Qualifying Exam for Initial Certification

Study Guide for Radiation and Cancer Biology

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This exam tests your knowledge of the principles of cancer and radiation biology underlying the practice of radiation oncology. Included are questions on the following topics:
  • Basic cancer biology and the molecular biology of cancer
  • Response to radiation at the subcellular and cellular levels
  • Radiation responses of normal and malignant tissues
  • Radiation carcinogenesis
  • Hereditary effects as they relate to radiation protection

Categories for Radiation and Cancer Biology

  • Interaction of radiation with matter
    • Definition of ionizing radiation and types
    • Generation of free radicals
    • Direct and indirect action of radiation
  • Molecular and cellular damage and repair
    • Molecular mechanisms of DNA damage
      • Assays for DNA damage
      • Types of DNA lesions and numbers per cell per Gy
      • Multiply damaged sites
      • Single lethal hits and accumulated damage (inter- and intratrack)
    • Molecular mechanisms of DNA repair
      • Types of repair
      • Repair of base damage, single-strand and double-strand breaks
      • Homologous recombination
      • Nonhomologous end joining
    • Chromosome and chromatin damage
      • Assays
      • Dose-response relationships
      • Use of peripheral blood lymphocytes in vivo dosimetry
      • Stable and unstable chromatid and chromosome aberrations
      • Human genetic diseases that affect DNA repair, fragility, and radiosensitivity
      • Genomics
    • Repair at the cellular level
      • Sublethal damage repair
      • Dose-rate effects and repair
      • Dose-fractionation effects
  • Cellular responses to radiation
    • Mechanisms of cell death
      • Apoptotic death
      • Necrotic death
      • Mitotic-linked cell death
      • Cell division postradiation and time to clonogen death
      • Radiation-induced senescence
      • Autophagy
    • Cell and tissue survival assays
      • In vitro clonogenic assays – effects of dose, dose rate, and cell type
      • In vivo clonogenic assays – bone marrow stem cell assays, jejunal crypt stem cell assay, skin clones, and kidney tubules
    • Models of cell survival
      • Random nature of cell killing and poison statistics
      • Single hit, multitarget models of cell survival
      • Two-component models
      • Linear-quadratic models
      • Calculations of cell survival with dose
  • Linear energy transfer (LET) and oxygen effect
    • Linear energy transfer
      • Definition of LET and quality of radiation
      • RBE defined
      • RBE as a function of LET
      • Tissue type
    • Oxygen Effect
      • Definition of OER
      • Dose or dose per fraction effects
      • OER vs LET
      • Impact of O2 concentration
      • Mechanisms of oxygen effect
  • Tumor biology and microenvironment
    • Solid tumor assay systems
      • TCD50 tumor control assay
    • Tumor microenvironment
      • Tumor vasculature
      • Angiogenesis
      • Hypoxia in tumors
      • Reoxygenation after irradiation
      • Relevance of hypoxia in radiation therapy
      • Hypoxia as a factor in tumor progression
      • Hypoxia-induced signal transduction
      • Cellular composition of tumors
    • Immune microenvironment
  • Cancer biology
    • Cell
      • Cell cycle
      • Effect of cell cycle phase on radiosensitivity
      • Cell cycle arrest and redistribution after irradiation
      • Cell cycle checkpoints, cyclins, cyclin-dependent kinase inhibitors
    • Molecular signaling
      • Receptor/ligand interactions
      • Phosphorylation/dephosphorylation reactions
      • Transcriptional activation
      • Radiation-induced signals
      • Cell survival and death pathways
    • Mechanisms of cancer development
      • Cancer as a genetic disease
      • Oncogenes
      • Tumor suppressor genes
      • Telomeric changes in cancer
      • Multistep nature of carcinogenesis
      • Signaling abnormalities in carcinogenesis
      • Effects of signaling abnormalities on radiation responses
      • Prognostic and therapeutic significance of tumor characteristics
    • Cancer genetics/genomics
      • Epigenetic changes in cancer
      • Molecular profiling of cancer
  • Radiobiology of normal tissues
    • Clinically relevant normal tissue responses to radiation
      • Responses in skin, oral mucosa, oropharyngeal and esophageal mucous membranes, salivary glands, bone marrow, lymphoid tissues, bone and cartilage, lung, kidney, testis, eye, and central and peripheral nervous tissues
      • Reirradiation
    • Mechanisms of normal tissue radiation responses
      • Molecular and cellular responses in slowly and rapidly proliferating tissues
      • Mechanisms underlying clinical symptoms
      • Tissue kinetics
    • Total body irradiation
      • Prodromal radiation syndrome
      • Cerebrovascular syndrome
      • Gastrointestinal syndrome
      • Hematopoietic syndrome
      • Mean lethal dose and dose/time responses
      • Immunological effects
      • Assessment and treatment of radiation accidents
      • Bone marrow transplantation
  • Dose delivery
    • Therapeutic ratio
      • Tumor control probability (TCP) curves
      • Normal tissue complication probability (NTCP) curves
      • Causes of treatment failure
    • Time, dose, and fractionation
      • The four R’s of fractionation
      • Radiobiological rationale behind dose fractionation
      • Effect of tissue type on the response to dose fractionation
      • Effect of tissue/tumor types on A/B ratios
      • Quantitation of multifraction survival curves
      • BED and isoeffect dose calculations
      • Hypofractionation
    • Brachytherapy
      • Dose-rate effects (HDR and LDR)
      • Choice of isotopes
      • Radiolabeled antibodies
    • Radiobiological aspects of different radiation modalities
      • Protons, high LET sources
      • Stereotactic radiosurgery/radiotherapy, IMRT, IORT
      • Dose distributions and dose heterogeneity
  • Combined modality therapy
    • Chemotherapeutic agents and radiation therapy
      • Classes of agents
      • Mechanisms of action
      • Oxygen effect for chemotherapy
      • Multiple drug resistance
      • Interactions of chemotherapeutic agents with radiation therapy
      • Molecular-based therapy
    • Radiosensitizers, bioreductive drugs, and radioprotectors
      • Tumor radiosensitization
      • Normal tissue radioprotection
      • Biological response modifiers
      • DNA repair inhibitors
      • Hyperthermia
    • Immune therapeutics
  • Late effects and radiation protection
    • Radiation carcinogenesis
      • Dose response for radiation-induced cancers
      • Importance of age at exposure and time since exposure
      • Malignancies in prenatally exposed children
      • Second tumors in radiation therapy patients
      • Risk estimates in humans
      • Calculations based on risk estimates
    • Heritable effects of radiation
      • Single gene mutation
      • Relative vs absolute mutation risk
      • Doubling dose
      • Heritable effects in humans
      • Risk estimates for hereditable effects
    • Radiation effects in the developing embryo
      • Intrauterine death
      • Congenital abnormalities and neonatal death
      • Microcephaly, intellectual disabilities
      • Dose, dose rate, and stage in gestation
      • Human experience of pregnant women exposed to therapeutic doses
    • Radiation protection
      • General philosophy
      • Stochastic and deterministic effects
      • Relative weighting factors
      • Equivalent dose – tissue weighting factor
      • Effective dose, committed dose
      • Collective exposure dose
      • Dose limits for occupational and public exposure
      • ICRP and NCRP

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