book flashcards
In what positions do you do a BSE
upright & supine
What is a CBE
Clinical quest examination- provider exams
In CBE special attention is paid to the month note in the axilla and around the clavicle because breast cancer spreads from the breast via what
Lymph nodes
What dose does mammography us le
Glandular dose
What is an average glandular dose for typical mammography
.3 rad (3 mGy) with grid
.1 rad (1 mGy) without a grid
If a woman has a first degree relative (mother, sister, daughter) with br ca, what does it do to her chance of having br ca
Doubles chance
If a woman has two first degree relatives with breast cancer, what does it do her risk of it
Triples chance
What race has the highest incident rate of breast cancer
White women
What race is the most likely race to die as a result of breast cancer
African American
A proliferative lesion with or without atypia is associated with the highest risk
Lesions with atypia
What percent of untreated DCIS turn into invasive br ca
20% - 50%
Does lobular carcinoma in situ show mammographically
Not typically
What is nulliparous
A woman who never carried a pregnancy beyond 20 weeks
What is primiparous
A woman who has given birth at least once
What are the first two most common cancers in the US
Breast & lung
First and second leading cause of cancer death in US
Lung/ bronchus first, breast second
What percent of women will have breast cancer in their life
13%
What percentage of breast cancer is from men
1%
When do they start external beam radiation therapy & how long does it last
1 month after the surgery. 5x per week for 6-8 weeks
What is internal beam radiation therapy also called
Brachytherapy
What is the treatment time from for internal beam radiation therapy
5-9 days
What is neoadjuvant chemotherapy
Administered before the surgery to help shrink the cancerous tumor
What is adjuvant chemotherapy
Administered in addition to another breast cancer treatment EX mastectomy
What is the first line of treatment for triple negative breast cancer
Chemotherapy
How long does chemotherapy treatment last
3-6 months
What does Hormone therapy do
Slows or stops the growth of hormone sensitive tumors by blocking the body’s ability to produce hormones or by interfering with hormone actions.
SERM stands for
Selective estrogen receptor modulators
What does a SERM do
Treats cancers that rely on the supply of estrogen to grow
What is Tamoxifen
A SERM - can be used to shrink large tumors
What does TRAM flap stand for
Transverse rectus abdomen’s myocutaneous flap
What is a latissimus flap
Skin, fat, and muscle from the upper back are used to make new breast.
One of the minor risk factors for developing breast cancer is
Not breastfeeding
What is a symptom of a possible breast disease that cannot be demonstrated on a mammogram
Nipple discharge
HER2 stand for
Human epidural growth factor receptor 2
What is HER2 and ERBB2 receptors
A protein which functions as a receptor on the breast
What nipple discharge is normal
Clear, milky, yellow, or green (bloody is not good)
Postmenopausal obesity is associated with what
A relatively high risk of developing breast cancer
Glandular dose for routine mammography is what
2-3 mGy
Removal of breast tissue, skin, nipple and areola
Simple mastectomy
Removes entire breast, nipple, areola, & some of the underarm lymph nodes
Modified mastectomy
What KVP values are used in Mammo
20-40 kvp
Fatty breasts use which target
Molybdenum
Dense breasts use which target
Rhodium
What are the controlling factors of contrast
Kv value, software & digital algorithms
What is the normal clinical practice range of KVP
25-28 kvp
Minimum HVL should not measure less than what
.3 mm aluminum at 30 kvp or .25 mm at 25 kvp but not more than .4 mm at 30 kvp
HVL assessment should include what filtration
Inherent & added
Angled target allows a larger area of the electromagnetic to strike while maintaining a small effective focal spot
Line focus principle
Anode angles for mammo are what
0-16 degrees
6 degrees is common
SID is what for mammo
24-30 inches (60-75 cm)
Ensures that the cray beam does not extend beyond the edge of the detector, especially at the chest wall
Half field geometry
Large focal spot vs small: what are they used for
Large is for routine work, small is for mags
What is the most commonly used exit port
Beryllium
What is positioned towards the cathode at? Why
Chest wall = thickest part of the chest (anode heel effect)
Compression minimum & max (MQSA)
25 lb - 45 lb
What type of grid does Mammo use
Moving grid
Grid ratio for Mammo
3:1 - 5:1
How to determine magnification factor
SID/SOD or image size/object size
Benign growth involving the milk ducts
Ductal papilloma
Eight bits equals what
One byte
In positioning for the XCCL projection, if the shoulder is in the way of compression what do you do
Use a 5degree lateral tube angulation
In the CC, the pectoral muscle is seen what percent of the time
30%-40% of the time
Montgomery glands are specialized what glands
Sebaceous glands
Noncancerous tumor - solid lump
Fibroadenoma
A form of carcinoma associated with changes in the nipple
Paget’s disease
The inframammory fold is at the level of what rib
6th & 7th rib
When evaluation the SMPTE or AAPM TG18 QC test patterns for Review Workstation QX, what does the lighting need to be at
20-45 lux
Surgical removal of the breast to reduce the risk of cancer
Prophylactic mastectomy
Where does the coopers ligaments attach
Anteriorly attach to the fascia of the skin
Immediately behind the nipple, there is a widened area of the collecting duct called the what
Lactiferous sinus
Postmenopausal obesity is associated with what
A relatively high risk of developing breast cancer
Approximately how many women will be diagnosed with invasive breast cancer each year
268,600
The age of a woman undergoing HRT is likely to be what age
More than 40 years old
A side effect of tamoxifen treatment is what
Uterine Cancer
Antiestrogen drugs, such as tamoxifen, can be used to
1. Slow or stop the growth of cancer
2. Prevent breast cancer in high risk women
3. Prevent the reoccurrence of breast cancer
1, 2, 3
The most common immunohistochemical tumor marker is what
Estrogen receptor positive
Which of the following are side effects of radiation treatment
1. Loss of appetite
2. Fatigue
3. heaviness of the breast
All 3
Whaat are contraindications for lumpectomy
Previous lumpectomy
Multiple cancer sites in one breast
Large tumors in a small breast
Which of the following is a name given to the clear fluid that can sometime form and a complication to the mastectomy procedure
Seroma
What features of the high transmission cellular grid allow these grids to maintain quality or less radiation doses to the patient compared with linear grids
They have copper as the strips and air as the interspace material
The general criteria to pass the new American College of radiology – digital mammography phantom require a minimum of what masses
Two masses
To get a meaningful analysis the repeat analysis needs a patient volume of a at least how many patients
250
Mammography facilities can receive certifications from which of the following
ACR
FDA
States as certifiers
FDA and state as certifiers
Aluminum filtration is likely to be matched with what kind of targets
Tungsten
Function of the filter in mammography is to remove what
Photon energy is higher or lower than the range needed for breast imaging
Aluminum can be used as the filtration, and what kind of tubes with what kind of targets
Digital breast tubes with tungsten targets
Which of the following is a system that can be used to store 12 months or more of image data and can retrieve the data within a few minutes
Redundant array of independent discs RAID
Which of the following is included in a workflow plan for a technologist?
A. Determining whether a lesion requires biopsy
B. Completed the medical audit.
C. Retrieving the results of a prior examination for a patient.
D. Monitoring the radiation output of the unit.
C
When transmitting mammography images, the compression required is termed
Lossless compressing
What is the maximum possible score for each test object in the ACR phantom?
Six
Most mobile margins of the breast are the what
Lateral and inferior aspects
Hormone replacement therapy could be recommended to
1. Relieve insomnia symptoms
2. Prevent osteoporosis.
3. Reduce weight gain.
One and two only
A benign self-limiting breast tumor that is a result of new disorganized. Cell growth is what
Hamartoma
An overgrowth of cells lining the ducts is termed what
Hyperplasia
In the ark method of localization, the arc is drawn with the radius of the arc from where to the lesion
The nipple
if any breast tissue is poorly damaged on the MLO projection, it is likely to be what
Medial
In general, when imaging tall, thin patients, the angulation is adjusted to what
Close to 60°
An infusaport can be used to what
Allow repeated access to the Venus system
The results from which of the following tech techniques is often used to reduce the amount of lymph nodes removed during a check for breast cancer spread
Sentinel node mapping
An ultrasonography the term acoustic enhancement refers to what
The amount of sound passing through an anechoic structure
What do you use to calculate the horizontal vertical in depth of non-palpable lesions
Stereotactic breast localization
Which biopsy technique is most accurate
Open surgical biopsy
Which biopsy technique often requires the presence of a cytological technologist
Fine needle biopsy
What is a lesion that mostly occurs in the terminal ductile lobular unit units when the extra lobular terminal ducts becomes blocked
Cyst
What are some advantages of a single track tubes?
More reliable and less expensive to manufacture and allow shorter exposure time
What is the term used to describe the hormone therapy used by women who still have a uterus?
Hormone replacement therapy
Approximately how many cases of male breast cancer were diagnosed in the US recently
3000
Dystrophic calcifications are often identified as what
Course heterogeneous calcifications
What is pectus carinatum
Prominent sternum
In the tube, what material is usually used for the exit port window?
Beryllium
Which breast cancer accounts for approximately 10% of breast cancer and it’s difficult to perceive on radiographs in may cause architectural distortion or skin reaction
Invasive lobular carcinoma
The process where multiple images are created in projection sizes that are reconstructed into a 3-D volume by the computer is called what
DBT
How many orifices are found on the nipple?
15 to 20
Which surgery removed skin and fat from the abdomen back and Botox and uses those to form a new breast
Autologous tissue or flap surgery
What is a technique that is used during an open surgical biopsy where part of lesion are removed for biopsy?
Incisional biopsy
What is the first line of treatment for triple negative breast cancer
Chemotherapy
A radiation treatment that usually begins one month after the surgery is what
External beam radiation
Apart from the ACR, what are the states accreditation bodies in the United States?
Arkansas
Texas
What are state certifiers?
Illinois
South Carolina
Texas
Iowa
There are how many equip questions
Three
What comprehensive evaluation test must be performed on the unit before clinical test
Mammography equipment evaluation
The structure at the beginning of the ductal system is called what
TDLU
What are the two layers of tha acini
Myoepithelial and epithelial
Which layer of the acini rests on the basement membrane
Myoepithelial layer
What is the main arteries supplying the breast?
Internal mammory artery
Which agency has established procedures for the application approval, evaluation, and withdrawal of the certification
FDA
What is the main drainage of blood from the breast?
Internal mammary vein
Lymphatic drainage from the breast goes mainly to wear
Axillary nodes of the ventral and lateral breast
Where does the lymph drain to initiate cross mediastinal drainage?
Internal mammary nodes
What is an image storage device?
RAID
In digital imaging, a graph of the optical density (receptor exposure) range to the log of relative exposure is a what kind of response
Linear
In the new 2018 ACR Digital Mammography Quality Control Manual, the approved accreditation phantom has a total of what
6 specks
6 fibers
6 masses
Keratosis if demonstrates on the mammogram as a what
Sharply outlined multilobulated lesion
The advantages of a quality assurance program, such as the Mammography Quality Standards Act, includes all except which
- increased efficiency
- cost effectiveness
- ability to manipulate the final image
- improved patient satisfaction
Ability to manipulate the final image
What has a protein receptor that controls how the breast cells divide and repair themselves
HER2/neu aggressive cancers
Scanning the breast to locate a cancer on basis of the vast amount of glucose used by cancer cells is the technique used in what type of imaging
Positron emission mammography imaging
Evaluations, such as the mammography equipment evaluation, is performed by the who
Medical physicist
What is a disadvantage of lossless compression
Transmission times can be too long
Skin thickening can be malignant but could also be caused by nonmalignant factors, such as what
Sarcoidosis
What is sarcoidosis
Growth of collections of inflammatory cells (granulomas)
The method of locating the lymph nodes through which cancer is spreading from the breast is called what
Lymphoscintigraphy
What is lossless compression vs lossy
Lossless - A data compression technique that preserves all of the original file data, resulting in a smaller file.
Lossy - reduces file size by removing part of the original file
An overgrowth of cells in the ducts or lobules
Epithelial hyperplasia
Benign milk filled cyst
Galactocele
A beryllium window on the xray tube enhances contrast by
Transmitting more low energy photons
Functional milk producing units of the breast are contained within the
Lobules
What is the ampulla in the breast
Reservoir for milk, connects to lactiferous sinus
During lactation, the contraction of which cells helps eject milk from the alveoli
Myoepithelial cells
Epithelial layers of TDLU from inner to outer
Epithelial cells
Myoepithelial cells
Basal surface
Basement membranes
Interlobular connective tissue
What is used as a treatment for estrogen dependent tumors in postmenopausal and premenopausal women
Tamoxifen
Thin supportive layer located between the basal surface of the epithelium and the connective tissue layer of the lobule
Basement membrane
Dimples skin condition seen in cases of lymphatic edema of the breast is called what
Paeu d’orange
The interspace material of the mammography linear grid is generally made of
Carbon or wood
According to the EQURP mandate by the FDA, which of the following is a true statement
A. Each breast center must have a written policy for corrective action when images are of poor quality to show the MQSA inspector
B. Documentation is not required for corrective action when images are a poor quality.
C. The policy for the lead interpreting physician oversight of QA/QC records must be a written policy
D. Written documentation of the required clinical image review of each RT and IP done at least annually is required.
D
Where are coopers ligaments located
Transverse at the inferior of the breast
For the compression thickness indication QC test, what is the performance criterion
Must be accurate to within .5 cm
What causes a seroma
Trauma, injury or surgery
Higher optical density means what
Appears whiter on the mammogram / higher density
In the CC position, what technique is used to minimize skin folds in the lateral aspect of the breast
Arm hanging relaxed on the side being imaged with the humerus externally rotated
A condition where the chest protrudes outward from the body, causing the breast tissue to extend laterally under the arms is called what
Barrel chest
If a tube has a single track, what is that single track likely to be made of
Tungsten
The repeat rate should should be analyzed if the rate changes from the previous measure rate by more than
Within 2 points
A benign inflammatory condition of the lactiferous duct leading to nipple discharge, inversion or periareolar sepsis is called what
Ductal ectasia
What physicist test is performed to verify the SNR of the detector is consistent
AEC
The x-ray failed and Lightfield must be within what percent of the SID for any edge
2%
Paddle must not extend more than what percent of the SID beyond the wall edge of the detector
One percent
Is there a grid on the magnification platform?
No
TFT array is part of indirect or direct
Direct
CCD array is part of indirect or direct
Indirect
Phantom pass criteria
2 fibers
3 specks
2 masses
Repeat rate needs to be what
2%-5%
If changes more than 2%, explanation requires
Radiologist reading room lux
Les than 5 - 1 or 2 preferred
The period of time before the breast cancer becomes clinically evident
Sojourn time
Simple cyst vs complex cyst
Simple is black hole on US
Complex has a solid component or debris within the fluid sac
Is Lobular Carcinoma In Situ cancer
Not a true cancer
What is atypical Ductal hyperplasia
Breast cells become abnormal in number, size, shape, growth & appearance.
Can possibly present as distortion, mass or micro calcifications.
High risk for developing breast cancer so surgical excision advised
What is atypical lobular hyperplasia
Breast cells become abnormal in number, size, shape, growth & appearance.
Can possibly present microcalcifications.
High risk for developing breast cancer so surgical excision advised
Amorphous or pleomorphic
Lacking specific shape or shape
What percent of mammographically diagnosed breast cancer is DCIS
20% - 40%
What is the most common form of breast cancer?
Invasive ductile carcinoma
What percent of breast cancer is invasive ductile carcinoma
80%
What percent of breast cancer is invasive tubular carcinoma
10% of all breast cancer
What is multifocal breast cancer
All arisen from one original tumor, typically in the same quadrant
Multicentric breast cancer, what is it
More than one tumor, all separately & rarely in same quadrant
Rare
