Principles and Practice of Radiation Therapy 4th Edition Test Bank

Name: Principles and Practice of Radiation Therapy 4th Edition Test Bank
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Principles and Practice of Radiation Therapy 4th Edition Test Bank strengthens your knowledge with concise summaries, formulas, and exam-style problems.

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Chapter 01: Cancer: An Overview
Washington & Leaver: Principles and Practice of Radiation Therapy, 4th Edition
MULTIPLE CHOICE
1. Knowledge of cancer dates back to which of the following?
a. 1600 BC Egypt
b. 1600 AD England
c. 400 BC Greece
d. 1900 AD Germany
ANS: A
The first known observations of cancer date back to 1600 BC Egypt.
REF: p. 3
2. Which of the following is not a term for genes involved in the cancer process?
a. Anti-oncogenes
b. Oncogenes
c. Proto-oncogenes
d. Somato-oncogenes
ANS: D
Anti-oncogenes, oncogenes, and proto-oncogenes have all been identified as playing a part in
the development of tumors. Somato-oncogenes do not exist.
REF: p. 3
3. Tumor-suppressor genes are also known as ___________.
a. anti-oncogenes
b. oncogenes
c. proto-oncogenes
d. somato-oncogenes
ANS: A
Although more commonly called tumor-suppressor genes, these genes are also known as
anti-oncogenes.
REF: p. 3
4. Which of the following is not a phase of the mammalian cell cycle?
a. G0
b. G1
c. G2
d. G3
ANS: D
G0 is a resting phase where cells do not enter mitosis. G1 and G2 are growth phases during
the mammalian cell cycle. Although some algae species demonstrate a relatively long phase
between nuclear division and cleavage of the cell termed G3, this phase is not part of the
mammalian cell cycle.

REF: pp. 3-4
5. Which phase of the mammalian cell cycle is composed of functional cells not preparing for
DNA replication?
a. G0
b. G1
c. G2
d. S
e. M
ANS: A
G0 is typically depicted outside the cell cycle because cells in this phase are not preparing for
DNA synthesis.
REF: pp. 3-4
6. In which phase of the mammalian cell cycle does DNA synthesis occur?
a. G0
b. G1
c. G2
d. S
e. M
ANS: D
“S” is representative of synthesis and is the phase in which DNA synthesis occurs.
REF: p. 4
7. Identify the correct order for the phases of the mammalian cell cycle.
a. G1, G2, M, S
b. G1, G2, S, M
c. G1, M, G2, S
d. G1, S, G2, M
ANS: D
The typical mammalian cell will move from G1 to S, followed by G2, and then M. Some cells
will eventually pause in G0 after M.
REF: pp. 3-4
8. Which of the following is true of anaplastic tumors?
a. Closely resemble the cells of origin
b. Maintain some resemblance of the cells of origin
c. Do not resemble the cells of origin
ANS: C
Anaplastic tumors are also known as undifferentiated tumors. Undifferentiated cells do not
resemble the normal cells of origin.
REF: p. 4

9. Which of the following is (are) true of benign tumors?
a. Well differentiated
b. Do not metastasize
c. Encapsulated
d. All of the above
ANS: D
Benign tumors typically are well differentiated, do not metastasize, and are encapsulated.
REF: p. 4
10. Which of the following factors does not affect the incidence of tumor sites?
a. Informational
b. Environmental
c. Technological
d. Geographic
ANS: A
Tumor site incidence is affected by environmental factors such as sun exposure. It is also
affected by technological factors such as the advent of more precise imaging modalities.
Additionally, tumor site incidence is affected by geographic factors, as exemplified by
gastrointestinal cancers in Japan.
REF: pp. 5-6
11. What is defined as the “study of the cause of disease”?
a. Etiology
b. Etymology
c. Epidemiology
d. Entomology
ANS: A
Etiology is defined as the “study of the cause of disease.” Etymology is the “study of word
origins,” epidemiology is the “study of disease incidence,” and entomology is the “study of
insects.”
REF: p. 5
12. What is the “study of disease incidence”?
a. Etiology
b. Etymology
c. Epidemiology
d. Entomology
ANS: C
Epidemiology is defined as the “study of disease incidence.” Etiology is the “study of the
cause of disease,” etymology is the “study of word origins,” and entomology is the “study of
insects.”
REF: p. 6
13. Which of the following make(s) for an effective screening examination?

a. Specific
b. Sensitive
c. Cost-effective
d. Accurate
e. All of the above
ANS: E
For a screen tool to be effective, it must be specific, sensitive, accurate, and cost effective.
REF: p. 6
14. What is the “workup”?
a. The initial nursing visit
b. The initial physician visit
c. A series of diagnostic examinations
d. A physical assessment of the patient
ANS: C
Although the term workup may be used by different radiation oncology departments in
various ways, the generally accepted definition of this term is a series of diagnostic
examinations performed after a patient has been diagnosed with a disease or condition. This
may be done at the time of the initial physician or nurse visit and may include a physical
assessment, but these are only portions of the entire workup.
REF: p. 6
15. Which of the following is not typically part of the workup?
a. Patient demographics
b. Type, location, and size of tumor
c. Normal tissue invasion
d. Presence of metastases
ANS: A
The workup includes information about the tumor such as type, size, and location, amount of
normal tissue invasion, and presence of metastases. Typically, demographic information is
collected at a time other than during the workup by support staff.
REF: pp. 6-7
16. Which imaging modality is beneficial for distinguishing between recurrent disease and other
tissue changes post treatment?
a. CT
b. PET
c. Plain films
d. MR
ANS: B
Although a CT or MR scan may be used as part of the diagnostic process for ruling out
recurrent disease, PET is the only imaging modality listed that can differentiate recurrence
from other tissue changes.
REF: p. 7

17. What is the most common tumor staging system?
a. AJCC
b. FIGO
c. TNM
d. UICC
ANS: C
TNM is the most commonly used staging system. This system has been adopted by AJCC and
UICC. FIGO is the staging system used for gynecologic tumors but has no application to the
majority of tumors.
REF: p. 7
18. A T1N0MX tumor has how many positive lymph nodes?
a. 0
b. 1
c. 2
d. Unknown
ANS: A
N0 is an indication of no positive lymph nodes.
REF: p. 7
19. Tumors are the result of which of the following?
a. Black bile
b. Necrotic tissue
c. Abnormal cellular proliferation
d. Traumatic injury
ANS: C
Once thought to be the result of black bile or traumatic injuries, tumors are now known to be
the result of abnormal cellular proliferation. Tumor growth may result in a large central area
of necrosis, but this is an effect rather than a cause.
REF: p. 3
20. Tumor grade is a measure of ________.
I. aggressiveness
II. differentiation
III. spread
a. I and II
b. I and III
c. II and III
d. I, II, and III
ANS: A
Tumor grade is a measure of both aggressiveness and differentiation. Staging is used to
describe the tumor’s spread.
REF: pp. 7-8

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21. Which of the following biopsy methods results in the removal of the entire tumor?
a. Fine needle aspiration
b. Core needle
c. Incisional
d. Excisional
ANS: D
During a fine needle aspiration, only a few cells of the tumor are removed. The same is true of
core needle biopsies. Incisional biopsies remove more tumor than either fine needle aspiration
or core needle biopsy, but some of the tumor remains. During an excisional biopsy, the entire
tumor is removed en bloc.
REF: pp. 8-9
22. Which of the following biopsy methods cannot evaluate tumor architecture?
a. Fine needle aspiration
b. Core needle
c. Incisional
d. Excisional
ANS: A
Fine needle aspiration removes cells from a tumor but cannot retain the architecture of the
tumor.
REF: pp. 8-9
23. Factors that may exclude a patient from having surgery include all except which of the
following?
a. Preexisting medical conditions
b. Tumor location
c. Patient preference
d. Classification
ANS: D
The invasive nature of surgical procedures for cancer removal may exclude some patients
with preexisting conditions. In addition, the location of some tumors (such as base of skull
lesions) may eliminate surgery as a possible treatment option. Furthermore, surgery may be
excluded in an attempt to preserve function, as in the treatment of anal cancers. Tumor
classification alone is not a contraindication for surgery.
REF: pp. 9-10
24. When compared with surgery, benefits of radiation therapy include all except which of the
following?
a. Instantaneous cure
b. Better cosmetic results
c. Preservation of function
d. Noninvasive
ANS: A

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Individual results will vary based on tumor type and other factors but, as a general rule,
radiation therapy provides patients with better cosmetic results than surgery. In addition,
radiation therapy is noninvasive and can often preserve function not possible with surgery.
However, only surgery can provide an instantaneous cure via total resection.
REF: p. 10
25. Which of the following treatment techniques uses radioactive sources?
a. External beam
b. Intraoperative
c. Brachytherapy
d. IMRT
ANS: C
Typically, brachytherapy treatments require a radioactive source, although advances in
nanotechnology have resulted in some brachytherapy procedures using miniature x-ray tubes.
In times past, radioactive cobalt was used in external beam radiation therapy, but this process
is now antiquated.
REF: p. 11
26. Which of the following is not used for brachytherapy treatments?
a. Cesium
b. Cobalt
c. Iodine
d. Iridium
ANS: B
Although some reports document the use of cobalt for brachytherapy, it is traditionally used
for external beam radiation therapy.
REF: p. 11
27. High-dose after loading equipment is used in association with which treatment technique?
a. External beam
b. Intraoperative
c. Brachytherapy
d. IMRT
ANS: C
High-dose after loading equipment is used during brachytherapy treatments to reduce staff
exposure to high doses of radiation.
REF: p. 11
28. Pancreatic cancer may be treated using which technique?
a. Intraluminal
b. Intravascular
c. Intracavitary
d. Intraoperative
ANS: D

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Although pancreatic cancer can be treated with radiation therapy by a number of different
techniques, including 3D conformal, IMRT, and IGRT, it can also be treated using an
intraoperative technique. Intraluminal, intravascular, and intracavitary are brachytherapy
techniques not used for the treatment of pancreatic cancer.
REF: pp. 10-11
29. Which of the following is a systemic treatment?
a. Surgery
b. Radiation therapy
c. Chemotherapy
d. All of the above
ANS: C
Radiation therapy and surgery are localized treatments, whereas chemotherapy is a systemic
treatment.
REF: p. 11
30. Which of the following routes of administration is used when treating bladder cancer with
chemotherapy?
a. Oral
b. Intra-arterial
c. Intracavitary
d. Intrathecal
ANS: C
As described in the text, bladder cancer may be treated by instilling the chemotherapy agent
directly into the bladder via a catheter. This process is known as intracavitary chemotherapy.
REF: p. 12
31. Which classification of chemotherapy agents was the first to be identified as having anticancer
activities?
a. Alkylating agents
b. Antimetabolites
c. Antibiotics
d. Hormonal agents
e. Nitrosoureas
f. Vinca alkaloids
ANS: A
The first chemotherapy agent was nitrous mustard, an alkylating agent.
REF: p. 12
32. Which of the following are not cell cycles specific?
I. Alkylating agents
II. Antimetabolites
III. Antibiotics
IV. Hormonal agents
V. Nitrosoureas

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VI. Vinca alkaloids
a. I and II
b. I and III
c. I, III, and V
d. II, IV, and VI
e. II, III, and VI
ANS: C
Alkylating agents are not cell cycle specific. Neither are anticancer antibiotics (although they
are more effective during certain phases) nor nitrosoureas.
REF: p. 12
33. Which classification of chemotherapy agents is derived from the periwinkle plant?
a. Alkylating agents
b. Antimetabolites
c. Antibiotics
d. Hormonal agents
e. Nitrosoureas
f. Vinca alkaloids
ANS: F
Periwinkle plants are part of the genus Vinca and are sometimes called vinca. It is from these
plants that vinca alkaloids are derived.
REF: p. 12
34. In which classification are the chemotherapy agent’s lipids soluble and capable of crossing the
blood-brain barrier?
a. Alkylating agents
b. Antimetabolites
c. Antibiotics
d. Hormonal agents
e. Nitrosoureas
f. Vinca alkaloids
ANS: E
Nitrosoureas are the only classification of chemotherapy agents that are both lipid soluble and
capable of passing through the blood-brain barrier.
REF: p. 12
35. Which of the following is a radiosensitizing chemotherapy agent?
a. Cyclophosphamide
b. 5-Fluorouracil
c. Doxorubicin
d. Cisplatin
ANS: C
Doxorubicin, also known as Adriamycin, acts a radiosensitizer. Cyclophosphamide,
5-fluorouracil, and cisplatin are not known to enhance the effects of radiation.

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REF: p. 14
36. Which of the following acts as a radioprotector?
a. Amifostine
b. Actinomycin D
c. Adriamycin
d. Etoposide
ANS: A
Amifostine acts to protect normal tissue against the effects of radiation and is, therefore,
considered a radioprotector. Adriamycin is a radiosensitizer. Actinomycin and etoposide are
not known to be radioprotectors.
REF: p. 14
37. Injecting monoclonal antibodies is an example of which type of treatment?
a. Surgery
b. Radiation therapy
c. Chemotherapy
d. Immunotherapy
ANS: D
Injection of monoclonal antibodies is an example of immunotherapy.
REF: p. 14
38. Which of the following best describes tumor spread?
a. Exophytic
b. Multicentric
c. Dissemination
d. Ulceration
ANS: C
Dissemination is defined as the act of spreading or diffusion and is most closely associated
with cancer spread. Exophytic is used to describe tumors that grow outward. Multicentric
describes tumors with more than one focus. Ulceration is the development of an ulcer and is
unassociated with cancer spread.
REF: p. 15
39. Which of the following factors is not considered when determining a prognosis?
a. Tumor stage
b. Nodal status
c. Gender
d. All are considered
ANS: D
Many factors are considered when a physician determines a prognosis, including tumor site,
grade, stage, size, and histology; lymph node status; performance status; and the patient’s age,
gender, and race.
REF: pp. 15-16

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40. Randomized studies are, by definition, which phase?
a. I
b. II
c. III
d. IV
ANS: C
Phase III studies are used to compare an experimental treatment to a standard treatment using
a randomized sample.
REF: p. 16
41. Which staff member is most responsible for designing the patient’s treatment plan?
a. Medical physicist
b. Radiation oncologist
c. Dosimetrist
d. Radiation therapist
ANS: C
Specific duties will vary between specific departments, but as a general rule the medical
dosimetrist is responsible for designing the patient’s treatment plan. The medical physicist or
radiation oncologist may oversee this process. In some departments, radiation therapists
participate in the treatment planning process.
REF: pp. 16-17
42. Which staff member is most responsible for the quality assurance to the treatment equipment?
a. Medical physicist
b. Radiation oncologist
c. Dosimetrist
d. Radiation therapist
ANS: A
Although all members of the cancer treatment team are responsible for quality assurance and
the radiation therapists and medical dosimetrists may perform some of the duties specific to
treatment equipment quality assurance, the person most responsible is the medical physicist.
REF: pp. 16-17
43. Which of the following is an example of an etiologic factor?
a. Gender
b. Sex
c. Race
d. Social habits
ANS: D
An etiologic factor would be one associated with the cause of cancer. Social habits such as
smoking and alcohol use have been linked to the cause or elevation of the risk of certain
cancers.
REF: pp. 5-6

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44. A cancer designated with an N1 classification using the TNM staging system likely indicates
which of the following?
a. No positive lymph nodes are involved.
b. Positive lymph nodes are involved at distant sites.
c. Positive lymph nodes are involved near the site.
d. Lymph nodes cannot be accessed.
ANS: C
The N category describes the status of lymph node involvement. Nx, N0-N4 are often used.
N1 likely indicates that one or more positive lymph nodes are involved close to the original
site of malignancy.
REF: p. 7

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Chapter 02: The Ethics and Legal Considerations of Cancer Management
Washington & Leaver: Principles and Practice of Radiation Therapy, 4th Edition
MULTIPLE CHOICE
1. What is the study of ethical issues in medicine?
a. Biometrics
b. Bioethics
c. Macro ethics
d. Micro ethics
ANS: B
Bioethics is defined as the application of ethics to medicine, nursing, and health care.
Biometrics is a branch of biology that studies biological phenomena and observations by
means of statistical analysis. Micro ethics consider individuals and internal relations of the
specific situations, whereas macro ethics applies to the collective social responsibility and to
societal decisions.
REF: p. 25
2. Which of the following is not a sanctionable offence by the American Registry of Radiologic
Technologists (ARRT)?
a. Failure to participate in professional activities, share knowledge with colleagues,
and investigate new aspects of professional practice
b. Impersonation of a candidate for the examination
c. Failure to perform radiation therapy procedures with reasonable skill and safety
d. Knowingly assisting, aiding, or allowing a person without a current certificate of
registration with the ARRT to engage in the practice of radiologic technology, in a
jurisdiction that requires such registration
ANS: A
Although participation in professional activities, sharing knowledge, and researching new
aspects of professional practice result in professional growth and other benefits, failure to be
involved in any of these activities is not a sanctionable offense by the ARRT.
REF: pp. 23-24
3. Which of the following is a theory of ethics developed by Immanuel Kant?
a. Virtue ethics
b. Communitarianism
c. Contextual ethics
d. Deontology
ANS: D
In its purest form, deontology was developed by Immanuel Kant.
REF: p. 26
4. Who is most closely associated with the stages of grief?
a. Nel Noddings

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b. Elisabeth Kübler-Ross
c. John Mill
d. Immanuel Kant
ANS: B
In 1969, in her book titled On Death and Dying, Dr. Elisabeth Kübler-Ross described several
stages a patient passes through while dealing with grief.
REF: p. 31
5. Which group is responsible for producing the rules of ethics for radiation therapists?
a. American Registry of Radiologic Technologists (ARRT)
b. American Society of Radiologic Technologists (ASRT)
c. American Medical Association (AMA)
d. American Hospital Association (AHA)
ANS: A
The rules of ethics are part of the ARRT’s standards of ethics document. The ASRT has a
code of ethics for radiation therapists but no rules of ethics. The AMA and AHA do not have
any documents specific to radiation therapists.
REF: p. 21
6. Utilitarianism is an example of which broad group of ethical theories?
a. Teleology
b. Deontology
c. Virtue ethics
ANS: A
Utilitarianism is one of the two major divisions of teleology (with egoism).
REF: pp. 26-27
7. Jeremy Bentham and John Mill are most closely associated with which ethical theory?
a. Communitarianism
b. Egoism
c. Natural law ethics
d. Utilitarianism
ANS: D
Bentham and Mill are typically held to be the founders of utilitarianism as an ethical theory.
REF: pp. 26-27
8. What occurs when the obvious solution to a problem is prohibited by institutional constraints?
a. Ethical dilemma
b. Ethical dilemma of justice
c. Ethical distress
d. Locus of authority
ANS: C
Ethical distress occurs when a problem has an obvious solution, but institutional constraints
prohibit the application of the solution.

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REF: pp. 26-27
9. Allocation of scarce resources is an example of which ethical category?
a. Ethical dilemma
b. Ethical dilemma of justice
c. Ethical distress
d. Locus of authority
ANS: B
Ethical dilemmas of justice are problems associated with the distribution of benefits and
burdens, such as the allocation of scarce resources.
REF: p. 27
10. Which patient/provider relationship model is best represented by the informed consent
process?
a. Engineering
b. Priestly
c. Collegial
d. Contractual
e. Covenant
ANS: D
The contractual model is based on a business relationship model and includes a “contract,”
such as the informed consent form.
REF: p. 27
11. Which patient/provider relationship model devalues autonomy?
a. Engineering
b. Priestly
c. Collegial
d. Contractual
e. Covenant
ANS: B
The priestly model assumes that the caregiver knows what is best for the patient and does not
allow for the patient to provide input into the decision-making process.
REF: p. 27
12. Which of the following is not a source from which values are derived?
a. Money
b. Experience
c. Religion
d. Science
ANS: A
Although money may factor into many aspects of decisions, values are not derived from
money. Values are instead the result of culture, experience, religion, and science.

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