ABR Radiation Oncology Qualifying Exams — Exam Playbook

Window: Three written Qualifying Exams – Medical Physics for RO, Radiation & Cancer Biology, and Clinical Radiation Oncology – taken at defined points during residency before the oral boards.

Must-do topics (by paper)

a) Medical Physics for RO

External beam physics, photons & electrons, linac internals.

Dose calculation concepts, heterogeneity, wedges/bolus/blocks, IMRT/VMAT basics.

Imaging for RT: CT simulation, CBCT, portal imaging, motion management.

QA principles – patient-specific and machine.

b) Radiation & Cancer Biology

4 Rs of radiobiology, survival curves, fractionation concepts.

LQ model, BED/EQD2 thinking, α/β for common tissues.

Normal tissue vs tumour response, hypoxia, radiosensitisers.

c) Clinical Radiation Oncology

Bread-and-butter disease sites: breast, prostate, lung, CNS, GI, GU, GYN, H&N.

Stage-by-stage indications for RT, chemo-RT, post-op RT.

Standard dose-fractionation schemes and key OAR limits.

Top traps (avoid)

Treating all three as separate silos; real questions will blend physics, bio, and clinical judgement.

Rote-memorising dose numbers but forgetting why a constraint matters.

Over-studying exotic syndromes; under-studying common bread-and-butter cases.

Ignoring guidelines – the exam expects you to know “standard of care,” not your attending’s quirks.

Time split (per 12–16 week block)

40% Clinical RO (cases, staging, indications, fractionation).

25% Physics for RO.

20% Radiation + cancer biology.

15% Mixed question banks that force you to think across all three.

Last-48h checklist

One pass over a concise site-by-site summary: staging → indications → dose/fx → key OARs.

Re-do 15–20 radiobiology numericals (BED/NTCP-style reasoning).

Skim RT physics notes for “classic ABR favourites”: build-up region, SSD vs SAD, wedges, electrons, imaging pitfalls.

Make a small “never miss” list: spinal cord max, brainstem, optic structures, lung V20, heart constraints, kidney limits.

Quick facts / frames

For a clinical Q:

Stage the disease mentally.

Decide: surgery vs RT vs chemo-RT vs systemic alone.

Choose fractionation that fits intent + surrounding organs.

Remember that ABR questions are written by practising ROs; answers should feel reasonable in a real clinic, not just in a textbook.

Speed tactics

In long case stems, read the last line first (“What is the most appropriate…?”), then scan the stem with that in mind.

Use pattern recognition for “classic” cases: early breast, intermediate-risk prostate, limited-stage SCLC, HPV-positive oropharynx.

If two options are both technically possible, pick the one that best matches guidelines + organ protection.

Day-of mini-plan

Take each exam as a separate sprint. Don’t mentally re-grade the last paper in the break.

For clinically heavy blocks, write quick margin/OAR notes on your scratch sheet and reuse them.

When tired, lean on your well-rehearsed standard regimens instead of inventing exotic ones.