Practice

Question 1

In general, the optimal duration of tamoxifen treatment is

(A) 2 years

(B) 3 years

(C) 4 years

(D) 5 years

Answer 1

(D) 5 years

Question 2

Which of the following are contraindications for lumpectomy?

1. previous lumpectomy
2. multiple cancer sites in one breast
3. large tumors in a small breast

(A) 1 and 2 only

(B) 2 and 3 only

(C) 1 and 3 only

(D) 1, 2, and 3

Answer 2

(D) 1, 2, and 3

previous lumpectomy, multiple cancer sites in one breast, and large tumors in a small breast.

Question 3

1. Radiation therapy is a treatment that utilizes

(A) drugs to treast cancer that may have spread

(B) high-energy radiation to destroy cancer cells

(C) radioactive tracers to track the path of cancer to the lymph nodes

(D) potent pain medication to treat the severe pain from cancer

Answer 3

B - high energy radition to destroy cancer cells.

Question 4

2. Between ages 20 and 30 years, an asymptomatic woman should be undergoing mammography every

(A) year

(B) 2 years

(C) 3 years

(D) none of the above

Answer 4

D - none of the above

Annual mammography is generally not recommended for asymptomatic women 40 years and below. At any age, breast imaging can be recommnded by a physician on the basis of clinical finders.

Question 5

3. Medical history may include questions on hormone use because

(A) treatment with synthetic hormones, such as hormone replacement therapy (HRT), will always cause breast cancer

(B) the use of reproductive hormones can increase risk factors for breast cancer

(C) family history of hormone use predisposes a woman to cancer

(D) personal history of hormone use decreases a womans risk for breast cancer

Answer 5

B - the use of reproductive hormones can increase risk factors for breast cancer

Studies have suggested that synthetic hormones, used in HRT, or reproductive hormones influence breast cancer risk and promote cancer growth.

Question 6

4. In imaging implants, some of the projections taken will include an image of the implant. In these projections, compression is used

(A) to allow a uniform tissue density

(B) for immobilization only

(C) to separate the breast tissue

(D) to separate and spread out the implant

Answer 6

B - for immobilizaiton only

When imaging implants, the standart projections are used for immobilization purposes onlly; full compression is not applied. The implant is then displaced, and four additional compression projections are taken. The results is an eight projection series.

Question 7

5. The glandular dose is a measure of

(A) the radiation dose to the skin of the breast

(B) the dose to the radiosensitive cells of the breast

(C) the significant background dose recorded in the US

(D) the radiation dose to the gonads

Answer 7

B - the dose to radiosensitive cells of the breast.

Radiation dose is often the calculation of the entrance skin exposure, which is the dose received at the skin. HOwever, in mammography, glandular dose, which is a record of the dose to the glandular and more radiosensitive cells and tissues of the breast, is considered more significant.

Question 8

6. In digital imaging, “high detective quantum efficiency” means that

(A) the system is more efficient in coverting input x-ray signals and or the system needs higher exposure factors to create an image

(B) the system needs higher exposure factors to create an image and or the system has a high fill factor on the TFT array

(C) the system is more efficient in converting input x-ray signals and or the system has a high fill factor on the TFT array

(D) all of the above

Answer 8

C - the system is more efficient converting input xray signals and/or the system has a high fill factor on the TFT array.

Detective quantum efficiency DQE is the product of absorption and version effficiency. It is the percentage of energy that strikes a detector that results in a useful output signal. High DQE means lower patient dose when imaging.

Question 9

7. In digital imaging, a graph of the optical denisty range to the log of relative exposure is a

(A) shallow sloping curve

(B) steep sloping curve

(C) linear response

(D) curvilinear response

Answer 9

C - linear response

Digital imaging systems have a linear response to xray intensity. This means that regardless of the intensity of the xray beam, a small change in the intensity i recorded as the same change in the electronic image.

Question 10

8. In the new 2016 American College of Radiology (ACR) Digital Mammography Quality Control Manual, the approved accreditation phantom has a total of

(A) 5 fibers, 5 speck groups and 5 masses

(B) 5 fibers, 6 speck groups and 5 masses

(C) 6 fibers, 5 speck groups and 5 masses

(D) 6 fibers, 6 speck groups and 6 masses

Answer 10

D 6 fibers, 6 speck groups, and 6 masses

Question 11

9. The circular pigmented area around the nipple is called the

(A) skin

(B) areola

(C) Montgomery gland

(D) ampulla

Answer 11

B- areola

Question 12

10. Keratosis is demonstrated mammographically as a

(A) sharply outlined multilobulated lesion

(B) sharply outlined lesion with a halo

(C) mixed radiolucent and radiopaque circular lesion with a radiolucent center

(D) mixed radiolucent and radiopaque oval lesion

Answer 12

A - sharply outlined multilobulated lesion

Question 13

12. The advantages of a quality assurance program, such as the Mammography Quality Standards Act (MQSA), includes all of the following except

(A) increased efficiency

(B) cost- effectiveness

(C) permission for maniplation of the final image

(D) improved patient satisfaction

Answer 13

C - permission for manipulation of the final image.

Question 14

13. In magnification, what immediate role does the large object to image receptor distance (OID) play in reducing scatter radiation?

(A) It allows the use of lower peak kVp values

(B) There is an increased source to object distance (SOD), which allows for absorption of the scattered radiation

(C) Most of the scattered radiation misses the detector

(D) the larger OID utilizes a smaller source to image receptor distance (SID)

Answer 14

C - most of the scattered radiation misses the detector.

In magnification, the large air gap acts like a grid and reduces scattered radiation, thus improving constrast. Positioning the breast away from the detector takes advantage of the inverse square law.

Question 15

14. Using a small focal spot size is recommeded for magnification

(A) to reduce the resultant loss of image detail

(B) because of increased patient dose

(C) to compensate for the small OID

(D) to compensate long exposure times

Answer 15

A - to reduce the resultant loss of image detail

Question 16

15. What is the best placement for the needle wire during needle localization

(A) the needle wire should pass immediately below the lesion

(B) the needle wire should pass immediately above the lesion

(C) the needle wire should pass through the lesion

(D) the needle wire should pass immediately beside the lesion

Answer 16

C - the needle wire should pass through the lesion.

Question 17

16. Although it may mean losing some of the lateral breast tissue, in imaging for the craniocaudal (CC) projeciton, most experts agree that all efforts should be made to maximize imgaing of the medial breast tissue, why?

(A) medial breast is imaged best on CC

(B) medial breast is imaged only on CC

(C) Most cancers are found in the medial breast

(D) the lateral breast is generally distorted on CC

Answer 17

A - medial breast is imaged best on CC

Including the medial breast is very important in the CC projection. The other routine projection MLO, will not image the medial breast clearly because it is an oblique projection, and the medial tissue will be distorted.

Question 18

17. Which is true when positioning for all tangential (TAN) projections?

(A) The patient is always in the CC position

(B) The central ray is always directed vertically

(C) The central ray is always parallel to the plane of the breast

(D) The central ray is always parallel to the skin surface

Answer 18

D - the central ray is always parallel to the skin surface

Question 19

18. In the rolled medial (RM) position, the inferior (lower) surface of the breast is rolled in which direction

(A) lateral

(B) medial

(C) inferior

(D) superior

Answer 19

A - lateral

Question 20

19. A radiopaque implant that is used in breast reconstruction and can be adjusted for cup size after surgical placement in the breast is the

(A) silicone gel implant

(B) flap implant

(C) silicone liquid implant

(D) saline implant

Answer 20

D - saline implant

The saline implant can be inserted as an expandable sac, where the fluid content can be adjusted, as needed, during surgery and even after surgery.

Question 21

20. In addition to the routine CC and mediolateral oblique (MLO) projections, a routine series after mastectomy could also inlcude

(A) axiallary tail (AT)

(B) mediolateral (ML)

(C) TAN

(D) lateromedial oblique (LMO)

Answer 21

B - Mediolateral ML

After mastectomy, a three projection series, including CC, MLO, and ML is often recommended because without the other breast for comparison, this series gives the radiologist a better opportunity to diagnose any new malignancy. (AT - images the axilla and TAN images skin lesions, LMO is true reverse of MLO)

Question 22

21. Men with family history of breast cancer will

(A) have a greater risk for breast cancer

(B) Have a minor risk for breast cancer

(C) have no significantly increased risk for breast cancer

(D) always get breast cancer

Answer 22

A - have a greater risk for breast cancer

Even though men generally have a low risk of developing breast cancer, they should be aware of the risk factors, especially family history, which could be associated with genetic changes. However, a family history of breast cancer does not mean breast cancer will develop.

Question 23

22. The dynamic range is

(A) the detectors ability to respond to different exposure levels

(B) a measure of the image quality

(C) an indication of how efficient the detector is at converting the remnant beam to useful data

(D) the ability of the detector to record lower exposure factors

Answer 23

A - the detectors ability to respond to different exposure levels.

The “dynamic range” refers to the detector’s ability to respond to different exposure levels. Digital systems have a wide dynamic range.

Question 24

23. The absorbed dose in mammography is generally __ the entrance skin exposure (ESE)

(A) significantly higher than

(B) significantly lower than

(C) about the same as

(D) slightly higher than

Answer 24

B - significantly lower than

Because of the low xray energies used in mammography, the dose to the skin may be high, but the dose falls off rapidly as the beam penetrates the breast.

Question 25

24. In the compression test required by the MQSA, the maximum compression for the initial power drive should not exceed (A) 100 newtons (N) (B) 200 N (C) 400 N (D) 500 N

Answer 25

B - 200 N ## Footnote The actual compression applied to the breast is always under the discretion of the technologist. However, to ensure that the equipment is working properly, the MQSA requires compression force of at least 111 newtons (25lbs) and a maximum of 200N for the initial power drive.

Question 26

25. Collimation should not extend beyond any edge of the detector by more than (A) 1% of the SID (B) 2% of the SID (C) 3% of the SID (D) 4% of the SID

Answer 26

B - 2% of the SID ## Footnote The collimation standard is MQSA requirement to avoid excess radiation dose to the patient. All units should have a beam-limiting device that allows the entire chest wall of the xray field to extend to the chest wall edge of the detector and should not extend beyond any of the edges on the detector by >2%

Question 27

26. Inherent filtration will include filtration by all of the following except (A) exit port of the tube (B) compression paddle (C) molybdenum filters (D) mirror assembly

Answer 27

C - molybednum filters ## Footnote The radiation leaving the mammography tube is filtered by everything in its path. This is the inherent filtration and includes the oil in the tube, the window of the tube, the mirror of the collimation assembly, and the compression paddle. To reduce the lower energy photons that would only contribute to skin dose, addded filtration is needed. Addded filtration can be molybdenum, rhodium, silver, or alumnimum.

Question 28

27. The MQSA was enacted (A) because mammography was overregualted (B) to address the inconsistent quality of mammography (C) to enforce continuing education for the radiologic technologist (D) to enforce continuing education for the radiologist

Answer 28

B - to address the inconsistent quality of mammogram ## Footnote The MQSA enacted in 1992 and enforcement started in 1995 to address the need for ensuring high quality mammograms. Under the MQSA, all mammography units in the US must be accredited, certified, and inspected regularly.

Question 29

28. Grids are utlized in mammography (A) during normal imaging (B) during magnificaiton imaging only (C) only if requested by the radiologist (D) to reduce radiation dose to the patient

Answer 29

A - during normal imaging only ## Footnote Grids absorb scatter and increase visibility of image detail and are necessasry during normal mammogrpahy. The use of a grid typically requires increased dose. Grids are placed between the patients breast and the detector. Grids are not used in magnification radiography or Hologic tomosynthesis imaging.

Question 30

29. Breast tissue can extend medially to the (A) latissimus dorsi muscle (B) mid-sternum (C) retromammary space (D) inframammary fold (IMF)

Answer 30

B - mid sternum ## Footnote The breast can reach superiorly to the clavicle (level of the 2nd or 3rd rib), inferiorly to meet the abdominal wall at the level of the 6th or 7th rib (IMF), laterally to the edge of the latissimus dorsi muscle, and medially to the mid-sternum.

Question 31

30. Which of the following hormones has the most influence on the normal physiological changes of the breast (A) estrogen and prolactin (B) estrogen and progesterone (C) prolactin and estrogen (D) profesterone and prolactin

Answer 31

B - estrogen and progesterone

Question 32

31. Which of the following are considered first degree relatives (A) mother and aunt (B) first cousin and mother (C) aunt and sister (D) sister and mother

Answer 32

D

Question 33

32. Image compression is often required to allow (A) teleradiography (B) digital imaging and communication in medicine (DICOM) interpretation (C) picture archiving and communication system (PACS) transmission (D) digital imaging

Answer 33

A - teleradiology ## Footnote Transmitting digital mammography signals involve transmission of huge data files that are typically as much as 32MB in size for a single projection, and the tramission must often occur without timeout to avoid compromising the signal.

Question 34

33. Network limited to a small geographical area is called (A) wide area network (WAN) (B) local area network (LAN) (C) personal area network (PAN) (D) PACS

Answer 34

B local area network ## Footnote Local area network is limited computer network. A LAN network would interconnect computers to a server within a small georgraphical area, such as within a school or a hospital. Computers and other mobile devices using a LAN connnection can share resources, such printers or network storage.

Question 35

34. In the lower kVp range using molybdenum target tube, what type of photon interaction predominates (A) photoelectric (B) compton (C) bremsstrahlung (D) coherent

Answer 35

A - Photoelectric

Question 36

35. In digital imaging, a repeat analysis test is (A) unnecessary - digital imaging automatically corrects exposure mistakes (B) necessary - digital imaging automatically cannot correct for overexposure (C) unneccessary - digital imaging corrects unsharpness by altering the spatial display (D) necessary - digital imaging cannot correct factors such as motion unsharpness

Answer 36

D - necessary - digital imaging cannot correct factors such as motion unsharpness.

Question 37

36. The same technologist should view the phantom images because (A) subjective judgement about images is always difficult (B) it is not wise to have different individuals handling the phantom (C) not all mammographers know the MQSA regualtions (D) given different images, different mammographers will calculate the optical densities differently

Answer 37

A - subjective judgement about images is always difficult. ## Footnote To ensure consistency and the effectiveness of the mammography QC program, the ACR recommends that a single technologist be the primary QC technologist. This technologist would be responsible for overseeing all tests but could delegate responsibility to other individuals.

Question 38

37. The from-below (FB) projection utlizes a beam directed (A) perpendicular to the detector (B) horizontally (C) tangentially (D) parallel to the detector

Answer 38

A

Question 39

38. Changes in the breast as a result of radiation therapy include (A) erythema (B) edema (C) hardening (D) all of the above

Answer 39

D

Question 40

39. Scanning the breast to locate a cancer based on the vast amount of glucose/sugar utilized by cancer cells is the technique used in (A) scintigraphy (B) positron emission mammography (PEM) imaging (C) magnetic resonance imaging (MRI) (D) lymphoscintigraphy

Answer 40

B - positron emission mammography (PEM) imaging ## Footnote Positron emission mammography technology utilizes the fact that cancerous tissue uses vasts amounts of sugar. PEM is similar to positron emission tomography PET but uses an organ specific high resolution gamma detector.

Question 41

40. Which of the following projections could be used to replace MLO in patients where MLO is not possible (A) ML (B) lateromedial (LM) (C) rolled lateral (RL) (D) AT

Answer 41

B Lateromedial (LM) ## Footnote LMO provides a mirror image of the MLO. The next best position is the LM projection, which can replace MLO when imagine patients with difficult body habitus. LM cannot be used as a routine imaging projection because it does not image the deep posterior breasts.

Question 42

41. Which of the following does not describe mammogrpahy filtration (A) It shapes the emerging beam by abdorbing low-energy x-rays that would only be abdorbed by the superficial tissue and contribute to patient dose (B) It will affect the half-value layer (HVL) of the emerging x-ray beam (C) filtration makes the emerging beam compatible with the characteristics of the breast (D) the filtration used in mammography is never aluminum

Answer 42

D the filtration used in mammography is never aluminum. ## Footnote Filtration removes lower energy photons that would only contribute to skin dose. With filtration, the average energy of the beam will increase, but the maximum energy remains the same. Generally xray tubes use aluminum filtration. Mammography units can use molybdenum, rhodium, silver, or aluminum as the filtration materal.

Question 43

42. An artifact caused by dust is more common in (A) flat panel detector systems (B) computer radiography systems (C) indirect flat panel detector systems (D) scintillator based systems

Answer 43

B computer radiography systems ## Footnote The PSP based digital mammography system is referred to as computer mammographry by some, and the digital systems using flat panel technologist is sometimes referred to as digital mammography DM.

Question 44

43. Evaluations such as the mammography equipment evaluation (MEE) is performed by the (A) radiologic assistant (B) technologist (C) medical physicist (D) radiologist

Answer 44

C - medical physicist

Question 45

B44. The test pattern used to ensure that the acquistition workstation monitors are clean and free of dust, fingerprints, and other artifacts is (A) signal to noise ratio (SNR) (B) SMPTE ( Society of motion pciture and telvision engineers) (C) contrast to noise ratio (CNR) (D) moduation transfer funcion (MTF)

Answer 45

B - SMPTE society of motion picture and television engineers. ## Footnote SMPTE is a test pattern that can be used to ensure that the monitor is calibrated correctly with brightness and contrast settings. This pattern is also used to check that the monitors are clean and free of dust, fingerprints, and other marks that could interfere with clinical interpretation.

Question 46

45. According to the 2016 American College of Radiology (ACR) Digital Quality Control Manual, which of the following test is performed monthly ? (A) phantom check (B) repeat/rejection analysis (C) compression thickness indicator check (D) compression force check

Answer 46

C - compression thickness indicator check

Question 47

46. On a reject/repeat analysis, the rate was \<5% but one category of the reject/repeat analysis is significantly higher than others. What should be done (A) Although the rate is \<5% that one are should be targeted for improvement (B) If the other catefories are within normal limits, that are can be disregarded (C) because the rate was \>2% the entire department needs to be reassessed (D) WIth an overall rate \<5% one high riate is statistically meaningless

Answer 47

A - although the rate is /<5% that one are should be targeted for improvement. ## Footnote Idetally, the rate should not exceed 2%, but a rate of 5% is acceptable once a QC program has been established. Too low or no repeat may indicate that poor image quality is being tolerated. An analysis of the number of repeated mammograms and rejected images identifies ways to improve efficiency and reduce cost and patient exposure.

Question 48

47. Typically, grid ratios in mammography range from (A) 7:1 to 8:1 (B) 6:1 to 7:1 (C) 4:1 to 6:1 (D) 3:1 to 5:1

Answer 48

D - 3:1 to 5:1

Question 49

48. Positron emission tomography/mammography (PET or PEM ) imaging is useful in staging tumors because (A) the postiron emitting isotopes are radioactive (B) PET or PEM imaging can display the extent and location of the tumor (C) the positron emitting isotopes will distroy the tumor bed (D) PET or PEM imaging tracks the increased blood flow from teh cancerous tumor

Answer 49

B - PET or PEm imaging can display the extent and location of the tumor. ## Footnote The staging of breast cancer is useful to determine the extend of the spread of cancer. In general, the higher the stage, the poorer is the prognosis. The PET or PEM technique injects extremely short-lived nuclides into an arm vein. The technologist is based on the principle that because of the increase in metabolic activity, most cancerous tissue uses vast amounts of sugar (glucose) and a much higher rate compared with benign tissue.

Question 50

49. Medical history is importnat in (A) assessing risk factors for breast cancer (B) preventing breast cancer (C) evaluating treatment options (D) more than one of the above

Answer 50

D - more than 1 of the above.

Question 51

50. Unlike general radiography x-ray tubes, some mammography tubes are tilted 6 to 24 degrees from the horizontal. The effect of this is to (A) allow the use of smaller focal spot size (B) minimize the heel effect (C) increase resolution (D) all of the above

Answer 51

D - all of the above

Question 52

51. The term retromammary space describes the area (A) between the breast and pectoral muscle (B) separating the skin of the breast from the deep fascia (C) separating the skin from the superficial fascia (D) between the glandular tissue and the IMF

Answer 52

A - between the breast and pectoral muscle ## Footnote The retromammary space separates the breast from the pectoral muscle. This space is filled with a layer of adipose or fatty tissue as opposed to the supporting and connective tissue (stroma), blood vessels, and various ductal structures that make up the glandular and fibrous tissues of the breast.

Question 53

52. In which of the following are breast cysts least common (A) young women in their early 20s (B) premenopausal women (C) postmenopausal women on estrogen therapy (D) women aged 70 years

Answer 53

D - women aged 70 years ## Footnote Cysts occur in the terminal ductal lobular units when the extralobular terminal ducts becomes blocked. Fluid accumulates faster than it can be reabsorbed. Cysts vary in size and respond to hormonal fluctuations, but the development of a cyst also depends on a woman's genetic predisposition.

Question 54

53. The CC projection shows a circumscribed oval radiolucent lesion. There is a definite halo surroudning the lesion. It is most likely to be a (A) fibroadenoma (B) galactovele (C) cyst (D) hematoma

Answer 54

C - cyst ## Footnote Lesion is a cyst. The halo often surrounds cysts. Although fibroadenoma, hematoma, and galactocele are all oval or circular lesions, they are of mixed density.

Question 55

54. The indirect effect of breast compression on Compton interaction is (A) the absolute number of compression interactions increases (B) the absolute number of compton interactions decreases (C) compression has no effect on compton interactions (D) compression affects compton interactions only about 70 kVp

Answer 55

B - the absolute number of compton interaction decreases. ## Footnote As the peak kilovoltage increases, the relative number of xrays undergoing Compton interaction also increases. With compression, the part is thinner, less kvp is needed to penetrate the part and therefore, there is less Compton scatter.

Question 56

55. One disadvantage of lossless compression is (A) it does not provide exact measurement for fine detail on reconstruction (B) it provides exact recontruction of the original image (C) transmission times can be too long (D) it does not support teleradiography

Answer 56

C - transmission times can be too long ## Footnote In information technology, lossy compression reduces a file by permanently eliminating certain information, especially redundant information.

Question 57

56. Grids with strips that are linear but slanted to match the divergence of the x-ray beam are ___ grids (A) parallel (B) crossed (C) focused (D) moving

Answer 57

C - focused grids ## Footnote focus grids have linear lead strips that are slanted to match the divergence of the xray beam. A focused grid must be used at the correct SID, and correct side of grid must be facing the xray tube to prevent grid cutoff.

Question 58

57. Fatty tissue is generally radiolucent and will show on the mammogram as (A) glandular areas (B) high-optical density area (C) low- optical density areas (D) white or gray areas

Answer 58

B high optical density ## Footnote Fibrous and glandular tissues are together referred to as fibroglandular densities. xray pass more easily through fatty tissue than through fibrous or glandular tissue. Fatty areas are more radiolucent and will appear as black on mammogram. Fibroglandular tissue is more radiopque than fatty tissue and results in areas of lower optical density on the mammogram (white areas).

Question 59

58. The mammogram of a woman who is aged 50 years and has recently started estrogen replacement therapy is likely to show a breast that is (A) more fibroglandular than in her previous mammograms (B) more fatty than in her previous mammograms (C) less fibrous and less glandular than in her previous mammograms (D) unchanged from her previous mammograms

Answer 59

A - more fibroglandular than in her previous mammograms ## Footnote Estrogen and progesterone are two of the many hormones responsible for the physiological changes that occur in the breast. Estrogen is responsible for ductal proliferation and progresterone for lobular proliferation.

Question 60

59. The mammogram shows an oval shaped lesion with mixed radiolucent and radiopaque content. The lesion has a central radiolucent area and is freely movable. This lesion is most likely to be (A) fibroadenoma (B) hematoma (C) lymph node (D) galactocele

Answer 60

C - lymph node ## Footnote The lesion is likely to be a lymph node. Lymph nodes are lesions with mixed density and genrally have a radiolucent center corresponding to the hilus. Fibroadenoma, hematoma, and galactocele are all mixed density, oval, or circular lesions, but none has the lucent center typical of the lymph nodes.

Question 61

60. The method of locating the lymph nodes through which cancer is spreading from the breast is called (A) scintigraphy (B) PEM (C) MRI (D) lymphoscintigraphy

Answer 61

D - lymphoscintigraphy ## Footnote Lymphoscintigraphy, or sentinel node mapping, the radiopharmaceutical is injected into the subareolar lymphatic plexus (or lesion). The tracer travels to the sentinel node-identifying that node for dissection and eliminating the need for extensive lumph node dissection.

Question 62

61. The change in OID could cause loss of image detail in magnification mammography. What factors help compensate for this loss of image detail? (A) decreased OID and breast compression (B) Increased focal spot size and breast compression (C) decreased focal spot size and compression of the part (D) increased OID and compression of the part

Answer 62

C - decreased focal spot size and compression of the part ## Footnote As the magnification factor increases, to maintain a sharp images, the focal spot must be reduced or the thickness of the part has to decrease.

Question 63

62. What does the actual focal spot size measure? (A) the area on the anode exposed to electrons (B) the are projected on the patient (C) the area projected on the detector (D) the nominal focal spot size

Answer 63

A - the area of the anode exposed to electrons. ## Footnote The actual focal spot size is the area on the anode target that is exposed to electrons from the tube current.

Question 64

63. The mammography report has an assessment score of 0, accoridng to the BIRAD (breast imaging reporting and data) system. This means that (A) the mammography results is negative (B) there is a higher probability if a benign finding (C) additional imaging is needed (D) the findings are suspicious

Answer 64

C - additional imaging is needed.

Question 65

64. Differentiate between repeat and reject images (A) Repeat is the percentage of repeats from a specific cause. Reject is the percentage of repeats from multiple causes (B) Rejects are all images that are discarded. Repeats are images that resulted in extra radiation doses to the patient (C) Repeats are all images that are discarded. Rejects are images that resulted in extra radiation doses to the patient (D) Rejects are images discarded after any quality control (QC\_ testing. Repeats are any images discared

Answer 65

B - Rejects are all images that are discarded. Repeats are images that resulted in extra radiation doses to the patient.

Question 66

65. What is epithelial hyperplasia (A) a calcified hematoma resulting from trauma (B) an oil cyst within the breast (C) an overgrowth of cells in the ducts or lobules (D) an epidermoid cyst on the skin of the breast

Answer 66

C - an overgrowth of cells in the ducts or lobules. ## Footnote epithelial hyperplasia, also known as proliferative breast disease, is an overgrowth of cells that line either ducts or lobules.

Question 67

67. After four projection mammography, calcifications are visualized superior to the nipple but only on the MLO projection. What additional projection would be used to best locate the positon of the lesion (A) exaggerated craniocaudal (XCCL) (B) cleavage (CV) (C) ML (D) AT

Answer 67

C - ML ## Footnote When comparing the MLO projecto to the ML, a lateral abnormality will move down from its position on MLO. A medial abnormality will move up from its position on MLO. A centrally located lesion and lesions at the areola will show little or no movement.

Question 68

68. Approximately how much contrast agent is injeted into the breast during ductography? (A) approximately 1 cc (B) 15-25 cc (C) 20-40 CC (D) approximately 50 cc

Answer 68

A approximately 1ml/cc ## Footnote During ductography a collecting duct that ends at the nipple is cannulated, and a small amount of contrast agent is injected. Generally about 1ml of the agent is enough to fill a duct.

Question 69

69. What does the glandular dose measure? (A) the average dose to the patients skin (B) the absorbed dose to the skin (C) the absorbed dose at the tissue level (D) the same as the entrance skin dose

Answer 69

C - the absorbed dose at the tissue level ## Footnote The glandular dose is used in mammography because the biological effects of radiation are most likely to be related to the total energy absorbed by glandular tissue.

Question 70

70. Which of the following relationshipes does not change when moving from routine to magnification mammography (A) OID (B) focal spot size (C) SID (D) SOD

Answer 70

C - SID ## Footnote The SID of mammography unit does not change.

Question 71

71. Who performs the compression device check for mammography QC? (A) physicist (B) any staff technologist (C) radiologist (D) technologist

Answer 71

D - technologist ## Footnote QC testing should always be performed by the dedicated QC personnel or the same individual, Here the technologist would be the most obvious person.

Question 72

72. A galactocele is (A) a lesion associated with trauma to the breast (B) a benign milk filled cyst (C) assicaiated with eggshell-like calcifications (D) associated with a central radiolucent hilus

Answer 72

B - benign milk filled cyst ## Footnote galactoceles are small, milk-filled cysts with a high fat content.

Question 73

73. Instead of using a grid, what does manification mammography use to reduce scatter during normal imaging? (A) lead shielding (B) increase OID (C) a low milliampere second (D) increased SID

Answer 73

B - increase OID ## Footnote Using increased OID or the air gap technique is effective in reducing scatter to the detector.

Question 74

74. Most of the glandular tissue is arraned in the breast around the (A) medial and upper-inner quadrants (B) lateral and lower-inner quadrants (C) central and upper-out quadrants (D) medial and upper-out quadrant

Answer 74

C - central and upper out quadrants

Question 75

75. A beryllium (Be) window on the x-ray tube enhances contrast by (A) increasing the output of the x-ray tube (B) reducing production of scattered radiation (C) transmitting more low energy photons (D) transmitting more high-energy photons

Answer 75

C - transmitting more low energy photons

Question 76

76. Proper compression of the breast is indicated when the (A) patient is in pain (B) compression paddle stops (C) breast is taut (D) breast feels soft

Answer 76

C - breast is taut

Question 77

77. Which factors cause increased skin dose in magnification (A) larger OID and smaller focal spot size (B) increased mAs and larger SOD (C) increased OID and decreased SOD (D) smaller OID and larger SID

Answer 77

C - increased OID and decreased SOD ## Footnote In magnification mammogrpahy, OID is increased and SOD is decreased, but SID remains fixed.

Question 78

78. In radiology, according to the line focus principle, the effective focal spot is (A) larger than the actual focal spot (B) smaller than the actual focal spot (C) the same as the actual focal spot (D) decreased as the target angle increases

Answer 78

B - smaller than the actual focal spot ## Footnote The actual focal spot size is the area on the anode target that is exposed to the electrons from the tube. As the size of the focal spot decreases, the heating of the target is concentrated into a smaller area. The effective focal spot is the area projected onto the patient and detector. As the target angle is made smaller, the effective focal spot decreases.

Question 79

80. WHen using the air-gap technique in magnification mammogrpahy, what additioanl step is necessary (A) grid use (B) decreased SID (C) increased OID (D) increased SID

Answer 79

C - increase OID

Question 80

81. Which of the following projections would best separate superimposed 12 o'clock and 6 o'clock masses? (A) MLO (B) XCCL (C) CC (D) AT

Answer 80

A - MLO ## Footnote In XCCL and CC the centrals rays are directed superior to inferior, 12 and 6 oclock. AT images the axilla and would misss 6oclock. in MLO the beam is directed medial to lateral separating the upper aspects of the brest from the lower aspect.

Question 81

82. In positioning terminology, CV means (A) compressed position (B) cranial view (C) cleavage view (D) compression view

Answer 81

C- cleavage view

Question 82

83. Malignant casting-type calcifications can appear on the mammogram as (A) granulated-sugar or crushed stone calcifications (B) eggshell-like calcifications (C) elongated, branching and needle-like calcifications (D) fragmented, linear branching calcification

Answer 82

D - fragmented, linear branching calcification. ## Footnote Malignant casting clcifications are produced when carcinoma insitu fills ducts and their branches. The shape of the cast is determined by the uneven production of calcification and the irregular necrosis of the cellular debris.

Question 83

84. The functional milk-producing units of the breast are contained within the (A) lactiferous sinuses (B) lobules (C) ampulla (D) areola

Answer 83

B - lobules ## Footnote Starting at the TDLU the collecting ductal system gradually widens like tree branches, forming segmental ducts.

Question 84

85. What is the grid ratio (A) the height of the lead strips divided by the distance between each strip (B) the height of the lead strips multiplied by the distance between each strip (C) twice the height of each lead strip (D) the distance between each strip divided by the height

Answer 84

A - the height of the lead strips divided by the distance between each strip ## Footnote the grid ratio is equal to the height of the lead strips divided by the distance between each lead strip.

Question 85

86. The AT projection best demonstrates the (A) subareolar area (B) medial aspect of the breast (C) axillary aspect of the breast (D) lower-inner quadrant of the breast

Answer 85

C - axillary aspect of the breast ## Footnote The AT projection best demonstrates the AT of the breast. The medial and subareolar areas are not visualized on the AT projection. The upper-outter quadrant, which extends toward the axilla, is known as the axillary tail, tail of the breast or tail of Spence.

Question 86

88. The patient had trauma to the breast 1 month ago and has developed a lump. Such an injury may show mammographically as a (A) galactocele (B) hematoma (C) lymph node (D) fibroadenoma

Answer 86

B - hematoma

Question 87

89. A device used to convert light to a digtital signal is a (A) film digitizer (B) DICOM (C) analog to digital converter (ADC) (D) digital to anlog converter (DAC

Answer 87

C - analog to digital converter

Question 88

90. If too much of the upper axilla and shoulder are under the compression paddle when imaging for MLO, the effect is to (A) inhibit proper comprssion of the upper breast (B) inhibit proper compression of the lower breast (C) ensure equal compression of the upper and lower breast (D) ensure proper compression of the lower breast

Answer 88

B - inhibit proper compression of the lower breast

Question 89

91. Which of the following types of breast imaging methods will fall under the category of nuclear imaging. (A) PEM (B) MIR (C) ultrasonography (D) digital tomosynthesis

Answer 89

A - PEM

Question 90

93. A rolled projection can be performed to (A) separate superimposed tissues (B) identify microcalcifications (C) localize a skin lesion (D) determine the location of a finding seen only on one of the standard projections

Answer 90

A - separate superimposed tissues ## Footnote The rolled positions are helpful when dense breast tissue is superimposed on a lesion. The dense tissue is rolled off the lesion.

Question 91

94. Ideally, in an open surgical biopsy, when should a breast tissue specimen be imaged? (A) immediately after surgery (B) within 24 hours of the surgery (C) just prior to the surgery (D) after the lesion is removed but before the surgical site is closed

Answer 91

D - after the lesion is removed, but before the surgical site is closed.

Question 92

95. Which projection gives a mirror image of MLO (A) ML (B) LM (C) LMO (D) AT

Answer 92

C - LMO

Question 93

96. The nominal focal spot size of the mammography unit is 0.3. This means that the (A) actual focal spot size is 0.3 (B) effective focal spot size is 0.3 (C) both effective and actual focal spot sizes are 0.3 (D) actual focal spot is smaller than 0.3

Answer 93

B effective focal spot size is 0.3

Question 94

97. After lumpectomy, patients could have magnified images of the tumor bed taken to (A) confirm the removal of the cancer (B) check calcium deposits that may result from radiation and surgical changes (C) all of the above (D) none of the above

Answer 94

C - confirm the removal of the cancer and check calcium deposits that may result from radiation and surgical changes.

Question 95

99. Where is the grid placed (A) above the breast (B) between the breast and the image plate or detector (C) below the image plate (D) between the breast and the x-ray tube

Answer 95

B - between the breast and image place or detector.

Question 96

100. Which of the following statements is true of both the photstimulable phosphor (PSP) and the flat-panel mammography systems? (A) The imaging plates (IPs) used can be damaged or dropped during transport (B) The system has a wide latitude and dynamic range (C) PSP is very sensitive to radiation (D) The imaging system is susceptible to scratches

Answer 96

B the system has a wide latitude and dynamic range ## Footnote Mammography imaging system using PSP, referred to as CM and those using flat panel technology DM or full field digital mammography both have a wide latitude and a dynamic range.

Question 97

101. The puporse of the mammography certification and accreditation process is to (A) provide legal mammography services (B) enforce minimum national quality standards for mammography (C) ensure that all women have access to a certifeid mammography facility (D) authorize certain states to certify mammography facilities and conduct inspections

Answer 97

B enforce minimum national quality standards for mammography

Question 98

102. A facility has a sign posted advising patiensts to contact a designated person within the organization with comments. This facility is meeting the US Food and Drug Administartion (FDA) (A) medical outcome audit program (B) record keeping program (C) patient communication of results program (D) customer complaint program

Answer 98

D customer complaint program

Question 99

103. A hamartoma is (A) a malignant tumor of the breast (B) a benign tumor of the breast (C) associated with trauma of the breast (D) associated with nursing

Answer 99

B - benign tumor of the breast ## Footnote a hamartoma is a benign tumor. It is considered self limiting because it consists of an overgrowth of normal tissue and the tumor cells do not reproduce.

Question 100

104. During lactation, the contraction of which cells help eject milk from the alveoli (A) epithelial cells (B) myoepithelial cells (C) basement cells (D) superficial cells

Answer 100

B - myoepithelial cells

Question 101

105. A finding of BIRAD 2 on the mammogram means that (A) it cannot aid in accurate evaluation of the breast (B) the findings are benign (C) the findings are suspicious (D) it is suggestive for malignancy

Answer 101

B - the findings are benign

Question 102

106. Erythema of the breast is an indication (A) of inflammatory breast cancer (B) a breast abscess (C) of a breast infection (D) that further testing of the breast is necessary

Answer 102

D - further testing of the breast is necessary

Question 103

107. Which of the following is used as a treatment for estrogen-dependent tumors in postmenopausal and premenopausal women? (A) Radiation therapy (B) chemotherapy (C) tamoxifen (D) antibody therapy

Answer 103

C tamoxifen ## Footnote Tamoxifen is a nonsteroidal antiestrogen durg given to patients with breast cancer.

Question 104

108. In flat-panel detector systems, the spatial resolution of the system is controlled by the (A) pixel number (B) detector element (DEL) size (C) matrix size (D) thin film transistor (TFT) number

Answer 104

B - detector element (DEL) size ## Footnote The detector elements are located within the thin film transistor. DEL size controls the recorded detail, or spatial resolution, for the flat panel device.

Question 105

109. A thin supportive layer located between the basal surface of the epithelium and the connective tissue layer of the lobule is called (A) chief cells (B) myoepithelial (C) basement membrane (D) superfical A cells

Answer 105

C - basement membrane ## Footnote Between the epithelium and the connective tissue is a layer called the basement membrane.

Question 106

110. The appearance of a "camel's nose" breast contour in the MLO projection can be prevented by (A) including all of the breast under the compression paddle (B) angling the detector parallel to the pectoralis muscle (C) properly supporting the anterior breast during compression (D) ensuring that the nipple remains in profile during compression

Answer 106

C - properly supporting the anterior breast during compression ## Footnote the camel's nose contour refers to the sloping of the anterior breast in the MLO projection cuased by insufficient compression. The result is poor separation of the breast tissues.

Question 107

111. The superioinferior oblique (SIO) projection will best demonstrate the (A) outer-upper quadrant and the lower outer quadrant of the breast (B) lower inner quadrant and the upper inner quadrant of the breast (C) upper inner quadrant and lower outer quadrant of the breast (D) lower inner quadrant and the outer upper quadrant of the breast

Answer 107

C - the upper inner quadrant and lower outer quadrant of the breast

Question 108

112. The basic premise of a medical audit is that 1. all positive mammograms should be followed up 2. the pathology results of all biopsy procedures performed should be collected 3. all pathology results should be correlated with the radiologists findings (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

Answer 108

D

Question 109

113. Under the MQSA, how long are facilities required to maintain the records of a patient who died shortly after her first mammography (A) 5 years (B) 10 years (C) 20 year (D) permanently

Answer 109

B 10 years

Question 110

114. Under which of the following circumstances would the triangulation technique be necessary (A) to locate an abnormality visualized on one projection only (B) during routine mammography screening (C) when performing spot magnification (D) to locate a palpable lesion

Answer 110

C - when performing spot magnification ## Footnote triangulation is used to determine location of a nonpalpable lesion seen mammographically. AFter triangulation, the lesion can be spot compressed or magnified.

Question 111

115. A dimpled skin condition seen in cases of lymphatic edema of the breast is called (A) inflammatory carcinoma (B) ductal ectasia (C) plasma cel mastitis (D) peau d' orange

Answer 111

D. peau d'orange ## Footnote the term peau d'orange describes breast skin that is thickened and resembles an oragne.

Question 112

What does the kV supplied to the cathode do

Answer 112

causes it to heat up and send electrons toward the anode

Question 113

What are the varying energies of xrays called

Answer 113

keVs (kiloelectron volts)

Question 114

The higher the kV the ___ the keV

Answer 114

higher

Question 115

The kV applied to the generator is chosen by the \_\_\_\_

Answer 115

operator