telangiectasia is sensitivity erythema may be produced by a dose of 2 Gy, with
to x rays but not to ultraviolet radiation. The correct 6 Gy required for a robust erythema. Temporary
option is B (1, p 41). epilation occurs after a dose of 3 Gy and permanent
epilation after 7 Gy. A dose of 3.5 Gy or more is re-
Question 11. The shoulder of the survival curve quired to produce sterility in the female. The correct
(the β component in the α-β formalism) is most option is B (1, pp 122–124).
pronounced for low linear energy transfer (LET)
radiations and minimal for high-LET radiations. For Question 16. Three of the four options in this
a given particle, the LET goes down as the energy question relate to death by total body irradiation
goes up. For a given energy, the LET increases at differing dose levels. The LD 50/60 refers to the
with the mass of the particle. Electrons are by far death of 50% of the exposed population in 60 days
the lightest of the particles listed; pi mesons are the due to failure of the hematopoietic system. Its value
next lightest, then neutrons, with alpha particles the is about 3–4 Gy. C matches with 4 (1, p 127). LD
heaviest. The correct option is C (1, pp 111–112; 2, 50/5 refers to the dose required to kill humans by
pp 821–824). denuding the lining of the gastrointestinal tract.
Its value is about 10 Gy. B matches with 3 (1, pp
Question 12. The number of free radicals produced 119–120). Only a few examples of death by the
is a function of dose and does not depend on dose cerebrovascular syndrome have ever been seen in
rate; option A cannot be correct. Ion pairs recombine humans; death occurs in about 48 hours, and the
in fractions of a millisecond, so that is not a factor dose required is about 100 Gy. A matches with 1
here; option D is incorrect. The mitotic cycle is length- (1, pp 118–119). The fourth option involves heredi-
ened, not shortened, by radiation; option B is incorrect. tary effects (ie, effects in offspring due to irradiation
This leaves options C and E. If the dose rate is very of parents). The dose required to double the natu-
low, cell survival would be dominated by cell division ral or spontaneous mutation rate is about 1 Gy. D
occurring during a prolonged exposure, and option matches with 2 (1, pp 162, 166).
C would be correct. However, for any practical dose
rates, the dominant factor in the dose-rate effect is
the repair of sublethal damage during a prolonged
exposure. The correct option is E (1, pp 71–74).

Question 17. The minimum dose of x rays in an Question 21. Temporary sterility in males occurs
acute exposure likely to produce a vision-impairing after a dose as low as 0.15 Gy; option A is true
cataract is 2 Gy; option A is false (1, p 185). Dicen- (1, pp 157, 166). Permanent sterility in females oc-
tric chromosomal aberrations in stimulated human curs at doses of 3.5 Gy or more; option B is true
peripheral lymphocytes can be observed at any dose (1, pp 157, 166). Radiation-induced sterility in males
above about 0.25 Gy; option B is true (1, p 25). A does not affect hormone levels or libido; option C is
transient early erythema may be produced by a dose false (1, pp 157, 166). Radiation-induced sterility in
of about 2 Gy, and a robust erythema requires 6 Gy; females results in symptoms similar to those in nor-
option C is false (1, p 205). Ataxia is not a likely re- mal menopause; option D is true (1, p 157). Because
sult of any dose, except perhaps hundreds of grays; the cells in the male reproductive system involve a
option D is false (1, pp 118–119). The risk estimate hierarchy of cells in a self-renewal system, there is a
for radiation-induced cancer is 8%/Gy for an acute latent period between irradiation and sterility; option
exposure. A 25% increase would require 25/8 Gy, or E is false (1, p 157).
3.1 Gy; option E is false (1, p 146).
Question 22. Mutations produced by radiation are
Question 18. Vomiting and other GI symptoms in indistinguishable from those that occur spontaneous-
the majority of individuals exposed require a dose of ly; option A is false (1, p 166). There is no statistically
several grays; option A is false (4, pp 15, 123). Diar- significant excess of hereditary effects in the children
rhea indicates a supralethal dose (ie, a dose in ex- of the Japanese exposed to radiation by the atomic
cess of 3–4 Gy); option B is false (1, p 123). Option bombs, which indicates that humans are certainly
C is true because temporary sterility in males occurs not more sensitive than mice and might be less
after a dose as low as 0.15 Gy (1, p 166). However, sensitive; option B is false (1, p 165). Risk estimates
permanent sterility in females requires a dose of 3 for hereditary effects are based on the “Megamouse”
Gy or more; option D is false (1, p 166). A decrease project; option C is true (1, pp 162–164). If 1 Gy
in lymphocyte count would be observed at a dose as (or 1 Sv) is required to increase the mutation rate
low as 0.5 Gy; option E is true (1, p 123). by 100%, 0.1–0.2 Gy (or Sv) would be required to
increase the mutation rate by 10%–20%. However,
Question 19. The dose that would kill 50% of a the average background radiation in the United
population as the result of failure of the hematopoi- States is only 3 mSv (ie, 0.003 Sv). Option D is false
etic system (ie, LD 50/60) is 3–4 Gy; option A is true (1, p 166). The doubling dose is the dose required to
(1, p 127). Seizures are not a feature of any radiation double the natural or spontaneous level of mutations.
dose short of the central nervous system/cerebro- The BEIR committee quoted a range, 0.5–2.5 Sv,
vascular syndrome, which requires a dose in excess while UNSCEAR quoted a single figure, 1 Gy. Option
of 100 Gy; option B is false (1, pp 118–119). The E is true (1, p 166).
nadir of the white blood cell count, determined by the
lifetime of mature circulating cells, is several weeks Question 23. The risk estimate for the hereditary
following irradiation; option C is false (1, p 123; 3, effects of radiation, based on a doubling dose of 1
pp 19–20; 4, pp 26, 123). Bone marrow transplants Gy, plus an allowance for multifactorial diseases, is
cannot save persons exposed to doses in excess of estimated by the ICRP to be 0.2%/Sv. (For x rays,
about 10 Gy, because they will die a gastrointestinal sieverts and grays are interchangeable units, since
death; option D is false (1, pp 119–120). the radiation weighting factor for x rays is unity.) The
risk for a hereditary effect from an exposure of 0.1
Question 20. Transient erythema is evident in Gy is therefore 0.2/100 × 0.1 = 2 × 10–4, a risk of 2
hours, and the main wave of erythema occurs after in 10,000. The correct option is A (1, p 166).
10 days. Epilation occurs after about 3 weeks.
Ulceration and depigmentation are late effects due
to damage to the dermis. Pain would be secondary
to extremely high doses. The correct option is D
(1, p 205; 2, pp 829–830).

Question 24. Carcinogenesis by radiation is result of fallout from the testing of nuclear weapons.
considered to be a stochastic process (ie, it is an C matches with 5 (1, p 139). An excess of lung
all-or-nothing event). The severity of the response cancer is observed in underground miners, including
is not dose dependent, although the probability of uranium miners, who breathe radon, which concen-
it occurring is. There is no threshold (ie, there is trates in the environment of the mine. Radon is a
no dose below which there is no risk). The BEIR noble gas with a half-life of about 3 days. It decays
V and UNSCEAR committees found that for solid to solid radioactive isotopes that stick to particles
tumors in the Japanese survivors, the excess cancer of dust and are deposited in the bronchi and lungs.
incidence was a linear function of dose, with no These radionuclides emit alpha particles that irradi-
threshold. The leukemia data were best fitted with a ate the bronchial epithelium and may cause lung
linear-quadratic function of dose. The correct option cancer. D matches with 3 (1, pp 140–141). Women
is A (1, pp 144, 152–153). employed as dial painters ingested radium by licking
their brushes for the application of luminous paint to
Question 25. The thyroid is most sensitive to induc- watches. Bone sarcomas and carcinomas of epithelial
tion by radiation of both benign nodules and malig- cells lining the paranasal sinuses and nasopharynx
nant tumors. None of the other tissues shows such were observed in this exposed population. E matches
an incidence of benign tumors due to x rays. The with 4 (1, p 166).
correct option is C (1, pp 139–140; 5, pp 282, 290).
Question 29. The prostate has a relatively high
Question 26. At the time of the Three Mile Island natural or spontaneous incidence of cancer in the
accident, it was estimated that the number of cancer United States, but a low risk of induction by radiation.
deaths due to the release of radioactive materials D matches with 1 (2, p 848; 5, p 316). Thyroid cancer
was about 0.5! The closest and correct option is A is relatively rare in the population, but both benign
(6, p 422). and malignant tumors are induced by radiation, espe-
cially in children and young people. B matches with
Question 27. The excess cancer risk estimated by 2 (1, pp 139–140). Breast cancer is relatively common
the UNSCEAR and BEIR V committees was 8%/Sv, in the U.S. population and is readily induced by radia-
based on the data from the Japanese survivors. tion. C matches with 3 (1, p 140). Malignancies in
However, the Japanese survivors experienced an the kidney are rare and do not figure prominently in
acute exposure. The ICRP uses a dose and dose-rate any of the major populations exposed to radiation.
reduction factor (DDREF) of 2, so that the estimate of A matches with 4 (2, p 848).
cancer risk at low doses and low dose rate, applicable
to the radiation protection of a working population, is Question 30. Radiation-induced abortions after a
4%/Sv. The correct option is A (1, p 146). 2-Gy exposure are very likely during weeks 0–2 of
gestation but are unlikely during weeks 8–15; op-
Question 28. An excess incidence of leukemia was tion A is false (1, pp 168–180). During weeks 0–2,
observed in patients with ankylosing spondylitis treat- radiation-induced abortions are likely, but congeni-
ed with x rays for the relief of pain. A matches with 1 tal abnormalities are unlikely to occur until weeks
(1, p 139). An excess of breast cancer was observed 2–6; option B is false (1, pp 168–180). Although not
in patients who underwent fluoroscopy many times high, the risk of mental retardation may occur during
during the management of tuberculosis, first reported weeks 15–25 (a risk level of about 10%/Sv); option
from Canada and later repeated in a New England C is true (1, pp 168–180). The risk of mental retar-
study. B matches with 2 (1, p 140). Thyroid tumors, dation is as much as 40%/Sv during weeks 8–15.
both benign and malignant, were observed in the During the period of organogenesis (2–6 weeks of
inhabitants of the Marshall Islands in the Pacific as a gestation), congenital abnormalities are likely after a
dose of 2 Gy; option D is true (1, pp 168–180).

Question 31. In a general dictionary, stochastic is Question 34. Latency is the time between irradiation
simply defined as “random.” In radiation protection, and the appearance of malignancy. For leukemia,
it has taken on a special specific meaning and ap- the latent period is short, on the order of 5–7 years,
plies to carcinogenesis and hereditary effects. A sto- while for solid tumors the latent period may be as
chastic effect is an all-or-nothing effect. The severity long as 20–50 years. Option A is false (1, p 138);
of the effect is not dose related; option A is false option D is true (1, p 138). Children are more sensi-
(1, pp 135–136). However, the probability of the ef- tive than adults for some malignancies, while for
fect occurring increases with dose; option B is true others, there appears to be little difference with age.
(1, pp 135–136). There is no dose below which the However, children are certainly not less sensitive
effect cannot occur (ie, there is no threshold); op- than adults; option B is false (1, p 146). Radiation
tion C is false (1, pp 135–136). Damage to a small induces benign as well as malignant tumors (thyroid
number of cells, even one cell, can cause the effect; tumors are the best example); option C is true
option D is true (1, pp 135–136). (2, p 850). The ICRP risk estimate for radiation-in-
duced cancer in a working population at low dose
Question 32. The total number of excess malig- and dose rate is 4%/Gy. A dose of 0.1 Gy would re-
nancies attributable to radiation at Hiroshima and sult in a cancer incidence of 0.4%, not 10%; option
Nagasaki is about 600; option A is true (1, p 137). E is false (1, p 146).
There was an increase in leukemia and many solid
tumors, including those of the breast; option B is Question 35. Animal experiments indicate that ex-
true (1, p 140). Exposure in utero led to an increased posure to radiation during organogenesis leads
incidence of reduced head diameter and mental to a wide spectrum of malformations; B matches with
retardation; option C is true (1, p 173). While there 1 (1, pp 169–172). During preimplantation, radiation
is a trend, there was no statistically significant appears to have an all-or-nothing effect; either the
increase in hereditary (genetic) effects in the first- newly fertilized egg is killed, or it develops normally.
generation children of persons exposed; option D is Growth retardation and malformations do not result
true (1, p 165). from irradiation at this time. A matches with 2
(1, pp 169–172). There is an increased risk of cancer
Question 33. Risk estimates for radiation-induced due to exposure in utero; C matches with 3 (1, pp
cancer are based on studies of exposed popula- 169–172).
tions in which there is a clear dose-related excess of
cancer cases. Good examples include the survivors Question 36. Prior to 8 weeks after conception, the
of the atomic bombs in Hiroshima and Nagasaki, fetal thyroid does not take up iodine, so hypothyroidism
as well as the women who underwent fluoroscopy will not occur in the fetus even from a therapeutic
many times during the management of tuberculosis; dose; option A is true (1, pp 218–219). The total body
options B and C are true (1, pp 137–138). Patients dose to the conceptus from the administration of 20
treated with I-131 show no clear dose-related excess mCi is less than 7 rad (70 mGy), which is too low to
of cancer or leukemia, nor do populations living near cause death; option B is false (1, pp 218–219). The
nuclear power plants; consequently, neither can be red marrow dose to the mother from the administra-
used to obtain risk estimates; options A and D are tion of 20 mCi is about 0.09 Sv. The absorbed dose
false (1, pp 137–138). to maternal organs other than the thyroid is typically
not more than 0.12 Sv from a 20-mCi administration.
The ICRP risk of all cancers from an acute dose
of radiation is about 8%/Sv and for leukemia about
1%/Sv; both C and D are false (1, pp 215–216).

Question 37. An accident situation in which injuries Question 40. In the lens, dividing cells are confined
are possible justifies the small risks associated with to the equatorial region. Progeny migrate to the pos-
diagnostic x rays; option A is false (7, pp 12–13). terior pole of the lens. Cells damaged by radiation
A therapeutic abortion would not be justified; lead to opaque fibers that congregate in the posterior
option B is false (7, pp 12–13). On the basis of the pole; option A is false (1, p 182). The minimum acute
Japanese survivors’ data, 8–15 weeks is the sensi- dose to produce a cataract is about 2 Gy; 1 Gy over
tive period for reduced head diameter and mental 5 years will certainly not result in a cataract; option
retardation. The doses are not large enough for this B is false (1, p 184). Prescription eyeglasses today
to be very likely, but if a radiation-induced defect oc- are almost always plastic and absorb little radiation.
curred, it would involve the central nervous system; Lead glass is required to significantly attenuate x rays;
option C is true (1, pp 177–178). On the basis of option C is false (2, p 771). Vision-impairing cataracts
the case-control studies of Stewart et al, even a few take time to develop and are preceded by less-impor-
radiographs during pregnancy increase the risk of tant opacities; option D is true (1, pp 182–183).
leukemia and childhood cancer; option D is true
(1, pp 176–177). The dose to the fetus would be Question 41. A stochastic effect is one in which
considerably less than 0.1 Gy; option E is false the severity of the effect is independent of the dose
(7, pp 12–13). and for which there is no threshold. In the case of a
cataract, there is a practical threshold of 2 Gy, and
Question 38. Intrauterine death occurs as a result the severity of the cataract increases with the dose;
of irradiation during preimplantation (0–10 days), option A is false (1, pp 181–184). The minimum
and neonatal death (ie, death at or about the time dose, in a single acute exposure, required to result
of birth) occurs because of irradiation during or- in a cataract is indeed 2 Gy; option B is true
ganogenesis (10 days to 6 weeks). Irradiation at 18 (1, pp 181–184). Cataractogenesis by radiation
weeks is too late for this; options A and B are false shows a substantial dose-rate and fractionation ef-
(1, pp 169–171). The data from persons exposed in fect (ie, a larger dose is required if it is protracted);
utero at Hiroshima and Nagasaki show that irradia- option C is true (1, pp 181–184). For a given dose,
tion to a sufficient dose may produce microcephaly high-LET radiations, such as neutrons and heavy
(reduced head diameter) and mental retardation. charged particles, are much more effective at induc-
The most sensitive time interval for these effects was ing cataracts; option D is true (1, pp 181–184).
8–15 weeks. There was a less sensitive interval at
15–25 weeks; option C is true (1, pp 176–177). The Question 42. A dirty bomb is a dispersal device that
case-control studies of Stewart et al showed that causes purposeful dissemination of radioactive ma-
even a few obstetric radiographs could lead to an terial over a wide area without a nuclear detonation.
elevation of risk of leukemia and childhood cancer; Potential sources of radioactive material for a dirty
option D is true (1, pp 176–177). bomb include naturally occurring radionuclides (eg,
radium, uranium, thorium), products of the nuclear
Question 39. A multislice CT scan results in a dose fuel cycle, radioisotopes used in medicine, com-
to the lens of the eye of less than 5 cGy. Cerebral ponents of military systems, and radiation sources
angiography can contribute an additional dose of used in industry. Highly radioactive material such as
5 cGy to the lens of the eye. The minimum dose that nuclear fuel rods, cobalt-60 teletherapy sources, and
will produce a cataract in a single exposure is about industrial radiography units could deliver significant
2 Gy. The correct option is A (1, p 184). whole body exposure to those present, resulting in
acute radiation syndrome. Contaminated-injured
patients are anticipated from an explosive device
that releases radioactive material. Patients with
large amounts of radioactive contamination pose an
exposure hazard to medical personnel. As an act
of terrorism, the primary purpose of a dirty bomb is
to inflict fear, destroy the sense of well-being, and
disrupt community function. All options are true
(3, pp 9, 16, 27).

II. Radiation Safety/Protection Question 47. Medical (including dental) radiation
represents about a quarter of the effective dose to
Question 43. Système International (SI) units are the U.S. population and is therefore by far the larg-
the gray and the sievert. The gray is the unit of est source of exposure from human activity. Natural
absorbed dose and is defined as 1 J/kg. The sievert background radiation is slightly greater. The correct
is the unit of equivalent dose, or the product of dose option is D (10, p 55).
in grays and the radiation weighting factor (Wr). The
rad, rem, and curie are the old units, replaced in the Question 48. The effective dose from average
SI system by the gray, sievert, and becquerel. Options background radiation, including radon, for the United
C and E are true (2, p 59). States is about 3 mSv per year; D matches with 1
(10, p 53). Once a pregnancy is declared, the NCRP
Question 44. The maximum permissible doses dose limit to the conceptus is 0.5 mSv per month.
recommended by the NCRP are effective doses. Also, Until a pregnancy is declared, there are no special
the dose outside the lead apron does not reflect the dose limits other than those applicable to any radia-
dose under the lead apron. The dose under the lead tion worker. C matches with 2 (9, p 38). The effective
apron is usually lower by about a factor of 20. The dose received in flying across the North Atlantic in a
dose to the conceptus is more than a factor of two commercial jetliner is about 0.05 mSv. This is due to
less than this because of protection from the mother’s the cosmic radiation at the altitude of about 35,000
overlying tissues. Therefore, the actual dose to the feet. A matches with 3 (10, p 11). The genetically
conceptus is less than about 0.1 mSv for the 90-day significant dose (GSD) is the dose that if given to
period. This is less than 0.05 mSv to the conceptus everyone in the U.S. population would result in the
per month, which is much lower than the 0.5-mSv same number of mutations as would the actual vari-
monthly limit recommended by the NCRP; option C is able dose received by part of the population during
true. Option A is false for two reasons: (a) The dose medical irradiation. The GSD is about 0.25 mSv. B
to the conceptus is not at a level of true concern, matches with 4 (10, p 54).
and (b) the Nuclear Regulatory Commission (NRC)
regulates exposures only to radionuclear by-product Question 49. Radon tends to accumulate in the
material. The NRC would be an improper agency to basement of a house as it seeps in from rocks and
notify for exposures to x rays. The individual can soil. This is particularly true in winter when the house
continue to work in fluoroscopy as long as she main- is heated and the pressure inside is a little less than
tains proper radiation management practices; option that outside. This draws radon into the house. In the
B is false. Since the radiation levels are well below outside air, radon dissipates. Option A is true. The
any of concern, option D would be unconscionable BEIR VI best estimate of lung cancer deaths from
(1, p 177; 8; 9, p 38). radon was 15,400 to 21,800 per year, depending
on which model is adopted. This is about 10% of
Question 45. Inhaled radon contributes a little more the lung cancer deaths per year, which were about
than half of the effective dose to the U.S. population, 157,990 in 2003 in the United States. Option B is
with the remainder approximately equally divided true. Two of the progeny of radon emit energetic
between medical radiation and background radiation alpha particles, which are thought to be the cause
arising from cosmic rays and from the ground. The of lung cancer; option C is true. When radon decays
correct option is B (10, p 55). into solid progeny, it does so with a half-life of about
3 days; option D is false. The parent is indeed radium;
Question 46. Radon is the largest single contributor option E is true (1, pp 189–190).
to the “effective” dose; the effective dose is the prod-
uct of the absorbed dose, the radiation weighting
factor (Wr), and the tissue weighting factor (Wt ). The
radiation weighting factor for the alpha particles emit-
ted by radon progeny is 20, while the tissue weighting
factor for the lung, the only tissue irradiated by radon
progeny, is 0.1. The correct option is C (10, p 55).

Question 50. Radon is a naturally occurring option C is false (1, p 231). Because of repair of dam-
radioactive gas that seeps out of the ground into age, a low-dose-rate exposure is less effective than a
mines and the basements of homes; option A is true. high-dose-rate exposure; option D is true (1, p 146).
Radon constitutes about 55% of the effective dose to
the U.S. population, which is about double that from Question 55. The genetically significant dose is the
medical x rays; option B is true. In the United States, dose that if given to everyone in the U.S. population
the action level for radon (the maximum concentration would result in the same number of mutations as
in the lived-in area of a house above which modifica- would the actual variable dose received by part of
tions to the building are recommended) is 4 pCi/L. the population during medical irradiation. It therefore
This is lower than the action levels in Canada and gives some idea of the impact of gonadal radiation.
Europe. Option C is true. The half-life of radon is about C matches with 1 (10, p 5). Dose is a physical term,
3 days; it is radium that has a half-life of about 1,600 expressed as energy per unit mass. One gray of
years; option D is false. Two of the progeny of radon different types of radiation does not result in the same
emit energetic alpha particles, which are thought to biologic effect. The equivalent dose is the product of
cause lung cancer; option E is false (1, pp 189–190). dose and the radiation weighting factor (Wr), a dimen-
sionless factor designed to reduce all radiation to a
Question 51. Of the options given, fluoroscopy of common scale. The unit is the sievert. One sievert of
the trunk of the body involves by far the largest dose any kind of radiation produces the same biologic
to the operator. The correct option is C (2, pp 252– effect. B matches with 2 (9, p 16). Different organs and
253, 755, 769–770). tissues show different susceptibilities to the biologic
effects of radiation. The effective dose is the sum
Question 52. The genetically significant dose (GSD) of the products of equivalent dose and the tissue
is the dose that if given to everyone in the U.S. popu- weighting factor (Wt ) for all organs or tissues exposed.
lation would result in the same number of mutations D matches with 3 (9, p 21). In the case of an incorpo-
as would the actual variable dose received by part of rated radionuclide, the dose is not delivered instan-
the population during medical irradiation. The GSD taneously but over a period of time depending on the
due to medical radiations, therefore, depends on the half-life of the radionuclide. Committed equivalent
gonad doses, the age and sex of the patients, and dose takes that into account and is the effective dose
the number of persons exposed; options A, B, and C integrated over 50 years. A matches with 4 (9, p 24).
are true. The time of day is obviously irrelevant; op-
tion D is false (2, p 746; 10, p 5). Question 56. The maximum permissible effective
dose for individuals occupationally exposed is 50
Question 53. Until a worker declares a pregnancy, mSv per year; C matches with 1 (9, p 34). The
no special protection limits apply apart from those public is allowed an exposure that is one-tenth of the
generally applicable to a radiation worker. Once a occupational cumulative dose limit of 10 mSv per
pregnancy is declared, the recommended limit is 0.5 year; B matches with 2 (9, p 46). After a pregnancy
mSv per month. If this is adhered to, the dose for the is declared, the maximum permissible dose per
duration of the pregnancy would be similar to that month to the conceptus is 0.5 mSv, so that during
allowed for an occasional exposure of a member of the duration of the pregnancy the dose is similar
the general public. The mother may be a radiation to that allowed a member of the general public as
worker, but the conceptus is not. The correct option an occasional exposure (one-tenth of the annual
is C (9, p 38). occupational effective dose limit); A matches with 3
(9, p 38). The limit for the eye of an occupationally
Questions 54. Hands and legs are of concern for exposed individual is 150 mSv, which is designed
deterministic effects, which do not include cancer to prevent a deterministic effect; D matches with 4
induction; option A is false (1, p 231). The risk of (9, p 36).
cancer from low-dose-rate exposures is about 4%/Sv;
option B is true (1; p 146). Hands are allowed a larger Question 57. The unit of absorbed dose is the gray,
maximum dose (500 mSv) than the eyes (150 mSv) defined as 1 J/kg; B matches with 1 (9, p 59). The unit
because the eyes are much more sensitive to radiation; of activity of a radionuclide is the becquerel, defined

as one disintegration per second; D matches with the usual 30 frames per second. Dose reduction
2 (9, p 59). The equivalent dose is the product of is 50%. However, manufacturers may increase the
absorbed dose in grays and the radiation weighting radiation level per frame to achieve a more pleasing
factor (Wr), which is a dimensionless factor. The unit visual appearance, and the dose reduction may be
is the sievert. A matches with 3 (9, p 60). The collec- only 25%. Nevertheless, pulsed fluoroscopy offers
tive effective dose is the sum of the effective doses reduced exposure rate and improved image quality
for all members of a population. The unit is the person- compared with continuous fluoroscopy (sampling
sievert. C matches with 4 (1, p 496; 2, p 745). time for each frame is less with pulsed fluoroscopy).
Pulsed fluoroscopy can be performed at lower frame
Question 58. The maximum permissible dose for rates (10, 7.5, or 3 frames per second). Low frame
the hands is 500 mSv because the main concern for rates adversely affect the ability to display rapidly
the hands is not skin cancer but deterministic effects. moving structures. Option C is true (2, p 778; 11, pp
Maximum permissible dose is based on low-dose- 133–139). The design of the fluoroscopy system may
rate exposures, and nuclear power plant employees incorporate operator-selectable filtration. Substan-
have not contributed to the database for hand expo- tial reductions in skin dose, particularly for large
sure. The correct option is D (1, p 231). patients, can be achieved by inserting appropriate
metal filters (aluminum, copper, or other materi-
Question 59. The minimum age for occupationally als) into the x-ray beam at the collimator. Filtration
exposed workers is 18 years; option A is true (9, reduces skin dose by preferentially removing low-
p 53). It is assumed that medical radiation confers energy x rays, which generally do not penetrate the
some benefit, so it is not included in the dose al- patient to contribute to the image. Option D is true
lowed to a person occupationally exposed; option B (11, pp 133–139). The presence of a grid improves
is false (9, p 34). ALARA is intended to minimize oc- contrast by absorbing scattered x rays. However, the
cupational exposure; option C is false (9, p 43). The dose to the patient is increased by a factor of two
purpose of radiation protection for those occupation- or more. For pediatric cases, the removal of the grid
ally exposed is to prevent deterministic effects and reduces the dose, with little degradation of image
limit stochastic effects to levels that are acceptable quality. Grids should be used with discretion when
against a background of other risks in society; option fluoroscopic studies are performed on children.
D is true (9, p 9). These systems should have the capability for easy
removal and reintroduction of the grid. Option E is
Question 60. The patient attenuates a fraction of true (11, pp 133–139). In most interventional fluoro-
the incident x rays. This fractional reduction in x-ray scopic procedures, the x-ray beam is directed toward
intensity is essentially independent of the patient’s a particular anatomic region for the bulk of the
position between the x-ray source and image recep- fluoroscopic time. Some reduction in maximum skin
tor. Therefore, the automatic brightness control dose can be achieved by periodically rotating the
response is also independent of patient position. fluoroscope to image the anatomy of interest from a
Changing the source-to-skin distance from 20 inches different direction. This method tends to spread the
to 12 inches can increase the entrance exposure entry dose over a broader area, thereby reducing
rate by a factor of 2.8. Option A is true (2, p 778). the maximum skin dose. Option F is true (12, p 470).
Many modern fluoroscopy systems have the capabil- A magnified image (reduced field of view) typically
ity to freeze the last image on the monitor after the results in higher dose to the patient. There are two
x-ray exposure is terminated. This allows the physi- ways to magnify the image: geometric and electronic.
cian to study the last image and plan the next task The geometric method usually positions the patient
without radiation exposure to the patient. Option B closer to the x-ray source but can also be achieved
is true (2, p 778; 11, pp 133–139). During pulsed by moving the image receptor farther away from the
fluoroscopy, the x-ray beam is emitted as a series of patient. The technique factors are driven higher for
short pulses rather than continuously. For continu- electronic magnification because a smaller area of
ous fluoroscopy, the video display is a constant 30 the image receptor is utilized for image formation.
frames per second. At reduced frame rates, sub- Each method increases the entrance exposure rate.
stantial dose reduction can be achieved. Images can Options G and H are false (2, p 237).
be acquired at 15 frames per second rather than

Question 61. The use of protective clothing (aprons Question 62. On September 30, 1994, the FDA
and thyroid collars) in addition to ceiling-mounted issued a Public Health Advisory regarding radiation-
lead glass shields is well documented (2, p 771). The induced skin injuries from fluoroscopic procedures.
transmission of x rays through radiation-attenuat- These injuries are usually delayed, so the physician
ing surgical gloves is typically stated as 60%–70% cannot discern damage by observing the patient
at 80 kVp. In clinical practice, this value is higher immediately after the treatment. The radiation dose
(less attenuating) because of beam geometry differ- required to cause skin injury is typically 3 Gy for
ences. By comparison, devices made with 0.5-mm erythema (onset 1–2 days after exposure) and tem-
lead-equivalent material have a transmission of 2%. porary epilation (onset 2–3 weeks after exposure).
Radiation-attenuating surgical gloves offer minimal Additional fluoroscopy time above the threshold dose
protection of the operator’s hands. The instanta- increases the severity of the skin injury: a dose of 6
neous dose from scatter radiation is reduced some- Gy for main erythema (onset 10 days after exposure)
what when the hands covered with one layer of glove and a dose of 15–20 Gy for moist desquamation
material are located near the radiation field. Howev- (onset 4 weeks after exposure). Vascular damage
er, the total time near the radiation field depends on is expected for skin doses above 20 Gy. The proce-
the speed at which the procedure is performed, as dures of concern are primarily interventional pro-
well as the distance from the imaged anatomy when cedures during which fluoroscopy is used to guide
the x-ray beam is activated. The increased thickness instruments. The dose rate to the skin from the direct
of these gloves reduces dexterity and therefore can beam is typically between 1 and 3 rad/min (10–30
increase procedure time. The automatic brightness mGy/min) for continuous fluoroscopy. The maximum
control system in fluoroscopy increases the radia- exposure rate permitted by the FDA is 10 R/min. The
tion output to penetrate the glove when the hand dose rate is usually reduced if pulsed fluoroscopy
is present in the beam. This can be confirmed by is employed. For units with a high-level fluoroscopy
noting that anatomy is seen even though the glove is mode of operation, the maximum exposure rate to
present. The dose to the hand is comparable to that the skin from the direct beam is 20 R/min. Risk of
when the radiation-attenuating glove is not present. skin injury is associated with prolonged fluoroscopy
time. The time required to deliver a threshold dose
The following statements are from “Teaching Radiation for temporary epilation is typically greater than 1.5
Safety to Invasive Fluoroscopists” by S. Balter, PhD hours in fluoroscopy (0.03 Gy/min). At maximum
(12): exposure rate, the time to deliver this dose to a
single skin site is 30 minutes in normal mode and
Radiation-attenuating surgical gloves are available. 15 minutes in high-level fluoroscopy mode. Large
They offer minimal protection to the operator’s hands. patients are more susceptible to skin injury because
(There is a real myth around that these gloves elimi- automatic brightness control automatically changes
nate hand exposure.) The automatic exposure control
(without operator intervention) the technique factors
system often increases radiation output to “penetrate”
the gloves. Anatomy is seen through 2, 4, or 6 layers
to increase the x-ray output. The correct option is C
of glove material. The operator’s hand is covered by a (1, p 205; 2, p 830; 13, p 2).
single layer of glove material.
The cost of radiation-attenuating surgical gloves and

the minimal dose reduction do not justify the use
of these devices in a risk-versus-benefit radiation
protection analysis. Radiation-attenuating surgical
gloves provide a false sense of protection and are
not recommended. The correct option is D (12, p 471).

Question 63. Since ultrasound is nonionizing radia- Question 66. Pregnant health care workers have
tion, no radiation dose is delivered to the fetus (2, p not been shown to be at increased risk of adverse
13). Scattered radiation to the fetus from a head CT outcomes from exposure to static magnetic fields.
examination is less than 0.01 mGy (2, pp 802–803). Although pregnant health care practitioners are per-
The entrance exposure for a KUB radiograph is mitted to work in the MR environment, they should
usually about 300 mR. By using a dose conversion not remain within the magnet room during data
factor of 0.2 rad/R for the fetus (depends on beam acquisition/imaging. The recommendation to exit the
quality, patient size, and field size), the dose per MR magnet room during data acquisition/imaging is
radiograph is estimated to be 60 mrad (0.6 mGy). not based on reported studies of potential adverse
The chest radiographic examination is a very low- effects but is a conservative approach based on a
dose procedure requiring only an entrance exposure recognition that there are insufficient data regarding
of 10–40 mR (0.1–0.4 mGy) for the posteroanterior the effects of MR electromagnetic fields. Positioning
projection and slightly more for the lateral projection patients, imaging, archiving, injection of contrast agent,
(2, p 798). Scattered radiation to the fetus would be and entering the MR magnet room in response to an
considerably lower. The correct option is D (2, p 798; emergency are considered acceptable activities for
6, p 451). the pregnant health care worker. The correct option
is B (14, p 9; 15, pp 178–179).
Question 64. For a declared pregnancy, the dose
limit to the fetus is 500 mrem (5 mSv). For fluoros- Question 67. On the basis of the currently available
copy, portable radiography, and nuclear medicine data, there is no association of cancer or any other
imaging, the dose to the conceptus from occupational deleterious effect with the use of clinical MR imaging
exposure to the mother will very likely be less than during pregnancy. The ACR has adopted the policy
5 mSv if proper radiation protection practices are that MR procedures may be performed during any
followed. Radioiodine treatments with I-131 sodium stage of pregnancy if medically indicated. The use
iodide are considered to place the fetus at higher of ultrasound, the desired information and effect on
probability of exceeding 5 mSv and are potentially the management of the patient, and the potential for
very hazardous in terms of uncontrolled release of delay are appropriate considerations for the selec-
the radioactive material. The fetal thyroid takes up tion of a pregnant patient for MR imaging. The MR
radioiodine after age 12 weeks. The correct option procedure is considered appropriate if the informa-
is B (8, pp 29–31). tion requested addresses the clinical problem or is
necessary to manage potential complications for the
III. Magnetic Resonance Imaging patient and/or fetus; that is, the results of the MR
examination can potentially affect the care of the
Question 65. Actively shielded magnets are designed patient and/or fetus during the pregnancy. The risk to
to decrease the surrounding fringe field so that siting the fetus from gadolinium-based contrast agents is
concerns are reduced. Nevertheless, a strong mag- unknown and may be harmful. MR contrast agents
netic field is present in the magnet room. Ferromag- should not be routinely administered to pregnant
netic materials (oxygen tanks, hemostats, scissors, patients. The ACR makes no recommendation
etc) brought into the magnet room can become regarding appropriate pulse sequences or imaging
airborne as projectiles in the static magnetic field. parameters. The correct option is A (14, p 9).
Projectiles pose a serious risk to the patient and
others in the magnet room. Patient screening and
staff training are the most effective methods to exclude
ferromagnetic materials from the magnet room.
However, new ferromagnetic detection systems are
capable of detecting small ferromagnetic objects
external to the patient and can now differentiate
between ferromagnetic and nonferromagnetic mate-
rials. The ACR recommends ferromagnetic detection
systems as an adjunct to screening of patients and
devices. The correct option is A (14, p 4).

Question 68. The vast majority of patients with NSF Question 71. The need for controlled access is based
were receiving therapy with dialysis or had stage 4 on the potential risk from the attraction of objects
or 5 renal disease at the time of MR imaging with containing ferromagnetic materials, torque on metallic
gadolinium-based contrast agents. The population materials, and the possible dysfunction of medical
at risk can be identified by an additional question implants for persons with such devices inadvertently
regarding a history of renal disease or dialysis. entering the area. Control may be established by
Prospective hematologic screening is not warranted. barriers or signs based on the manufacturer’s recom-
Option A is false. No special treatment is recommendations. The correct option is B (16, p 27).
mended for patients with stage 1 or 2 chronic kidney
disease (defined as GFR > 90 mL/min/1.73 m2 or Question 72. Significant risk criteria were developed
GFR between 60 and 89 mL/min/1.73 m2 ). However, by the FDA to include static magnetic field over 4 T,
gadodiamide (Omniscan) is not recommended for RF exposure sufficient to produce a core temperature
a patient with any level of renal disease. Option B increase of 1°C, time-varying magnetic fields (dB/dt)
is true. A risk-benefit assessment for that particular sufficient to produce severe discomfort or painful
patient with stage 3, 4, or 5 renal disease should in- stimulation, and peak acoustic noise over 140 dB. All
dicate a clear benefit for the administration of a gad- options are true (16, p 6).
olinium-based contrast agent. The default standard
dose for these patients should be one-half the usual Question 73. During MR imaging, the patient absorbs
dose. A written order from the radiologist approving a portion of the transmitted RF energy, which results
the examination is recommended. Informed consent in tissue heating. This could cause an elevation of
should also be provided. Under these conditions, core body temperature or a skin burn by localized
option C is true. If patients with severe to end-stage heating. The specific absorption ratio (SAR) is the
renal disease receive gadolinium-based contrast dosimetric means by which RF power absorbed per
agents, prompt dialysis following MR imaging should unit mass is characterized. The FDA has set limits for
be considered. Option D is true (14, p 9). SARs to limit whole-body and local temperature rise.
The SAR should not exceed 4 W/kg for the whole
Question 69. All implanted intracranial aneurysm body for 15 minutes, 3 W/kg averaged over the head
clips composed of titanium and/or titanium alloy are for 10 minutes, 8.0 W/kg in 1 g of tissue (head or
acceptable for MR imaging without any additional torso) for 15 minutes, and 12 W/kg in 1 g of tissue
testing. However, documentation of the composition (extremities) for 5 minutes. Alternatively, RF heat-
in writing is necessary. The correct option is C ing is considered acceptable if the core temperature
(14, pp 5, 11, 16). increase is less than 1°C and local heating is no
greater than 38°C in the head, 39°C in the trunk, and
Question 70. Quenching is the loss of superconduc- 40°C in the extremities. The SAR is proportional to
tivity of the magnet coils, which is accompanied by the number of images acquired per unit of time and
the rapid escape of helium as evidenced by clouds depends on patient dimensions, RF waveform, tip
or fog around the MR imager. Helium will displace angle, and coil type. Patient heating also depends on
oxygen in the room. All magnet rooms should have ambient temperature, relative humidity, airflow rate,
helium-venting equipment. The ACR, citing reliability blood flow, and patient insulation. The correct option
concerns, does not currently recommend oxygen is B (2, pp 465–467; 15, p 56; 16, p 6).
monitors in the magnet room. An uncontrolled quench
is an emergency situation requiring the rapid removal Question 74. Gradient magnetic fields are rapidly
of all personnel/patients from the magnet room. Site applied by passing currents through the gradient
access must be restricted until the magnetic field has coils. In the presence of the static magnetic field,
dissipated. The correct option is D (14, pp 11–12). a current in the gradient coil creates a force on the
coil, which causes the coil to vibrate. The mountings
for coils also flex and vibrate in response to move-
ment of the gradient coils. The result is acoustic
noise in the form of loud knocking. The correct option
is C (15, p 119).

Question 75. Rapidly switched gradients allow IV. Ultrasound
improved image quality and faster acquisition. The
potential physiologic response includes peripheral Question 78. The instantaneous intensity (i) is
nerve stimulation, muscle movement, and discomfort. determined from the measured acoustic pressure (p)
The thresholds for cardiac stimulation and brain stim- by using the equation,
ulation are much greater than for peripheral nerve p2
stimulation and are unlikely to occur with current MR i = ,
ρc
systems. The correct option is C (15, pp 31–53).
where c is the speed of sound, and ρ is the density of
Question 76. Focal heating and thermal injuries the medium. Intensity parameters, such as (a) spatial
have been induced by time-varying RF magnetic peak, temporal average intensity and (b) spatial
fields during MR examination. The presence of a average, temporal average intensity, are typically
conductive loop (crossed arms, ECG leads or un- derived by averaging the instantaneous intensity with
connected surface coil leads in contact with patient’s respect to space, time, or both. Frequently, pulsed-
skin, etc) can produce induced electrical currents, wave ultrasound is characterized by a peak negative
which can cause thermal injury. Near the inner bore pressure (expressed in megapascals). The peak
of the magnet, high levels of RF standing waves may negative pressure is also called the peak rarefac-
form. The patient must be positioned so that there is tional pressure. The correct option is A (18, p 296).
no direct contact between the patient’s skin and the
inner bore of the magnet. Absorption of RF energy Question 79. Relative measurement of intensity
by the metallic object creates a heated surface, compares the value at one point with a reference
which can cause local temperature elevations. The intensity and is expressed on a logarithmic scale in
correct option is E (14, pp 10–11; 17). units of decibels (dB). The intensity change or level
in decibels is
Question 77. At magnetic field strengths below 4 T,
no deleterious biologic effects (either acute or chronic) Level (dB) = 10 log  I  ,
Iref
have been identified. At magnetic field strengths
above 4 T, magnetophosphenes and vertigo have where I is the intensity at the point of interest, and
been reported. The two major concerns associated I ref is the reference intensity. If the intensity at the
with the static magnetic field are forces exerted on point of interest equals one-half the reference
ferromagnetic objects (either rotational or attractive) intensity, then the level in decibels calculated by 10
and magnetically sensitive equipment whose func- log (0.5) is –3 dB. The correct option is E (18, p 25).
tion may be disrupted. The correct option is D (2, pp
465–467; 17). Question 80. The “Standard for Real-time Display of
Thermal and Mechanical Acoustic Output Indices on
Diagnostic Ultrasound Equipment” was adopted by
the AIUM and NEMA in 1992, with minor revisions in
1996 and 1998. This benchmark, which has become
known as the output display standard (ODS), devel-
oped a formalism to calculate in real time the effect
of operator-selected parameters on acoustic output.
Two acoustic output parameters, the thermal index
(TI) and the mechanical index (MI), were devised.
The TI, in essence, gives the maximum temperature
rise in tissue caused by energy absorption, and the
MI describes the likelihood of cavitation based on
peak rarefactional pressure and frequency. The cor-
rect option is C (19).

Question 81. The thermal index indicates the Question 85. Cavitation is more likely to occur at
maximum temperature rise in tissue based on a high pressures and low frequencies. Scientific re-
homogeneous tissue model and instrument param- search has indicated that cavitation-induced effects
eters (power, transducer aperture, beam dimen- may be possible at peak pressures and frequencies
sions, and scanning mode). The correct option is A within the operational range of diagnostic equipment.
(18, pp 320–321). Specifically, lung and intestinal hemorrhages in
mice have been reported at diagnostic output levels.
Question 82. The heat production rate in a small The mechanical index equals the peak rarefactional
volume is determined by the absorption coefficient pressure in tissue divided by the square root of the
of the tissue and the time-averaged intensity of the frequency and is expressed as a dimensionless
ultrasound beam, which depends on the pulse rep- quantity. For water, cavitation has not been observed
etition frequency and power. The rate of absorption if the mechanical index is less than 0.7 over the
for most tissues increases linearly with frequency. frequency range 1–10 MHz. The correct option is C
Variations in the heat production rate occur because (18, p 326).
of different tissue types and nonuniformity of the
ultrasound field. The initial rate of temperature rise Question 86. The Bioeffects Committee of the AIUM
cannot be maintained. Heat removal by conduction was established to examine the current knowledge
and perfusion quickly slows the rate of temperature concerning bioeffects and to assess the risk of clini-
rise. Focused beams create small localized regions cal diagnostic ultrasound. This committee regularly
of heating. The removal of heat from small volumes publishes critiques of research reports and issues
is very rapid. Continuous insonation ultimately statements regarding the safety of diagnostic ultra-
produces a steady-state condition in which the sound. Its conclusions are acknowledged to be
maximum temperature does not change. Results of safety guidelines throughout the ultrasound com-
experiments quantifying the heating of rat skull bone munity. The history and rationale for this statement
exposed to a focused ultrasound beam form the are provided in Bioeffects and Safety of Diagnostic
basis for thermal models involving the insonation of Ultrasound (21). The correct option is A (21).
bone. The correct option is E (18, p 318).
Question 87. Cavitation can be either stable or
Question 83. Thermal-induced damage is a thresh- transient. In stable cavitation, microbubbles already
old phenomenon; that is, no biologic effects are present in the medium expand and contract dur-
observed unless the temperature elevation exceeds ing each cycle in response to the applied pressure
a particular value for a minimum time duration. For oscillations. The bubbles may also grow as dissolved
example, a temperature increase of 2.5°C must be gas leaves the solution during the negative-pressure
present for 2 hours to cause fetal abnormalities. At phase, a process called rectified diffusion. Each bub-
higher temperatures, the time necessary to induce ble oscillates about the expanding radius for many
damage is shortened dramatically (eg, at 43°C, the cycles without collapsing completely. At a character-
time decreases to 1 minute). The correct option is D istic frequency (which is a function of the size of the
(20, p 31). bubble), the vibration amplitude of neighboring liquid
particles is maximized. Transient cavitation is a more
Question 84. Time-gain compensation (TGC) and violent form of microbubble dynamics in which short-
gray-scale mapping do not affect acoustic output. lived bubbles undergo large size changes over a few
TGC is a processing technique during acquisition acoustic cycles before completely collapsing. During
which applies variable amplification to the detected the rarefaction phase, bubbles may be formed by
signal based on time delay since the transmitted dissolved gases leaving the solution, or bubbles of
pulse. Gray-scale mapping is a postprocessing submicron dimensions may already exist in the
technique which translates echo signal strength into medium. The correct option is B (18, p 303).
brightness level in the displayed image. The correct
option is H (18, pp 155–167, 293–297).

Question 88. Three thermal indices corresponding Question 90. Based on bioeffects data and clinical
to soft tissue (TIS), bone (TIB), and cranial bone efficacy, as well as psychosocial, economic, and
(TIC) have been developed depending on whether legal/ethical issues, the NIH panel concluded that
bone is encountered along the path and, if it is, ultrasound examination in pregnancy should be
whether bone is located near the transducer or in the performed for a specific medical indication. A recom-
interior of the body. TIS applies when the ultrasound mendation for routine screening was not justified
beam passes through soft tissue only and bone is by data on clinical efficacy and safety. Specifically,
not present (examinations of the abdomen and fetus there is not enough evidence that routine screening
during the first trimester). If bone is encountered benefits either the mother or the fetus. There is no
near the transducer, then TIC is used (examina- evidence showing potential damage to either mother
tions of pediatric and adult head). TIB applies if the or fetus from routine screening. The correct option is
ultrasound beam, after passing through soft tissue, B (23, pp 3–12).
impinges on bone near the focal zone (examinations
of the fetus during the second and third trimesters). Question 91. The acoustic pressure or temperature
The correct option is B (18, p 320). rise at the site of interest may be either under-
estimated or overestimated by the acoustic output
Question 89. Epidemiologic studies and surveys of parameter, and therefore the knowledgeable user
clinical experience have yielded no firm evidence must consider the nature of the clinical situation in
of any adverse effects from in utero ultrasound order to make an informed judgment. The NCRP
exposure. An association of diagnostic ultrasound recommends the risk-benefit decision if the MI
with low birth weight, dyslexia, and delayed speech exceeds 0.5 or the TI exceeds 1.0. The correct
development has been reported in some studies. option is C (22, p 432).
However, the majority of epidemiologic studies have
been negative for any bioeffect. The correct option is
D (22, pp 425–427).

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 Radiation Biology Syllabus for Diagnostic and Interventional Radiologists 2007

The Radiological Society of North America is a nonprofit organization.

2007 Radiation Biology Syllabus for Diagnostic and Interventional Radiologists 

Instructions for Sample Questions

 Radiation Biology Syllabus for Diagnostic and Interventional Radiologists 2007

2007 Radiation Biology Syllabus for Diagnostic and Interventional Radiologists 

 Radiation Biology Syllabus for Diagnostic and Interventional Radiologists 2007

2007 Radiation Biology Syllabus for Diagnostic and Interventional Radiologists 

 Radiation Biology Syllabus for Diagnostic and Interventional Radiologists 2007

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I. Radiation 17. A-False 30. A-False 40. A-False

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I. Radiation Biology/Effects Question 5. Lymphocytes from a blood sample can

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The cost of radiation-attenuating surgical gloves and

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