Part I – General Medical Physics

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Contents

Exam Description

Part I – General Medical Physics is intended to test the general knowledge of the basic principles of medical physics. These are the principles with which all medical physicists should be familiar, regardless of their specialization. Questions will be restricted to basic principles only. Detailed questions appear in the appropriate Part II examinations.

The questions in the examination are apportioned by topic as follows.

Examination Content Outline

Radiological Physics 20%
Radiation Detection and Measurement 15%
Biology and Radiobiology 5%
Radiation Protection 15%
Imaging and Other Diagnostic Studies 17%
Principles of Radiation Therapy 15%
Anatomy, Physiology, and Medical Science 7%
Computers 6%

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Radiological Physics (20%)

  1. Radiological Physics Units
    • fundamental units
    • derived units
    • electrical units
    • radiation units
  2. Atomic and Nuclear Structure
    • Bohr model
    • shell structure
    • periodic table
    • electron binding energy
    • ionization and excitation
    • elementary particles
    • nuclear structure
    • nuclear binding energy
    • mass-energy equivalence
  3. Electromagnetic Radiation
    • frequency
    • wavelength
    • energy
    • electromagnetic spectrum
    • properties of non-ionizing radiation
    • properties of ionizing radiation
    • infrared radiation
    • LASERs
    • microwaves
  4. Ultrasound
    • speed in different media
    • properties of ultrasound
  5. Radioactivity
    • decay constant
    • half-life
    • mathematics of decay
    • equilibrium
    • exposure rate constant
    • dose rate near a point source
    • isotope production
    • modes of decay
      1. alpha
      2. beta+/beta-
      3. electron capture
    • internal conversion
    • isometric conversion
    • fission
  6. Production of X-Rays
    • basic x-ray circuits
    • spectra
    • factors affecting spectra
    • cathode
    • anode
    • rectification
    • filtration
    • quality
    • half-value layer (HVL)
    • transformers
    • characteristic and Bremsstrahlung x-rays
    • angular distribution vs energy
  7. Interaction of Photons with matter
    • attenuation
    • attenuation coefficients
    • absorption
    • photoelectric absorption
    • Compton scatter
    • coherent scatter
    • pair production
    • relative importance of different interactions at different energies and in different media
  8. Interactions of Charged Particles with Matter
    • collisional
    • radiative
    • range
    • stopping power
    • LET
    • Bragg peak
  9. Neutron Interactions
    • elastic
    • inelastic

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Radiation Detection and Measurement (15%)

  1. Dosimetry Fundamentals
    • exposure
    • absorbed dose
    • kerma
    • radiation detection (photons, neutrons)
  2. Ionization Chambers
    • general principles and composition
    • ion collection efficiency
    • recombination
    • survey meters
    • pancake chambers
    • thimble chambers
    • well chambers
  3. Dose Measurements
    • general Bragg-Gray theory and principles
    • stopping power ratio principles
  4. Dosimeters
    • photographic
    • TLD
    • basic principles of chemical (FeSO4) dosimeters
    • semiconductors
    • calorimetry
  5. Detectors
    • Geiger-Mueller
    • scintillation
    • proportional
    • PM tubes
  6. Internal Dosimetry
    • gamma and beta radiations
    • effective half-life
    • beta particles
    • mean life

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Biology and Radiobiology (5%)

  1. The Cell
    • basic structure
    • function
    • proliferation
      1. phases of cell cycle
      2. cell cycle time
      3. enzymes
      4. sensitivity
  2. Chromosomes
    • DNA and replication
    • chromosomal aberrations
  3. Basic Genetics
    • genes
    • genetic mutations
  4. Radiation Chemistry
    • direct / indirect actions
    • protectors and sensitizers
  5. Cell Survival Curves
    • basic target and L-Q theories
  6. Dose Response
    • statistical nature of dose-response curves
    • sublethal damage and repair
  7. Acute Radiation Syndrome
    • hematopoietic
    • LD50
    • gastrointestinal
    • latent period
    • CNS syndrome
  8. Radiation Carcinogenesis
    • human data
    • relative and absolute risk models
    • latent period
    • BEIR reports
  9. Radiation Cataractogenesis
    • ocular lens
    • dose response
    • cataracts
    • threshold
  10. Radiation Embryology
    • human and animal data
    • effect of age
    • occupational exposure
    • patients
  11. Risk vs Benefit
    • typical doses
    • relative risks
    • sources of human exposure

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Radiation Protection (15%)

  1. Radiation Protection Units
    • dose equivalent
    • Sievert
    • quality factor
  2. Sources of Human Exposure
    • medical and other sources
    • natural sources
  3. Regulatory Agencies
    • federal
    • state
    • local
  4. Dose Equivalent Limits
    • protection (ALARA)
    • maximum possible dose (MPD)
    • philosophy of radiation
    • radiation protection guides
    • stochastic and non-stochastic considerations
    • occupational and non-occupational exposures
  5. Radioactive Sources
    • radionuclides
    • storage
    • transportation
    • wipe testing
  6. Surveys
    • basic methodology
    • instrumentation
  7. Personnel Monitoring
    • films
    • TLD
    • pocket dosimeters
    • filters
  8. External Radiation Protection
    • time
    • distance
    • shielding
    • WUT
    • basic protection design
  9. Internal Radiation Protection
    • internal radiation hazards
    • contamination
    • assessment of hazards
    • waste management
    • principles of control
  10. Hazards of Non-Ionizing Radiation
    • LASERs
    • microwaves
    • ultrasound
    • magnetic resonance power and energy
    • biological effects
  11. Statistics
    • Samples, sample surveys
    • Observations
    • Random Sampling
    • Frequency Distributions
      1. histograms
      2. cumulative frequency
      3. distributions
      4. probability distributions
    • Mean, Standard Deviations
      1. arithmetic and population means
      2. degrees of freedom
      3. standard deviations
      4. mean values
      5. variance
      6. modal values
      7. coefficient of variation
    • Normal (or Gaussian) Distributions
      1. standard errors
      2. sample sizes
      3. confidence limits
    • Test of Hypothesis
      1. null hypothesis
      2. confidence intervals
      3. statistical significance
      4. chi-square test
    • Binomial and Poisson Distributions
      1. relationship to normal distributions
      2. propagation of errors
      3. applications
    • Regressions
      1. linear regression
      2. correlation coefficient
      3. least squares estimate

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Imaging and Other Diagnostic Studies (17%)

  1. The Photographic Process
    • latent image production
    • film processing and chemistry
    • electrostatic imaging – Xerography
    • photographic emulsions and chemistry
  2. Sensitometry & Characteristic Curves
    • density
    • reciprocity failure
    • contrast
    • fog
    • latitude
    • reversal
    • gamma
    • solarization
    • energy dependence
    • effect of processing
    • speed condition
  3. Resolution and Contrast
    • modulation transfer function
    • line spread function
    • film contrast
    • line pairs
    • basic principles of MTF & LSF
    • phosphors
  4. Screens
    • resolution
    • modification of H&D curves
    • effect on image quality and dose
    • mottle
  5. Noise
    • signal-to-noise ratio
    • model structured and statistical grids
    • scatter
  6. Image Formation – subject contrast as related to:
    • density
    • atomic number
    • energy spectrum
  7. Fluoroscopy
    • basic principles of digital systems
    • basic principles of luminescences
    • Image Intensification
      1. design
      2. brightness
      3. flux gain and minification
      4. dose
  8. Radiography
    • general equipment
    • imaging considerations
  9. Basic Principles of:
    • angiography
    • Computed Tomography (CT)
    • tomography
    • mammography
  10. Nuclear Medicine
    • basic principles
      1. uptake
      2. scanning
      3. emission tomography
      4. radionuclides
    • instrumentation and basic performance checks
    • applications
    • hazards
  11. Magnetic Resonance (Imaging and Spectroscopy)
    • basic principles
      1. nuclear magnetic resonance
      2. relaxation times
      3. chemical shifts
    • instrumentation
    • applications
    • hazards
  12. Clinical Ultrasound
    • basic principles
      1. propagation of sound
      2. generation and detection
      3. interactions in tissues
      4. uses of Doppler shift
    • instrumentation
    • applications
    • hazards

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Principles of Radiation Therapy (15%)

  1. Therapy Photons
    • depth dose distribution
    • percent depth dose
    • parameters affecting depth dose
    • scatter
    • isodose curves
    • phantoms
  2. Therapy Particles
    • electrons
      1. depth dose and isodose distributions
    • heavy particles
      1. protons
      2. neutrons
      3. pions
      4. stripped nuclei
      5. Bragg peak
  3. Brachytherapy
    • radioactive sources
    • sealed sources
    • activity
    • exposure rate constant
    • dose calculation principles
  4. Hyperthermia
    • basic principles of application and monitoring

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Medical Electronics basic Principles of DC Circuits

 potential difference  batteries
 current  power
 Ohm’s Law  series and parallel circuits
 resistance  Kirchoff’s Laws
 voltage dividers

Basic Principles of AC Circuits

 sinusoidal waveforms  inductive reactance
 capacitors  RL circuits
 capacitance  transformers
 RC circuits  impedance matching
 capcitative reactance  resonant circuits
 rise and fall times  complex wave forms
 Fourier analysis  inductors and inductance

Measuring Instruments

 moving-coil meters  Wheatstone bridge
 moving iron meters  AC bridges
 dynamometers  potentiometers
 AC and DC measurements  capacitance and inductance meters
 RMS values  practical applications
 digital voltmeters and multimeters  analog multimeters
 electrometers

Oscilloscopes

 triggering  basic principles and components
 storage and sampling scopes  dual beam/ dual trace scopes

Diodes

 p-n junction  Zener diodes
 RC filters  vaccuum and semiconductor diodes
 half-wave and full-wave rectification  voltage doubler rectification

Transistors

 bipolar junction  field-effect transistor (FET)
 applications

Amplifier Circuits

 types and applications  basic principles and properties

OP-AMPS

 properties  inout and output impedance
 gain  applications

Digital Basics

 basic principles  Boolean algebra
 logic gates  flip flops
 gate construction  numbering systems
 positive/negative logic  digital displays

Digital Circuitry

 counters and registers  D/A and A/D conversions
 voltage to frequency conversions

Noise

 origins  reduction techniques

Grounding and Shielding

 principles and methods  coax cables
 RF shielding  isolation
 guard shields  ground loops

References

Carr J.J., “Introduction to Biomedical Equipment Technology,” 4th Edition, Prentice-Hall Career & Technology, 2000.

Khandpur R.S., “Biomedical Instrumentation: Technology and Applications”, McGraw-Hill, 2005.

Tsoulfanaids N. “Measurement and Detection of Radiation”, 2nd Edition, Taylor & Francis, 1995.

Webster J.G. , “Medical Instrumentation: Application and Design”, John Wiley & Sons, 1998.

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Medical Applications of Lasers Basic Theories

 stimulated emission  metastable atomic states

Types

 Nd-YAG  He-Ne alignment device
 argon  ruby
 krypton  CO2

Uses

 retinal detachment  surgery
 endobronchial stenosis  dermatology
 photocoagulation  laser angioplasty

Safety

 types of injuries  standards
 protection

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Anatomy, Physiology, and Medical Science (7%)

  1. Organization Of The Human Body
    • anatomical nomenclature
    • anatomical position
    • body cavities, their subdivisions and contents
    • body planes
    • directional terms
    • regional names
  2. Levels of Structural Organization
    • systems
    • organs
    • tissue
    • cellular
    • chemical
  3. Principal Systems of the Human Body
    • structure
    • function
    • pathology
    • medical terminology
    • principal methods of diagnosis and therapy
  4. Skeletal, Muscular, and Integumentary Systems
    • axial and appendicular skeletons
    • skeletal tissue
    • muscular systems
    • muscle tissue
    • articulations
    • skin and its derivatives
  5. Nervous System
    • spinal cord and nerves
    • nervous tissue
    • nerve impulse
    • autonomic nervous systems
    • brain and its principal parts
    • sensory and motor systems
    • sensory system – ear
      1. structure of the outer, middle, and inner ear
      2. physiology of hearing, equilibrium
    • sensory system – eye
      1. structure of the eyeball
      2. visual physiology
  6. Endocrine System
    • endocrine glands: identity, location, function
    • other endocrine tissues
    • mechanism of hormonal action
  7. Cardiovascular System
    • Blood
      1. physical characteristics
      2. functions
      3. components
      4. hemostasis
      5. interstitial fluid and lymph
    • Vessels
      1. arteries
      2. veins
      3. capillaries
      4. lymph
    • the Heart
      1. structure and components
        • pericardium
        • chambers
        • wall
        • vessels
        • valves
      2. functions and physiology
        • cardiac cycles
        • cardiac output
        • conduction systems
  8. Lymphatic System
    • lymphatic vessels
    • lymphatic tissue
    • immunity
    • reticuloendothelial system
    • non-specific resistance to disease
  9. Respiratory System
    • Organs
      1. nose
      2. pharynx
      3. larynx
      4. trachea
      5. bronchea
      6. lungs
    • Respiration and its Control
      1. pulmonary ventilation air volumes and capacities
      2. gas exchange and transport
  10. Digestive System
    • Organs
      1. Mouth
        • tongue
        • salivary glands
        • teeth
      2. Pharynx and Esophagus
        • structures
        • deglutition
      3. Stomach
        • structures
        • mixing and emptying actions
        • gastric secretions and absorptions
      4. Pancreas
      5. Gall Bladder
      6. Liver
      7. Small and Large Intestines
      8. Rectum and Anus
    • Metabolism
      1. anabolism and catabolism enzymes
      2. carbohydrates, lipids, and proteins
      3. body heat and temperature regulations
  11. Urinary System
    • external and internal anatomy: male and female
      1. Kidneys
      2. Ureters
      3. Urethra
      4. Bladder
    • blood and nerve supply
    • nephrons
    • urine formation
    • urine elimination
  12. Reproductive System
    • the breast
      1. structure
      2. function of mammary glands
      3. pathology
    • the male reproductive system
      1. anatomy & physiology
      2. spermatogenesis
    • the female reproductive system
      1. anatomy & physiology
      2. ovarian and menstrual cycles
    • pregnancy
      1. fertilization and implantation
      2. embryonic development
      3. fetal growth and development
      4. birth
  13. Bodily Fluids
    • Compartments
    • Compositions
    • Balance
      1. Electrolyte balance
      2. acid/base balance
    • Fluid movements
  14. Human Genetics
    • chromosomes
    • inheritance of traits
    • dominant and recessive genes
    • meiosis
  15. Presentation in Imaging: anatomic (physical) and chemical
      1. conventional radiography
      2. transverse and tomographic radiography
      3. computed tomography
      4. radiopharmaceuticals
      5. magnetic resonance imaging
      6. ultrasound

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Computers (6%)

      1. Fundamentals of Computers
        • analog vs digital
        • computer hardware
          1. CPU
          2. speed
          3. memory
          4. bus
        • peripheral devices (input & output)
          1. printers (laser, ink jet, thermal, 3-D)
          2. mouse, touch screen, trackball, etc.)
        • storage devices
          1. hard disks
          2. optical disks
          3. CDs
          4. USB / thumb drives
          5. “cloud” storage
        • micro vs mini vs mainframe computers
      2. Computer Software
        • operating systems
        • programming basics
        • user applications
        • software
      3. Information Transfer & Security

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Appendix

of Types A, B, K, and S.

TYPE A

The average annual collective dose equivalent in mSv from natural sources (excluding radon) to the population in the USA is about:
A. 0.1
B. 0.5
C. 1.0
D. 2.0
E. 3.0

TYPE B

Match the property (1-4) with the appropriate particle (A-E):
A. Proton
B. Neutron
C. Electron
D. Neutrino
E. Pion

(B) 1. Has the greatest mass
(E) 2. Has rest mass of 140 MeV
(B) 3. Has no charge and rest mass of 939 MeV
(A) 4. Electron capture reduces the number of these in the nucleus

TYPE K

Within hours of receiving a nearly lethal whole body dose of radiation an individual is likely to experience acute radiation syndrome symptoms which include:

1. nausea and diarrhea
2. convulsive seizures
3. severe fatigue
4. loss of hair

A. (1,2,3 only)
B. (1,3 only)
C. (2,4 only)
D. (4 only)
E. (All are correct)

TYPE S

A variable X is determined by making a series of measurements of two independent variables Y and Z with variances 10 and 5 and mean values 100 and 50, respectively.

1. If X=Y+Z, then the variance of X is:
A. 5
B. 7.5
C. 15
D. 75
E. 125

2. If X=Y-Z, then the variance of X is:
A. 5
B. 7.5
C. 15
D. 75
E. 125

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Suggested References

Textbooks

  1. Allisy-Roberts, P., Williams, J., Farr’s Physics for Medical Imaging, Elsevier, 2nd edition, 2007, ISBN 978-0702028441
  2. Bushberg, Seibert, Leidholdt and Boone, The Essential Physics of Medical Imaging, Philadelphia: Lippincott Williams & Wilkins, 3rd Edition, 2013, ISBN: 978-0781780575
  3. Cherry, S.R., J.A. Sorenson, and M.E. Phelps, Physics in Nuclear Medicine, Philadelphia: Elsevier Saunders, 4th edition, 2012. ISBN 978-1416051985
  4. Huda, W., Review of Radiologic Physics, Philadelphia: Lippincott Williams & Wilkins, 4th edition, 2016, ISBN 978-1496325082

NATIONAL COUNCIL ON RADIATION PROTECTION & MEASUREMENTS (NCRP) REPORTS

  1. NCRP Report 116 – Limitation of Exposure to Ionizing Radiation, Bethesda, MD: NCRP (1993)
  2. NCRP Report 147 – Structural Shielding Design for Medical X-Ray Imaging Facilities, Bethesda, MD: NCRP,  (2004)
  3. NCRP Report 149 – A Guide to Mammography and Other Breast Imaging Procedures, Bethesda, MD: NCRP,  (2004)
  4. NCRP Report 155 – Management of Radionuclide Therapy Patients, Bethesda, MD: NCRP, (2006)
  5. NCRP Report 160 – Ionizing Radiation Exposure of the Population of the United States, Bethesda, MD: NCRP, (2009).
  6. NCRP Report168 – Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures, Bethesda, MD: NCRP, (2010)
  7. NCRP Report 174 –  Preconception and Prenatal Radiation Exposure: Health Effects and Protective Guidance, Bethesda, MD: NCRP, (2013)
  8. National Council on Radiation Protection and Measurements. Proceedings of the 43rd Annual NCRP Meeting (2007). Adv Radiat Protect Med Health Phys 2008;95(5).

OTHER REPORTS & GUIDANCE DOCUMENTS

  1. American College of Radiology, Disaster Preparedness for Radiology Professionals, Response to Radiological Terrorism: A Primer for Radiologists, Radiation Oncologists and Medical Physicists, version 3, 2006.  www.acr.org
  2. American College of Radiology, ACR Practice Guideline for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation, 2008
  3. American Association of Physicists in Medicine. AAPM Report 181: The Selection, Use, Calibration, and Quality Assurance of Radionuclide Calibrators Used in Nuclear Medicine. College Park, MD: AAPM, 2012.
  4. Federal Guidance Report No. 14 Radiation Protection Guidance for Diagnostic and Interventional X-Ray Procedures, November 2014.  https://www.epa.gov/sites/production/files/2015-05/documents/fgr14-2014.pdf
  5. Code of Federal Regulations (CFR): Title 10 CFR Parts 19, 20, 30, 32, 37, 35, 49   https://www.nrc.gov/reading-rm/doc-collections/cfr
  6. US Nuclear Regulatory Commission, NUREG-1556. Consolidated Guidance about Materials Licenses. Volume 9, Program-Specific Guidance about Medical Use Licenses. Revision 2,
  7. U.S. Nuclear Regulatory Commission, Washington, DC, January 2008.US Nuclear Regulatory Commission, Safety Culture Policy Statement, NUREG/BR-0500, June 2011.