Review Notes for the

RADIOGRAPHY EXAM Appleton

Chapter 3: Radiation Protection (150 Q & Ans.) b) Patient questionnaires obtain that
information from the patient and are
1. The dose of radiation that will cause a often also used in an informed
noticeable skin reaction is referred to as the consent form.

(A) linear energy transfer (LET). c) Patient postings in waiting and

(B) source-to-skin distance (SSD). changing areas alert patients to
(C) skin erythema dose (SED). advise the radiographer if there is
(D) source-image distance (SID). any chance of pregnancy.
———————————————— o These three safeguards replace the
————————— earlier "10-day rule," which is now
 Erythema is the reddening of skin as a obsolete.
result of exposure to large quantities of (Bushong, pp 528-529)
ionizing radiation. Ans. D
o It was one of the first somatic
responses to irradiation 3. Radiographers use monitoring devices to
demonstrated to the early radiology record their monthly exposure to radiation.
pioneers. The types of devices suited for this purpose
include the
 The effects of radiation exposure to
the skin follow a nonlinear, threshold 1. Pocket dosimeter.
dose-response relationship. 2. Thermoluminescent dosimeter
(TLD).
 An individual's response to skin 3. Optically stimulated
irradiation depends on the dose luminescence dosimeter (OSL).
received, the period of time over (A) 1 only
which it was received, the size of the (B) 1 and 2 only
area irradiated, and the individual's (C) 2 and 3 only
sensitivity. (D) 1, 2, and 3
 The dose that it takes to bring about ————————————————
a noticeable erythema is referred to —————————
as the skin erythema dose (SED). 1.) The OSL is rapidly becoming the most
(Bushong, p 488) commonly used personnel monitor
Ans. C today.
2.) Film badges and TLDs have been used
2. What safeguards are taken to prevent successfully for years.
inadvertent irradiation in early pregnancy?
 A pocket dosimeter is used primarily
1. Patient postings when working with large amounts of
2. Patient questionnaire radiation and when a daily reading is
3. Elective booking desired.
(A) 1 and 2 only (Sherer et al, pp 222-223)
(B) 1 and 3 only Ans. C
(C) 2 and 3 only
(D) 1, 2, and 3 4. If the exposure rate to an individual standing
———————————————— 2.0 m from a source of radiation is 15 R/min,
————————— what will be the dose received after 2 min at a
a) Elective booking of a radiologic distance of 5 m from the source?
examination after inquiring about the (A) 1.2 R
patient's previous menstrual cycle is (B) 2.4 R
the most effective means of (C) 4.8 R
preventing accidental exposure of a (D) 9.6 R
recently fertilized ovum. ————————————————
—————————

Reviewer A&R
Question & Answer
1
Review Notes for the
RADIOGRAPHY EXAM Appleton
The relationship between x-ray intensity and Late or long-term effects of radiation can
distance from the source is expressed in the occur in tissues that have survived a previous
inverse square law of radiation. The formula is irradiation months or years earlier.
I1 D22 These late effects, such as carcinogenesis and
― = ― genetic effects, are "all-or-nothing" effects
I2 D12 either the organism develops cancer or it does
not.
Substituting known values:
Most late effects do not have a threshold
dose; that is, any dose, however small,
15 25 (52x)
theoretically can induce an effect.
― = ― ; 25x = 60 ; x =
2.4 R/min  Increasing that dose will increase the
x 4 (22x) at 2 m = 4.8 likelihood of the occurrence, but will not
R after 2min affect its severity; these effects are
termed stochastic.
Distance has a profound effect on dose
 Nonstochastic effects are those that will
received and therefore is one of the cardinal
not occur below a particular threshold
rules of radiation protection. As distance from
dose and that increase in severity as the
the source increases, dose received decreases.
dose increases.
(Bushong, pp 65, 66)
(Sherer et al, p 136)
Ans. C
Ans. B
5. What minimum total amount of filtration
7. If the exposure rate to a body standing 5 ft
(inherent plus added) is required in x-ray
from a radiation source is 10 mR/min, what
equipment operated above 70 kVp?
will be the dose to that body at a distance of 8
(A) 2.5 mm Al equivalent ft from the source?
(B) 3.5 mm Al equivalent
(A) 25.6 mR/min
(C) 2.5 mm Cu equivalent
(B) 16 mR/min
(D) 3.5 mm Cu equivalent
(C) 6.25 mR/min
————————————————
(D) 3.9 mR/min
—————————
————————————————
The x-ray tube's glass envelope and oil coolant —————————
are considered inherent ("built-in") filtration.
The relationship between x-ray intensity and
Thin sheets of aluminum are added to make a distance from the source is expressed in the
total of at least 2.5 mm Al equivalent filtration inverse square law of radiation. The formula is
in equipment operated above 70 kVp.
I1 D22
This is done in order to remove the low-
― = ―
energy photons that only serve to contribute
I2 D12
to patient skin dose.
(Sherer et al, p 155) Substituting known values,
Ans. A
10 64 (82X)
6. Late or long-term effects of radiation — = — ; 64x = 250 ; x
exposure are generally represented by which = 3.9 R/min at 8 ft
of the following dose-response curves? x 25 (52X)
from the source
(A) Linear threshold
(B) Linear nonthreshold
Note the inverse relationship between
(C) Nonlinear threshold
distance and dose. As distance from the
(D) Nonlinear nonthreshold
source of radiation increases, dose rate
————————————————
significantly decreases.
(Bushong, pp 65, 66)

Reviewer A&R
Question & Answer
2
Review Notes for the
RADIOGRAPHY EXAM Appleton
Ans. D 9. Which of the following are radiation
protection measures that are appropriate for
8. Which of the following radiation-induced mobile radiography?
conditions is most likely to have the longest
1. The radiographer must be at
latent period?
least 6 ft from the patient and
(A) Leukemia the x-ray tube during the
(B) Temporary sterility exposure.
(C) Erythema 2. The radiographer must announce
(D) Acute radiation lethality in a loud voice that an exposure
———————————————— is about to be made and wait for
————————— personnel, visitors, and patients
to temporarily leave the area.
 Radiation effects that appear days or
3. The radiographer must try to use
weeks following exposure (early effects)
the shortest practical SID.
are in response to relatively high radiation
doses.
(A) 1 and 2 only
o These should never occur in (B) 1 and 3 only
diagnostic radiology today; they (C) 2 and 3 only
occur only in response to doses much (D) 1, 2, and 3
greater than those used in diagnostic ————————————————
radiology. —————————
o One of the effects that may be noted  Mobile radiography (along with
in such a circumstance is the fluoroscopy and special procedures) is an
hematologic effect reduced numbers area of higher occupational exposure.
of white blood cells, red blood cells,
 With no lead barrier to retreat
and platelets in the circulating blood.
behind, distancebecomes the best
 Immediate local tissue effects can include source of protection.
effects on the gonads (temporary sterility)
o The exposure switch of mobile
and on the skin (epilation, erythema).
equipment must be manufactured to
 Acute radiation lethality, or radiation allow the technologist to stand at
death, occurs after an acute exposure and least 6 ft away from the patient and
results in death in weeks or days. the x-ray tube.
 Radiation-induced malignancy, leukemia,  Hospital personnel, visitors, and patients
and genetic effects are late effects (or must also be protected from unnecessary
stochastic effects) of radiation exposure. radiation exposure.
o These can occur years after survival o Therefore, the 1.) radiographer must
of an acute radiation dose, or after request that these people leave the
exposure to low levels of radiation immediate area until after the
over along period of time. exposure is made, and 2.) announce in
a loud voice when the exposure is
Radiation workers need to be especially
about to be made, 3.) allowing time for
aware of the late effects of radiation
individuals to leave the area.
because their exposure to radiation is
usually low-level over a long period of The use of a short SID increases patient
time. exposure and produces poor recorded detail.
Occupational radiation protection (Carlton & Adler, p 523)
guidelines are therefore based on late Ans. A
effects of radiation according to a linear,
nonthreshold dose-response curve. 10. The recommendation of "elective booking"
states that elective abdominal radiographic
(Bushong, pp 484-486)
examinations on women of reproductive age
Ans. A
should be limited to the

Reviewer A&R
Question & Answer
3
Review Notes for the
RADIOGRAPHY EXAM Appleton
(A) 10 days following the menses. (Ballinger & Frank, vol 1, p 45)
(B) 10 days following the onset of Ans. B
menses.
(C) 10 days before the onset of menses. 12. What is the established fetal dose limit
(D) last 10 days of the menstrual cycle. guideline for pregnant radiographers during
——————————————————— the entire gestation period?
——————
(A) 100 mrem
We must be particularly careful to avoid (B) 250 mrem
radiating a newly fertilized ovum. (C) 500 mrem
(D) 1000 mrem
This is precisely the time when a pregnancy
————————————————
may be unsuspected and fetal irradiation
—————————
could be most damaging.
 The pregnant radiographer poses a
 The ICRP used to recommend use of the
special radiation protection
"10-day rule."
consideration, for the safety of the
o Current protocol now recommends unborn individual must be considered.
its use along with 1.) elective booking,
o It must be remembered that the
2.) patient questionnaires, and 3.)
developing fetus is particularly
patient postings.
sensitive to radiation exposure.
 Elective booking recommends that
o Therefore, established guidelines
discretionary abdominal radiography on
state that the occupational radiation
women of childbearing age should be
exposure to the fetus must not
limited to the first 10 days following the
exceed 0.5 rem (500 mrem, or 5 mSv)
onset of menses, a time when pregnancy
during the entire gestation period.
is most improbable.
(Bushong, p 525)
(Bushong, p 528)
Ans. C
Ans. B
13. Some patients, such as infants and children,
11. Guidelines for the use of protective shielding
are unable to maintain the necessary
state that gonadal shielding should be used
radiographic position without assistance. If
1. if the patient has reasonable mechanical restraining devices cannot be
reproductive potential. used, which of the following should be
2. when the gonads are within 5 cm requested or permitted to hold this patient?
of the collimated field.
(A) Transporter
3. when tight collimation is not
(B) Patient's father
possible.
(C) Patient's mother
(A) 1 only (D) Student radiographer
(B) 1 and 2 only ————————————————
(C) 1 and 3 only —————————
(D) 2 and 3 only
 If mechanical restraint is impossible, a
————————————————
friend or relative accompanying the
—————————
patient should be requested to hold the
 It is our professional responsibility to patient.
minimize exposure dose to both patients
o If a parent is to perform this task, it is
and ourselves, and one of the most
preferable to elect the father so as to
important ways is with a closely
avoid the possibility of subjecting a
collimated radiation field.
newly fertilized ovum to even
 Gonadal shielding should be used when scattered radiation.
the patient is of reproductive age or
o If a friend or relative is not available,
younger, when the gonads are in or near
the collimated field, and when the clinical a nurse or transporter may be asked
objectives will not be compromised. for help.

Reviewer A&R
Question & Answer
4
Review Notes for the
RADIOGRAPHY EXAM Appleton
 Protective apparel, such as lead o Free radicals contain enough energy
apron and gloves, must be provided to damage other molecules some
to the person(s) holding the patient. distance away.
 Radiology personnel must never assist in  They can migrate to and damage a
holding patients, and the individual DNA molecule (indirect hit theory).
assisting must never be in the path of the
(Bushong, pp 573-574)
primary beam.
Ans. B
(Thompson et al, p 484)
Ans. B 16. Which of the following is (are) important for
patient protection during fluoroscopic
14. A "controlled area" is defined as one procedures?
1. that is occupied by people 1. Intermittent fluoroscopy
trained in radiation safety. 2. Fluoroscopic field size
2. that is occupied by people who 3. Focus-to-table distance
wear radiation monitors.
(A) 1 and 2 only
3. whose occupancy factor is 1.
(B) 1 and 3 only
(A)
1 and 2 only (C) 2 and 3 only
(B)
2 only (D) 1, 2, and 3
(C)
1 and 3 only ————————————————
(D)
1, 2, and 3 —————————
————————————————
1.) The fluoroscopist should release his
—————————
or her foot from the exposure pedal
 A controlled area is one that is occupied
at frequent intervals, thus reducing
by radiation workers who are trained in
total patient exposure, as the image
radiation safety and who wear radiation
will fade from the screen only slowly.
monitors.
(Intermittent fluoroscopy)
o The exposure rate in a controlled area
2.) Field size plays an important role in
must not exceed 100 mR per week; its
controlling patient dose in
occupancy factor is considered to be
fluoroscopy (as in radiography).
1, indicating that the area may
always be occupied, and therefore 3.) Focus-to-table distance is extremely
requires maximum shielding. important in controlling patient
exposure; the law states that this
 An uncontrolled area is one occupied by
distance must be a minimum of 12 in
the general population; the exposure rate
(preferably 15 in) to decrease patient
there must not exceed 10 mR per week.
dose.
Shielding requirements vary according to
(Bushong, p 555)
several factors, one being occupancy factor.
Ans. D
(Sherer et al, p 204)
Ans. D 17. Which of the following refers to a regular
program of evaluation that ensures the proper
15. Irradiation of water molecules within the functioning of x-ray equipment, thereby
body, and their resulting breakdown, is termed protecting both radiation workers and
patients?
(A) epilation.
(B) radiolysis. (A) Sensitometry
(C) proliferation. (B) Densitometry
(D) repopulation. (C) Quality assurance
———————————————— (D) Modulation transfer function
————————— ———————————————————
——————
 Radiolysis has to do with the irradiation of
water molecules and the formation of free  1.)Sensitometry and2.) densitometry
radicals. are used in evaluation of the film

Reviewer A&R
Question & Answer
5
Review Notes for the
RADIOGRAPHY EXAM Appleton
processor; they are just one portion released as a photon of identical energy
of a complete quality assurance (QA) but changed direction.
program.
o Thompson scatter is another name
 Modulation transfer function (MTF) is for classical scatter.
used to express spatial resolution;
(Sherer et al, pp 25-26)
another component of the QA
Ans. B
program.
A complete QA program includes testing of all 19. If a patient received 2000 mrad during a 10-
components of the imaging system: min fluoroscopic examination, what was the
a.) dose rate?
processors, b.) focal spot, c.) x-ray timers, d.)
filters, e.) intensifying screens, f.)beam (A) 0.2 rad/min
alignment, and so on. (B) 2.0 rad/min
(C) 5 rad/min
(Thompson et al, pp 399-400)
(D) 200 rad/min
Ans. C
————————————————
—————————
18. The x-ray interaction with matter that is
responsible for the majority of scattered Two thousand mrad is equal to 2 rad. If 2 rad
radiation reaching the film is was delivered in 10 min, then the dose rate
must be 0.2 rad/min: (1000mrad=1000rad)
(A) the photoelectric effect.
(B) Compton scatter.
2 rad x rad
(C) classical scatter.
——— = ——— ; 10x =
(D) Thompson scatter.
2 ; x = 0.2 rad/min
————————————————
10 min 1 min
—————————
 In the Photoelectric effect, a relatively (Selman, p 117)
low-energy photon uses all its energy Ans. A
to eject an inner-shell electron,
leaving a vacancy. 20. Which of the following are features of
fluoroscopic equipment that are designed
o An electron from the shell above
especially to eliminate unnecessary radiation
drops down to fill the vacancy, and in
exposure to the patient and/or personnel?
doing so gives up a characteristic ray.
1. Bucky slot cover
o This type of interaction is most
2. Exposure switch / foot pedal
harmful to the patient, as all the
3. Cumulative exposure timer
photon energy is transferred to
tissue. (A) 1 only
(B) 1 and 2 only
 In Compton scatter, a high-energy
(C) 2 and 3 only
incident photon ejects an outer-shell
(D) 1, 2, and 3
electron.
————————————————
o In doing so, the incident photon is —————————
deflected with reduced energy, but it
1.) The bucky slot cover shields the opening
usually retains most of its energy and
at the side of the table, as the bucky tray
exits the body as an energetic
is parked at the end of the table for the
scattered ray.
fluoroscopy procedure; this is important
This scattered ray will either contribute to film because the opening created would
fog or pose a radiation hazard to personnel, otherwise allow scatter radiation to
depending on its direction of exit. emerge at approximately the level of the
operator's gonads.
 In classical scatter, a low-energy photon
interacts with an atom but causes no 2.) The exposure switch (usually a foot pedal)
ionization; the incident photon disappears must be of the dead-man type; that is,
into the atom, and is then immediately when the foot is released from the

Reviewer A&R
Question & Answer
6
Review Notes for the
RADIOGRAPHY EXAM Appleton
switch, there is immediate termination of to the quantity of radiation we ingest
exposure. and inhale.
3.) The cumulative exposure timer sounds or 2.) Man-made radiation, however, is the type
interrupts the exposure after 5 min of of background radiation overwhich we
fluoro time, thus making the fluoroscopist have some control.
aware of accumulated fluoro time.
o Medical and dental x-rays contribute
 In addition, source-to-tabletop to our exposure to man-made
distance is restricted to at least 15 in background radiation.
for stationary equipment and at least
(Selman, p 501)
12 in for mobile equipment.
Ans. B
o Increased source-to-tabletop
distance increases source-to-patient 22. Each time an x-ray beam scatters, its intensity
distance, thereby decreasing patient at 1 m from the scattering object is what
dose. fraction of its original intensity?
(Bushong, p 534) (A) 1/10
Ans. D (B) 1/100
(C) 1/500
21. Sources of natural background radiation (D) 1/1000
exposure include ————————————————
—————————
1. the food we eat.
2. air travel. One of the radiation protection guidelines for
3. medical and dental x-rays. the occupationally exposed is that the x-ray
beam should scatter twice before reaching the
(A) 1 only
operator.
(B) 1 and 2 only
(C) 2 and 3 only Each time the x-ray beam scatters, its intensity
(D) 1, 2, and 3 at 1 m from the scattering object is one one-
——————————————————— thousandth of its original intensity.
——————
Of course, the operator should be behind a
The entire population of the world is exposed shielded booth while making the exposure,
to varying amounts of background but multiple scatterings further reduce the
(environmental) radiation. danger of exposure from scatter radiation.
Sources of background radiation are (Bushong, p 534)
either natural or man-made. Ans. D
 Exposure to natural background radiation
23. The purpose of filters in a film badge
is a result of cosmic radiation from space,
24. is
naturally radioactive elements within the
earth's crust, and our own bodies. (A) to eliminate harmful rays.
(B) to measure radiation quality.
1.) Naturally, the closer we are to the cosmic
(C) to prevent exposure by alpha
radiations from space, the greater our
particles.
personal exposure will be; living at higher
(D) as a support for the film contained
elevations and air travel expose us to
within.
greater amounts of radiation.
————————————————
 Living or working in a building made —————————
of materials derived from the ground
The filters (usually aluminum and copper)
exposes us to some background
serve to help measure radiation quality
radiation from the naturally
(energy).
radioactive elements found in the
earth's crust. Only the most energetic radiation will
penetrate the copper; radiation of lower levels
o The food we eat, the water we drink,
of energy will penetrate the aluminum, and
and the air we breathe all contribute

Reviewer A&R
Question & Answer
7
Review Notes for the
RADIOGRAPHY EXAM Appleton
the lowest-energy radiation will pass readily within, and emitted from, the
through the unfiltered area. patient.
Thus, radiation of different energy levels can  Background radiation is naturally
be recorded, measured, and reported. occurring radiation that is emitted from
the earth and that also exists within our
(Bushong, pp 556-557)
bodies.
Ans. B
(Sherer et al, p 190)
25. A thermoluminescent dosimetry system would Ans. C
use which of the following crystals?
27. All of the following affect patient dose except
(A) Silver bromide
(B) Sodium sulfite (A) inherent filtration.
(C) Lithium fluoride (B) added filtration.
(D) Aluminum oxide (C) source-image distance.
———————————————— (D) focal spot size.
————————— ————————————————
—————————
 TLDs are personnel radiation monitors
that use lithium fluoride crystals. 1. Inherent filtration is provided by
materials that are a permanent part
o Once exposed to ionizing radiation
of the tube housing, that is, the glass
and then heated, these crystals give
envelope of the x-ray tube and the oil
off light proportional to the amount
coolant.
of radiation received.
2. Added filtration, usually thin sheets
o TLDs are very accurate personal
of aluminum, is present in order to
monitors.
make a total of 2.5 mm Al equivalent
 Even more accurate are optically for equipmentoperated above 70
stimulated luminescence dosimeters kVp.
(OSLs).
 Filtration is used to decrease patient dose
o OSLs use aluminum oxide as their by removing the weak x-rays that have no
sensitive crystal. value but contribute to the skin dose.
(Bushong, p 557) o According to the inverse square law
Ans. C of radiation, exposure dose increases
as distance from the source
26. Sources of secondary radiation include decreases, and vice versa.
1. background radiation.  The effect of focal spot size is principally
2. leakage radiation. on radiographic sharpness; it has no effect
3. scattered radiation. on patient dose.
(A) 1 only (Sherer et al, pp 155-156)
(B) 1 and 2 only Ans. D
(C) 2 and 3 only
(D) 1, 2, and 3 28. The photoelectric effect is an interaction
—————————————————— between an x-ray photon and
———————
(A) an inner-shell electron.
 Secondary radiation consists of leakage (B) an outer-shell electron.
and scattered radiation. (C) a nucleus.
(D) another photon.
1. Leakage radiation can be
————————————————
emitted when a defect exists in
—————————
the tube housing.
 In the photoelectric effect, a relatively
2. A significant quantity of
low-energy incident photon uses all of its
scattered radiation is generated

Reviewer A&R
Question & Answer
8
Review Notes for the
RADIOGRAPHY EXAM Appleton
energy to eject an inner-shell electron, the radiation type is expressed as
leaving a vacancy. rem or DE (dose equivalent), and may
be used to predict the type and
o An electron from the next shell will
extent of response to radiation.
drop to fill the vacancy, and a
characteristic ray is given up in the (Sherer et al, p 43)
transition. Ans. B
o This type of interaction is more
31. Which of the following are recommended for
harmful to the patient, as all the
the pregnant radiographer?
photon energy is transferred to
tissue. 1. Continue monthly dosimeter
readings.
(Bushong, pp 167-169)
2. Wear a second dosimeter under
Ans. A
the lead apron.
3. Wear two dosimeters and switch
29. Which of the following terms refers to the
their position periodically.
period between conception and birth?
(A) 1 only
(A) Gestation
(B) 1 and 2 only
(B) Congenital
(C) 1 and 3 only
(C) Neonatal
(D) 2 and 3 only
(D) In vitro
————————————————
————————————————
—————————
—————————
 Special arrangements are required
 The length of time from conception to
for occupational monitoring of the
birth, that is, pregnancy, is referred
pregnant radiographer.
to as gestation.
o The pregnant radiographer will wear
 The term congenital refers to a
two dosimeters: 1one in its usual
condition existing at birth.
place at the collar, and 2the other, a
 Neonatal relates to the time "baby / fetal dosimeter," worn over
immediately after birth and the first the abdomen and under the lead
month of life. apron during fluoroscopy.
 In vitro refers to something living o The baby / fetal dosimeter must be
outside a living body (as in a test identified as such and must always be
tube), as opposed to in vivo (within a worn in the same place.
living system).
o Care must be taken not to mix the
(Taber's, p 868) position of the two dosimeters.
Ans. A
o The dosimeters are read monthly, as
usual.
30. In radiation protection, the product of
absorbed dose and the correct modifying (Bushong, p 525)
factor (rad × QF) is used to determine Ans. B
(A) roentgen (C/kg).
32. The annual dose limit for medical imaging
(B) rem (Sv).
personnel includes radiation from
(C) rad (Gy).
(D) radiation quality. 1. medical x-rays.
———————————————— 2. occupational exposure.
————————— 3. background radiation.
 Rem (dose-equivalent) is the only unit (A) 1 only
of measure that expresses the dose- (B) 2 only
effect relationship. (C) 2 and 3 only
o The product of rad (absorbed dose) (D) 1, 2, and 3
and the quality factor appropriate for ————————————————

Reviewer A&R
Question & Answer
9
Review Notes for the
RADIOGRAPHY EXAM Appleton
————————— 4.) Optically stimulated luminescence
dosimeters (OSLs) are personnel
 Occupationally exposed individuals
radiation monitors that use
are required to use devices that will
aluminum oxide crystals.
record and provide documentation of
the radiation they receive over a o These crystals, once exposed to
given period of time, traditionally 1 ionizing radiation and then subjected
month. to a laser, and give off luminescence
proportional to the amount of
o The most commonly used personal
radiation received.
dosimeters are the 1film badge, the
2
TLD, and the 3OSL. (Bushong, p 558)
Ans. C
o These devices must be worn only for
documentation of occupational
34. The symbols 13056Ba and 13856Ba are examples of
exposure.
which of the following?
o They must not be worn for any
(A) Isotopes
medical or dental x-rays one receives
(B) Isobars
as a patient, and they are not used to
(C) Isotones
measure naturallly occurring
(D) Isomers
background radiation.
————————————————
(Thompson et al, p 459) —————————
Ans. B
a. 130
Ba and 13856Ba are isotopes of the
56
same element, barium (Ba), because
33. In which type of monitoring device do photons
they have the same atomic number
release electrons by their interaction with air?
but different mass numbers (numbers
(A) Film badge
of neutrons).
(B) Thermoluminescent dosimeter (TLD)
(C) Pocket dosimeter b. Isobars are atoms with the same
(D) Optically stimulated luminescence mass number but different atomic
dosimeter (OSL) numbers.
———————————————— c. Isotones have the same number of
————————— neutrons but different atomic
There are different types of monitoring numbers.
devices available for the occupationally d. Isomers have the same atomic
exposed. Ionization is the fundamental number and mass number; they are
principle of operation of both the film badge identical atoms existing at different
and the pocket dosimeter. energy states.
1.) In the film badge, the film's silver (Bushong, p 47)
halide emulsion is ionized by x-ray Ans. A
photons.
2.) The Pocket dosimeter contains an 35. Medical and dental radiation accounts for
ionization chamber (containing air), what percentage of the general public's
and the number of ions formed (of exposure to man-made radiation?
either sign) is equated to exposure (A) 10 percent
dose. (B) 50 percent
3.) Thermoluminescent dosimeters (C) 75 percent
(TLDs) are personnel radiation (D) 90 percent
monitors that use lithium fluoride ————————————————
crystals. —————————
o Once exposed to ionizing radiation  Artificial / man-made sources of
and then heated, these crystals give radiation include radioactivefallout,
off light proportional to the amount industrial radiation, and medical and
of radiation received. dental x-rays.

Reviewer A&R
Question & Answer
10
Review Notes for the
RADIOGRAPHY EXAM Appleton
o About 90 percent of the general  X-rays produced at the tungsten
public's exposure to artificial target make up a heterogeneous
radiation is from medical and dental primary beam.
x-rays.
 Filtration serves to eliminate the
o It is our professional obligation,
softer, less penetrating photons,
therefore, to keep our patient's leaving an x-ray beam of higher
radiation dose to a minimum. average energy.
(Sherer et al, p 6) o Filtration is important in patient
Ans. D
protection because unfiltered,
low-energy photons that are not
36. Which of the following is (are) possible long-
energetic enough to reach the
term somatic effects of radiation exposure?
film stay in the body and
1. Nausea and vomiting contribute to total patient dose.
2. Carcinogenesis
(Sherer et al, p 155)
3. Leukemia
Ans. A
(A) 1 only
(B) 1 and 2 only 38. The skin response to radiation exposure, which
(C) 2 and 3 only appears as reddening of the irradiated skin
(D) 1, 2, and 3 area, is known as
————————————————
(A) dry desquamation.
—————————
(B) moist desquamation.
o Somatic effects are those induced in (C) erythema.
the irradiated body. (D) epilation.
————————————————
o Genetic effects of ionizing radiation
—————————
are those that may not appear for
many years (generations) following
 The first noticeable skin response to
exposure.
excessive irradiation would be
o Formation of cataracts or cancer erythema, a reddening of the skin
(such as leukemia) and embryologic very much like sunburn.
damage are all possible long-term
 Dry desquamation, a dry peeling of
somatic effects of radiation exposure.
the skin, may follow.
o A fourth is life-span shortening.
 Moist desquamation is peeling with
o Nausea and vomiting are early effects associated puslike fluid.
of exposure to large quantities of  Epilation, or hair loss, may be
ionizing radiation. temporary or permanent depending
(Bushong, pp 503-504) on sensitivity and dose.
Ans. C (Bushong, p 488)
Ans. C
37. How does filtration affect the primary beam?
(A) It increases the average energy of the 39. How does the use of rare earth intensifying
primary beam. screens contribute to lowering the patient
(B) It decreases the average energy of dose?
the primary beam. 1. It permits the use of lower mAs.
(C) It makes the primary beam more 2. It permits the use of lower kVp.
penetrating. 3. It eliminates the need for patient
(D) It increases the intensity of the shielding.
primary beam. (A) 1 only
———————————————— (B) 1 and 2 only
————————— (C) 1 and 3 only
(D) 2 and 3 only

Reviewer A&R
Question & Answer
11
Review Notes for the
RADIOGRAPHY EXAM Appleton
————————————————  Rad is an acronym for radiation
————————— absorbed dose;
 The faster the intensifying screens o it measures the energy
used, the less the required mAs. deposited in any mate-rial.
o Decreasing the intensity (mAs,  Rem is an acronym for radiation
quantity) of photons significantly equivalent man;
contributes to reducing total
o it includes the relative biologic
patient dose.
effectiveness (RBE) specific to the
 Decreasing the kilovoltage would tissue irradiated, and therefore is
increase patient dose because the a valid unit of measure for the
primary beam would be made up of dose to biologic material.
less penetrating photons, and so the
(Bushong, p 23)
mAs would have to be increased.
Ans. C
 The importance of patient shielding is
never diminished. 42. Radiation that passes through the tube
housing in directions other than that of the
(Sherer et al, p 163)
useful beam is termed
Ans. A
(A) scattered radiation.
40. Immature cells are referred to as (B) secondary radiation.
(C) leakage radiation.
1. undifferentiated cells.
(D) remnant radiation.
2. stem cells.
————————————————
3. genetic cells.
—————————
(A) 1 only
(B) 1 and 2 only  Scattered and secondary radiations are
(C) 1 and 3 only those that have deviated in direction
(D) 1, 2, and 3 while passing through a part.
————————————————
 Leakage radiation is radiation that
—————————
emerges from the leaded tube housing in
 Cells are frequently identified by directions other than that of the useful
their stage of development. beam.
 Immature cells may be referred to as o Tube head construction must
undifferentiated or stem cells. keep leakage radiation to less
than 0.1 R/h at 1 m from the
o Immature cells are much more
tube.
radiosensitive than mature cells.
 Remnant radiation is the radiation that
(Sherer et al, p 109)
emerges from the patient to form the
Ans. B
radiographic image.
41. The unit of measure used to express (Sherer et al, p 202)
occupational exposure is the Ans. C
(A) roentgen (C/kg).
43. To be in compliance with radiation safety
(B) rad (Gy).
standards, the fluoroscopy exposure switch
(C) rem (Sv).
must
(D) relative biologic effectiveness (RBE).
———————————————— (A) sound during fluoro-on time.
————————— (B) be on a 6-ft-long cord.
(C) terminate fluoro after 5 min.
 Roentgen is the unit of exposure;
(D) be the dead-man type.
o it measures the quantity of ————————————————
ionizations in air. —————————

Reviewer A&R
Question & Answer
12
Review Notes for the
RADIOGRAPHY EXAM Appleton
 For radiation safety, the fluoroscopy centimeters of air, they are
exposure switch must be of the dead-man practically harmless as an external
type. source.
o When the foot is removed from the (Sherer et al, p 190)
fluoro pedal, the dead-man switch Ans. C
will terminate the exposure
immediately. 46. The interaction between x-ray photons and
matter pictured in Figure 3-1 is associated
o There must also be a fluoroscopy
with
timer that will either sound or
interrupt exposure after 5 min of 1. high-energy x-ray photons.
fluoroscopy. 2. ionization.
3. characteristic radiation.
(Bushong, p 534)
Ans. D (A) 1 only
(B) 1 and 2 only
44. Primary radiation barriers must be at least (C) 1 and 3 only
how high? (D) 2 and 3 only
————————————————
(A) 5 ft
—————————
(B) 6 ft
(C) 7 ft  Diagnostic x-ray photons interact with
(D) 8 ft tissue in a number of ways, but most
———————————————— frequently they are involved in the
————————— photoelectric effect or in the production
of Compton scatter.
 Radiation protection guidelines have
established that primary radiation o The photoelectric effect is pictured in
barriers must be 7 ft high. Figure 3-6; it occurs when a relatively
low-energy x-ray photon uses all its
o Primary radiation barriers are walls that
energy to eject an inner-shell
the primary beam might be directed
electron.
toward.
o That electron is ejected
o They usually contain 1.5 mm lead (1/16
(photoelectron), leaving a "hole" in
in), but this may vary depending on use
the K shell and producing a positive
factor, etc.
ion.
(Sherer et al, pp 204-205)
 An L-shell electron then drops down
Ans. C
to fill the K vacancy, and in doing so
emits a characteristic ray whose
45. The annual dose limit for occupationally
energy is equal to the difference
exposed individuals is valid for
between the binding energies of the
(A) alpha, beta, and x-radiations. K and L shells.
(B) x- and gamma radiations only.
 The photoelectric effect occurs with
(C) beta, x-, and gamma radiations.
high-atomic-number absorbers such
(D) all ionizing radiations.
as bone and positive contrast media,
————————————————
and is responsible for the production
—————————
of contrast.
 The occupational dose limit is valid for
 Therefore, its occurrence is helpful
beta, x, and gamma radiations.
for the production of the
o Because alpha radiation is so rapidly radiographic image, but it contributes
ionizing, traditional personnel significantly to the dose received by
monitors will not record alpha the patient (because it involves
radiation. complete absorption of the incident
photon).
o However, because alpha particles are
capable of penetrating only a few  Scattered radiation, which produces a

Reviewer A&R
Question & Answer
13
Review Notes for the
RADIOGRAPHY EXAM Appleton
radiation hazard to the radiographer but when the exam necessitates
(as in fluoroscopy), is a product of the obtaining oblique, lateral, or erect
Compton scatter interaction projections, they become less
occurring with higher-energy x-ray efficient.
photons.
2) Shaped contact (contour) shields are
(Selman, pp 125-126) best because they enclose the male
Ans. D reproductive organs and remain in
position in oblique, lateral, and erect
47. The advantages of beam restriction include positions.
1. Less scattered radiation is 3) Shadow shields that attach to the
produced. tube head are particularly useful for
2. Less biologic material is surgical sterile fields.
irradiated.
(Sherer et al, pp 156-160)
3. Less total filtration will be
Ans. D
necessary.
(A) 1 only 49. The unit of absorbed dose is the
(B) 1 and 2 only
(A) roentgen (C/kg).
(C) 2 and 3 only
(B) rad (Gy).
(D) 1, 2, and 3
(C) rem (Sv).
————————————————
(D) RBE.
—————————
————————————————
With greater beam restriction, less biologic —————————
material is irradiated, thereby reducing the
 Rad is an acronym for radiation
possibility of harmful effects.
absorbed dose;
If less tissue is irradiated, less scattered
o it measures the energy deposited in
radiation is produced, resulting in improved
any material.
film contrast.
 Roentgen is the unit of exposure;
The total filtration is not a function of beam
restriction, but rather is a radiation protection o it measures the quantity of
guideline aimed at reducing patient skin dose. ionizations in air.
(Selman, p 247)  Rem is an acronym for radiation
Ans. B equivalent man;
o it includes the relative biologic
48. Types of gonadal shielding include which of
the following? effectiveness (RBE) specific to the
tissue irradiated and therefore is a
1. Flat contact valid unit of measure for the dose to
2. Shaped contact (contour) biologic tissue.
3. Shadow
(Bushong, p 23)
(A) 1 only Ans. B
(B) 1 and 2 only
(C) 2 and 3 only 50. The law of Bergonié‚ and Tribondeau states
(D) 1, 2, and 3 that cells are more radiosensitive if they are
————————————————
————————— 1. highly mitotic.
2. undifferentiated.
 Gonadal shielding should be used 3. mature cells.
whenever appropriate and possible
during radiographic and fluoroscopic (A) 1 only
exams. (B) 1 and 2 only
(C) 2 and 3 only
1) Flat contact shields are useful for (D) 1, 2, and 3
simple recumbent (AP, PA) studies, ————————————————

Reviewer A&R
Question & Answer
14
Review Notes for the
RADIOGRAPHY EXAM Appleton
————————— o It may be stated that the alpha
particle has one of the highest LETs of
 Bergonié‚ and Tribondeau were
all ionizing radiations.
French scientists who, in 1906,
theorized what has now become (Bushong, p 464)
verified law. Ans. C
 Cells are more radiosensitive if they
52. The skin response to radiation exposure that
are immature (undifferentiated or
appears as hair loss is known as
stem) cells,
(A) dry desquamation.
 if they are highly mitotic (having a
(B) moist desquamation.
high rate of proliferation), and if the
(C) erythema.
irradiated tissue is young.
(D) epilation.
o Cells and tissues that are still ————————————————
undergoing development are more —————————
radiosensitive than fully developed
The various skin responses to irradiation
tissues.
include all four choices.
(Sherer et al, p 109)
1.) The first noticeable response would
Ans. B
be erythema, a reddening of the skin
very much like sunburn.
51. For exposure to 1 rad of each of the following
ionizing radiations, which would result in the 2.) Dry desquamation may follow; it is a
greatest dose to the individual? dry peeling of the skin.
(A) External source of 1-MeV x-rays 3.) Moist desquamation is peeling with
(B) External source of diagnostic x-rays associated puslike fluid.
(C) Internal source of alpha particles
4.) Epilation is hair loss;
(D) External source of beta particles
———————————————— o it may be temporary or permanent,
———————— depending on sensitivity and dose.
 Electromagnetic radiations such as x- (Sherer et al, p 116)
rays and gamma rays are considered Ans. D
low LET-radiations because they
produce fewer ionizations than the 53. Biologic material is most sensitive to
highly ionizing particulate radiations irradiation under which of the following
such as alpha particles. conditions?
 Alpha particles are large and heavy (A) Anoxic
(two protons and two neutrons), and (B) Hypoxic
although they possess a great deal of (C) Oxygenated
kinetic energy (approximately 5 (D) Deoxygenated
MeV), their energy is rapidly lost ————————————————
through multiple ionizations —————————
(approximately 40,000 atoms/cm of
o Tissue is most sensitive to radiation when
air).
it is oxygenated.
o As an external source, alpha particles
 Anoxic refers to tissue without
are almost harmless, because they
oxygen;
ionize the air very quickly and never
reach the individual.  hypoxic refers to tissue with little
oxygen.
o As internal sources, however, they
ionize tissues, and are potentially the o Anoxic and hypoxic tumors are typically
most harmful. avascular (with little or no blood supply)
and therefore more radioresistant.
(Sherer et al, p 109)

Reviewer A&R
Question & Answer
15
Review Notes for the
RADIOGRAPHY EXAM Appleton
Ans. C 56. The presence of ionizing radiation may be
detected in which of the following ways?
54. The reduction in the intensity of an x-ray beam
1. Ionizing effect on air
as it passes through material is termed
2. Photographic effect on film
(A) absorption. emulsion
(B) scattering. 3. Fluorescent effect on certain
(C) attenuation. crystals
(D) divergence.
(A) 1 only
————————————————
(B) 1 and 2 only
—————————
(C) 1 and 3 only
1.) The reduction in the intensity (quantity) of (D) 1, 2, and 3
an x-ray beam as it passes through matter ————————————————
as a result of absorption and scatter is —————————
called attenuation.
 The presence of ionizing radiation
2.) Absorption occurs when an x-ray photon may be detected in several ways.
interacts with matter and disappears, as
1.) It has an ionizing effect on air, which
in the photoelectric effect.
is the basic principle of the roentgen
3.) Scattering occurs when there is partial as unit of measure.
transfer of energy to matter, as in the
2.) X-rays have a photographic effect on
Compton effect.
film emulsion, which is readily
(Bushong, p 158) observable on radiographic images.
Ans. C
3.) The fluorescent effect on certain
crystals, such as calcium tungstate
55. The person responsible for ascertaining that
and lanthanum, accounts for our use
all radiation guidelines are adhered to and
of these phosphors in intensifying
that personnel understand and employ
screens.
radiation safety measures is the
4.) Radiation's physiologic effects have
(A) radiology department manager.
been demonstrated to be genetic
(B) radiation safety officer.
damage, erythema, and
(C) chief radiologist.
cataractogenesis; many of these
(D) chief technologist.
were noted by the early radiology
————————————————
pioneers.
—————————
(Bushong, p 538)
 Radiation safety guidelines are
Ans. D
valuable only if they are followed by
radiation personnel.
57. What unit of measure expresses the amount of
o The radiation safety officer (RSO) energy deposited in tissue?
is responsible for being certain
(A) Roentgen (C/kg)
that established guidelines are
(B) Rad (Gy)
enforced and that personnel
(C) Rem (Sv)
understand and employ radiation
(D) RBE
safety measures to protect
————————————————
themselves and their patients.
—————————
o The RSO is also responsible for
 The rad is the unit of absorbed dose.
performing routine equipment
checks to ensure that all o It is equal to 100 ergs of energy per
equipment meets radiation safety gram of any absorber.
standards.
 The roentgen measures quantity of
(NCRP Report No. 405, p 34) ionization in air.
Ans. B

Reviewer A&R
Question & Answer
16
Review Notes for the
RADIOGRAPHY EXAM Appleton
 The rem and RBE express radiation an increase in exposure factor
dose to biologic material. (usually mAs) and therefore results in
increased patient dose.
(Bushong, p 23)
Ans. B (Sherer et al, p 150)
Ans. A
58. The largest dose to the male gonads is most
likely to result from which of the following 60. The dose-response curve that appears to be
exposures? valid for genetic and some somatic effects is
the
(A) Lateral thoracic spine
(B) Oblique lumbar spine 1. linear.
(C) Cross-table lateral hip 2. sigmoidal.
(D) AP axial skull 3. nonthreshold.
———————————————————
(A) 1 only
——————
(B) 1 and 3 only
The cross-table lateral hip will bring the (C) 2 and 3 only
primary beam in closest proximity to the male (D) 1, 2, and 3
reproductive organs. ————————————————
—————————
A grid is required, and gonadal shielding is
most likely not possible. The genetic effects of radiation and some
somatic effects, like leukemia, are plotted on a
Close, accurate collimation is recommended
linear dose-response curve.
to keep exposure to a minimum, but the
cross-table lateral hip will deliver the greatest The linear dose-response curve has no
dose to the male reproductive organs. threshold; that is, there is no dose below
which radiation is absolutely safe.
(Bontrager, p 267)
Ans. C The sigmoidal dose-response curve has a
threshold and is thought to be generally
59. Which of the following is likely to improve correct for most somatic effects.
image quality and decrease patient dose?
(Bushong, p 466)
1. Beam restriction Ans. B
2. Low kV and high mAs factors
3. Grids 61. According to National Council on Radiation
Protection and Measurements (NCRP)
(A) 1 only
regulations, leakage radiation from the x-ray
(B) 1 and 3 only
tube must not exceed
(C) 2 and 3 only
(D) 1, 2, and 3 (A) 10 mR/h.
———————————————— (B) 100 mR/h.
————————— (C) 10 mR/min
(D) 100 mR/min
 The use of beam restrictors limits the
———————————————————
amount of tissue being irradiated,
——————
thus decreasing patient dose and
decreasing the production of X-ray photons produced in the x-ray tube can
scattered radiation. radiate in directions other than the one
desired.
o High mAs factors increase patient
dose. The tube housing is therefore constructed so
that very little of this leakage radiation is
o Patient dose is reduced by using high-
permitted to escape.
kVp and low-mAs combinations.
The regulation states that leakage radiation
o Although the use of a grid improves
must not exceed 100 mR/h at 1 m while the
image quality by decreasing the tube is operated at maximum potential.
amount of scattered radiation
reaching the film, it always requires (Bushong, p 535)

Reviewer A&R
Question & Answer
17
Review Notes for the
RADIOGRAPHY EXAM Appleton
Ans. B b. Isobars are Atoms with the same
mass number but different atomic
62. Which of the following most effectively number.
minimizes radiation exposure to the patient?
c. Isotones are Atoms with the same
(A) Small focal spot atomic number but different neutron
(B) Low-ratio grids number.
(C) Long source-image distance
d. Isomers are Atoms with the same
(D) High-speed intensifying screens
atomic number and mass number.
———————————————————
—————— (Bushong, p 47)
Ans. B
 Focal spot size affects recorded detail
and x-ray tube heat limits, it has no
64. The effects of radiation on biologic material
effect on patient dose.
are dependent on several factors. If a quantity
 Low-ratio grids, although they of radiation is delivered to a body over a long
require less mAs than high-ratio period of time, the effect.
grids, are not a means of patient
(A) will be greater than if it were
protection.
delivered all at one time.
 Long source-image distances usually (B) will be less than if it were delivered all
require the use of higher mAs and so at one time.
would not be an effective means of (C) has no relation to how it is delivered
patient protection. in time.
(D) is solely dependent on the radiation
 The use of high-speed intensifying
quality.
screens enables the use of lower mAs
————————————————
values and is therefore an important
—————————
consideration in limiting patient dose.
The effects of a quantity of radiation delivered
 Limiting the irradiated field size,
to a body are dependent on the amount of
through collimation or other beam
radiation received, the size of the irradiated
restriction, is perhaps the most
area, and how the radiation is delivered in
effective way of controlling patient
time.
exposure dose.
If the radiation is delivered in portions over a
(Bushong, p 208)
period of time, it is said to be fractionated and
Ans. D
has a less harmful effect than if it were
delivered all at once, as cells have an
63. Isotopes are atoms that have the same
opportunity to repair and some recovery
(A) mass number but a different atomic occurs between doses.
number.
(Bushong, p 514)
(B) atomic number but a different mass
Ans. B
number.
(C) atomic number but a different
65. Which of the following accounts for the x-ray
neutron number.
beam's heterogeneity?
(D) atomic number and mass number.
———————————————— 1. Incident electrons interacting
————————— with several layers of tungsten
target atoms
a. Isotopes are atoms of the same
2. Energy differences among
element (the same atomic number or
incident electrons
number of protons) but a different
3. Electrons moving to fill different
mass number.
shell vacancies
o They differ, therefore, in the number
(A) 1 only
of neutrons.
(B) 1 and 2 only
(C) 1 and 3 only

Reviewer A&R
Question & Answer
18
Review Notes for the
RADIOGRAPHY EXAM Appleton
(D) 1, 2, and 3 ————————————————
———————————————— —————————
—————————
 X-radiation used for diagnostic
The x-ray photons produced at the tungsten purposes is of relatively low energy.
target make up a heterogeneous beam, a
o Kilovoltages of up to 150 are used, as
spectrum of photon energies.
compared with radiations having
This is accounted for by the fact that the energies of up to several million
incident electrons have differing energies. volts.
Also, the incident electrons travel through  LET (linear energy transfer) refers to
several layers of tungsten target material, lose the rate at which energy is
energy with each interaction, and therefore transferred from ionizing radiation
produce increasingly weaker photons. tosoft tissue.
During characteristic x-ray production,  Particulate radiations, such as alpha
vacancies may be filled in the K, L, or M shells, particles, have mass and charge, and
which differ from each other in binding therefore lose energy rapidly as they
energies, and therefore photons with varying penetrate only a few centimeters of
amounts of energy are emitted. air.
(Bushong, pp 144-146)  X- and gamma radiations, having no
Ans. D mass or charge, are low-LET
radiations.
66. In the production of bremsstrahlung radiation,
(Bushong, p 480)
the incident electron
Ans. A
(A) ejects an inner-shell tungsten
electron. 68. Which of the following contributes most to
(B) ejects an outer-shell tungsten patient dose?
electron.
(A) The photoelectric effect
(C) is deflected, with resulting energy
(B) Compton scatter
loss.
(C) Classical scatter
(D) is deflected, with resulting energy
(D) Thompson scatter
increase.
————————————————
————————————————
—————————
—————————
Bremsstrahlung (or Brems) radiation is one of  In the photoelectric effect, a relatively
the two kinds of x-rays produced at the low-energy photon uses all its energy
tungsten target of the x-ray tube. to eject an inner-shell electron,
leaving a vacancy.
The incident high-speed electron, passing
through a tungsten atom, is attracted by the o An electron from the shell above
positively charged nucleus and therefore is drops down to fill the vacancy, and in
deflected from its course, with a resulting loss doing so emits a characteristic ray.
of energy.
o This type of interaction is most
This energy loss is given up in the form of an x- harmful to the patient, as all the
ray photon. photon energy is transferred to
(Bushong, p 145) tissue.
Ans. C  In Compton scatter, a high-energy
incident photon uses some of its
67. Diagnostic x-radiation may be correctly energy to eject an outer-shell
described as electron.
(A) low energy, low LET. o In doing so, the incident photon is
(B) low energy, high LET. deflected with reduced energy, but
(C) high energy, low LET. usually retains most of its energy and
(D) high energy, high LET.

Reviewer A&R
Question & Answer
19
Review Notes for the
RADIOGRAPHY EXAM Appleton
exits the body as an energetic (B) ions produced in air.
scattered ray. (C) energy deposited in an absorber.
(D) biologic effects.
o The scattered radiation will either
————————————————
contribute to film fog or pose a
—————————
radiation hazard to personnel,
depending on its direction of exit. The curie is the unit of radioactivity, describing
disintegrations per second.
 In classical scatter, a low-energy
photon interacts with an atom but The roentgen is the unit of exposure; it
causes no ionization; the incident measures the quantity of ionization in air.
photon disappears in the atom, then
Rad is an acronym for radiation absorbed
immediately reappears and is
dose; it measures the energy deposited in any
released as a photon of identical
material.
energy but changed direction.
Rem is an acronym for radiation equivalent
o Thompson scatter is another
man; it includes the relative biologic
name for classical scatter. effectiveness (RBE) specific to the tissue
(Bushong, pp 167-169) irradiated, and therefore is a valid unit of
Ans. A measure for the dose to biologic material.
(Sherer et al, pp 44-66)
69. Which of the following illustrates the inverse Ans. C
square law?
1. Distance is a most effective protection 71. The interaction between x-ray photons and
from radiation. tissue that is responsible for radiographic
2. Distance is a rather ineffective contrast but that also contributes significantly
protection from radiation. to patient dose is
3. As distance from the radiation source (A) the photoelectric effect.
decreases, radiation decreases. (B) Compton scatter.
(A)
1 only (C) coherent scatter.
(B)
1 and 2 only (D) pair production.
(C)
1 and 3 only ————————————————
(D)
2 and 3 only —————————
———————————————————  In the photoelectric effect, the
—————— incident (low-energy) photon is
 The inverse square law of radiation completely absorbed, and thus is
states that the intensity or exposure responsible for producing contrast
rate of radiation at a given distance and contributing to patient dose.
from a point source is inversely o The photoelectric effect is the
proportional to the square of the
interaction between x-ray and tissue
distance.
that predominates in the diagnostic
o This means that if the distance from a range.
radiation source is doubled, the dose  In Compton scatter, only partial
received will be one-fourth the absorption occurs, and most energy
original intensity (quantity). emerges as scattered photons.
o Distance, therefore, can be a very o In coherent scatter, no energy is
effective means of protection from absorbed by the part; it all emerges
radiation exposure. as scattered photons.
(Bushong, pp 56-66)  Pair production occurs only at very
Ans. A high energy levels, at least 1.02 MeV.
70. The rad may be described as (Bushong, pp 165-166)
Ans. A
(A) disintegrations per second.

Reviewer A&R
Question & Answer
20
Review Notes for the
RADIOGRAPHY EXAM Appleton
72. Which of the following is a measure of dose to compared to the useful beam at the patient's
biologic tissue? surface?
(A) Roentgen (C/kg) (A) 0.01 percent
(B) Rad (Gy) (B) 0.1 percent
(C) Rem (Sv) (C) 1.0 percent
(D) RBE (D) 10.0 percent
———————————————— ————————————————
————————— —————————
Roentgen is the unit of exposure; it measures The patient is the most important radiation
the quantity of ionization in air. scatterer during both radiography and fluoroscopy.
Rad is an acronym for radiation absorbed In general, at 1 m from the patient, the intensity is
dose; it measures the energy deposited in any reduced by a factor of 1000, to about 0.1 percent
material. of the original intensity. Successive scatterings can
Rem is an acronym for radiation equivalent render the intensity to unimportant levels.
man; it includes the relative biologic (Bushong, p 535)
effectiveness (RBE) specific to the tissue Ans. B
irradiated, and therefore is a valid unit of
measure for the dose to biologic material. 75. Which of the following formulas is a
(Sherer et al, pp 44-66) representation of the inverse square law and
Ans. C may be used to determine x-ray intensity at
different distances?
(A) I1 D22
73. Which of the dose-response curve(s) seen in
― = —
Figure 3-2 illustrate(s) a threshold response to
I2 D12
radiation exposure?
1. Dose-response curve A
(B) I1 D12
2. Dose-response curve B
― = —
3. Dose-response curve C
I2 D22
(A) 1 only
(B) 1 and 2 only (C) kVp1 D22
(C) 2 and 3 only — = —
(D) 1, 2, and 3 kVp2 D12
————————————————
————————— (D) kVp1 D12
— = —
Figure 3-2 illustrates three dose-response curves.
kVp2 D22
Curve A begins at zero, indicating that there is no
safe dose, that is, no threshold. Even one x-ray
——————————————————
photon can, theoretically, cause a response. It is a
———————
straight (linear) line, indicating that response is
proportional to dose. That is, as dose increases, As an x-ray source moves away from a detector,
response increases. Curve B is another linear the x-ray intensity (quantity) decreases.
curve, but this one illustrates a situation in which a
Conversely, as the source of x-rays moves closer to
particular dose of radiation must be received
the detector, the intensity increases.
before the response will occur. That is, there is a
threshold dose, and this is a linear threshold curve. This is a predictable relationship that may be
Curve C is another threshold curve, but this curve calculated using the inverse square law, which
is nonlinear. It illustrates that once the minimum states that the intensity (exposure rate) of
dose is received, a response initially occurs slowly, radiation at a given distance from a point source is
then increases sharply as exposure increases. inversely proportional to the square of the
(Sherer et al, p 115) distance.
Ans. C
For example, if the distance from an x-ray source
were doubled, the intensity of x-rays at the
74. What is the intensity of scattered radiation
detector would be one-fourth of its original value.
perpendicular to and 1 m from the patient,

Reviewer A&R
Question & Answer
21
Review Notes for the
RADIOGRAPHY EXAM Appleton
This relationship is represented by the formula: exposed and those (family and friends) who might
assist a patient during an exam must wear
protective apparel and keep out of the way of the
I1 D22
primary beam.
― = —
(Sherer et al, p 195)
I2 D12
Ans. A
(Bushong, pp 65-66)
78. The amount of time that x-rays are being
Ans. A
produced and directed toward a particular
wall is referred to as the
76. The biologic effect on an individual is
(A) workload.
dependent on which of the following?
(B) use factor.
1. Type of tissue interaction(s) (C) occupancy factor.
2. Amount of interactions (D) controlling factor.
3. Biologic differences ———————————————————
——————
(A) 1 and 2 only
Use factor describes the percentage of time that
(B) 1 and 3 only
the primary beam is directed toward a particular
(C) 2 and 3 only
wall. The use factor is one of the factors
(D) 1, 2, and 3
considered in determining protective barrier
————————————————
thickness. Another is workload, which is
—————————
determined by the number of x-ray exposures
Photoelectric interaction in tissue involves made per week. Occupancy factor is a reflection of
complete absorption of the incident photon., who occupies particular areas (radiation workers
or nonradiation workers) and is another factor
whereas Compton interactions involve only partial
used in determining radiation barrier thickness.
transfer of energy.
(Sherer et al, pp 203-204)
The larger the quantity of radiation and the Ans. B
greater the number of photoelectric interactions,
the greater the patient dose. 79. The operation of personnel radiation
monitoring devices depends on which of the
Radiation to more radiosensitive tissues such as
following?
gonadal tissue or blood-forming organs is more
1. Ionization
harmful than the same dose to muscle tissue.
2. Luminescence
(Selman, pp 513-514) 3. Thermoluminescence
Ans. D (A) 1 only
(B) 1 and 2 only
77. Protective devices such as lead aprons (C) 2 and 3 only
function to protect the user from (D) 1, 2, and 3
———————————————————
1. scattered radiation.
——————
2. the primary beam.
Ionization is the fundamental principle of
3. remnant radiation.
operation of both the film badge and the pocket
(A) 1 only dosimeter. In the film badge, the film's silver
(B) 1 and 2 only halide emulsion is ionized by x-ray photons. The
(C) 1 and 3 only pocket dosimeter contains an ionization chamber,
(D) 1, 2, and 3 and the number of ionizations taking place may be
———————————————— equated to the exposure dose. TLDs contain
————————— lithium fluoride crystals that undergo
characteristic changes upon irradiation. When the
Protective apparel functions to protect the
crystals are subsequently heated, they emit a
occupationally exposed person from scattered
quantity of visible (thermo)luminescence / light in
radiation only. Lead aprons and lead gloves do not
proportion to the amount of radiation absorbed.
protect from the primary beam. No one in the
OSLs contain aluminum oxide crystals that also
radiographic room except the patient must ever be
undergo characteristic changes upon irradiation.
exposed to the primary beam. The occupationally
When the Al2O3 crystals are stimulated by a laser,

Reviewer A&R
Question & Answer
22
Review Notes for the
RADIOGRAPHY EXAM Appleton
they emit (optically stimulated) luminescence / effects of radiation, such as carcinogenesis
light in proportion to the amount of radiation (including leukemia) and cataractogenesis.
absorbed. (Sherer et al, pp 218-219) However, if a large amount of radiation is
Ans. D delivered to the whole body at one time, the
short-term early somatic effects must be
80. Which of the following result(s) from considered. If the whole body receives 600 rad at
restriction of the x-ray beam? one time, acute radiation syndrome is likely to
1. Less scatter radiation production occur. Early symptoms of acute radiation
2. Less patient hazard syndrome include nausea, vomiting, diarrhea,
3. Less radiographic contrast fatigue, and leukopenia (decreased white blood
(A) 1 only cells); these occur in the first (prodromal) stage of
(B) 1 and 2 only acute radiation syndrome. (Sherer et al, pp 116-
(C) 2 and 3 only 117)
(D) 1, 2, and 3 Ans. A
———————————————————
—————— 83. Referring to the nomogram in Figure 3-3, what
As the size of the irradiated field decreases, scatter is the approximate patient entrance skin
radiation production and patient hazard decrease. exposure (ESE) from an AP projection of the
If the amount of scatter radiation decreases, then abdomen made at 105 cm using 70 kVp, 300
radiographic contrast is higher (shorter scale). mA, 0.2 s, and 2.5-mm Al total filtration?
(Sherer et al, pp 151-154) (A) 5 mR
Ans. B (B) 166 mR
(C) 245 mR
81. The primary function of filtration is to reduce (D) 288 mR
(A) patient skin dose. ———————————————————
(B) operator dose. ——————
(C) film noise. An approximate ESE (entrance skin dose) can be
(D) scattered radiation. determined using the illustrated nomogram. First,
——————————————————— mark 2.5 mm Al on the x / horizontal axis. Next,
—————— mark where a line drawn up from that point
It is our ethical responsibility to minimize the intersects the 70-kVp line. Draw a line straight
radiation dose to our patients. X-rays produced at across to the y/ vertical axis; this should
the tungsten target make up a heterogeneous approximately reach the 4.8 mR/mAs point.
primary beam. There are many "soft" (low-energy) Because 60 mAs was used for the exposure, the
photons that, if not removed by filters, would only approximate entrance skin dose is 288 mR (60 ×
contribute to greater patient skin dose. They are 4.8). (Bushong, p 550)
too weak to penetrate the patient and expose the Ans.D
film; they penetrate a small thickness of tissue and
are absorbed. (Bushong, p 11) 84. What is the term used to describe x-ray
Ans. A photon interaction with matter and the
transference of part of the photon's energy to
82. Early symptoms of acute radiation syndrome matter?
include (A) Absorption
1. leukopenia. (B) Scattering
2. nausea and vomiting. (C) Attenuation
3. cataracts. (D) Divergence
(A) 1 and 2 only ———————————————————
(B) 2 only ——————
(C) 1 and 3 only Scattering occurs when there is partial transfer of
(D) 2 and 3 only the proton's energy to matter, as in the Compton
——————————————————— effect. Absorption occurs when an x-ray photon
—————— interacts with matter and disappears, as in the
Occupationally exposed individuals generally photoelectric effect. The reduction in the intensity
receive small amount of low-energy radiation over (quantity) of an x-ray beam as it passes through
a long period of time. These individuals are matter is termed attenuation. Divergence refers to
therefore concerned with the potential long-term

Reviewer A&R
Question & Answer
23
Review Notes for the
RADIOGRAPHY EXAM Appleton
a directional characteristic of the x-ray beam as it 87. Which of the following factors can affect the
is emitted from the focal spot. (Bushong, p 158) amount or the nature of radiation damage to
Ans. B biologic tissue?
1. Radiation quality
85. If 600 rad or more is received as a whole-body 2. Absorbed dose
dose in a short period of time, certain 3. Size of irradiated area
symptoms will occur; these are referred to as (A) 1 only
(A) short-term effects. (B) 2 only
(B) long-term effects. (C) 1 and 2 only
(C) lethal dose. (D) 1, 2, and 3
(D) acute radiation syndrome. ———————————————————
——————————————————— ——————
—————— Radiation quality determines degree of
Radiation is most hazardous when it is received in penetration and the amount of energy transferred
a large dose, all at one time, to the whole body. to the irradiated tissue (LET). Certainly, the larger
When 600 rad or more is received as a whole-body the absorbed radiation dose, the greater the
dose in a short time, biologic effects will appear effect. Biologic effect is increased as the size of the
within minutes to weeks (depending on the dose irradiated area is increased. The nature of the
received). These immediate effects are known as effect is influenced by the location of irradiated
acute radiation syndrome. (Sherer et al, pp 116- tissue (bone marrow versus gonads and so on).
117) (Sherer et al, p 115)
Ans. D Ans. D

86. Which of the following contributes most to 88. Which of the following is (are) features of
occupational exposure? fluoroscopic equipment that are designed
(A) The photoelectric effect especially to eliminate unnecessary radiation
(B) Compton scatter to patient and personnel?
(C) Classical scatter 1. Protective curtain
(D) Thompson scatter 2. Filtration
——————————————————— 3. Collimation
—————— (A) 1 only
In the photoelectric effect, a relatively low-energy (B) 1 and 2 only
photon uses all its energy to eject an inner-shell (C) 1 and 3 only
electron, leaving a vacancy. An electron from the (D) 1, 2, and 3
shell above drops down to fill the vacancy, and in ———————————————————
doing so gives up a characteristic ray. This type of ——————
interaction is most harmful to the patient, as all The protective curtain, which is usually made of
the photon energy is transferred to tissue. In leaded vinyl with at least 0.25 mm Pb equivalent,
Compton scatter, a high-energy incident photon must be positioned between the patient and the
uses some of its energy to eject an outer-shell fluoroscopist to greatly reduce the exposure of the
electron. In doing so, the incident photon is fluoroscopist to energetic scatter from the patient.
deflected with reduced energy, but it usually As with overhead equipment, fluoroscopic total
retains most of its energy and exits the body as an filtration must be at least 2.5 mm Al equivalent to
energetic scattered ray. This scattered ray will reduce excessive exposure to soft radiation.
either contribute to film fog or pose a radiation Collimator / beam alignment must be accurate to
hazard to personnel, depending on its direction of within 2 percent.
exit; thus, Compton scatter contributes the most (Bushong, p 534)
to occupational exposure. In classical scatter, a Ans. D
low-energy photon interacts with an atom but
causes no ionization; the incident photon 89. The most efficient type of male gonadal
disappears into the atom, and then is immediately shielding for use during fluoroscopy is
released as a photon of identical energy but with (A) flat contact.
changed direction. Thompson scatter is another (B) shaped contact (contour).
name for classical scatter. (Selman, p 128) (C) shadow.
Ans. B (D) cylindrical.
———————————————————

Reviewer A&R
Question & Answer
24
Review Notes for the
RADIOGRAPHY EXAM Appleton
—————— The dose-equivalent limit for the hands and skin of
Gonadal shielding should be used whenever an occupationally exposed individual is 50 rem.
appropriate and possible during radiographic and The dose-equivalent limit for the lens of the eye is
fluoroscopic exams. Flat contact shields are useful 5 rem. An occupationally exposed individual may
for simple recumbent studies, but when the exam receive up to 3 rem in a given calendar quarter, or
necessitates obtaining that oblique, lateral, or 13-week period. However, that individualmay not
erect projections, they are easily displaced and exceed 5 rem in that particular year. If, for
become less efficient. Shaped contact (contour) example, one received 3 rem during the first 3
shields are best because they enclose the male months of a year, that individual must not receive
reproductive organs and remain in position for more than 2 rem in the remaining 9 months.
oblique, lateral, and erect projections. Shadow (Bushong, p 522)
shields that attach to the tube head are Ans. C
particularly useful for surgical sterile fields.
(Bushong, pp 562-563) 92. Methods of reducing radiation exposure to
Ans. B patients and/or personnel include
1. beam restriction.
90. Which of the following statements is/are true 2. shielding.
with respect to radiation safety in 3. high-kV, low-mAs factors.
fluoroscopy? (A) 1 only
1. tabletop radiation intensity must not (B) 1 and 2 only
exceed 2.1 R/min/mA (C) 2 and 3 only
2. tabletop radiation intensity must not (D) 1, 2, and 3
exceed 10 R/min ———————————————————
3. in high level fluoroscopy, tabletop ——————
intensity up to 20 R/min is permitted Beam restriction is probably the single best
(A) 1 only method of protecting your patient from excessive
(B) 1 and 2 only radiation. It is also an important factor in obtaining
(C) 2 and 3 only high-quality radiographs because there will be less
(D) 1, 2, and 3 fog from scatter radiation. Shielding areas not
——————————————————— included in the radiograph, especially particularly
—————— radiosensitive areas, is another effective means of
In fluoroscopy, the source of x-rays is 12-15inches reducing patient dose. If the patient is subjected to
below the x-ray tabletop. Since the SOD is so short, less radiation exposure, then so is the operator.
patient skin dose can be quite high. Consequently, Shielding, distance, and time are the three cardinal
the x-ray intensity at the tabletop is limited in rules of radiation protection. High-kV, low-mAs
order to keep patient dose (ESE) within safe limits. exposure factors employ the use of fewer and
The radiation protection guidelines state that x-ray more penetrating x-rays. (Bontrager, p 58)
intensity at tabletop must not exceed 2.1 Ans. D
R/min/mA at 80 kVp. In equipment without high-
level fluoroscopy capability the guideline can be 93. Factors that determine the amount of
expressed as 10 R/min tabletop limit. In scattered radiation produced include
equipment with high-level fluoroscopy capability, 1. radiation quality.
the tabletop limit is 20 R/min. 2. field size.
(Bushong, p 534) 3. pathology.
Ans. B (A) 1 only
(B) 1 and 2 only
91. What is the annual dose-equivalent limit for (C) 2 and 3 only
the skin and hands of an occupationally (D) 1, 2, and 3
exposed individual? ———————————————————
(A) 5 rem ——————
(B) 25 rem The amount of scattered radiation produced is
(C) 50 rem dependent first on the kilovoltage (beam quality)
(D) 100 rem selected; the higher the kVp, the more the
——————————————————— scattered radiation produced. The size of the
—————— irradiated field has a great deal to do with the
amount of scatter radiation produced; the larger

Reviewer A&R
Question & Answer
25
Review Notes for the
RADIOGRAPHY EXAM Appleton
the field size, the greater the amount of scattered nuclear medicine. A photocathode is an integral
radiation. Thickness and condition of tissue are part of the image intensification system.
important considerations; the thicker and/or more (Bushong, p 111)
dense the tissue, the more scatter produced. If the Ans. A
condition of the tissue is such that pathology
makes it more difficult to penetrate, more 96. LET is best defined as
scattered radiation will be produced. (Thompson et 1. a method of expressing radiation
al, pp 280, 282) quality.
Ans. D 2. a measure of the rate at which
radiation energy is transferred to soft tissue.
94. The focal spot-to-table distance, in mobile 3. absorption of polyenergetic radiation.
fluoroscopy, must be (A) 1 only
(A) a minimum of 15 in. (B) 1 and 2 only
(B) a maximum of 15 in. (C) 1 and 3 only
(C) a minimum of 12 in. (D) 1, 2, and 3
(D) a maximum of 12 in. ———————————————————
——————————————————— ——————
—————— When biologic material is irradiated, there are a
Lead and distance are the two most important number of modifying factors that determine what
ways to protect from radiation exposure. kind and how much response will occur in the
Fluoroscopy can be particularly hazardous because material. One of these factors is LET, which
the SID is so much shorter than in overhead expresses the rate at which particulate or photon
radiography. Therefore, it has been established energy is transferred to the absorber. Because
that fixed (stationary) and mobile fluoroscopic different kinds of radiation have different degrees
equipment must provide at least 12 in (30 cm) of penetration in different materials, it is also a
source-to-tabletop / skin distance for the useful way of expressing the quality of the
protection of the patient. (Bushong, p 533) radiation. (Thompson et al, p 419)
Ans. C Ans. B
97. It is necessary to question a female patient of
95. The automatic exposure device that is located childbearing age regarding the
immediately under the x-ray table is the 1. date of her last menstrual period.
(A) ionization chamber. 2. possibility of her being pregnant.
(B) scintillation camera. 3. number of children she presently has.
(C) photomultiplier. (A) 1 only
(D) photocathode. (B) 1 and 2 only
——————————————————— (C) 1 and 3 only
—————— (D) 2 and 3 only
Automatic exposure control (AEC) devices are used ———————————————————
in today's equipment and serve to produce ——————
consistent and comparable radiographic results. In It is our ethical responsibility to minimize radiation
one type of AEC, there is an ionization chamber exposure to ourselves and our patients,
just beneath the tabletop above the cassette. The particularly during early pregnancy. One way to do
part to be examined is centered on it (the sensor) this is to inquire about the possibility of our female
and radiographed. When a predetermined patients being pregnant, or for the date of their
quantity of ionization has occurred (equal to the last menstrual period (to determine the possibility
correct density), the exposure terminates of irradiating a newly fertilized ovum). The safest
automatically. In the other type of AEC, the time for a woman of childbearing age to have
phototimer / photomultiplier, a small fluorescent elective radiographic exams is during the first10
screen is positioned beneath the cassette. When days following the onset of menstruation.
remnant radiation emerging from the patient (Thompson et al, p 487)
exposes the film and exitsthe cassette, the Ans. B
fluorescent screen emits light. Once a
predetermined amount of fluorescent light is 98. In 1906, Bergonié‚ and Tribondeau established
"seen" by the photocell sensor, the exposure is their law, which states that cells are more
terminated. A scintillation camera is used in radiosensitive if they
1. are young.

Reviewer A&R
Question & Answer
26
Review Notes for the
RADIOGRAPHY EXAM Appleton
2. are stem cells. contribute to skin dose. (Thompson et al, pp 293-
3. have a low proliferation rate. 294)
(A) 1 only Ans. A
(B) 1 and 2 only
(C) 2 and 3 only [Link] NCRP recommends an annual effective
(D) 1, 2, and 3 occupational dose equivalent limit of
——————————————————— (A) 2.5 rem (25 mSv).
—————— (B) 5 rem (50 mSv).
The Law of Bergonié‚ and Tribondeau states that (C) 10 rem (100 mSv).
stem cells (which give rise to a specific type of cell, (D) 20 rem (200 mSv).
as in hematopoiesis) are particularly ———————————————————
radiosensitive, as are young cells and tissues. Italso ——————
states that cells with a high rate of proliferation In the past few decades, ICRP and NCRP studies
(mitosis) are more sensitive to radiation. This law have indicated that radiation-induced cancer risks
is historically important in that it was the first to are greater than radiation-induced genetic
recognize that some tissues have greater riskscontrary to previous thought. Their
radiosensitivity than others (such as the fetus). philosophy then grew to be concerned with the
(Sherer & Ritenour, p 109) probability of radiation-induced cancer mortality
Ans. B in the occupational radiation industry in
comparison with annual accidental mortality in
99. What is the effect on relative biologic "safe" (radiation free) industries. The NCRP
effectiveness (RBE) as LET increases? reexamined its 1987 recommendations, and in
(A) As LET increases, RBE increases. NCRP report 116 reiterates its annual effective
(B) As LET increases, RBE decreases. occupational dose limit as 50 mSv (5 rem). (NCRP
(C) As LET increases, RBE stabilizes. Report 116, pp 1, 4, 12)
(D) LET has no effect on RBE. Ans. B
———————————————————
—————— [Link] of the following groups of exposure
LET expresses the rate at which photon or factors will deliver the least amount of
particulate energy is transferred to (absorbed by) exposure to the patient?
biologic material (through ionization processes); it (A) 400 mA, 0.25 s, 100 kVp
is dependent on the type of radiation and the (B) 600 mA, 0.33 s, 90 kVp
characteristics of the absorber. RBE describes the (C) 800 mA, 0.5 s, 80 kVp
degree of response or amount of biologic change (D) 800 mA, 1.0 s, 70 kVp
one can expect of the irradiated material. As the ———————————————————
amount of transferred energy (LET) increases (from ——————
interactions occurring between radiation and mAs regulates the quantity of radiation delivered
biologic material), the amount of biologic effect / to the patient, and kVp regulates the quality
damage will also increase. (Thompson et al, pp (penetration) of the radiation delivered to the
419-420) patient. Therefore, higher-energy (more
Ans. A penetrating) radiation (which is more likely to exit
the patient), accompaniedby lower mAs, is the
[Link] of the following would most likely safest combination for the patient. (Thompson et
result in the greatest skin dose? al, p 275)
(A) Short SID Ans. A
(B) High kVp
(C) Increased filtration [Link] an individual receives 50 mR while standing
(D) Increased mA 4 ft from a source of radiation for 2 min, which
——————————————————— of the options listed below will most
—————— effectively reduce his or her radiation
The shorter the SID, the greater the skin dose. That exposure to that source of radiation?
is why there are specific source-to-skin distance (A) Standing 3 ft from the source for 2 min
restrictions in fluoroscopy. High kVp produces (B) Standing 8 ft from the source for 2 min
more penetrating photons, thereby decreasing (C) Standing 5 ft from the source for 1 min
skin dose. Filtration is used to remove the low- (D) Standing 6 ft from the source for 2 min
energy photons from the primary beam, which ———————————————————

Reviewer A&R
Question & Answer
27
Review Notes for the
RADIOGRAPHY EXAM Appleton
—————— effects.
A quick survey of the distractors reveals that 3. are late effects.
option A will increase exposure dose and thus is (A) 1 only
eliminated as a possible correct answer. Options B, (B) 1 and 2 only
C, and D will serve to reduce radiation exposure, as (C) 2 and 3 only
in each case either time is decreased or distance is (D) 1, 2, and 3
increased. It remains to be seen, then, which is the ———————————————————
more effective. Using the inverse square law of ——————
radiation, at a distance of 8 ft, the individual will Late effects of radiation can occur in cells that
receive 12.5 mR in 2 min (double distance from have survived a previous irradiation months or
source = one-fourth the original intensity). years earlier. These late effects, such as
carcinogenesis and genetic effects, are "all-or-
At 5 ft, the individual will receive 16 mR in 1 min: nothing" effectseither the organism develops
cancer or it does not. Most late effects do not have
50(I1) 25(D22) a threshold dose; that is, any dose, however small,
 =  ; 25x = 800 ; x = 32 mR in 2 min; theoretically can induce an effect. Increasing that
therefore, 16 mR in 1 min at 5 ft dose will increase the likelihood of the occurrence,
x(I2) 25(D12) but will not affect its severity; these effects are
termed stochastic. Nonstochastic effects are those
At 6 ft, the individual will receive 22.2 mR in 2 min: that will not occur below a particular threshold
dose and that increase in severity as the dose
50(I1) 36(D22) increases. (Sherer et al, p 136)
 =  ; 36x = 800 ; x = 22.22 mR in 2 Ans. C
min at 6 ft
x(I2) 16(D12) [Link] photoelectric effect is the interaction
between x-ray photons and matter that is
Therefore, the most effective option is B, 12.5 mR largely responsible for patient dose. The
in 2 min at 8 ft. (Bushong, p 66) photoelectric effect is likely to occur under
Ans. B which of the following conditions?
1. With absorbers of high atomic number
[Link] of the following tissues or organs is the 2. With low-energy incident photons
most radiosensitive? 3. With the use of positive contrast media
(A) Rectum (A) 1 and 2 only
(B) Esophagus (B) 1 and 3 only
(C) Small bowel (C) 2 and 3 only
(D) Central nervous system (CNS) (D) 1, 2, and 3
——————————————————— ———————————————————
—————— ——————
The most radiosensitive portion of the GI tract is The photoelectric effect occurs when a relatively
the small bowel. Projecting from the lining of the low-energy photon uses all its energy to eject an
small bowel are villi, from the crypts of inner-shell electron. That electron flies off into
Lieberkühn, which are responsible for the space, leaving a hole in, for example, the K shell.
absorption of nutrients into the bloodstream. An L-shell electron then drops down to fill the K
Because the cells of the villi are continually being vacancy, and in doing so emits a characteristic ray
cast off, new cells must continually arise from the whose energy equals the difference in binding
crypts of Lieberkühn. Being highly mitotic, energies for the Kand L shells. The photoelectric
undifferentiated stem cells, they are very effect occurs with high atomic number absorbers
radiosensitive. Thus, the small bowel is the most such as bone and with positive contrast media.
radiosensitive portion of the GI tract. In the adult, (Bushong, pp 167-169)
the CNS is the most radioresistant system. (Travis, Ans. D
p 121)
Ans. C [Link] used in radiographic x-ray tubes are
generally composed of
[Link] effects of radiation are those that (A) aluminum.
1. have a threshold. (B) copper.
2. may be described as "all-or-nothing" (C) tin.

Reviewer A&R
Question & Answer
28
Review Notes for the
RADIOGRAPHY EXAM Appleton
(D) lead. Ans. B
———————————————————
—————— [Link] within what percentage of the SID must the
Filters are used in radiography to remove soft collimator light and actual irradiated area be
(low-energy) radiation that contributes only to accurate?
patient dose. The filters are usually made of (A) 2 percent
aluminum. Equipment operating above 70 kVp (B) 5 percent
must have total filtration of 2.5 mm aluminum (C) 10 percent
equivalent (inherent + added). (Bushong, p 11) (D) 15 percent
Ans. A ———————————————————
——————
[Link] use of all of the following will function to Restriction of field size is one important method of
reduce patient dose except patient protection. However, the accuracy of the
(A) collimation. light field must be evaluated periodically as part of
(B) high-kVp, low-mAs factors. a QA program. Guidelines for patient protection
(C) a grid. state that the collimator light and actual irradiated
(D) fast intensifying screens. area must be accurate to within 2 percent of the
——————————————————— source-image distance. (Thompson et al, p 403)
—————— Ans. A
The use of a grid requires an increase in mAs and,
therefore, patient dose; the higher the grid ratio, [Link] of the following is considered the unit
the greater the increase in mAs required. of exposure in air?
Collimation restricts the amount of tissue being (A) Roentgen (C/kg)
irradiated and therefore reduces patient dose. (B) Rad (Gy)
High kVp reduces the amount of radiation (C) Rem (Sv)
absorbed by the patient's tissues (recall the (D) RBE
photoelectric effect), and low mAs reduces the ———————————————————
quantity of radiation delivered to the patient. The ——————
higher the speed (fast) of the intensifying screens, The roentgen measures ionization in air and is
the less the required mAs. (Bushong, pp 11, 234) referred to as the unit of exposure. Rad is an
Ans. C acronym for radiation absorbed dose, and rem is
an acronym for radiation equivalent man. RBE is
[Link] of the following factors will affect both used to determine biologic damage in living tissue.
the quality and the quantity of the primary (Thompson et al, p 456)
beam? Ans. A
1. Half-value layer (HVL)
2. kV [Link] of the following are considered
3. mA especially radiosensitive tissues?
(A) 1 only 1. Blood-forming organs
(B) 1 and 2 only 2. Reproductive organs
(C) 1 and 3 only 3. Lymphocytes
(D) 1, 2, and 3 (A) 1 only
——————————————————— (B) 1 and 2 only
—————— (C) 2 and 3 only
Kilovoltage (kV) and the half-value layer (HVL) (D) 1, 2, and 3
effect a change in both the quantity and the ———————————————————
quality of the primary beam. The principal ——————
qualitative factor of the primary beam is kV, but an All of the tissues listed are considered especially
increase in kV will also increase the number of radiosensitive tissues. Excessive radiation to the
photons produced at the target. HVL, defined as reproductive organs can cause genetic mutations
the amount of material necessary to decrease the or sterility. Excessive radiation to the blood-
intensity of the beam to one-half, therefore forming organs can cause leukemia or life span
changes both beam quality and beam quantity. shortening. Lymphocyte cells are the most
Milliamperage is directly proportional to x-ray radiosensitive cells in the body. (Bushong, pp 490,
intensity (quantity) but is unrelated to the quality 491)
of the beam. (Thompson et al, p 405) Ans. D

Reviewer A&R
Question & Answer
29
Review Notes for the
RADIOGRAPHY EXAM Appleton
expandable type.
[Link] many HVLs are required in order to
reduce the intensity of a beam of (A) 1 only
monoenergetic photons to less than 10 (B) 1 and 2 only
percent of its original value? (C) 2 and 3 only
(A) 2 (D) 1, 2, and 3
(B) 3 ———————————————————
(C) 4 ——————
(D) 5 Radiographic and fluoroscopic equipment is
——————————————————— designed to help decrease the exposure dose to
—————— patient and operator. One of the design features is
An HVL may be defined as the amount and the exposure cord. Exposure cords on fixed
thickness of absorber necessary to reduce the equipment must be short enough to prevent the
radiation intensity to half its original value. Thus, exposure from being made outside the control
the first HVL would reduce the intensity to 50 booth. Exposure cords on mobile equipment must
percent of its original value, the second to 25 be long enough to permit the operator to stand at
percent, the third to 12.5 percent, and the fourth least 6 ft from the x-ray tube. (Sherer et al, p 194)
to 6.25 percent of its original value. (Bushong, p Ans. B
52)
Ans. C [Link] aprons are worn during fluoroscopy to
protect the radiographer from exposure to
[Link] of the following has (have) an effect on radiation from
the amount and type of radiation-induced (A) the photoelectric effect.
tissue damage? (B) Compton scatter.
1. Quality of radiation (C) classical scatter.
2. Type of tissue being irradiated (D) pair production.
3. Fractionation ———————————————————
(A) 1 only ——————
(B) 1 and 2 only In the photoelectric effect, a relatively low-energy
(C) 1 and 3 only photon uses all its energy to eject an inner-shell
(D) 1, 2, and 3 electron, leaving a vacancy. An electron from the
——————————————————— shell above drops down to fill the vacancy and in
—————— doing so gives up acharacteristic ray. This type of
All the factors listed influence the effect of interaction is most harmful to the patient, as all
radiation on tissue. Larger quantities, of course, the photon energy is transferred to tissue. In
increase tissue effect. The energy (quality, Compton scatter, a high-energy incident photon
penetration) of the radiation determines whether ejects an outer-shell electron. The incident photon
the effects will be superficial (erythema) or deep is deflected with reducedenergy, but it usually
(organ dose). Certain tissues (such as blood- retains most of its energy and exits the body as an
forming organs, the lens, and the gonads) are energetic scattered ray. This scattered ray will
more radiosensitive than others (such as muscle either contribute to film fog or pose a radiation
and nerve). The length of time over which the hazard to personnel, depending on its direction of
exposure is spread (fractionation) is important; the exit. In classical scatter, a low-energy photon
longer the period of time, the less the tissue interacts with an atom but causes no ionization;
effects. (Bushong, pp 459, 464) the incident photon disappears into the atom, and
Ans. D is then immediately released as a photon of
identical energy but changed direction. Pair
[Link] dose to personnel is reduced by production is an interaction that occurs only at
which of the following exposure control cord energies of 1.02 MeV, and therefore it does not
guidelines? occur in diagnostic radiography. (Bushong, pp 167-
1. Exposure cords on fixed equipment 169)
must be very short. Ans. B
2. Exposure cords on mobile equipment
should be fairly long. [Link] of the following body parts is (are)
3. Exposure cords on fixed and mobile included in whole-body dose?
equipment should be of the coiled 1. Gonads

Reviewer A&R
Question & Answer
30
Review Notes for the
RADIOGRAPHY EXAM Appleton
2. Blood-forming organs ———————————————————
3. Extremities ——————
(A) 1 only Ionization is the fundamental principle of
(B) 1 and 2 only operation of both the film badge and pocket
(C) 1 and 3 only dosimeter. In the film badge, the film's silver
(D) 1, 2, and 3 halide emulsion is ionized by x-ray photons. The
——————————————————— pocket dosimeter contains an ionization chamber,
—————— and the number of ionizations taking place may be
Whole-body dose is calculated to include all the equated to exposure dose; it is accurate, but it is
especially radiosensitive organs. The gonads, the used only to detect larger amounts of radiation
lens of the eye, and the blood-forming organs are exposure. The TLD can measure exposures as low
particularly radiosensitive. Some body parts, such as 5 mrem, whereas film badges will measure a
as the skin and extremities, have a higher annual minimum exposure only as low as 10 mrem. TLDs
dose limit. (Bushong, p 523) contain lithium fluoride crystals that undergo
Ans. B characteristic changes upon irradiation. When the
crystals are subsequently heated, they emit a
[Link] what circumstances might a quantity of visible (thermo)luminescence / light in
radiographer be required to wear two proportion to the amount of radiation absorbed.
dosimeters? The relatively new OSLs contain aluminum oxide
1. During pregnancy crystals that also undergo characteristic changes
2. While performing vascular procedures upon irradiation. When the Al2O3 crystals are
3. While performing mobile radiography stimulated by a laser, they emit (optically
(A) 1 and 2 only stimulated) luminescence / light in proportion
(B) 2 only tothe amount of radiation absorbed. OSLs can
(C) 2 and 3 only measure exposures as low as 1 mrem. (Thompson
(D) 1, 2, and 3 et al, p 461)
——————————————————— Ans. C
——————
Radiographers are usually required to wear one [Link] of macromolecules in vitro can
dosimeter, positioned at their collar and worn result in
outside a lead apron. Special circumstances, 1. main chain scission.
however, warrant the use of a second monitor. 2. cross-linking.
During pregnancy, a second "baby monitor" is 3. point lesions.
worn at the abdomen, under any lead apron. (A) 1 only
During special vascular procedures, the dose to (B) 1 and 2 only
the radiographer can increase significantly. This is (C) 2 and 3 only
because the leaded protective curtain is often (D) 1, 2, and 3
absent from the fluoro tower and because of the ———————————————————
extensive use of cineradiography. As a result, the ——————
radiographer's upper extremities can receive a Irradiation damage is a result of either the effects
greater exposure (e.g., when assisting during of irradiation on water (radiolysis) or its effects on
catheter introduction), and a ring or bracelet macromolecules. Effects on macromolecules
badge is often recommended. A second dosimeter include main chain scission, cross-linking, and
is not required when performing mobile point lesions. Main chain scission breaks the DNA
radiography. (Bushong, p 525) molecule into two or more pieces. Cross-linking is
Ans. A incorrect joining of broken DNA fragments. A point
lesion is the disruption of a single chemical bond
as a result of irradiation. Because 80 percent of the
[Link] of the following personnel monitoring body is made up of water, radiolysis of water is the
devices used in diagnostic radiography is predominant radiation interaction in the body.
considered to be the most sensitive and (Bushong, p 470)
accurate? Ans. D
(A) TLD
(B) Film badge [Link] of macromolecules in vitro can
(C) OSL result in
(D) Pocket dosimeter 1. main chain scission.

Reviewer A&R
Question & Answer
31
Review Notes for the
RADIOGRAPHY EXAM Appleton
2. cross-linking. (D) 1, 2, and 3
3. point lesions. ———————————————————
(A) 1 only ——————
(B) 1 and 2 only Lead aprons require certain maintenance and care
(C) 2 and 3 only if they are to continue to provide protection from
(D) 1, 2, and 3 ionizing radiation. They can be kept clean with a
——————————————————— damp cloth. It is very important that they be hung
—————— when not in use, rather than being folded or left in
Irradiation damage is a result of either the effects a heap between examinations. A folded or
of irradiation on water (radiolysis) or its effects on crumpled position encourages the formation of
macromolecules. Effects on macromolecules cracks in the leaded vinyl. Lead aprons should be
include main chain scission, cross-linking, and fluoroscoped (at about 120 kVp) at least once a
point lesions. Main chain scission breaks the DNA year to check for development of any cracks.
molecule into two or more pieces. Cross-linking is (Bushong, p 560)
incorrect joining of broken DNA fragments. A point Ans. A
lesion is the disruption of a single chemical bond
as a result of irradiation. Because 80 percent of the [Link] of the following types of radiation is
body is made up of water, radiolysis of water is the (are) considered electromagnetic?
predominant radiation interaction in the body. 1. X-ray
(Bushong, p 470) 2. Gamma
Ans. C 3. Beta
(A) 1 only
[Link] much protection is provided from a 75- (B) 1 and 2 only
kVp x-ray beam when using a 0.50-mm lead (C) 2 and 3 only
equivalent apron? (D) 1, 2, and 3
(A) 51 percent ———————————————————
(B) 66 percent ——————
(C) 88 percent Alpha and beta radiation are particulate
(D) 99 percent radiations; alpha is composed of two protons and
——————————————————— two neutrons, and beta is identical to an electron.
—————— Gamma and x-radiation are electromagnetic,
Lead aprons are worn by occupationally exposed having wavelike fluctuations like other radiations
individuals during fluoroscopic procedures. Lead of the electromagnetic spectrum (visible light,
aprons are available with various lead equivalents; radio waves, etc.).
0.25, 0.5, and 1.0 mm are the most common. The (Bushong, p 60)
1.0-mm lead equivalent apron will provide close to Ans. B
100 percent protection at most kVp levels, but it is
rarely used because it weighs anywhere from 12 to [Link] of the following is (are) associated with
24 lb. A 0.25-mm lead equivalent apron will Compton scattering?
attenuate about 97 percent of a 50-kVp x-ray 1. High-energy incident photons
beam, 66 percent of a 75-kVp beam, and 51 2. Outer-shell electrons
percent of a 100-kVp beam. A 0.5-mm apron will 3. Characteristic radiation
attenuate about 99 percent of a 50-kVp beam, 88 (A) 1 only
percent of a 75-kVp beam, and 75 percent of a (B) 1 and 2 only
100-kVp beam. (Thompson et al, p 457) (C) 2 and 3 only
Ans. C (D) 1, 2, and 3
———————————————————
[Link] correct way(s) to check for cracks in lead ——————
aprons is Compton scattering occurs when a relatively high-
1. to fluoroscope them once a year. energy incident photon uses part of its energy to
2. to radiograph them at low kilovoltage eject an outer-shell electron, and in doing so
twice a year. changes its direction (is scattered). The energy
3. by visual inspection. retained by the scattered photon depends on the
(A) 1 only angle formed by the ejected electron and the
(B) 1 and 2 only scattered photon: The greater the angle of
(C) 2 and 3 only deflection, the less the retained energy. Compton

Reviewer A&R
Question & Answer
32
Review Notes for the
RADIOGRAPHY EXAM Appleton
scatter is very energetic scatter. It emerges from ———————————————————
the patient and is responsible for scatter radiation ——————
reaching the film in the form of fog. Characteristic Chromosome aberration, cell death, and malignant
radiation is associated with the photoelectric disease are major effects of DNA irradiation, often
effect. (Bushong, pp 165-167) as a result of abnormal metabolic activity. If the
Ans. B damage happens to the DNA of a germ cell, the
radiation response may not occur until one or
[Link] of the following cells are the most more generations later. (Bushong, pp 472, 492,
radiosensitive? 503)
(A) Myelocytes Ans. D
(B) Erythroblasts
(C) Megakaryocytes [Link] of the following statements regarding
(D) Myocytes the human gonadal cells is (are) true?
——————————————————— 1. The female oogonia reproduce only
—————— during fetal life.
Bergonié‚ and Tribondeau theorized in 1906 that 2. The male spermatogonia reproduce
all precursor cells are particularly radiosensitive continuously.
(e.g., stem cells found in bone marrow). There are 3. Both male and female stem cells
several types of stem cells in bonemarrow, and the reproduce only during fetal life.
different types differ in degree of radiosensitivity. (A) 1 only
Of these, red blood cell precursors, or (B) 2 only
erythroblasts, are the most radiosensitive. White (C) 1 and 2 only
blood cell precursors, or myelocytes, follow. (D) 3 only
Platelet precursor cells, or megakaryocytes, arethe ———————————————————
least radiosensitive. Myocytes are mature muscle ——————
cells and are fairly radioresistant. (Bushong, p 463) The development of male and female reproductive
Ans. B stem cells has important radiation protection
implications. Male stem cells reproduce
[Link] of the following personnel radiation continuously. However, the female stem cells
monitors will provide an immediate reading? develop only during fetal life; females are born
(A) TLD with all the reproductive cells they will ever have.
(B) Film badge It is exceedingly important to shield children
(C) Lithium fluoride chips whenever possible, as they have their
(D) Pocket dosimeter reproductive futures ahead of them. (Bushong, pp
——————————————————— 489-490)
—————— Ans. C
A TLD is used to measure monthly exposure to
radiation, as is the film badge. Lithium fluoride [Link] of the following statements is (are) true
chips are the thermoluminescent material used in with respect to the dose-response curve
TLDs. A pocket dosimeter (a small personal shown in Figure 3-4?
ionization chamber) measures the quantity of 1. The quantity of radiation is directly
ionizations occurring during the period worn and related to the dose received.
reads out in mrem; it is used primarily when 2. No threshold is required for effects to
working with large quantities of radiation. occur.
(Bushong, p 557) 3. A minimum amount of radiation is
Ans. D required for manifestation of effects.
(A) 1 only
[Link] is (are) the major effect(s) of (B) 1 and 2 only
deoxyribonucleic acid (DNA) irradiation? (C) 1 and 3 only
1. Malignant disease (D) 2 and 3 only
2. Chromosome aberration ———————————————————
3. Cell death ——————
(A) 1 only Figure 3-4 illustrates a linear threshold dose-
(B) 1 and 2 only response curve. Its linear aspect indicates that the
(C) 2 and 3 only response / effect is directly related to the dose
(D) 1, 2, and 3 received, i.e., as thedose increases, the response

Reviewer A&R
Question & Answer
33
Review Notes for the
RADIOGRAPHY EXAM Appleton
increases. The fact that this is a threshold curve The genetically significant dose (GSD) illustrates
indicates that a particular dose is required before that large exposures to a few people are cause for
any response / effect will occur. (Sherer et al, p little concern when diluted by the total population.
115) On the other hand, we all share the burden of that
Ans. C radiationreceived by the total population,
especially as the use of medical radiation
[Link] tabletop exposure rate during fluoroscopy increases, and so each individual's share of the
shall not exceed total exposure increases.
(A) 5 mR/min. (Bushong, pp 552-553)
(B) 10 R/min. Ans. A
(C) 10 mR/h.
(D) 5 R/h. [Link] likelihood of adverse radiation effects to
——————————————————— any radiographer whose dose is kept below
—————— the recommended guideline is
It is important to limit tabletop exposure during (A) very probable.
fluoroscopy, because the SSD is so much less than (B) possible.
in overhead radiography, so that a muchhigher (C) very remote.
skin dose is delivered to the patient. For this (D) zero.
reason, the tabletop exposure rate during ———————————————————
fluoroscopy shall not exceed 10 R/min. ——————
(Bushong, p 534) The likelihood of radiation effects to
Ans. B occupationally exposed individuals whose dose is
kept below the recommended limits is very
[Link] the production of characteristic radiation at remote. Exposure to ionizing radiation always
the tungsten target, the incident electron carries some risk, but studies have indicated that
(A) ejects an inner-shell tungsten electron. the risk is a very small one if established guidelines
(B) ejects an outer-shell tungsten electron. are followed. Potential hazards must be
(C) is deflected, with resulting energy loss. understood and proper precautions taken.
(D) is deflected, with resulting energy increase. (Bushong, p 520)
——————————————————— Ans. C
——————
Characteristic radiation is one of two kinds of x- [Link] term effective dose refers to
rays produced at the tungsten target of the x-ray (A) whole-body dose.
tube. The incident, or incoming, high-speed (B) localized organ dose.
electron ejects a K-shell tungsten electron. This (C) genetic effects.
leaves a hole in the K shell, and an L-shell electron (D) somatic and genetic effects.
drops down to fill the K vacancy. Because L ———————————————————
electrons are at a higher energy level than K-shell ——————
electrons, the L-shell electron gives up the Every radiographic examination involves an
difference in binding energy in the form of a entrance skin exposure (ESE), which can be
photon, a "characteristic x-ray" (characteristic of determined fairly easily. It also involves a gonadal
the K shell). (Bushong, pp 143, 144) dose and marrow dose, which if needed, can be
Ans. A calculated by the radiation physicist. If the ESE of a
particular exam was calculated to determine the
[Link] of the following defines the gonadal equivalent whole-body dose, this is termed the
dose that, if received by every member of the effective dose. For example, the ESE of a PA chest
population, would be expected to produce the is approximately 70 mrem, while the effective
same total genetic effect on that population dose is 10 mrem. The effective (whole-body) dose
as the actual doses received by each of the is much less because much of the body is not
individuals? included in the primary beam. (Fosbinder & Kelsey,
(A) Genetically significant dose p 390)
(B) Somatically significant dose Ans. A
(C) Maximum permissible dose
(D) Lethal dose [Link] of the following is (are) composed of
——————————————————— nondividing, differentiated cells?
—————— 1. Neurons and neuroglia

Reviewer A&R
Question & Answer
34
Review Notes for the
RADIOGRAPHY EXAM Appleton
2. Epithelial tissue inverse square law of radiation. The formula is
3. Lymphocytes
(A) 1 only I1 D22
(B) 1 and 2 only = 
(C) 1 and 3 only I2 D12
(D) 1, 2, and 3
——————————————————— Substituting known values,
——————
Nondividing, differentiated cells are specialized, 16 R/h x2
mature cells that do not undergo mitosis. Having  =  ; 6x2 = 256 ; x2 = 42.66
these qualities, they are rendered radioresistant, 6 R/h 16
according to the theory proposed by Bergonié‚ and x = 6.5 ft (necessary to
Tribondeau. The adult nervous system is decrease the exposure to 6 R/h)
composed of nondividing, differentiated cells, and
thus is the most radioresistant system in the adult. Note that in order for the exposure rate to
Epithelial tissue and lymphocytes contain many decrease, the distance from the source of
precursor stem cells, and hence are among the radiation must increase. (Bushong, pp 65-66)
most radiosensitive cells in the body. (Bushong, p Ans. B
459)
Ans. A [Link] material irradiated under hypoxic
conditions is
[Link] of the following is (are) acceptable (A) more sensitive than when irradiated under
way(s) to monitor the radiation exposure of oxygenated conditions.
those who are occupationally employed? (B) less sensitive than when irradiated under
1. TLD anoxic conditions.
2. OSL (C) less sensitive than when irradiated under
3. Quarterly blood count oxygenated conditions.
(A) 1 only (D) unaffected by the presence or absence of
(B) 1 and 2 only oxygen.
(C) 1 and 3 only ———————————————————
(D) 1, 2, and 3 ——————
——————————————————— Biologic tissue is more sensitive to radiation when
—————— it is in an oxygenated state. A characteristic of
The OSL and TLD are frequently used to measure many avascular (and therefore hypoxic) tumors is
the radiation exposure of radiographers. The their resistance to treatment with radiation.
pocket dosimeter may be employed by those Hyperbaric (high-pressure oxygen) therapy is used
radiation workers who are exposed to higher in some therapy centers in an effort to increase
doses of radiation and need a daily reading. A the sensitivity of the tissues being treated.
blood test is an unacceptable method of (Bushong, pp 464-465)
monitoring radiation dose effects, as a very large Ans. C
dose would have to be received before blood
changes would occur. (Sherer et al, pp 218-220) [Link] exposure can be minimized by using
Ans. B which of the following?
1. Accurate positioning
[Link] exposure rate to a body 4 ft from a source 2. High-kV, low-mAs factors
of radiation is 16 R/h. What distance from the 3. Rare earth screens
source would be necessary to decrease the (A) 1 only
exposure to 6 R/h? (B) 1 and 2 only
(A) 5 ft (C) 1 and 3 only
(B) 7 ft (D) 1, 2, and 3
(C) 10 ft ———————————————————
(D) 14 ft ——————
——————————————————— Accurate positioning helps decrease the number of
—————— retakes. The use of high-kV and low-mAs exposure
The relationship between x-ray intensity and factors limits the quantity of radiation delivered to
distance from the source is expressed in the the patient. Use of rare earth screens can enable

Reviewer A&R
Question & Answer
35
Review Notes for the
RADIOGRAPHY EXAM Appleton
the technologist to reduce mAs by as much as 4 to (A) 0.1 rem (1 mSv).
8 times. Patient shielding should be used (B) 0.5 rem (5 mSv).
whenever appropriate and possible. (Sherer et al, (C) 5 rem (50 mSv).
pp 148-151) (D) 10 rem (100 mSv).
Ans. D ———————————————————
——————
[Link] is the single most important scattering Because the established dose-limit formula
object in both radiography and fluoroscopy? guideline is used for occupationally exposed
(A) The x-ray table persons 18 years of age and older, guidelines had
(B) The x-ray tube to be established to cover the event that a student
(C) The patient entered the clinical component of a radiography
(D) The film educational program prior to age 18. The guideline
——————————————————— states that the occupational dose limit for students
—————— under age 18 is 0.1 rem (100 mrem or 1 mSv) in
The patient, as the first scatterer, is the most any given year. It is important to note that this 0.1
important scatterer. At 1 m from the patient, the rem is includedin the 0.5-rem dose limit allowed
intensity of the scattered beam is 0.1 percent of the student as a member of the general public.
the intensity of the primary beam. Compton (Bushong, p 523)
scatter emerging from the patientis almost as Ans. A
energetic as the primary beam entering the
patient. (Selman, p 535) [Link] the exposure rate at 3 ft from the
Ans. C fluoroscopic table is 40 mR/h, what will be the
exposure rate for 30 min at a distance of 5 ft
[Link] of the following statements regarding TLDs from the table?
are true except (A) 7 mR
(A) TLDs are reusable. (B) 12 mR
(B) TLDs store energy. (C) 14 mR
(C) The TLD's response is proportional to the (D) 24 mR
quantity of radiation received. ———————————————————
(D) Following x-ray exposure, TLDs are exposed ——————
to light and emit a quantity of heat in The intensity / exposure rate of radiation at a
response. given distance from a point source is inversely
proportional to the square of the distance. This is
——————————————————— the inverse square law of radiation, and it is
—————— expressed in the following equation:
A TLD is a sensitive and accurate device used in
radiation dosimetry. It may be used as a personal I1 D22
dosimeter or to measure patient dose during = 
radiographic examinations and therapeutic I2 D12
procedures. The TLD utilizes a thermoluminescent
phosphor, usually lithium fluoride. When used as a Substituting known values,
personal monitor, the TLD is worn for 1 month.
During this time, it stores information regarding 40 mR/h 25
the radiation to which it has been exposed. It is  =  ; 25x = 360 ; x = 14.4 mR/h,
then returned to the commercial supplier. In the therefore 7.2 mR in 30 min
laboratory, the phosphors are heated. They x mR/h 9
respond by emitting a particular quantity of light
(not heat) that is in proportion to the quantity of (Bushong, pp 56-66)
radiation delivered to it. After they are cleared of Ans. A
stored information, they are returned for reuse.
(Sherer et al, pp 223-224) [Link] the following tissues in order of
Ans. D increasing radiosensitivity.
1. Liver cells
143.A student radiographer who is under 18 years 2. Intestinal crypt cells
of age must not receive an annual 3. Muscle cells
occupational dose greater than (A) 1, 3, 2

Reviewer A&R
Question & Answer
36
Review Notes for the
RADIOGRAPHY EXAM Appleton
(B) 2, 3, 1 anywhere that the primary beam can possibly be
(C) 2, 1, 3 directed, e.g., the walls of the x-ray room. The
(D) 3, 1, 2 walls of the x-ray room usually require a 1/16-in
——————————————————— (1.5-mm) thickness of lead and should be 7 ft high.
—————— Secondary barriers protect from secondary
According to Bergonié‚ and Tribondeau, the most (scattered and leakage) radiation. Secondary
radiosensitive cells are undifferentiated, rapidly barriers are control booths, lead aprons and
dividing cells, such as lymphocytes, intestinal crypt gloves, and the wall of the x-ray room above 7 ft.
(of Lieberkühn) cells, and spermatogonia. Liver Secondary barriers require much less lead than
cells are among the types of cells that are primary barriers. (Bushong, p 535)
somewhat differentiated and capable of mitosis. Ans. B
These characteristics render them somewhat
radiosensitive. Muscle cells, as well as nerve cells 148.A test radiograph like the one pictured in
and red blood cells, are highly differentiated and Figure 3-5 would be made by the radiation
do not divide. Therefore, in order of increasing safety officer (RSO) or equipment service
sensitivity (from least to greatest sensitivity), the person and is used to evaluate
cells are muscle, liver, and then intestinal crypt (A) focal spot size.
cells. (Travis, pp 70-72) (B) linearity.
Ans. D (C) collimator alignment.
(D) spatial resolution.
[Link] of secondary radiation barriers include ———————————————————
1. the control booth. ——————
2. lead aprons. The radiograph illustrates testing done to evaluate
3. the x-ray tube housing. the x-ray beam and light beam alignment. Light-
(A) 2 only localized collimators must be tested periodically
(B) 1 and 2 only and must be accurate to within 2 percent of the
(C) 2 and 3 only focal-film distance. Linearity means that agiven
(D) 1, 2, and 3 mA, using different mA stations with appropriate
——————————————————— exposure time adjustments, will provide consistent
—————— intensity. A star pattern would be used to evaluate
Secondary radiation includes leakage and focal spot resolution, and a parallel line-type
scattered radiation. The control booth wall is a resolution pattern could also be used to evaluate
secondary barrier; therefore, the primary beam spatial resolution. (Bushong, p 532)
must never be directed toward it. The x-ray tube Ans. C
housing must reduce leakage radiation to less than
100 mR/h at a distance of 1 m from the [Link] of the following can be an effective
[Link] aprons, lead gloves, portable x-ray means of reducing radiation exposure?
barriers, and so on are also designed to protect 1. Barriers
the user from exposure to scattered radiation and 2. Distance
will not protect her or him from the primary beam. 3. Time
(Sherer et al, pp 193-194) (A) 1 only
Ans. D (B) 2 only
(C) 1 and 2 only
(D) 1, 2, and 3
[Link] wall that the useful x-ray beam can be ———————————————————
directed toward is called a ——————
(A) secondary barrier. As the amount of time one spends in a controlled
(B) primary barrier. area decreases, radiation exposure should
(C) leakage barrier. decrease. Radiation exposure is affected
(D) scattered barrier. considerably by one's proximity to the radiation
——————————————————— source, as defined by the inverse square law.
—————— Barriers (shielding) are an effective means of
Protective barriers are classified as either primary reducing radiation exposure; primary barriers,
or secondary. Primary barriers protect from the such as walls, protect one from the primary beam,
useful, or primary, x-ray beam and consist of a and secondary barriers, such as lead aprons, are
certain thickness of lead. They are located

Reviewer A&R
Question & Answer
37
Review Notes for the
RADIOGRAPHY EXAM Appleton
used to protect one from secondary radiation.
(Bushong, p 517)
Ans. D

[Link] should be the radiographer's main

objective regarding personal radiation safety?
(A) Not to exceed his or her dose limit
(B) To keep personal exposure as far below the
dose limit as possible
(C) To avoid whole-body exposure
(D) To wear protective apparel when "holding"
patients for exposures
———————————————
Even the smallest exposure to radiation can be
harmful. It must, therefore, be every
radiographer's objective to keep his or her
occupational exposure as far below the dose limit
as possible. Radiology personnel should never hold
patients during an x-ray examination. (Bushong, pp
9-10)
Ans. B

[Link] effects of radiation refer to effects

that are manifested
(A) in the descendants of the exposed individual.
(B) during the life of the exposed individual.
(C) in the exposed individual and his or her
descendants.
(D) in the reproductive cells of the exposed
individual.
————————————————
Somatic effects of radiation refer to those effects
experienced directly by the exposed individual,
such as erythema, epilation, and cataracts.
Genetic effects of radiation exposure are caused by
irradiation of the reproductive cells of the exposed
individual and are transmitted from one
generation to the next. (Sherer et al, pp 115, 131)
Ans. B

Reviewer A&R
Question & Answer
38