Rite ad 7 Flashcards by William Kerns

As you inspect your site, you notice that the quench pipe outside shows some signs of damage that may cause issues during a quench. Who is responsible for fixing this issue?

The facility
The manufacturer of the MR unit
The chief MR technologist
The MRMD

The facility

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What is the cause of a malfunctioned quench?

When the MRI unit is running a sequence
When the wrong cryogen is used
A small hole in the cryogen cryostat
Quench vent failure

Quench vent failure

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Why is asphyxia a risk associated with a quench malfunction?

Air is displaced by expanding helium gas
Helium is flammable so if ignited, it can burn breathable air
Temperatures get so cold that the diaphragm contracts
The changing magnetic field is associated with a quench that induction in the diaphragm to contract

Air is displaced by expanding helium gas

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What would we expect to see when a malfunctioned quench causes helium to leak into the MR room? Select all that apply.

Increase in room temperature
Decrease in room temperature
Decrease in magnetic field strength
Increase in RF heating

Decrease in room temperature
Decrease in magnetic field strength

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Which of the following would be a situation in which we would need to quench the MR unit?

All of the choices
When magnetohydrodynamic artifact begin to harm the patient.
When a patient is pinned against the MR unit and unable to be removed.
A patient is receiving a resonant burn.

When a patient is pinned against the MR unit and unable to be removed.

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Maintenance of the quench pipe in the MR room is the responsibility of who?

The MRSE
The MRMD
The facility
The MR manufacturer/3rd party servicing vendor

The MR manufacturer/3rd party servicing vendor

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Which of the following would be a situation where we need to quench the MR unit?

The power goes out.
There is an uncontrollable fire in the MR suite.
When we need to perform preventative maintenance.
A physician needs to go into the MR suite and does not want to remove his metal.

There is an uncontrollable fire in the MR suite.

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Which of the following are factors that may increase the risk of NSF in patients? Select all that apply.

Type of gadolinium contrast
Flow rate
Gadolinium dose
Renal function

Type of gadolinium contrast

Gadolinium dose
Renal function

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What type of GBCM would we expect to find in group 1?

Linear agents
Macrocyclic agents

Linear agents

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Which of the following are factors that may increase the risk of gadolinium retention in patients? Select all that apply.

Gadolinium dose
Type of gadolinium contrast
Body type
Flow rate

Gadolinium dose
Type of gadolinium contrast

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Which of following is NOT true of delivering a recommended dose of GBCM to a pregnant patient? Select all that apply.

Mutagenesis has not been observed in human fetuses
A dose of gadolinium contrast to a pregnant patient in the first trimester has shown more issues than in any other trimester.
Teratogenesis has been seen in fetuses
Fetuses have developed NSF

A dose of gadolinium contrast to a pregnant patient in the first trimester has shown more issues than in any other trimester.
Teratogenesis has been seen in fetuses
Fetuses have developed NSF

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The method to identify outpatients who may have renal function impairment is to utilize the following list of risk factors: (select the best answer )

History of renal disease, including: Dialysis, Kidney transplant, Single Kidney, Kidney surgery, History of known cancer involving the kidney(s),
History of CKD or prior history of AKI
Identification of renal function impairment is not required for the administration of any GBCM
History of renal disease, multiple myeloma, systemic lupus erythematosus, UTI, and diabetes mellitus
History of renal disease, including: Dialysis, History of CKD or prior history of AKI

History of renal disease, including: Dialysis, Kidney transplant, Single Kidney, Kidney surgery, History of known cancer involving the kidney(s), History of CKD or prior history of AKI

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An allergic reaction to MRI contrast is dependent on which of the following. Select all that apply.

Size of needle
Flow Rate
Patient sensitivity
Type of contrast media

Patient sensitivity
Type of contrast media

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What practices have led to the current state of reduced occurrence of nephrogenic system fibrosis in patient populations post contrast media injection? Select all that apply.

Injecting agents at a slower rate
Identifying renal function in patients
Using more stable agents
Limiting dose

Identifying renal function in patients
Using more stable agents
Limiting dose

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What group of GBCM is associated with confounded cases of NSF?

Group 2
Group 1 and 3
Group 1

Group 2

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Which of the following is suggested by the ACR when delivering a GBCM to a pregnant patient? Select all that apply.

Use an agent that is believed to demonstrate the lowest risk of NSF.
Use the lowest possible dose.
Group 1 GBCA should be used
Group 2 GBCA should be used.

Use an agent that is believed to demonstrate the lowest risk of NSF.
Use the lowest possible dose.

Group 2 GBCA should be used.

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A patient is having a liver study using a hepatobiliary agent for contrast, and the patient is doing great. After injection, we start to see motion artifacts due to difficulty holding their breath. Which of the following is true?

This is due to a lack of communication with the patient.
This may be caused by a phenomenon called “transient dyspnea”.
None of the choices
The patient must be having an allergic reaction.

This may be caused by a phenomenon called “transient dyspnea”.

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Which of the following are physiologic side effects of injecting gadolinium-based contrast? Select all that apply.

Pain at site
Coolness at site
Urtica
Nausea

Pain at site
Coolness at site

Nausea

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Which group of GBCM would we expect to find the highest risk of renal compromised patients developing NSF?

Group 1
Group 2
Group 3

Group 1

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Which of the following will produce the best opportunity for peripheral nerve stimulation?

Fast spin echo
EPI
Conventional spin echo
Spoiled gradient

EPI

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Which of the following would we expect to be the loudest sequence?

GRASS
Fast spin echo
Conventional gradient sequence
FLAIR

GRASS

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Properly placed earplugs reduce noise by how many decibels?

10 dB – 30 dB
5 dB-15 dB
40 dB – 80 dB
50 dB – 90 dB

10 dB – 30 dB

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Which of the following will influence peripheral nerve stimulation?

Static magnetic field
The magnetic field at isocenter
Patient weight
Slew rate

Slew rate

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Which of the following is considered a passive noise control technique? More than one answer may be correct.

Earplugs
Headphones
Quiet gradient sequences configuration
All of the choices

Earplugs
Headphones

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Peripheral nerve stimulation can be described by which of the following? Faraday’s law of induction Lenz’s Law Ohm’s law Planks Law

Faraday’s law of induction

A patient starts twitching during a diffusion-weighted image and not during any other. When questioned, they say that they are holding still. What may be happening? The patient may be experiencing peripheral nerve stimulation. The patient has dementia. The patient is definitely lying to you. The patient has Parkinsons disease.

The patient may be experiencing peripheral nerve stimulation.

The strength of the time-varying gradient field can reach a maximum strength of what according to this gradient distribution plot? 0mT – 20mT 20mT – 40mT 15mT – 20mT 10mT – 30mT

20mT – 40mT

he strongest time-varying gradient strength will reach maximum strength how far from isocenter according to this gradient distribution plot? 5 cm – 20 cm 20 cm – 40 cm 5 cm – 15 cm 30 cm – 60 cm

20 cm – 40 cm

We are scanning a cardiac MRI. What body part would be expected to experience peripheral nerve stimulation? Pelvis Heart Foot Diaphragm

Pelvis

Which of the following pulse sequences will produce the best chance for peripheral nerve stimulation? GRASS Fast spin echo DWI FLAIR

DWI

Which of the following have the least opportunity for patients experiencing peripheral nerve stimulation? GRASS Fast spin echo EPI DWI

Fast spin echo

What is the problem with passive ear protection? It is very expensive It has to be placed in a patient’s ears properly in order to work Even when placed in a patient’s ears properly, they do not block out enough sound

It has to be placed in a patient’s ears properly in order to work

A patient begins complaining of peripheral nerve stimulation. What can be done to reduce this patient’s discomfort? Select the best choice. Use spin echo pulse sequences Use an EPI sequences Use a gradient echo Perform a steady-state sequence

Use spin echo pulse sequences

A patient is having an MR pelvis exam. Where would we expect the patient to experience peripheral nerve stimulation on a patient who is 6 feet tall? Head Legs Groin Orbits

Legs

Due to Lenz Law, rapid motion of the patient/implant in a direction perpendicular to the static magnetic field orientation can resulting forces on the implant opposing this motion that may be detected by the patient As burning sensation As experiencing forces tugging or pulling on the implant. As peripheral stimulation As nausea

As experiencing forces tugging or pulling on the implant.

Which of the following slew rates would produce the greatest chance for peripheral nerve stimulation? 200 T/m/s 125 T/m/s 100 T/m/s 180 T/m/s

200 T/m/s

Peripheral nerve stimulation can best be explained by which of the following? All of the choices Faraday’s law of induction Ohm’s law Larmor’s law

Faraday’s law of induction

Tissue heating depends on which of the following factors. Select all that apply. Field strength Tissue Permeability Tissue Conductivity Dielectric constant

Field strength Tissue Conductivity Dielectric constant

Which of the following will increase the chance that an implant will cause a burn in the patient? Select all that apply. Part of a temporary endocardial pacing wire A hip replacement is found in the RF field. A bullet is within the RF field. A tattoo that uses yellow ink is within the RF field.

Part of a temporary endocardial pacing wire

Which of the following pulse sequences would produce minimal heating? DWI STIR FLAIR Single shot spin echo

DWI

Which of the following are potential problems associated with pacemakers and ICDs? Select all that apply. Movement and/or vibration of the pulse generator. Temporary or permanent modification of the function of the device. Induction of current leads. Excessive heating of the leads

Movement and/or vibration of the pulse generator. Temporary or permanent modification of the function of the device. Induction of current leads. Excessive heating of the leads

Where would we expect to see the most heating on this IVC filter? a d b c

Which of the following are true of scanning at 3T? There is an increased chance of burns from implants There is more RF energy deposition in tissue than 1.5 T There is less chance of burns from implants There are different SAR limits than 1.5 T

There is more RF energy deposition in tissue than 1.5 T

The amount of patient heating depends on which of the following? Select all that apply. Patient mass Patient’s surface area Controlled operation RF coil

Patient mass Patient’s surface area Controlled operation RF coil

When scanning an MR breast, where would we expect to find the least RF deposition in the patient? Head Breast Abdomen Knee

Knee

What size wire or loop would we expect to find the greatest heating? The larger the wire or loop, the greater the heating. A wire with the same wavelength as our transmit frequency. The shorter the wire or loop, the greater the heating. A wire half the wavelength of the transmit frequency.

A wire half the wavelength of the transmit frequency.

Which of the following techniques can be used to reduce patient heating? Select all that apply. Use a single shot spin echo Increase flip angle Increase repetition time Alternate between spin echo pulse sequences and gradient echo sequences

Increase repetition time Alternate between spin echo pulse sequences and gradient echo sequences

Which of the following pulse sequences would we expect to see the least patient heating? EPI Fast spin echo STIR Incoherent gradient

EPI

A patient is sweating profusely during an MR pelvis exam. What can be done to reduce this heating? Select all that apply. Use fat saturation sequences Use parallel imaging Decrease TR Use a gradient echo sequence

Use parallel imaging Use a gradient echo sequence

RF-induced heating in a patient or implant will depend on which of the following? Select all that apply. Items that are in the room during acquisition. RF pulses and induced E fields. The manufacturer of the MR unit. Surrounding tissue conductivity and permittivity. Implant electrical conductivity

RF pulses and induced E fields. Surrounding tissue conductivity and permittivity. Implant electrical conductivity

A patient has an iliac stent and the manufacturer’s instructions say to not expose the implant to a SAR of 1.9 W/kg. You are scanning a knee with a transmit-receive coil. How do you scan this patient safely? The implant will not receive RF heating. The patient should be scanned with a receive-only coil. The patient should not be scanned. The patient should be scanned in normal mode.

The implant will not receive RF heating.

A very obese patient is placed in the MR unit. How can we safely scan this patient without causing proximity burns? Scan the patient on an open MR unit Place a thin sheet or pillow case between skin and gantry Place a 0.5-1cm barrier between skin and gantry All of the choices are correct

Place a 0.5-1cm barrier between skin and gantry

Which of the following are responsible for producing the burns seen in MRI? Time-varying gradients fields All of the choices Magnetic fields E-fields

E-fields

Which situation increases the chance of burns? All of the choices are correct Tissue contact with the gantry Loops in equipment or tissues Skin-to-skin contact

Tissue contact with the gantry Loops in equipment or tissues Skin-to-skin contact

Where would we expect to see hotspots? Areas around implanted devices Areas under the transmit RF coil. All of the choices are correct Areas in the near field.

Areas around implanted devices Areas under the transmit RF coil. Areas in the near field.

How does a deep brain stimulator without a generator pose the greatest threat to a patient? Rotational force Translational force Heating/burning

Heating/burning

What is this a picture of? RF field map Spatial magnetic gradient map Time varying gradient map None of the choices

Spatial magnetic gradient map

A patient comes in with a 1 cm brain aneurysm clip and you find the package which lists what metal it is made from. Which of the following metals would make it unsafe to scan this patient? Elgiloy 405 stainless steel MP35N Phynox

405 stainless steel

Would you consider scanning this patient a high-risk situation? This patient has a bullet from world war 2 inside of them. Yes No Yes, when using low SAR techniques Yes, when not delivering RF energy to this body part

Yes

Which of the following is NOT true in regards to this diagram? -Beige Box=MRI scan room (Zone IV) -Orange Box=Control room (Zone III) The 5 gauss line is in zone 3. The room is not shielded properly. The MRI environment extents outside zone 4 The 5 gauss line is well into zone 3.

The 5 gauss line is well into zone 3.

What type of metal will most likely produce LESS magnetic susceptibility artifact in an image? Titanium Stainless steel

Titanium

The patient is having a brain MR scan. What is the greatest risk to a patient with a brain aneurysm clip while laying at isocenter? Translation force Peripheral nerve stimulation Rotational force Heating

Rotational force

A 5mm object deflects 30 degrees towards the static magnetic field during testing. This is considered what? High risk to scan Low risk to scan Depends on other factors MR Unsafe

Low risk to scan

A patient has an IVC filter that is MR conditional up to 700G/cm. Is this patient safe to be scanned when only considering the static magnetic field? Yes No

Yes

A patient has a brain aneurysm clip that is conditional up to 700G/cm. Is this patient safe to be scanned when only considering the static magnetic field? Yes No

Yes

Which of the following describes the translational force demonstrated to a patient at a specific location? T/m/s dB/dx dB/dt mT/m None of the choices

dB/dx

What is the spatial gradient for an MR unit at location “b.”? Spatial Magnetic Gradient Diagram 6T/m 200 G/cm 60 mT/m 9 G/cm

200 G/cm

4T/m is equal to what? 400 G/cm 4000 G/cm 40 G/cm 4 G/cm

400 G/cm

Which of the following is responsible for defining testing methods for the MR safety of implants? ASTM FDA HIPPA EPA

ASTM

Which room is shielded properly based on zoning? Tan room = Zone IV Orange room = Zone III A B

Which of the following has a steeper spatial magnetic gradient? Vertical B0 Horizontal B0

Vertical B0

A patient has an external fixator in the vicinity of what we are scanning and is no ferrous. What is the largest potential risk when scanning this device? Heating/burns All of the choices Translational force Torque

Heating/burns

Which of the following is NOT true of a dental implant? Select all that apply. Some of these implants will vibrate with great intensity The majority are held in place with sufficient counter-force to prevent any problems. They can produce sufficient heating in the MR environment. They should be scanned at 1.5T or less

They can produce sufficient heating in the MR environment. They should be scanned at 1.5T or less

Why do some manufacturers suggest that a patient should not undergo an MR scan within 6-8 weeks after implantation? So scar tissue can form and hold the implant in place. To wait for follow-up exams to make sure the implant is in the right location. To give the patient time to be healthy enough to receive an MRI. This statement is a myth and patients can be scanned immediately after implantation.

So scar tissue can form and hold the implant in place.

A non-ferrous iliac stent was placed in a patient yesterday. In terms of the static magnetic field (SMF), what is the best and safest practice for scanning this patient at 3.0 T? Make sure the implant is as far from the MR environment as possible Wait 6-8 weeks to make sure the implant is secured in place to prevent translational or rotational forces Scan the patient immediately after implantation when only considering the risks associated with the SMF Contact a fellow MRI technologist for advice

Scan the patient immediately after implantation when only considering the risks associated with the SMF

This individual is responsible for delegating appropriate licenses and qualifications, analyzing MR safety adverse events, reviewing policies annually, and identifying individuals who will receive MR training. MRSO MRMD MRSE

MRMD

A technologist is on their cellphone while a patient is being scanned. The patient is trying to get a hold of the technologist, but the technologist doesn’t notice. This is an example of what? Felony Malpractice Negligence Tort

Negligence

If a standard of care is not delivered to a patient that resulted in injury to that patient it is called what? Malpractice Negligence Tort Infraction

Malpractice

An MRI technologist has heart disease and requires a pacemaker. What does this mean for this technologist? None of the choices They must limit their time in zone 4. They can go into the MR environment as long as they can meet their pacemakers conditions They are unable to work in the MR environment.

They can go into the MR environment as long as they can meet their pacemakers conditions

Which of the following can be used to test if an object is ferrous? Select all that apply. Metal detector Ferromagnetic detection system Tester magnet Radiograph

Ferromagnetic detection system Tester magnet

A patient has a silicone otologic ventilation tube. What is the level of risk? Scan Don’t scan Low Risk Moderate Risk

Scan

An MR technologist should be within visual sight of which of the following during an MRI exam according to the ACR Manual on MRI Safety? Select all that apply. Console Patient Zone IV entrance Patient waiting room

Console Patient Zone IV entrance

Which of the following are guidelines that can be used for scanning pacemakers on non-pacemaker-dependent patients? Select all that apply. An electrophysiologist should test the device during acquisition. A cardiologist or electrophysiologist with ACLS training must be present for the entire exam. Constant communication with the patient should take place. Pretest pacemaker function outside the MR environment.

A cardiologist or electrophysiologist with ACLS training must be present for the entire exam. Constant communication with the patient should take place. Pretest pacemaker function outside the MR environment.

Which of the following are true of an MR safe object? Select all that apply. Object is non-conductive The object can be metallic, but will not cause harm to a patient Object is non-metallic Object is non-magnetic

Object is non-conductive Object is non-metallic Object is non-magnetic

Which of the following considerations for pregnancy are found in MRI according to the FDA? Select all that apply. Pregnant patients can be scanned in their first, second, and third trimesters. A pregnant MR technologist may enter zone 4, but not be present during acquisition. Contrast media is safe to be delivered. The fetus must receive earplugs

Pregnant patients can be scanned in their first, second, and third trimesters. A pregnant MR technologist may enter zone 4, but not be present during acquisition.

What is defined in the captain of the ship doctrine? It does not apply in medicine. It defines the fact that there is a person who is responsible for the care of another. It states that the technologist is responsible for the care of a patient. None of the choices

It defines the fact that there is a person who is responsible for the care of another.

Which of the following organizations investigate and perform studies to define the limits of the MRI environment on occupational works? ICNIRP JCAHO FDA ACR

ICNIRP

Which of the following are considered Non-MR Personnel? Select all that apply. Firefighter Nurse Anesthesiologist Police officer

Firefighter Nurse Anesthesiologist Police officer

What is the ICNIRP occupational worker’s dose for magnetic flux limit for the head and torso? 14 Tesla 2 Tesla 400 milliTesla 8 Tesla

2 Tesla

What is a deposition in a court case? A testimony of what happened. The reason why a defendant is on trial. The opening words in a court case. The final verdict in a case.

A testimony of what happened.

A physiologic monitor is brought into zone 3 and is about to be brought into zone 4. There is no signage on the unit defining any ASTM labeling. How should it be treated? As an MR safe implant As an MR conditional implant As an MR unsafe implant and it should not enter zone IV

As an MR unsafe implant and it should not enter zone IV

A patient has an unknown IVC filter. What is the risk of scanning this patient on a 1.5T? Scan Moderate Risk Don’t scan Low Risk

Scan Low Risk

A MR technologist is distracted by another patient and brings a non-MR compatible O2 tank into the room which severely injures a patient. This is an example of what? Infraction Tort Negligence Malpractice

Malpractice

If a standard of care is not delivered to a patient and did not result in injury, it is called what? Negligence Malpractice Tort Felony

Negligence

Which of the following is an ASTM MR labeling option for an object? Select all that apply. MR compatible MR unsafe MR safe MR conditional

MR unsafe MR safe MR conditional

Which of the following are true of level 1 MR personnel according to the ACR Manual on MRI Safety? Select all that apply. Can be responsible for non-MR personnel in zone 4 Can perform an MRI scan Can enter zone III unaccompanied Can enter zone IV unaccompanied

Can enter zone III unaccompanied Can enter zone IV unaccompanied

According to the ACR Manual on MRI Safety, which of the following are true of unresponsive patients? Select all that apply. Patients are suggested to be monitored during procedure. Must be examined by a level 2 personnel. Areas of suspected implantation should be radiographed. Areas of scars of unknown origin, and the chest and head region must be radiographed.

Patients are suggested to be monitored during procedure. Must be examined by a level 2 personnel. Areas of suspected implantation should be radiographed. Areas of scars of unknown origin, and the chest and head region must be radiographed.

What are the ICNIRP occupational worker’s dose magnetic flux limit for the extremities? 400 milliTesla 14 Tesla 8 Tesla 2 Tesla

8 Tesla

Which of the following are the cause of the noises heard in MRI? Lenz forces Lorentz forces Ohm’s law

Lorentz forces