Radiation Therapy

Below are the ARRT category specifications for exam coverage.

ARRT Radiation Therapy exam categories

200 Total Questions
1. Patient Interactions
A. Ethical and Legal Aspects
1. patient’s rights
a. informed consent(*e.g., written, oral, implied)
b. confidentiality (HIPAA)
c. American Hospital Association (AHA) Patient Care Partnership (Patient’s Bill of Rights)
1. privacy
2. goal of care (e.g., definitive, palliative)
3. access to information
4. living will, advanced directive (e.g., DNR), health care proxy
5. research participation
2. legal issues
a. verification (e.g., patientidentification, treatment site, prescription)
b. common terminology (e.g., battery, negligence, malpractice, beneficence)
c. legal doctrines (e.g., respondeat superior, res ipsa loquitur)
d. restraints versus immobilization
3. ARRT Standards of Ethics
B. Interpersonal Communications
1. modes of professional communication
a. verbal/written
b. nonverbal (e.g., eye contact, touching)
2. challenges in communication
a. interaction with others
1. language barriers
2. cultural and social factors
3. physical or sensory impairments
4. age
5. emotional status, acceptance ofcondition (e.g., stage of grief)
b. explanation of medical terms
3. patient education
a. explanation of treatment
b. strategies to improve understanding
c. treatment compliance (e.g., positioning, skin marks)
4. support services
a. hospice
b. other professionals (e.g., dietitian, clergy, social services)
C. Physical Assistance
1. patient transfer and movement
a. body mechanics (e.g., balance, alignment, movement)
b. patient transfer techniques
c. fall prevention
2. assisting patients with medical equipment
a. infusion catheters and pumps
b. oxygen delivery systems
c. other (e.g., nasogastric tubes, urinary catheters, tracheostomy tubes)
D. Medical Emergencies
1. allergic reactions
a. contrast media
1. contraindications
2. adverse reactions
b. other (e.g., latex)
2. cardiac or respiratory arrest(e.g., CPR)
3. physical injury or trauma
4. other medical disorders(e.g., seizures, diabetic reactions)
E. Infection Control
1. cycle of infection
a. pathogen
b. reservoir
c. portal of exit
d. mode of transmission
1. direct
2. indirect
e. portal of entry
f. susceptible host
2. asepsis
a. equipment disinfection
b. equipment sterilization
c. medical aseptic technique
d. sterile technique
3. CDC Standard Precautions
a. hand hygiene
b. use of personal protective equipment (e.g., gloves, gowns, masks)
c. safe needle practices
d. safe handling of contaminated materials
e. disposal of contaminated materials
1. linens
2. needles
3. patient supplies
4. blood and body fluids
4. transmission-based precautions
a. contact
b. droplet
c. airborne
5. additional precautions
a. neutropenic precautions (reverseisolation)
b. healthcare associated (nosocomial) infections
F. Handling and Disposal of Toxic or Hazardous Material
1. types of materials
a. metals (e.g., block alloy)
b. chemicals
c. chemotherapy
2. material safety data sheet (MSDS)
2. Patient and Medical Record Management
A. Evaluation
1. epidemiology and etiology
a. cancer risk factors
b. prevalence and incidence
2. cancer screening
3. signs and symptoms
4. history and physical examination
5. imaging studies (e.g., CT, MRI, PET/CT)
6. other diagnostic studies
a. lab results
b. surgical reports
c. pathology reports
B. Assessment
1. treatment side effects
a. signs and symptoms
b. causes
c. management
2. blood studies
a. types of studies (e.g., CBC, BUN, creatinine)
b. factors affecting blood values
3. dietary counseling
a. common problems
b. causes
c. dietary management
4. routine monitoring
a. weight
b. vital signs
c. signs and symptoms
d. documentation
C. Documentation
1. information included in treatment record
a. prescription
b. monitor units
c. target dose (daily and accumulated)
d. energy and type of radiation
e. date
f. time of day for b.i.d. treatment
g. fraction
h. elapsed days
i. field number and description
j. doses to other regions of interest
k. set-up instructions
2. elements of record keeping
a. patient identification
b. accountability (e.g., signatures)
c. accuracy and legibility
d. variance from prescription (errors, prescription changes)
e. medical events (definition and required documentation)
3. charge capture terminology
a. professional and technical components
b. CPT® principles
1. Radiation Protection
A. Biological Effects of Radiation
1. radiosensitivity
2. dose-response relationships
3. somatic effects
a. cellular
b. tissue (e.g., hemopoietic, skin, reproductive organs)
c. embryonic and fetal risks
d. carcinogenesis
e. early versus late effects
f. acute versus chronic effects
B. Radiation Tissue Tolerance
1. tolerance levels (TD5/5)
2. adverse effects
3. dose to critical structures
4. radiobiological factors (e.g., dose, fractionation, volume)
5. biological factors (e.g., age, anatomic variation, medical conditions)
6. medical factors (e.g., prior surgery, pacemakers)
7. other factors (e.g., radiosensitizers, radioprotectors)
8. contribution from other sources
a. chemotherapy
b. brachytherapy
c. other fields (e.g., prior or abutting)
d. radiation effect modifiers
C. Measurement of Radiation
1. units of measurement
a. absorbed dose
b. dose equivalent
c. exposure
2. instrumentation
a. ionization chamber
b. Geiger-Müller detector
c. TLD/OSL (optically stimulated luminescence)
d. diodes
e. neutron detectors
D. Fundamental Principles
1. ALARA
2. basic methods of protection(time, distance, shielding)
E. Personnel Monitoring
1. NCRP recommendations for personnel monitoring (report #116)
a. occupational exposure
b. public exposure
c. embryo/fetus exposure
2. maintenance and evaluation of personnel dosimetry records
F. Facilities and Area Monitoring
1. NRC regulations (10 CFR, parts 20 and 35)
a. classification of areas (restricted, controlled, unrestricted)
b. required postings (signs)
c. area monitoring devices
2. barrier requirements
a. primary
b. secondary
G. Handling and Disposal of Radioactive Materials
2. Radiation Physics, Equipment, and Quality Assurance
A. Sources of Radiation
1. radioactive material
2. machine-produced radiation
B. Basic Properties of Radiation
1. wave characteristics
2. attenuation
3. inverse-square law
4. x-ray beam quality
C. Interactions with Matter
1. photon interactions (e.g., Compton, photoelectric effect)
2. electron interactions
3. particle interactions (e.g., proton, neutron)
D. Components and Operation
1. linear accelerator
2. linear accelerator
E. Quality Control Procedures
1. warm-up and inspection of linear accelerators and CT simulators
a. interlock systems
b. safety lights
c. emergency switches
d. critical machine parameters(e.g., pressure, temperature)
e. electrical and mechanical hazards
f. imaging systems
2. radiation output verification
a. methods
b. frequency
c. effect of environment (e.g., humidity) on measurements
3. light and treatment field checks
a. light and radiation field agreement
b. collimator indicator agreement
c. multileaf collimator performance
d. sidelight/laser accuracy check (isocenter)
4. rotation check
a. safety procedures
b. operation of gantry/console
5. evaluation of quality assurance results
a. interpretation
b. course of action
c. documentation
1. Treatment Sites and Tumors
A. Anatomy, Pathophysiology, Lymphatic Drainage, and Metastatic Patterns
1. brain and spinal cord
2. head and neck (includes thyroid and salivary glands)
3. breast
4. lung
5. abdomen, pelvis, GI, and GU
a. esophagus, stomach, small bowel, large bowel, rectum, and anus
b. pancreas, adrenals, liver, and gallbladder
c. ureters, kidneys, bladder, and urethra
6. reproductive
a. prostate, testes
b. endometrium, cervix, ovaries, uterus, vagina, and vulva
7. skeletal
8. miscellaneous
a. lymphoma (Hodgkin andnon-Hodgkin)
b. sarcomas (bone and soft tissue)
c. multiple myeloma
d. skin
e. leukemia
f. mycosis fungoides
g. bone marrow transplant
h. benign (e.g., heterotopic bone,keloid, AVM)
i. oncologic emergencies (e.g., whole brain, SVC, cord compression)
B. Tumor Classification
1. histopathologic types(e.g., benign, sarcomas, carcinomas)
2. histopathologic grade
a. purpose (differentiation and growth rate)
b. grading system (e.g., GX, G1-G4)
3. staging (basic concepts; not specific sites)
a. purpose
b. components (e.g., TNM, I-IV)
2. Treatment Volume Localization
A. Treatment Techniques and Anatomic Relationships
1. radiation therapy techniques
2. sectional and topographic anatomy
3. critical organs
4. patient positioning and immobilization
5. types and uses of contrast media
B. CT Simulation
1. CT image acquisition (e.g., mA, slice thickness, and spacing)
2. CT image processing and display (e.g., reconstruction, window level, field of view, CT number)
3. contour volume and isocenter determinatio
4. image transmission, storage, and retrieval
5. programmable lasers
C. Documentation of Simulation Procedure
1. anatomic position
2. equipment orientation
3. accessory equipment
4. field parameters
5. set-up diagrams or photographs
6. temporary and/or permanent reference marks
3. Prescription and Dose Calculation
A. Treatment Prescription
1. total target dose
2. fractionation schedules
3. beam energy
4. types of radiation
5. treatment volume (e.g., GTV, CTV, PTV)
6. number of fields
7. fixed/rotational fields
8. field weighting
9. field orientation
10. treatment unit capabilities and limitations
11. plan modifications
12. beam modifiers
B. Geometric Parameters and Patient Measurements
1. field size and shape
2. target depth
3. patient thickness
4. SSD, SAD
5. collimator setting
6. abutting fields (e.g., gap calculations)
7. fusion with outside diagnostic studies
C. Dose Calculation and Verification
1. selection of energy
2. equivalent square (open and blocked field)
3. scatter factors (e.g., collimator,phantom)
4. Dmax
5. percentage depth dose
6. TAR, TMR
7. SSD, SAD
8. inverse square
9. extended distance factors
10. wedges (e.g., wedge angle or factor)
11. off-axis calculation
12. isodose curve characteristics (e.g., penumbra, DVH)
13. factors for beam modifiers (e.g., tray factor, bolus, compensator)
14. inhomogeneity correction factors
15. rotational factors
16. machine output data
17. verification and documentation
4. Treatments
A. Treatment Options (indications,benefits, risks)
1. chemotherapy
2. surgery
3. radiation therapy
a. external beam
b. brachytherapy
4. multimodality treatment
B. Verification and Application of the Treatment Plan
1. patient position
2. isocenter
3. treatment parameters(e.g., beam orientation, energy)
4. prescription
5. modality
a. 2D
b. 3D
c. 4D (e.g., respiratory gating)
d. IMRT
e. arc therapy
f. stereotactic
6. imaging procedures
a. kV imaging
b. cone beam CT (CBCT)
c. MV imaging
C. Treatment Machine Set-Up
1. auxiliary set-up devices
a. couch indexing
b. positioning aids
c. alignment lasers
2. machine operations
a. SSD, SAD
b. collimator or cone settings
c. optical or mechanical distance indicator
d. gantry angle
e. collimator angle
f. field light
g. treatment couch
h. console controls
i. pendant controls
D. Treatment Accessories
1. beam modifiers
a. compensating filters
b. shielding
c. blocks (e.g., thickness, half value layer (HVL), half-value thickness (HVT))
d. multileaf collimation
e. bolus
f. wedges (enhanced dynamic wedge, physical wedge)
2. immobilization devices
a. custom
b. standard
3. parameters
a. SSD, SAD, depth
b. gantry, collimator, and field size settings
c. beam energy and type
E. Treatment Administration
1. patient monitoring
a. visual (mirror, TV monitor)
b. two-way voice communication system
c. back-up systems
d. monitoring regulations
e. emergency situations
2. record and verify systems
3. image acquisition and registration
4. site verification
5. dose verification (e.g., diodes, film)
6. equipment malfunctions
a. types (e.g., radiation, electrical, mechanical, software)
b. troubleshooting and correction
c. documentation and reporting

Radiation Therapy Exam

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