TEST TEST TEST TEST TEST TEST Flashcards
The biggest risk factor for breast cancer is
(A) a family history of breast cancer
(B) a personal history of breast cancer
(C) gender
(D) not breastfeeding
(C) gender
One of the minor risk factors for breast cancer could be
(A) gender
(B) aging
(C) genetic risk factors
(D) not breastfeeding
(D) not breastfeeding
What is the approximate risk of developing breast cancer for a woman whose sister has the disease?
(A) higher than normal risk
(B) no significant change in risk
(C) lower than normal risk
(D) none of the above
(A) higher than normal risk
A woman with the greatest risk of developing breast cancer is
(A) age 30 years or below
(B) above age 50 years
(C) between ages 30 and 40 years
(D) above age 20 but below age 30 years
(B) above age 50 years
Symptoms of a possible breast disease that will not be demonstrated on the mammogram may include
(A) nipple discharge
(B) skin thickening
(C) circumscribed tumors
(D) stellate lesions
(A) nipple discharge
Symptoms of very early DCIS may include
(A) skin thickening
(B) nipple discharge
(C) macrocalcifications
(D) none of the above
(D) none of the above
Skin thickening can be malignant but could also be caused by nonmalignant factors, such as
(A) esophageal metastases
(B) bronchial cancer
(C) Hodgkin disease
(D) sarcoidosis
(D) sarcoidosis
Risks factors associated with taking hormone replacement therapy (HRT) include
(A) early menopause
(B) late menopause
(C) increased risks for birth defects
(D) increased risks for breast cancer
(D) increased risks for breast cancer
The ACS recommends that
(A) women older than 40 years should have a yearly magnetic resonance imaging (MRI)
(B) women younger than 40 years should have screening mammography every year
(C) new masses or lumps in the breast should be checked by a health care provider
(D) women between ages 20 and 39 years should have a CBE every year
(C) new masses or lumps in the breast should be checked by a health care provider
- A health care provider should evaluate which of the following breast changes?
- lumps or swellings
- skin irritation or dimpling
- milky discharge from the nipple
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
(B) 1 and 2 only
It is necessary for the technologist to document which of the following?
(A) edema
(B) dimpling of the skin
(C) pain
(D) all of the above
(D) all of the above
Pre-examination instructions that can be given to the patient include
(A) remove all clothing from the waist down
(B) remove deodorant
(C) remove panties
(D) A and B
(B) remove deodorant
Benefits of communication with your patient include
(A) helps identify sensitive breast and the reason for the sensitivity
(B) educates the patient
(C) reveals fears and misconceptions
(D) all of the above
(D) all of the above
In developing patient rapport, the technologist should strive to enhance the patient’s self-esteem. This means that the technologist should
(A) reflect the patient’s emotions to show understanding
(B) agree unconditionally with anything the patient says
(C) say “I understand” to any comment the patient makes
(D) offer reassurance and encouragement if the patient is confused or unable to help herself
(D) offer reassurance and encouragement if the patient is confused or unable to help herself
The two-step method of BSE is to
(A) look and feel for changes in the breast
(B) examine the breasts and undergo regular mammography
(C) check for lumps in the breast and keep a journal of changes in the breast
(D) examine the breasts and nipples
(A) look and feel for changes in the breast
The patient’s medical history and documentation will
- provide the radiologist with information on the patient’s risk factors for breast cancer
- give the radiologist information about general symptoms of breast cancer
- provide information about possible benign breast conditions of the patient
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(C) 1 and 3 only
Stressing the importance of the BSE can be controversial because
(A) BSE tends to detect only benign breast cancer
(B) BSE will help in the detection of malignant breast conditions
(C) mammography is not 100% effective
(D) BSE can cause unnecessary anxiety in women
(D) BSE can cause unnecessary anxiety in women
Which of the following are methods used in BSE?
- using the pads of the three middle fingers to palpate the entire breast
- palpating around the breast in a vertical pattern
- using varying degrees of pressure while palpating of the breast
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
(D) 1, 2, and 3
Which of the following statements is true?
- Breast cancer death rates in the United States are going down.
- Breast cancer is the leading cause of cancer-related deaths among women in the United States.
- The second leading cause of cancer-related deaths among women in the United States is breast cancer.
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(C) 1 and 3 only
Postmenopausal obesity is associated with
(A) a relatively high risk of developing breast cancer
(B) overall reduction in breast cancer risks
(C) circulating estrogen that is produced in fatty tissue
(D) a lower overall estrogen level
(C) circulating estrogen that is produced in fatty tissue
In routine mammography, the glandular dose per projection is generally about
(A) 1–2 mGy (0.1–0.2 rad)
(B) 10–20 mGy (1.0–2.0 rad)
(C) 0.1–0.2 mGy (0.01–0.02 rad)
(D) 2–3 mGy (0.2–0.3 rad)
(A) 1–2 mGy (0.1–0.2 rad)
Which age group is likely to get the most radiation dose during mammography?
(A) 20 to 35 years
(B) 40 to 50 years
(C) 55 to 60 years
(D) above 70 years
(A) 20 to 35 years
The 5-year survival rate for a patient with stage 0 breast cancer is about:
(A) 22%
(B) 72%
(C) 93%
(D) 100%
(D) 100%
During mammography, which of the following will affect the average glandular dose per breast?
- degree of breast compression
- the half-value layer (HVL) of the x-ray beam
- breast size and composition
(A) 1 only
(B) 2 only
(C) 3 only
(D) 1, 2, and 3
(D) 1, 2, and 3
Patients who are allowed to play an active role in applying compression are usually
- less likely to tolerate the compression
- more likely to tolerate the compression
- more relaxed during the compression
(A) 1 only
(B) 2 only
(C) 1 and 3 only
(D) 2 and 3 only
(D) 2 and 3 only
In breast imaging, the dose calculation is based on
(A) the entrance skin dose
(B) dose absorbed by the glandular tissue of the breast
(C) the average skin dose
(D) chest wall radiation dose
(B) dose absorbed by the glandular tissue of the breast
What is the purpose of requesting the patient to provide prior mammograms before starting the mammogram examination?
(A) to see if the patient has breast cancer
(B) to assess the exposure technique
(C) to provide the radiologist with an additional aid
(D) to verify the correct patient
(C) to provide the radiologist with an additional aid
The age of a woman taking HRT is likely to be:
(A) under 40 years
(B) 25 to 35 years
(C) over 40 years
(D) under 20 years
(C) over 40 years
The term primipara refers to a woman who
(A) has had multiply pregnancies
(B) was pregnant once but lost the baby at 6 weeks
(C) carried a pregnancy to over 20 weeks but had a stillbirth
(D) was never pregnant
(C) carried a pregnancy to over 20 weeks but had a stillbirth
In mammography, information included on the medical history documentation includes which of the following as they relate to the breast?
- patient’s history of trauma
- history of surgery
- unusual skin condition
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(D) 1, 2, and 3
All of the following are forms of subjective patient data except
(A) patient has a palpable lump in the right breast
(B) patient complains of severe pain during breast compression
(C) the mood or demeanor of the patient
(D) patient’s complaints of pain and tenderness in the left breast
(A) patient has a palpable lump in the right breast
When questioning a patient to obtain an accurate patient history
(A) keep questions general in nature so as not to offend the patient
(B) start with open-ended questions and then follow up with more direct inquiries
(C) do not let the patient talk too much in order to keep the examination moving
(D) use medical “jargon” to impress the patient with your expertise
(B) start with open-ended questions and then follow up with more direct inquiries
Which of the following are positive questioning skills that the radiographer can use when verifying the accuracy of patient information?
(A) leading questions
(B) open-ended questions
(C) repeating information
(D) facilitation
(C) repeating information
What is the purpose of “probing” questions used when interviewing patients?
(A) clarifies information by asking for specific details
(B) gives the patient time to remember details
(C) allows the patient time to tell his or her story
(D) summarizes the accuracy of the information
(A) clarifies information by asking for specific details
In gathering more information on a patient’s complaint of pain, a good probing question to ask would be
(A) “How would you describe the pain?”
(B) “When did the pain first occur?”
(C) “If the pain comes and goes, how often does it occur, and what is the time span between occurrences?”
(D) All of the above are good questions to ask.
(C) “If the pain comes and goes, how often does it occur, and what is the time span between occurrences?”
There are two types of data collection processes. If your patient says he or she has a bruise on the left breast, this information is regarded as
(A) objective
(B) subjective
(C) open-ended scenario
(D) probing
(A) objective
When questioning your patient, what is the purpose of repetition?
(A) to give the patient time to remember details
(B) to get more detail
(C) to summarize
(D) to allow the patient to tell his or her story
(C) to summarize
“Where is your pain?” is an example of
(A) a probing question
(B) repetition
(C) summarization
(D) an open-ended question
(D) an open-ended question
Which of the following will not result in increased breast cancer risks?
(A) having a mother who took diethylstilbestrol (DES) while pregnant
(B) having a first child before age 30 years
(C) history of Hodgkin lymphoma
(D) menarche at age 10 years
B
An informed consent is required before performing which of the following examination?
(A) ultrasonography
(B) mammography
(C) fine-needle biopsy (FNB)
(D) MRI
(C) fine-needle biopsy (FNB)
Phone consent is an example of
(A) written consent
(B) oral consent
(C) implied consent
(D) expressed consent
(B) oral consent
The patient has to sign an informed consent
- when there are significant risks associated with the procedure or test
- for all diagnostic examinations in the imaging department
- if the procedure is invasive
(A) 1 and 2 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
B
- Which kind of consent is binding but difficult to prove?
(A) oral
(B) written
(C) implied
(D) printed
(A) oral
Which of the following is not required information that must be included on any informed consent?
(A) name of the procedure
(B) risks and benefits of the procedure
(C) patient height and weight
(D) possible alternative procedure
(C) patient height and weight
Methods of acknowledging the patient and treating the patient courteously can included all of the following except
(A) using greetings (good morning, good afternoon, etc.)
(B) avoiding eye contact
(C) giving your full attention
(D) introducing yourself
(B) avoiding eye contact
Two disadvantages of mammography screening include
- the granularity of the breast can impact visualization of cancers
- mammography will not image all cancers
- the radiation dose from mammography is dangerous
(A) 1 and 3 only
(B) 1 and 2 only
(C) 2 and 3 only
(B) 1 and 2 only
The glandular dose is
(A) received on the skin of the breast
(B) the significant background dose recorded by ultrasonography
(C) associated with dose to the radiosensitive cells of the breast
(D) a record of the dose to the gonads
(C) associated with dose to the radiosensitive cells of the breast
Having a dense breast will
(A) increase the risk of breast cancer
(B) reduce the risk of breast cancer
(C) result in breast cancer
(D) help combat breast cancer
(A) increase the risk of breast cance
The technologist should review the previous mammography report to
(A) verify the physician’s signature
(B) verify the technologist’s initials
(C) provide the radiologist an additional aid
(D) confirm the type of exam (screen or diagnostic) needed
(D) confirm the type of exam (screen or diagnostic) needed
Why should the patient remove deodorant before mammography?
Deodorant can mimic malignant calcifications.
Preoperative localization will
- direct the surgeon to the area requiring biopsy
- help the surgeon excise a smaller specimen
- ensure that the correct area is removed
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(D) 1, 2, and 3
The specimen is compressed to reduce
(A) motion unsharpness
(B) radiation exposure
(C) tissue thickness
(D) magnification factor
(C) tissue thickness
Which procedure is performed to obtain cellular material from a suspicious area for cytological analysis?
(A) ductography
(B) needle localization
(C) pneumocystography
(D) fine needle biopsy (FNB)
(D) fine needle biopsy (FNB)
The core biopsy technique was developed as an alternative to surgical biopsy because this technique provided a larger sample of the area of suspicion and thus more information than
(A) ductography
(B) needle localization
(C) pneumocystography
(D) FNB
(D) FNB
Ultrasonography of a lesion showed a spherical mass with smooth regular borders, anechoic interior, and acoustic enhancement. The lesion is likely to be a
(A) fibroadenoma
(B) abscess
(C) simple cyst
(D) ductal carcinoma
(C) simple cyst
In ultrasonography, the term acoustic enhancement refers to
(A) a structure without internal echoes
(B) a structure with internal echoes
(C) the amount of sound passing through an anechoic structure
(D) few echoes within a structure
(C) the amount of sound passing through an anechoic structure
A procedure whereby the lactiferous duct is cannulated and a small amount of contrast agent is injected into the duct is termed
(A) ductography
(B) needle localization
(C) pneumocystography
(D) FNA
(A) ductography
A patient underwent ultrasonography, which confirmed the presence of a cyst in the breast. The radiologist wished to assess the contents of the cyst. What additional study could be recommended?
(A) ductography
(B) needle localization
(C) pneumocystography
(D) FNA
(D) FNA
Biopsy performed using a 14-gauge needle to remove tissue samples from the breast is termed
(A) core biopsy
(B) cytology
(C) ductography
(D) aspiration
(A) core biopsy
Stereotactic breast localization is used to
(A) obtain two-dimensional information on palpable breast lesions
(B) calculate the vertical position of nonpalpable lesions
(C) obtain a three-dimensional image of the breast
(D) calculate the horizontal, vertical, and depth of nonpalpable lesions
(D) calculate the horizontal, vertical, and depth of nonpalpable lesions
Which of the following biopsy techniques is most accurate?
(A) FNB
(B) open surgical biopsy
(C) core biopsy
(D) MRI core biopsy
(B) open surgical biopsy
In general, the optimal duration of tamoxifen treatment is
(A) 2 years
(B) 3 years
(C) 4 years
(D) 5 years
(D) 5 years
“Lumpectomy” describes the process of
(A) removing the entire breast, including the nipple
(B) removing the breast cancer tumor and margins of surrounding normal breast tissue
(C) making a small incision over or near the site of the breast lesion
(D) removing benign lumps from the breast
(B) removing the breast cancer tumor and margins of surrounding normal breast tissue
Radiation therapy can be used
- with other treatment options
- to kill any remaining cancer cells in the breast or the chest wall area
- to shrink the size of a tumor before surgery
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(D) 1, 2, and 3
Chemotherapy comprises a class of drugs that can be used to
(A) kill cancer cells in other parts of the body
(B) block estrogen from cancer cells
(C) reduce estrogen levels in the body
(D) kill cancer cells by using high-energy radiation
(A) kill cancer cells in other parts of the body
Breast reconstruction can involve the placement of small fluid-filled sacs behind the pectoral muscle. Two common types of such implants are
(A) saline and flap surgery
(B) TRAM flap and silicone implant
(C) silicone or saline implants
(D) saline-filled implant and latissimus dorsi flap implant
(C) silicone or saline implants
Chemotherapy
(A) involves the use of drugs to treat cancer that may have spread
(B) is the destruction of cancer cells using estrogen receptor drugs
(C) involves mapping the area around a tumor with the injection of a radioactive tracer
(D) is the removal of the cancerous tissue from the breast
(A) involves the use of drugs to treat cancer that may have spread
A process of removing tissue and fat from the abdomen and transferring that tissue to reconstruct the breast is called
(A) deep inferior epigastric perforator (DIEP) flap
(B) latissimus dorsi flap
(C) Transverse rectus abdominus myocutaneous (TRAM) flap
(D) transverse upper gracilis (TUG) flap
(A) deep inferior epigastric perforator (DIEP) flap
Antiestrogen drugs, such as tamoxifen, can be used to
- slow or stop the cancer’s growth
- prevent breast cancer in high-risk women
- prevent the recurrence of breast cancer
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(D) 1, 2, and 3
MRI
(A) uses the complex magnetic properties of elements
(B) explores the behavior of liquids or solids in metal
(C) images the patient in less than 15 minutes
(D) is less sensitive than mammography
(A) uses the complex magnetic properties of elements
Most of the risks of MRI of the breast are associated with
(A) the magnetic properties of the patient
(B) ferromagnetic metals
(C) technologist errors
(D) radiologist errors
(B) ferromagnetic metals
In breast cancer staging, the patient was rated N1. This means that
(A) the cancer has not spread beyond the breast
(B) the cancer is confined to one or two lymph nodes
(C) the patient has a small tumor
(D) there is no evidence of metastasis
(B) the cancer is confined to one or two lymph nodes
Cyst aspiration describes the removal of
(A) a sample of the content of a cyst for biopsy
(B) cell samples taken from a cyst for analysis
(C) fluid from a cyst
(D) any mass from the breast
(C) fluid from a cyst
If a breast lesion is seen only on breast ultrasonography, which modality should be used when performing a biopsy of the lesion?
(A) mammography
(B) ultrasonography
(C) MRI
(D) nuclear imaging
(B) ultrasonography
A pathology review is
(A) a method of tracking and reviewing all positive findings
(B) a process of eliminating all positive findings
(C) a method of tracking cosmetic intervention
(D) a process of identifying all cancers
(A) a method of tracking and reviewing all positive findings
The technique whereby contrast is injected into the ducts to check for an abnormality is called
(A) augmentation
(B) ductography
(C) biopsy
(D) mammoplasty
(B) ductography
A process by which the breast size is increased using implants is called
(A) augmentation mammoplasty
(B) ductography
(C) needle biopsy
(D) needle aspiration
(A) augmentation mammoplasty
The removal of one to three axillary nodes for testing is included in a/an
(A) axillary node dissection
(B) sentinel node mapping
(C) sentinel node biopsy
(D) lumpectomy
(C) sentinel node biopsy
Specimen radiography confirms that
(A) a biopsy is not necessary
(B) the patient has no malignancy
(C) the patient needs a mastectomy
(D) the suspected lesion is in the tissue that was removed
(D) the suspected lesion is in the tissue that was removed
Which of the following are side effects of radiation treatment?
- loss of appetite
- fatigue
- heaviness of the breast
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(D) 1, 2, and 3
A big advantage of brachytherapy over traditional radiation therapy treatments is
(A) reduced time of treatment
(B) ability of brachytherapy to treat larger tumors
(C) ability to give more radiation to healthy tissue
(D) more convenience because of the longer treatment times
(A) reduced time of treatment
The side effects of chemotherapy include
(A) nausea and or vomiting
(B) reduced white blood cell (WBC) count
(C) none of the above
(D) A and B
(D) A and B
What is tamoxifen treatment?
(A) an adjuvant therapy using drugs to reduce the risk of certain cancers
(B) a drug regimen that will effectively block certain hormones in the body
(C) an external method of killing cancer cells
(D) the removal of all cancer cells from the body, thereby reducing cancer risks
(A) an adjuvant therapy using drugs to reduce the risk of certain cancers
Which of the following biopsy techniques is the most accurate?
(A) FNB
(B) core biopsy
(C) stereotactic breast biopsy
(D) open surgical biopsy
(D) open surgical biopsy
Which of the following is the least expensive and least invasive method of breast biopsy?
(A) FNB
(B) core biopsy
(C) open surgical biopsy
(D) stereotactic breast biopsy
(A) FNB
A technique used to assess and evaluate nipple discharge by checking for defects or wall irregularity is called
(A) ductography
(B) interventional radiography
(C) aspiration biopsy
(D) lumpectomy
(A) ductography
“Neoadjuvant chemotherapy” refers to treatment
(A) before surgery to help shrink the size of cancerous tumors
(B) after mastectomy to slow the growth of cancer
(C) before surgery utilizing an antiestrogen drug
(D) after surgery that involves radiation
(A) before surgery to help shrink the size of cancerous tumors
Preoperative localization is
(A) stereotactic breast localization of a palpable abnormality
(B) used to locate palpable breast lesions
(C) a technique used to locate nonpalpable lesions
(D) checking of tissue for malignancy
(C) a technique used to locate nonpalpable lesions
A biopsy technique that often requires the presence of a cytological technologist is
(A) open surgical biopsy
(B) core biopsy
(C) stereotactic breast biopsy
(D) FNB
(D) FNB
“Cosmetic intervention” is
- breast reconstruction after treatment for breast cancer
- surgical reconstruction of the breast at the patient’s request
- breast augmentation for personal reasons
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(B) 2 and 3 only
The side effects of chemotherapy are related to the effect of the drug on
(A) all tissues and organs in the body
(B) cancer cells only
(C) the growth of cancer
(D) hair follicles only
(A) all tissues and organs in the body
Any size tumor with cancer spread to chest wall and/or skin of breast and up to 10 axillary or clavicular lymph nodes is describes as stage
(A) 1
(B) 2
(C) 3
(D) 4
(C) 3
Which of the following are contraindications for lumpectomy?
- previous lumpectomy
- multiple cancer sites in one breast
- 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
(D) 1, 2, and 3
The staging of cancer will determine
- if the cancer is invasive
- the exact tumor size
- if the cancer has spread to distant sites
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(D) 1, 2, and 3
In breast cancer staging, the patient was rated T1. This means that
(A) the cancer has not spread beyond the breast
(B) the cancer is confined to one or two lymph nodes
(C) the patient has a small tumor
(D) there is no evidence of metastasis
(C) the patient has a small tumor
A lesion located in the upper-outer quadrant of the right breast is located in the
(A) 2 o’clock position
(B) 5 o’clock position
(C) 7 o’clock position
(D) 10 o’clock position
(D) 10 o’clock position
Morgagni tubercles are usually found
(A) on the nipple
(B) on the lateral border of the breast
(C) in the terminal duct lobular unit (TDLU)
(D) on the areola
(D) on the areola
An inverted nipple
(A) always indicates breast cancer
(B) sometimes indicates breast cancer
(C) never indicates breast cancer
(D) usually indicates breast cancer
(B) sometimes indicates breast cancer
The most mobile margins of the breast are the
(A) medial and lateral aspects
(B) inferior and superior aspects
(C) medial and superior aspects
(D) inferior and lateral aspects
(D) inferior and lateral aspects
The normal breast may have
(A) 0–5 lobes
(B) 15–20 lobes
(C) 30–40 lobes
(D) 340–350 lobes
(B) 15–20 lobes
The structure that supports the breast and contributes to breast shape is called
(A) Montgomery ligament
(B) Cooper ligament
(C) fibroglandular tissue
(D) fatty tissue
(B) Cooper ligament
The breast extends vertically from the
(A) first through the ninth rib
(B) second through the tenth rib
(C) second through the sixth rib
(D) third through the tenth rib
(C) second through the sixth rib
The thickest skin portion of the breast is at the
(A) areola
(B) nipple
(C) tail of Spence
(D) inframammary crease
(C) tail of Spence
Cooper ligaments attach anteriorly to the
(A) deep fascia of the lobes
(B) fascia of the skin
(C) posterior surface of the breast
(D) connective and supporting stroma
(B) fascia of the skin
Fatty tissue is generally _______ and is seen on the mammogram as areas of _______ optical density.
(A) radiolucent/lower
(B) radiopaque/higher
(C) radiolucent/higher
(D) radiopaque/lower
(C) radiolucent/higher
Typically, a patient with dense fibrous and glandular tissue throughout the entire breast on a baseline mammogram is
(A) age 20 years or younger
(B) between ages 50 and 60 years
(C) above age 70 years
(D) below age 45 years
(D) below age 45 years
Glandular tissue is usually found in the _______ of the breast.
(A) medial and lower-inner quadrant
(B) central and upper-outer quadrant
(C) medial and lower-outer quadrant
(D) central and upper-inner quadrant
(B) central and upper-outer quadrant
Immediately behind the nipple, there is a widened area of the collecting duct called the
(A) lactiferous sinus
(B) ampulla acinus
(C) TDLU
(D) segmental duct
(A) lactiferous sinus
The portion of the breast that holds the milk-producing element is the
(A) ampulla
(B) segmental duct
(C) lobule
(D) lactiferous sinus
(C) lobule
Veins are normally located
(A) in the periphery of the breast
(B) in the central areas of the breast
(C) in the axillary area of the breast
(D) in the medial areas of the breast
(A) in the periphery of the breast
The TDLU consists of the
(A) mammary ducts and the extralobular terminal ducts (ETDs)
(B) intralobular terminal duct (ITD) and the segmental ducts
(C) the ETDs and the lactiferous ducts
(D) both the ETDs and the ITDs
(D) both the ETDs and the ITDs
A patient began taking synthetic hormones 6 months prior to her current mammography. The mammography result is most likely to
(A) be unchanged from the previous year
(B) show increased glandular tissue when compared with her previous result
(C) show decreased glandular tissue compared with her previous result
(D) show increased fatty tissue compared with her previous result
(B) show increased glandular tissue when compared with her previous result
A baseline mammogram shows that the patient’s breast consists primarily of adipose tissue. This patient is most likely to be
(A) on hormone therapy
(B) above age 60 years
(C) below age 20 years
(D) between ages 35 and 40 years
(B) above age 60 years
A patient is to undergo routine baseline mammography, but it is determined that the woman is lactating. What should be done, and why?
(A) Lactating breasts are extremely sensitive to compression; mammography should be postponed.
(B) Mammogram should be performed; radiation has no effect on lactation.
(C) Although lactating breasts are extremely dense, mammography should not be rescheduled.
(D) Lactation results in increased glandularity; mammography should be postponed.
(D) Lactation results in increased glandularity; mammography should be postponed.
The craniocaudal mammograms of a patient prior to menopause and 1 year after the onset of menopause are compared. The woman has never taken synthetic hormones. What is the most likely difference?
(A) The mammogram taken prior to menopause shows signs of atrophy.
(B) The mammogram taken after the onset of menopause shows signs of atrophy.
(C) There will be little or no change in the glandularity of the breast.
(D) The mammogram taken after menopause will show increased glandularity.
(B) The mammogram taken after the onset of menopause shows signs of atrophy.
Hormone replacement therapy could be recommended to
- relieve insomnia symptoms
- prevent osteoporosis
- reduce weight gain
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
(B) 1 and 2 only
A woman is referred to as “nullipara.” This means
(A) she has never given birth to a viable offspring
(B) the woman has had only one child
(C) the woman has given birth to more than 1 viable offspring
(D) she carried a pregnancy past the point of viability regardless of the outcome
(A) she has never given birth to a viable offspring
An asymptomatic patient presents with an oval, lobulated tumor with unsharp margins. There is no evidence of a halo sign.
(A) If the lesion is also radiolucent it is likely to be benign.
(B) The lesion could be malignant.
(C) All oval lesions are benign.
(D) The absence of a halo indicates malignancy.
(B) The lesion could be malignant.
The tumor is characteristic of
(A) ductal carcinoma in situ
(B) a mammographically malignant tumor
(C) a mammographically benign tumor
(D) a low optical density tumor typical of benign lesions
(B) a mammographically malignant tumor
The calcifications seen have the typcal appearance of
(A) mammographically malignant–type calcifications.
(B) calcifications typical of galactoceles
(C) calcifications typical of an oil cyst
(D) calcified microhematomas
(A) mammographically malignant–type calcifications
Characteristics of a malignant stellate tumor include which of the following?
- The spicules are generally bunched together.
- A central tumor mass is present.
- The larger the tumor, the longer are the spicules.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1 and 3 only
(C) 2 and 3 only
- The calcifications seen have the typical appearance of
(A) an oil cyst
(B) plasma cell mastitis calcification
(C) a small calcified hematoma
(D) a calcified sebaceous gland
(A) an oil cyst
- Postoperative scarring
- can sometimes be mistaken for carcinoma
- has a solid dense central tumor
- is usually not associated with skin thickening or dimpling over the lesion
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1 and 3 only
(D) 1 and 3 only
A mammogram shows a low optical density radiopaque tumor. The tumor is oval and lobulated, and a halo is seen along one border only. The next step should be
(A) pneumocystography
(B) ultrasonography
(C) biopsy
(D) no further testing, as the tumor is benign
(B) ultrasonography
A galactocele
(A) is always radiolucent
(B) is usually associated with trauma
(C) is associated with nursing
(D) usually has irregular borders
(C) is associated with nursing
A lipoma
(A) is generally seen as a high optical density radiopaque lesion on the mammogram
(B) can be a huge encapsulated lesion occupying the entire breast
(C) may have irregular borders typical of malignant lesions
(D) is usually difficult to image mammographically
(B) can be a huge encapsulated lesion occupying the entire breast
A rare form of cancer that presents with swelling, warmth, or erythema and mammographically with skin thickening describes
(A) inflammatory carcinoma
(B) invasive ductal carcinoma
(C) invasive lobular carcinoma
(D) papillary carcinoma
(A) inflammatory carcinoma
Sometimes described as an oil cyst, this lesion represents an encapsulated area on the mammogram and can be caused by surgery, biopsy, trauma, or radiation therapy.
(A) stellate lesion
(B) galactocele
(C) fat necrosis
(D) lipoma
(C) fat necrosis
A benign, self-limiting breast tumor that is the result of new disorganized cell growth is a(n)
(A) sarcoma
(B) radial scar
(C) invasive lobular carcinoma
(D) hamartoma
(D) hamartoma
An infusaport can be used to
(A) provide radiation therapy treatment
(B) allow repeated access to the venous system
(C) infuse radioactive tracers directly into the breast lesion
(D) infuse radioactive isotopes directly into the arterial system
(B) allow repeated access to the venous system
The low optical density radiopaque lesion seen are characteristic of a
(A) benign fibroadenoma
(B) skin mole
(C) galactocele
(D) keratosis
(B) skin mole
The calcifications seen are characteristic of
(A) a definite malignant
(B) benign skin calcifications
(C) benign calcifications but further tests are needed
(D) dermal calcifications
(C) benign calcifications but further tests are needed
The circular mixed radiopaque/radiolucent lesions seen are characteristic of
(A) calcified microhematomas
(B) galactocele, calcified
(C) malignant calcification
(D) epidermoid cyst
(D) epidermoid cyst
What target–filtration combination in analog imaging provides the best penetration for dense or thick breast?
(A) molybdenum target with molybdenum filtration
(B) rhodium target with rhodium filtration
(C) tungsten target with tungsten filtration
(D) molybdenum target with appropriate K-edge filtration
(B) rhodium target with rhodium filtration
The material used for the exit port of the mammography tube is necessary because
(A) the intensity of the beam is less on the anode side than on the cathode side
(B) regular glass would harden the emerging beam
(C) the intensity of the beam is more on the anode side than on the cathode side
(D) regular glass would soften the emerging beam
(B) regular glass would harden the emerging beam
The intensity of the x-ray beam from the cathode side of the tube is generally higher because
(A) soft characteristic radiation emerges from the anode side
(B) the cathode side is directed to the thickest part of the breast
(C) the heel effect causes variation in the intensity of the x-ray beam
(D) the heel effect increases the intensity of the beam at the anode side
(C) the heel effect causes variation in the intensity of the x-ray beam
The design of the lip of the compression paddle (both height and angle along the chest wall) affects all of the following except
(A) prevents the posterior and axillary fat from overlapping the body of the breast
(B) allows uniform compression of the posterior breast tissue
(C) helps increase structural strength of the compression paddle
(D) ensures greater compression of the anterior breast tissue
(D) ensures greater compression of the anterior breast tissue
The primary goal of compression is to
(A) reduce the object-to-image receptor distance (OID) of the lesion
(B) allow uniform penetration of structures within the breast
(C) reduce the possibility of motion during the exposure
(D) reduce the radiation dose to the breast
(B) allow uniform penetration of structures within the breast
What features of the high-transmission cellular grid allow these grids to maintain equal or less radiation dose to the patient compared with linear grids?
(A) These grids use lead as the strips and wood as the interspace material.
(B) They have copper as the strips and air as the interspace material.
(C) They use aluminum as the strips and air as the interspace material.
(D) They use wood as the strips and copper as the interspace material.
(B) They have copper as the strips and air as the interspace material.
The grid ratio can vary in modern mammography units. A common grid ratio used is
(A) 8:1
(B) 6:1
(C) 4:1
(D) 2:1
(C) 4:1
The chest wall edge of the compression paddle should be aligned just beyond the chest wall edge of the detector to
(A) avoid pushing the patient’s chest away and losing breast tissue
(B) properly position and compress the breast
(C) permit uniform exposure and reduce patient discomfort
(D) avoid projecting the chest wall edge of the paddle on the mammogram
(D) avoid projecting the chest wall edge of the paddle on the mammogram
Which of the following affects focal spot size?
(A) angle of the anode
(B) a decrease in the source-to-image receptor distance (SID)
(C) decreasing the size of the collimated beam
(D) changing the relationship between the OID and the SID
(A) angle of the anode
In mammography, the commonly used focal spot size for routine work is
(A) 3 mm
(B) 0.3 mm
(C) 1 mm
(D) 0.1 mm
(B) 0.3 mm
Which of the following mammography quality control tests is performed as needed?
(A) phantom images quality
(B) visual checklist
(C) repeat analysis
(D) Mammography Equipment Evaluation (MEE)
(C) repeat analysis
What is the compression thickness indicator test?
(A) a check of the minimum and maximum compression force on automatic compression
(B) a check of the minimum and maximum compression force on manual compression
(C) a check of the indicated compression thickness
(D) a check of the compression on the breast
(C) a check of the indicated compression thickness
A check to ensure that the lead interpreting radiologist is aware of all quality control (QC) tests are being performed at their required frequency is
(A) visual check list
(B) facility QC review
(C) MEE test
(D) monitor QC
(B) facility QC review
A technologist test that is performed semi-annually is
(A) phantom image test
(B) visual check list
(C) compression force test
(D) repeat analysis
(C) compression force test
Repeats are
(A) images taken during a breast stereo-localization
(B) images used for QC
(C) images that involve exposure to the patient
(D) all discarded images
(C) images that involve exposure to the patient
If the patient volume at a mammography site is 250 patients per week, the repeat/reject analysis could be performed every
(A) week
(B) 2 weeks
(C) 2 months
(D) 3 months
(D) 3 months
Mammography facilities can receive certification from
- the ACR
- the FDA
- a State-as-Certifiers (SAC) state
(A) 1 or 2 only
(B) 2 or 3 only
(C) 1 or 3 only
(D) 1, 2, or 3
(B) 2 or 3 only
Aluminum filtration is likely to be matched with __________ targets.
(A) molybdenum
(B) rhodium
(C) tungsten
(D) beryllium
(C) tungsten
Which of the following visual checklist tests must be performed before clinical use?
(A) Paddles/face shield must not be cracked.
(B) Indicators must be working correctly.
(C) C-arm motion must be smooth.
(D) Collimator light must be working.
(A) Paddles/face shield must not be cracked.
Digital images are printed using
(A) dry laser technology
(B) computer monitor
(C) photostimulable phosphor (PSP) technology
(D) red-light spectrum emitting lasers
(A) dry laser technology
A single binary digit of data, such as “0” or “1,” is called a
(A) pixel
(B) matrix
(C) bit
(D) byte
(C) bit
In general, greater magnification will require the use of a
(A) larger focal spot size
(B) smaller OID
(C) smaller focal spot
(D) larger SID
(C) smaller focal spot
A grid is not necessary during magnification because
(A) grid use decreases spatial resolution
(B) the small focal spot used will compensate for the loss of image detail
(C) the large OID produces the same effect as a grid
(D) magnification will magnify the normally invisible grid line
(C) the large OID produces the same effect as a grid
The air gap in magnification allows increase subject contrast by
(A) increasing scatter
(B) reducing scatter
(C) reducing motion
(D) increasing motion
(B) reducing scatter
If the magnification mammography is performed without using a small focal spot, the resulting image will be magnified
(A) and blurred
(B) and sharply outlined
(C) with increased subject contrast
(D) with increased detail
(A) and blurred
At higher magnification factors there is
- higher skin dose
- increased scatter
- decrease source-to-object distance (SOD)
(A) 1 and 2 only
(B) 2 and 3 only
(C) 1 and 3 only
(D) 1, 2, and 3
(C) 1 and 3 only
Magnification is beneficial in all of the following situations except
(A) imaging the surgical site of a patient undergoing a lumpectomy
(B) imaging a specimen radiograph
(C) evaluating microcalcifications in a lesion
(D) imaging the entire breast in a single exposure
(D) imaging the entire breast in a single exposure
Using a small focal spot size is recommended for magnification
(A) to compensate for the loss of image detail
(B) because of increased patient dose
(C) to compensate for the small OID
(D) to compensate for motion unsharpness
(A) to compensate for the loss of image detail
The greatest disadvantage of magnification is
(A) increased OID
(B) increased patient dose
(C) decreased subject contrast
(D) increased risk of motion unsharpness
(B) increased patient dose
If the backup time stops a breast exposure, the technologist can repeat the radiograph using a
(A) higher peak kilovolt (kVp) setting
(B) greater density compensation
(C) higher milliampere second (mAs) setting
(D) different automatic exposure control (AEC) setting
(A) higher peak kilovolt (kVp) setting
The type of x-rays created from displacement of K-shell–binding electrons in the molybdenum atom are called
(A) coherent scattering
(B) characteristic radiation
(C) Compton effect
(D) Bremsstrahlung radiation
(B) characteristic radiation
The function of the filter in mammography is to remove
(A) low-energy x-rays that would result in increased skin dose
(B) all low-energy photons
(C) low-energy x-rays needed to produce the breast image
(D) photon energies above and below the range needed for breast imaging
(D) photon energies above and below the range needed for breast imaging
A recommended labeling for the mammographic image that is not required by the Mammography Quality Standard Act (MQSA) is
(A) technologist identification
(B) date of service
(C) technical factors
(D) name of patient
(C) technical factors
Lack of breast compression is most likely to cause
(A) geometric unsharpness
(B) plate reader artifact
(C) motion unsharpness
(D) printer artifact
(C) motion unsharpness
How long should a facility maintain records of serious complaints?
(A) 1 year
(B) 2 years
(C) 3 years
(D) 4 years
(C) 3 years
Which of the following can require the use of a densitometer?
(A) film printer test
(B) phantom test
(C) acquisition workstation monitor (AWS) test
(D) compression thickness indicator
(A) film printer test
Which of the following system is likely to have a slit collimator system instead of a grid?
(A) flat-panel detector tomosynthesis imaging systems
(B) PSP imaging systems
(C) any magnification mammography system
(D) microdose photon-counting systems
(D) microdose photon-counting systems
Aluminum is used as the filtration in
(A) digital breast tomosynthesis tubes with tungsten targets
(B) tungsten target digital mammography tubes
(C) rhodium target digital mammography tubes
(D) analog mammography tubes
(A) digital breast tomosynthesis tubes with tungsten targets
- The detector element is located in the
(A) imaging plate (IP)
(B) flat-panel detector
(C) thin film transistor
(D) AEC
(C) thin film transistor
- Which of the follwing statements on detector elements is incorrect?
(A) The detector element size controls the spatial resolution of the system
(B) The size of the detector element can be controlled by the technologist
(C) After reading the detector element, the flat-panel detector automatically erases
(D) The larger the detector element in a flat-panel detector, the more the image blurs
(B) The size of the detector element can be controlled by the technologist
To allow full coverage of the detector, a tube with a 16 degree anode angle requires a tube tilt of about ____ degrees to achieve an effective anode angle of 22 degrees
(A) 2
(B) 4
(C) 6
(D) 8
(C) 6
The monitor used to interpret the mammogram is the
(A) acquisition workstation monitor
(B) liquid crystal display (LCD) monitor
(C) AWS monitor
(D) review workstation (RWS) monitor
(D) review workstation (RWS) monitor
A system used ot store 6 to 12 months of image data that can be retrieved within a few minutes is the
(A) jukebox
(B) redundant array of independedn (inexpensive) disk (RAID)
(C) digital linear tape (DLT)
(D) compack disk (CD)
(B) redundant array of independedn (inexpensive) disk (RAID)
A computer network system that allows images to be viewed at various monitors or transmitted or stored is termed
(A) picture archiving and communication systen (PACS)
(B) local area network (LAN)
(C) wide area network (WAN)
(D) digital imaging and communication in medicine (DICOM)
(A) picture archiving and communication systen (PACS)
The remote transmission of images is
(A) RAID
(B) DICOM
(C) PACS
(D) teleradiology
(D) teleradiology
What technique is used to eliminate scatter in the photon-counting digital systems?
(A) tomographic image reconstruction
(B) three-dimensional imaging
(C) slit scanning and doubel collimation
(D) comuter -aided detection
(C) slit scanning and doubel collimation
Which if the following statements is true?
(A) Compression increases image sharpness by reducing the focal spot size
(B) Compression decreases subject contrast by reducing the thickness of the penetrated tissue
(C) Compression increases the uniformity of the breast, making diagnosis easier
(D) The compressed breast requires increased peak kilovoltage (kVp) to penetrate the thicker tissue
(C) Compression increases the uniformity of the breast, making diagnosis easier
In assessing the degree of compression for any one patient, the technologist should take into consideration
- the maximum to which the patients brest can actually be compressed
- the amount of compression the patient can tolerate
- compression that should be just suffiecient to immobilize the breast
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 2 and 3 only
(B) 1 and 2 only
Manual compression in mammography
(A) has fixed upper and lower limits
(B) depends solely on breast size
(C) depends on breast size and the patients pain tolerance
(D) generally depends on the patients pain tolerance
(C) depends on breast size and the patients pain tolerance
Some condiserations that could be given to women with painful breasts include
- having the patient take ibuprofen prior to mammography
- scheudlign mammography during the menstrual cycle
- explaining, before the examination, the importance of compression
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1 and 3 only
(D) 1 and 3 only
Compression allows reduced radiation to the breast by
(A) providing a uniform breast thickness
(B) decreasing breast thickness
(C) decreasing motion unsharpness
(D) separating superimposed areas of glandular tissue
(B) decreasing breast thickness
What principle does compression use to visulaize the borders of circumscribed lesions?
- It brings the lesion closer to the detector
- It spreads apart overlapping tissue
- it separates superimposed areas of glandular tisse
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1,2,3
(D) 1,2,3
Ideally, breast compression is maximized when
- accompanied by a thorough explanation to increase patient cooperation
- the exposure is made on arrested inspiration to reduce motion
- the patient recognizes the advantage of compression in reducing radiation doese
(A) 1 and 2
(B) 2 and 3
(C) 1 and 3
(D) 1,2,3
(C) 1 and 3
Magnification can be used to assess the
(A) margins of a lesion
(B) size of a lesion
(C) location of a lesion
(D) tissue density of a lesion
(A) margins of a lesion
- With calcifications, magnification an be used to assess
- the number
- morphology
- tissue distribution
(A) 1 only
(B) 1 and 2
(C) 2 and 3
(D) 1,2,3
D
- The last degree of compression should be applied
(A) as gently as possible or by using manual compression
(B) after the breast is realeased from compression
(C) with as much force as possible to achieve maximum compression of the breast
(D) with the technologists hand between the breast and the compression paddle
A
- Which projection is used to determine whether a lesion is medial or lateral to the nipple?
(A) craniocaudal (CC)
(B) mediolateral oblique (MLO)
(C) tangential (TAN)
(D) mediolateral (ML)
A
- The lenfth of the posterior nipple line (PNL), visualized on CC, should be within how many centimeters of the PNL and MLO?
(A) 0.25
(B) 0.50
(C) 1.00
(D) 1.50
C
- Which of the followign conditions must be met when imaging the breast in MLO?
- The pectoral muscle should extend to or below the PNL
- visualized fat should be posterior to all the fibroglandular tissues
- the inframammary fold (IMF) should be open
(A) 1 and 2
(B) 2 and 3
(C) 1 and 3
(D) 1,2,3
D
- In positioning fo rthe CC projection, if the C-arm of the mammography unit is raised too high, the IMF is overelevated, resulting in loss of
- superior breast tissue
- inferior breast tissue
- posterior breast tissue
(A) 1 and 2
(B) 2 and 3
(C) 1 and 3
(D) 1,2,3
B
- The single projection that will best visulize the maximum amount of breast tissue is the
(A) CC
(B) MLO
(C) ML
(D) exxagerated craniocaudal lateral (XCCL)
B
- In general, whe imaging tall, thin patients the angulation is adjusted to
(A) below 30 degrees
(B) between 30 and 40 degrees
(C) close to 60 degrees
(D) over 70 degrees
C
- The position used to determine whether an abnormality is superior or inferior to the nipple is the
(A) CC
(B) MLO
(C) XCCL
(D) TAN
B
- The principle of mobile versus fixed tissue is used in mammography positioning to image the maximum
(A) medial breast on the MLO projection
(B) inferior breast on the CC projection
(C) superior breast on the MLO projection
(D) medial tissue on the CC projection
A
- In the CC projection of the breast, the detector is positioned
(A) at the level of the raised IMF
(B) below the level of the raised IMF
(C) at the level of the IMF
(D) just below th level of IMF
A
- In positioning for MLO, the tube is always angled
(A) 90 degrees
(B) 60 degrees
(C) 50 degrees
(D) none of the above
D
- What position is show
(A) CC
(B) MLO
(C) cleavage or “valley view” (CV)
(D) XCCL
A
- When positioning for right CC, where is the patients left arm placed?
(A) brought back - this action rotates the shoulder to remove it from the imaging area
(B) brought forwar - the patient an hold the handle bar of the unit
(C) brought forward - the patient can hold the detector
(D) remains at the patients side
B
- Your patient has had reent chest surgery and has a scarred and painful area running along the sternum. With the medial aspect of the breast immobile, whcih of the followign is an alternative to right mediulateral oblique (RMLO)?
(A) right lateromedial oblique (RLMO)
(B) left mediolaterl oblique (LMLO)
(C) left lateromedial (LLM)
(D) right mediolateral (RML)
A
- Which projection is used to best visualize the tail of the breast?
(A) lateromedial oblique (LMO)
(B) TAN
(C) lateromedial (LM)
(D) axillary tail (AT)
D
- Calcifications seen on the mammogram are suspected ot be in the skin. The best projection necessary to prove this theory is the
(A) LMO
(B) TAN
(C) LM
(D) AT
B
- The projection used to best demonstrate details of the medial breast structures of the breast is the
(A) LM
(B) AT
(C) ML
(D) TAN
A
- A lesion on the lateral aspet of the breast is not seen on CC. An additional projection used to image the lesion could be the
(A) CV
(B) XCCL
(C) FB
(D) TAN
B
- Which projection can be used instead of CC to image patients with severe kyphosis ?
(A) ML
(B) TAN
(C) FB
(D) CV
C
- A lesion moved up on the ML projection form its original position on MLO. The location of the lesion within the breast is
(A) lateral
(B) medial
(C) inferior
(D) superior
B
- Which projection can be used to prove breast calcifications are benign
(A) CC
(B) XCCL
(C) FB
(D) ML
D
- Which projection can be used to give a profile image of the area in question without superimposition of breast tissue?
(A) CV
(B) TAN
(C) LMO
(D) AT
B
- Idenitify the projection show
(A) FB
(B) XCCL
(C) ML
(D) AT
D
- A barrel chested patient whose chest wall protrudes outward may have breast tissue extending laterally under the arm. What projection, used to image the breast with the beam direted superior to inerior, should be taken in addtion to CC?
(A) AT
(B) XCCL
(C) CV
(D) MLO
B
- The FB projection can be useful in imaging
- patients with extreme kyphosis
- abnormalities high on the chest wall or superior aspect of breast
- inferior lesion or lesions near the IMF
(A) 1 and 2
(B) 2 and 3
(C) 1 and 3
(D) 1,2,3
A
- Why is MLO preferred to ML as the routine projection?
(A) MLO visualizes the medial breast
(B) ML does not visualize the medial breast
(C) ML poorly visualizes the posterior and lateral breast
(D) MLO does not distort the anterior structure of the breast
C
- Which projection best shows the extreme medial aspect of the breast?
(A) CC
(B) MLO
(C) ML
(D) CV
D
- In which modified projection is the superior aspect ofthe breast rolled medially?
(A) rolled medial (RM)
(B) rolled lateral (RL)
(C) magnification (M)
(D) lateromedial (LM)
A
- In the LMO projection, the beam is directed from the
(A) upper-inner aspet ot the lower-outer aspect of the breast
(B) inner-outer aspect to the upper- outer aspect of the breast
(C) lower-outer aspect to the upper-inner aspect of the breast
(D) superiolateral aspect to the inferomedial aspect of the breast
C
- Which projetion is especially useful when analyzing calcifications?
(A) RM
(B) M
(C) LM
(D) ML
B
- All of the following statements about magnification are true except
(A) with magnification, patient dose increases
(B) magnificaiton can be used in ontaining specimen radiographs
(C) magnification can be used to assess suspicious lesions
(D) magnification images the entire breast with one exposure
D
- In the rolled superior (RS) position, the surgace ____ the detector is rolled _____
(A) furthest from / inferiorly
(B) closest to /superiorly
(C) furthest from/ superiorly
(D) closest to /inferiorly
C
- Which technique accurately describes how the breast is rolled for RM ?
(A) the superior surface is rolled medially and the inferior surface does not move
(B) the superior surface is rolled alterally, and the inferior surface is rolled medially
(C) the inferior surface is rolled medially, and the superior surface does not move
(D) the inerior surface is rolled laterally, and the superior surface is rolled medially
D
- A patient with pectus excavatum may present a positioning problem because the patietn has
(A) extensive pectoral muscle
(B) barrel chest
(C) kyphosis
(D) depressed sternum
D
- In imaging the augmented breast in the CC position, using the implant-displaced techique the breast tissue is pulled or pushed
(A) anteriorly
(B) posteriorly
(C) inferiorly
(D) superiorly
A
- A routine serires on patients with encapsulated implants oculd include an additional projection, such as the
(A) TAN
(B) CC
(C) MLO
(D) ML
D
- Which of the followign is used to spread out the tissue and improve resolution on a localized area of interest
(A) CV
(B) AT
(C) TAN
(D) spot compression
D
- How many projections are routinely required to image a patient with implant-augmented breasts
(A) 5
(B) 6
(C) 7
(D) 8
D
- Which of the followign statements is correct?
(A) the breast should be imaged immediately after irradiation to rule out recurrent cancer
(B) The irradiated breast should never be imaged
(C) it is contraindicated to image the irradiated breast less than 6 months after irradiation treatment
(D) it is contraindcated to image the irradiated breast less than 2 years after irradiation treatment
C
- Which of the following projections or positions can be performed with any patient orientation, with or without magnification
(A) spot compression
(B) XCCL
(C) AT
(D) CV
A
- In addition to the routine series, after a lumpectomy how many patients can also be imaged using
(A) CC
(B) MLO
(C) ML
(D) CV
C
- The “implant in place” projections take on patietns with rbeast implants requires compression
(A) for immobilization only
(B) to separate the breast tissue
(C) to provide a uniform tisse thickness
(D) for improved spatial resolution
A
- Magnetic resonance imaging (MRI) could be used
- as a primary breast ancer detection tool
- to image patients with rbeast implants to evaluate ruptures
- to determine tumore margins and the extent of tumor spread
(A) 1 only
(B) 1 and 2
(C) 2 and 3
(D) 1 and 3
C
- WIth its high sensitivity, MRI is ideal as
(A) a routine screen tool for breast cancer
(B) a replacement for mammography screening in detecting breast cancer
(C) an adjunctive rool in detecting breast cancer
(D) a screening toll for older women
C
- MRI imgaging involves the use of
(A) radiation to detect breast lesions
(B) sound waves int he imaging of the breast
(C) magnetic properties plus radio waves to image the breast
(D) strong sound and radio waves in imaging the breast
C
- Ultrasonagraphy uses
(A) high-frequency sound waves to image the breast
(B) low-frequency sound waves to image the breast
(C) logitudinal microwaves to image the breast
(D) radiofrequency waves to image the breast
A
- MRI can be used to
- map the extent of a tumor
- image patietns with implants
- evaluate patients with dense breasts
(A) 1 and 2
(B) 2 and 3
(C) 1 and 3
(D) 1,2,3
D
- Ultrasonography of the breast is often used to
(A) map the extent of a breast tumor
(B) verify that lesion seen on the mammogram is solid or fluid filled
(C) verify the presend of microcalcifications
(D) perform a biopsy of a lesion seen only on MRI
B
- All of the following statements, referencing the Hologic digital tomosynthesis unit, are true except
(A) tomosynthesis does not use a grid
(B) the highest slice number is lcosest to the detector
(C) reconstruction is always in 1mm- thick slices
(D) slices can be slabbed together to visualize calcifications
B
- Disadvantages of the Hologic digital tomogrpahy system are that
(A) it does not use a grid resultignin lower resolution images
(B) greaster risks of motion as a result of the longer acquisition time
(C) the technology can be used to reduce the recall rate
(D) it can be used to remove overlapping tissue when imaging a dense breast
B
- Motion on images with the Hologic digital breast tomosynthesis (DBT) unit are better appreciated on
(A) the projection images at the radiologist workstation
(B) the projection images at the technologist workstation
(C) the reconstruction images at the radiologist workstation
(D) the reconstruction images at the technologist workstation
B
- Synthesized 2D imagingis a
(A) 2D recondstruction of the 3D image
(B) 3D reconstructin of the 2D image
(C) 2D imaging with tomosynthesis
(D) 2D tomosynthesis imaging
A
- Computer aided detection (CAD) is used to
(A) visually enhanced an image for viewing
(B) modify the constrast of brightness of an image
(C) analyze or preread the image
(D) provide accurate dianostic information about the image
C
- The results form one of the followign techniques is often used to reduce the amount of lymph noes removed during a chekc for breast cancer spread
(A) sentinel node mapping
(B) scintimammography
(C) positron emission mammography
(D) MRI
A
- Radiation therpay is a treatment that utilizes
(A) drugs to treast cancer taht 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
B
- 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
D
- Medical hystory 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 hromones 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
B
- 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
B
- 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
B
- 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 coverting input x-ray signals and or the system has a high fill factor on the TFT array
(D) all of the above
C
- In digital imaging, a graph of the optical denisty rand to the log of relative exposure is a
(A) shallow sloping curve
(B) steep sloping curve
(C) linear response
(D) curvilinear response
C
- 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
D
- The circular pigmented area around the nipple is called the
(A) skin
(B) areola
(C) Montgomery gland
(D) ampulla
B
- 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
A
- The advantages of a quality assurance program, such as the Mammography Quality Standards Act (MQSA), inlcudes all of the following except
(A) increased efficiency
(B) cost- effectiveness
(C) permission for maniplation of the final image
(D) improved patient satsfaction
C
- IN magnification, what immediate role does the large object to image receptor distane (OID) play in reduing scatter radiation?
(A) It allows the use of lower peak kVp values
(B) There is increase 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)
C
- 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 compensae for the small OID
(D) to compensate long exposure times
A
- What is the best placemtn for the needle wire during needle localization
(A) the needle wire should pass immediately below the lesion
(B) the needle wire should pass immmediately above the lesion
(C) the needle wire should pass through the lesion
(D) the needle wire should pass immediately beside the lesion
C
- 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) media 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
A
- 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 palne of the breast
(D) The central ray is always parallel to the skin surface
D
- In the rolled meidal (RM) position, the inferior (lower) surface of the breast is rolled in which direction
(A) lateral
(B) medial
(C) inferior
(D) superior
A
- 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
D
- 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)
B
- 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
A
- 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
A
- The abdosrbed dsoe 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
B
- 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
B
- 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
B
- 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
C
- 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
B
- 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
A
- breast tissue can extend medially to the
(A) latissimus dorsi muscle
(B) mid-sternum
(C) retromammary space
(D) inframammary fold (IMF)
B
- Which of the followign 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
B
- Which of the followng are considere first degre relatives
(A) mother and aunt
(B) first cousin and mother
(C) aunt and sister
(D) sister and mother
D
- Image compression is often required to allow
(A) teleradiography
(B) digital iamging and communication in medicine (DICOM) interpretation
(C) picture archiving and communication system (PACS) transmission
(D) digital imaging
A
- Network limited to a small geographical area is called
(A) wide area network (WAN)
(B) loca area network (LAN)
(C) personal area network (PAN
(D) PACS
B
- In the lower kVp range using molybdenum target tube, what type of photon interaction predominates
(A) photoelectric
(B) compton
(C) bremsstrahlung
(D) coherent
A
- In digital iamging, a reapeat analysis test is
(A) unnecessary - digital imaging automatically correts 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
D
- The same technologist should view the phantom images because
(A) subjective judgement about iamges 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
A
- The from-below (FB) projection utlizes a beam directed
(A) perpendicular to the detector
(B) horizontally
(C) tangentially
(D) parallel to the detector
A
- Changes in the breast as a result of radiation therapy include
(A) erythema
(B) edema
(C) hardening
(D) all of the above
D
- Scanning the breast to locate a cancer based ont eh 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
B
- 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
B
- 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
D
- 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
B
- Evaluations such as the mammography equipment evaluation (MEE) is performed by the
(A) radiologic assistant
(B) technologist
(C) medical physicist
(D) radiologist
C
B44. The test pattern used to ensure tha 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)
B
- 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
C
- 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
A
- Typically, frid 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
D
- 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
B
- 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
D
- 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
D
- 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) sepaarating the skin from the superficial fascia
(D) between the flandular tissue and the IMF
A
- 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
D
- 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
C
- The indirect effect of breast compession 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
B
- 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
C
- 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
C
- 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
B
- The mammogram of a woman who is aged 50 years and has recently started estrogen replacement therpay 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
A
- The mammogram shos an oval shaped lesion with mixed radiolucent and radiopaque content. The lesion has a central radiolucent area nd is freely movable. This lesion is most likely to be
(A) fibroadenoma
(B) hematoma
(C) lymph node
(D) galactocele
C
- 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
D
- The change in OID could cuase 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 coprssion of the part
C
- What does the actual focal spot size measure?
(A) the area on teh anode exposed to electrons
(B) the are projected on the patient
(C) the area projected on the detector
(D) the nominal focal spot size
A
- 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
C
- Differentiate between repeat and reject images
(A) Repeate is the percentage of repeats form a specific cause. Reject is the percentage of repeats from multiple causes
(B) rejects are all images that are discarded. Repeats are iamges that resulted in extra radiation doses to the patietn
(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
B
- 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
C
- After four projection mammography, calcifications are visualized superior to the niple 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
C
- 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
A
- 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
C
- 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
C
- Who performs the compression device check for mammography QC?
(A) physicist
(B) any staff technologist
(C) radiologist
(D) technologist
D
- 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
B
- 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
B
- 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
C
- A beryllium (Be) window on the x-ray tube enhances contrast by
(A) increaseing 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
C
- 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
C
- 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
C
- 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
B
- 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
C
- 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
A
- In positioning terminology, CV means
(A) compressed position
(B) cranial view
(C) cleavage view
(D) compression view
C
- 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
D
- The functional milk-producing units of the breast are contained within the
(A) lactiferous sinuses
(B) lobules
(C) ampulla
(D) areola
B
- 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
A
- 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
C
- 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
B
- 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
C
- 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 copression of the lower breast
(C) ensure equal compression of the upper and lower breast
(D) ensure proper compression of the lower breast
B
- 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
A
- A rolled projection cam 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
A
- Ideally, in an open surgical biopsy, when shoudl 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
D
- Which projection gives a mirror image of MLO
(A) ML
(B) LM
(C) LMO
(D) AT
C
- 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
B
- 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
C
- 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
B
- Which of the following statements is true of both the photstimulable phosphor (PSP) and the flat-panel mammography systems?
(A) The iamging 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 iamging system is susceptible to scratches
B
- 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
B
- 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 cmplaint program
D
- 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
B
- 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
B
- 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
B
- Erythema of the brest 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
D
- Which of the followign is used as a treatment for estrogen-dependent tumors in postmenopausal and premenopausal women?
(A) Radiation therapy
(B) chemotherapy
(C) tamoxifen
(D) antibody therapy
C
- 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
B
- A thin supportive layer located netweem 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
C
- The appearanc 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
C
- 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
C
- The basic premise of a medical audit is that
- all positive mammograms should be followed up
- the pathology results of all biopsy procedures performed should be collected
- 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
D
- 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
B
- Under which of the following circumstances would eb 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
C
- A dimpled skin condition seen in cases of lumphatic edema of the breast is called
(A) inflammatory carcinoma
(B) ductal ectasia
(C) plasma cel mastitis
(D) peau d’ orange
D
- Clinical breast examination (CBE) and breast self examination (BSE) are similar in that both
(A) involve looking and feeling for changes in the breast
(B) are performed by a trained medical professional
(C) are performed montly
(D) are performed yearly
A
- The most common cause of under compression is
(A) a faulty compression paddle
(B) inadequate compression by technologist
(C) the patients pain tolerance level
(D) a broken autmatic compression device
(B) inadequate compression by technologist
- The Health Insurance Portabilit and Acountability Act (HIPAA) of 1996 has an influence on the radiology department and other hospital departmenents because of its focus on
(A) patient record confidentiality
(B) facility reimbursement
(C) quality management
(D) risk management
(A) patient record confidentiality
- Ductal papilloma is
(A) a benign proliferation of tissue in the male breast
(B) a malignant tumor involving ducts
(C) a collection of blood in the breast occurring after surger
(D) benign growths involving the milk ducts
(D) benign growths involving the milk ducts
- The right craniocaudal (CC) projection in a routine imaging series showed a small irregular shaped lesion at the posterior margin of the image plus scattered calcifications, including calcification clusters. Typucally the radiologist will recommened ___ as the immediate next step
(A) ultrasonography to assess the content of the lesion and provide an analysis of the calcifications
(B) spot compression, includign magnification, to assess calcifications and the margins of the lesion
(C) magnetic resonance imaging to assess for malignancy and to assess any calcifications
(D) a breast biopsy to check for malignancy
(B) spot compression, includign magnification, to assess calcifications and the margins of the lesion
- A bunch of eight bits equals one
(A) pixel
(B) byte
(C) matrix
(D) bit depth
(B) byte
- Which of the followign could be used when imaging extrmely small breasts in the CC position
(A) spatula
(B) mediolateral (ML) projection
(C) cleavage view (CV) projection
(D) exaggerated craniocaudal (XCCL) projection
(A) spatula
- In the tangential (TAN) projection, any tube angulation will depend on
(A) the size of the patients breast
(B) the location of the abnormality
(C) the position of the mid axillary line in relation to the detector
(D) whether the abnomality is palpable or non palpable
(B) the location of the abnormality
- A small but growing cancer may not be obvious to the individual because it often presents as
(A) skin irritation
(B) inverted nipples
(C) a painless mass
(D) a painful mass
(C) a painless mass
- Mammography is more accurate in
(A) premenopausal women
(B) postmenopausal women
(C) women with fibrocystic breast
(D) women with dense breast tissue
(B) postmenopausal women
- In taking medical history, hormone use (both natural and artificial) is taken into account because
(A) hormones cause breast cancer
(B) early menarche can increase breast cancer risks
(C) late menarche can increase breast cancer risks
(D) contraceptive use lowers the risk for breast cancer
(B) early menarche can increase breast cancer risks
- One major difference between collimation in mammography and collimation in general radiography is that
(A) in mammography, the entire detector area is exposed
(B) decreasing collimation increases exposure in mammography
(C) mammography uses a variety of beam limiting device
(D) in radiogrpahy, the entire detector area is always exposed
(A) in mammography, the entire detector area is exposed
- Line pair per millimeter is the unit of
(A) matrix size
(B) spatial resolution
(C) field of view (FOV)
(D) bit depth
(B) spatial resolution
- Image brightness is adjusted by changing the
(A) milliampere second (mAs)
(B) peak kilovoltage (kVp)
(C) window level
(D) window width
(C) window level
- The retromammary space is filled with
(A) supportive and connecting tissues
(B) adipose tissue
(C) fibroglandular tissue
(D) blood vessels
(B) adipose tissue
- The fatty versus fibroglandular nature of the breast itssue is affected by which of the following
(A) age
(B) hormone use
(C) number of pregnancies
(D) all of the above
(D) all of the above
- In positioning for the exaggerated craniocaudal (XCCL) projection, if the shoulder of the affected side is in the way of the compression device
(A) push the shoulder down
(B) use 5-degree lateral tube angulation
(C) use 5-degree medial tube angulation to avoid superposing the shoudler on breast tissue
(D) reduce the patients lateral rotation
(B) use 5-degree lateral tube angulation
- In the CC position, the pectoral muscle is seen
(A) all the time
(B) rarely if ever
(C) about 30 to 40% of the time
(D) about 50% of the time
(C) about 30 to 40% of the time
- Between ages 20 and 39 years, the American Cancer Society (ACS) recommends CBE every
(A) year
(B) 2 years
(C) 3 years
(D) 4 years
(C) 3 years
- Regardless of the reason, if the proper amount of compression cannot be applied, which of the followign must apply
(A) the patient must be infomred
(B) the patients doctor must be informed
(C) the radiologist must be informed
(D) it must be noted on the patients history form
(D) it must be noted on the patients history form
- On the CC image, the posterior nipple line (PNL) should extend to the
(A) level of the nipple
(B) posterior breast or edge of the image
(C) level of the inframammary fole (IMF)
(D) most anterior breast
(B) posterior breast or edge of the image
- The interspace material of the mammography linear grid is generally made of
(A) carbon or wood
(B) aluminum
(C) any highly radiopaque material
(D) lead
(A) carbon or wood
- Which section of the breast is poorly visualized on the CC projection
(A) medial
(B) axial
(C) lateral
(D) superior
(C) lateral
- Adjusting the image contrast is achieved by
(A) changing the window level
(B) decreasing the pixel size
(C) changing the window width
(D) increasing the pixel size
(C) changing the window width
- Which projection could be used to demonstrate a deep medial lesion not seen on CC
(A) axillary tail (AT)
(B) XCCL
(C) CV
(D) MLO
(C) CV
- After a routine four projection mammographic series, the nipple is not seen in profile on any of the images. Additional projections are done if
- the nipple is indistinguishable from a mass
- a subareolar abnormality is suspected
- the nipple is not marked iwth a BB (lead shot )
(A) 1 and 2
(B) 2 and 3
(C) 1 and 3
(D) 1,2,3
(D) 1,2,3
- Your patients sister was diagnosed iwth rbeast cancer at age 35 years. Your patient is considered to have
(A) a greater risk of breast cancer
(B) a lower risk for breast cancer
(C) no significantly increased risk for breast cancer
(D) a personal history of breast cancer
(A) a greater risk of breast cancer
- The MQSA mandates tha the average flandular dose received per projection/position during routine mammogrpahy screening not exceed
(A) 1 mGy (100 mrad)
(B) 2 mGy (200 mrad)
(C) 3 mGy (300 mrad)
(D) 4 mGy (400 mrad)
(C) 3 mGy (300 mrad)
- The device used to vonvert the films in an analog imaging system to a digital image is called
(A) a film digitizer
(B) DICOM
(C) an analogn to digital converter (ADC)
(D) a digital to analog converter (DAC)
(A) a film digitizer
- The computer netweork that allows images to be viewed at various monitors or transmitted or stored is termed
(A) local area network (LAN)
(B) picture archivign and communications system (PACS)
(C) DICOM
(D) wide area network (WAN)
(B) picture archivign and communications system (PACS)
- Which of the following statements about health care records is false
(A) health records must inlcude all signed informed consent forms
(B) patients have a right to amend their health care records
(C) patietns can access their health records
(D) health care records cannot be used in a court of law
(D) health care records cannot be used in a court of law
- Montgomery glands are specialized
(A) sweat glands
(B) sebaceous glands
(C) Cooper ligaments
(D) hair follicles
(B) sebaceous glands
- A woman takign hormone replacement therpay may notice changes in the breast, such as
(A) breast enlargement
(B) increase in fibroadenomas
(C) increase in breast cysts
(D) all of the above
(D) all of the above
- Pagets disease of the breast is a
(A) infiltrating carcinoma generally limited to the breast
(B) form a carcinoma associated with changes in the nipple
(C) benign breast conidtion that is relatively common
(D) malignant form of breast carcinoma involving lobules
(B) form a carcinoma associated with changes in the nipple
- in a digital image, what determines the matrix size
(A) the number of bits in each pixel
(B) the number of pixels in the rows and columns
(C) the pciture elements in the matrix
(D) the number of gray shaes that a pixel can produce
(B) the number of pixels in the rows and columns
- A set of computer software standards that permits a wide range of digital imaging programs to understand each other is called
(A) DIGCOM
(B) PACS
(C) DICOM
(D) PCAS
(C) DICOM
- A PACS network typically would include
(A) digital images from multiple modalities
(B) images from a single modality
(C) all records of patients
(D) surgical and radiography patient records
(A) digital images from multiple modalities
- Women who were exposed to diethylstilbestrol (DES) in utero may have
(A) a lower risk for breast cancer
(B) a higher risk for breast cancer if they are also receiving hormone replacement therapy
(C) a lower risk for breast cancer if theya re also receiving HRT
(D) breast tissue that is extra sensitive to radiation
(B) a higher risk for breast cancer if they are also receiving hormone replacement therapy
- In which of the followign modified proejctions is the superior surface of the rbeast rolled medially
(A) rolled medial (RM)
(B) roller lateral (RL)
(C) medial (M)
(D) lateromeidal (LM)
(A) rolled medial (RM)
- factors that lower breast cancer risks include
- having the first child after age 30 years
- breastfeeding
- late menarch
(A) 1 and 2
(B) 2 and 3
(C) 1 and 3
(D) 1,2,3
(B) 2 and 3
- PACS stands for
(A) picture access to communication system
(B) picture archiving and computer system
(C) picture archiving and communication system
(D) pixel access and computer system
(C) picture archiving and communication system
- The computer processing or photostimulable phosphor (PSP) reader function to
(A) focus a beam of infrared light on the PSP
(B) trap excited electrons at a higher energy level
(C) scan, read, and erase the exposed PSP
(D) provide enrgy to rapped electrons
(C) scan, read, and erase the exposed PSP
- Gynecomastia is the term for
(A) a localized abscess
(B) increased breast tissue in the male breast
(C) decreased breast tissue in the female breast
(D) a risk of carcinoma in the male patient
(B) increased breast tissue in the male breast
- Photostimulable luminescence (PSL) is
(A) emission of bluish-purple light from electrons as they transition from higher energy to a lower enegery state
(B) conversion of light energy to an electrical signal by the phtomultiplier tube (PMT)
(C) conversion of the analog signal to a digital signal by the ADC
(D) conversion of light into an analog signal by the charge coupled device (CCD)
(A) emission of bluish-purple light from electrons as they transition from higher energy to a lower enegery state
- According to MQSA regulations, which of the following is not required on the final mammographic image?
(A) date of the examination
(B) tehcnical factors used
(C) technologist identification
(D) projection identification
(B) tehcnical factors used
- The IMF is located at approxiametely the level of the
(A) 2nd to 3rd rib
(B) 3rd to 4th rib
(C) 4th and 5th rib
(D) 6th to 7th rib
(D) 6th to 7th rib
- Scatted radiation is reduced during magnification mammography by
(A) using a small focal spot size
(B) using a grid
(C) using the air gap technique
(D) increasing the source to image receptor distance (SID)
(C) using the air gap technique
- Ductography can be used to determine
(A) the location of lesions in ducts
(B) whether a lesion is benign or malignant
(C) change or abnormalities associated with ducts
(D) more than one of the above
(D) more than one of the above
- When imaging smal breasta, a ueful option is
(A) replacing CC with XCCL
(B) using Ml instead of MLO
(C) using a spatula to avoid compressing the fingers
(D) reducing angulation to avoid to much comression of the pectoral muscle
(C) using a spatula to avoid compressing the fingers
- During magnification, positioning the breast away from the detector utilizes which law/principle in scatter reduction
(A) inverse square law
(B) reciprocity law
(C) heel effect
(D) line focus principle
(A) inverse square law
- A nulliparous woman has a lower risk for breast cancer compared with a woman with a history of
(A) late menopause
(B) late menarche
(C) breast cancer
(D) early menarche
(C) breast cancer
- In routine mammography, the primary purpose of the frid is to
(A) improve image sharpness
(B) reduce the productionof scatter
(C) reduce patient dose
(D) increase the subject contrast
(D) increase the subject contrast
- The implant displaced (ID) projection is possible on all of the following cases except
(A) implants placed posterior to the pectoral muscle
(B) implants placed anterior to the pectoral muscle
(C) soft implants
(D) encapsulated implants
(D) encapsulated implants
- A palpable mass that is not seen on a diagnostic mammogram generally means that
(A) breast cancer is ruled out; the mass is probably benign
(B) other diagnostic testing must be considered
(C) the mass is likely breast cancer
(D) the mass is likely caused by fluctuating hormones
(B) other diagnostic testing must be considered
- Which of the following patients has the greatest risk for breast cancer
(A) a nulliparous woman age 40 years
(B) a never married woman
(C) a woman age 70 years
(D) a owman age 30 years
(C) a woman age 70 years
- A technologist using a 0.1mm focal spot size is most likely performing
(A) routine mammography work
(B) magnification imaging
(C) spot compression imaging
(D) stereotactic work
(B) magnification imaging
- Which of the following patients cannot give consent
(A) a minor who is married
(B) a minor serving in the military
(C) a competent adult
(D) a mentally challenged adult
(D) a mentally challenged adult
- In the PSP computer reader (CR) the phtomultiplier tube
(A) collects the blue/purple light given off by trapped electrons
(B) scans the PSP with a red laser light
(C) provides energy to the trapped electrons in teh phosphor layer
(D) erases the PSP by releasing electrons
(A) collects the blue/purple light given off by trapped electrons
- Which of the following statmetns is true about imaging the breast
(A) fold and or wringkels should be eliminated by pusing the posteriorly
(B) skin folds and wrikles may be impossible to avoid in older adults
(C) when imaging older adults, the study will be compromised by folds and wrinkles
(D) fold and wrinkles can be eliminated by pulling them anteriorly
(B) skin folds and wrikles may be impossible to avoid in older adults
- The term base of the breast refers to the
(A) the nipple are of the areola
(B) areas adjacent to the chest wall
(C) axilla area of the breast
(D) lower outer quadrant of the breast
(B) areas adjacent to the chest wall
- Fibrous tissues are presented radiographically as
(A) black or radiolucent areas
(B) gray and less dense areas
(C) white or denser areas
(D) black and less dense areas
(C) white or denser areas
- The calcifications seen are characteristic of
** ADD PIC**
(A) invasive ductal carcinoma
(B) malignant calcifications
(C) calcifications caused by plasma cell mastitits
(D) numerous oil cysts
(B) malignant calcifications
- The MLO projection demostrates a large encapsulated lesion occupying almost the entire breast. The contour is sharp, and the lesion is radiolucent. This lesion is most likely to be
(A) oil cyst
(B) hematoma
(C) fibroadenoma
(D) lipoma
(D) lipoma
- The latent image on the PSP can last several hours but will lose
(A) 50% of its energy in 4 hours
(B) 50% of its energy in 8 hours
(C) 25% of its energy in 4 hours
(D) 25% of its energy in 8 hours
(D) 25% of its energy in 8 hours
- Disadvantages of the PSP or computed mammography (CM) technology includes
(A) reduced repeats
(B) wide latitude and dynamic range of the system
(C) PSPs sensitivity to radiation
(D) speed of the imaging system
(C) PSPs sensitivity to radiation
- In the nonscintillator direct-based flat-panel digital mammography (DM) system, the x-ray beam strikes a
(A) scintillator
(B) photoconductor
(C) thin film transistor
(D) photomultiplier
(B) photoconductor
- Spot compression
- applies more compression to a localized area
- can be perfored with magnification
- employs a coned collimated field to limit the area of interest
(A) 1
(B) 1 and 2
(C) 2 and 3
(D) 1,2,3
(B) 1 and 2
- To reduce the possibility of projecting the abdomen on the MLO image, the technologist could
(A) have the patient stand just at the detector and bend backward
(B) have the patient stand away fromt eh detector and bend forward
(C) have the patient turn medially to image the lateral breast on CC
(D) image the breasat in the lateral position instead
(B) have the patient stand away fromt eh detector and bend forward
- A four-projection mammography series shows a solitary tumor, with the halo sign, in the upper outer quadrant of the left breast. The lesion is partially obscured. The recommended next step is
(A) biopsy
(B) ultrasonography
(C) stereotactic localization
(D) aspiration
(B) ultrasonography
- Why is the specimen magnified
(A) to ensure that the lesion has been completely removed
(B) to visualize the cacifications within the specimen
(C) to compare the magnified and nonmagnified images
(D) to check the number and placement of calcifications
(B) to visualize the cacifications within the specimen
- In digital mammography, a grossly underexposed image
(A) appears excessively noisy
(B) is too light
(C) is too dark
(D) appears correctly exposed
(A) appears excessively noisy
- Which of the following patients is likely to be diagnosed with pathological gynecomastia
(A) lactating woman
(B) older man
(C) premonopausal woman
(D) young man
(B) older man
- Montgomery glands are located on the breasts
(A) skin
(B) nipple
(C) areola
(D) muscle
(C) areola
- Aluminum can be used as the filtration material in
(A) digital units, when imaging dense breasts
(B) digital tomosynthesis units
(C) digital units, when imaging fatty breasts
(D) digital units, when using molybdenum targets
(B) digital tomosynthesis units
- Digital mammography units often use ___ as the target material
(A) molybdenum
(B) rhodium
(C) aluminum
(D) tungsten
(D) tungsten
- The ACS has recommended that women over age 40 years undergo CBE every
(A) year
(B) 2 years
(C) 3 years
(D) 4 years
(A) year
- When imaging the breast usign the CC projection, if the detector is too high or too low, the IMF will be overelevated or underelevated. Overelevation of the IMF will result in
(A) loss of posterior and superior breast tissue in the image
(B) loss of anterior and posterior breast tissue in the image
(C) loss of superior and posterior breast tissue in the image
(D) loss of inferior and posterior breast tissue in the image
(D) loss of inferior and posterior breast tissue in the image
- Capture leemtns in the flat panel detector system can include all of the following except
(A) phtomultiplier
(B) cesium iodide
(C) gadolinium oxysulfide
(D) amorphous selenium
(A) phtomultiplier
- Which of the following involves the use of a small guage needle to remove cell samples from a suspected cancerous lesion int eh breast for cytoogical analysis
(A) core biopsy
(B) excisional biopsy
(C) needle localization
(D) fine needle biops (FNB)
(D) fine needle biops (FNB)
- A lesion is superimposed by breast tissue in the CC projection. A projection/position used to demonstrate the lesion int he same orientation but free of superimposition is the
(A) MLO
(B) ID
(C) XCCL
(D) RM
(D) RM
- In imaging the breast in the MLO projection, compression to the lower, anterior portion of the breast is compromised if
(A) the detector is too high
(B) the pectoral muscle extends to the nipple line
(C) too much axilla and shoulder are under compression
(D) the IMF is not horizontal
(C) too much axilla and shoulder are under compression
- The term involuation of the breast describes a process by which
(A) milk is removed from the breast by suckling
(B) breast epithelium proliferates during menstruation
(C) the glandular tissue in the breast is replaced by fat
(D) estrogen use causes an overall decrease in tissue density in the breast
(C) the glandular tissue in the breast is replaced by fat
- In imaging the breast for the CC projection, what technique is used to minimize skin folds in the lateral aspect of the breast
(A) lifting the posterior lateral aspect of the breast onto the detector
(B) drapign the contralateral breast over the corners of the detector
(C) having the patient turn the head to face the lateral breast
(D) the patients arm hanging relaxed on the side being imaged, with the humerus externally rotated
(D) the patients arm hanging relaxed on the side being imaged, with the humerus externally rotated
- Phosphor crystals in the flat panel detector system are classified as ___ phosphores when they are scattered through the phosphor level
(A) needle
(B) turbid
(C) amorphous
(D) selenium
(B) turbid
- Grid use in magnification mammography is contraindicated because
(A) the use of a grid will increase subject contrast
(B) scatter is already minimized
(C) grid use increases with scatter
(D) the use of grids would result in decreased subject contrast
(B) scatter is already minimized
- Which statement best describes a parallel or linear grid?
(A) lead strips are aligned adjacent to one another and placed lengthwise in the same direction within the structure of the grid
(B) lead strips are aligned at right angles to each other
(C) lead strips are designed to take advantage of the divergence of the x-ray beam as it leave the x-ray tube
(D) lead strips are designed to move during the exposure
(A) lead strips are aligned adjacent to one another and placed lengthwise in the same direction within the structure of the grid
- The main difference between the technlogist monitor and the radiologists monitor is
(A) display size
(B) resolution
(C) illuminance
(D) luminance
(B) resolution
- Scintillators are used to convert
(A) xrays to light
(B) xrays to electrons
(C) light to electrons
(D) electrons to light
(A) xrays to light
- The photoconductor in the direct digital radiography system is used to convert
(A) xray to light
(B) xrays to electrons
(C) light to electron
(D) electrons to light
(B) xrays to electrons
- The repeat rate should be analyzed if the rate changes from the previous measure rate by more than
(A) +/- 2% points
(B) +/- 3% points
(C) +/- 4% points
(D) +/- 5% points
(A) =/- 2% points
- A magnification image of a breast shows severa oval shaped radiolucent lesions with eggshell-like calcifications. These are most likely to be
(A) ductal papilloma
(B) fibroadenomas
(C) oil cysts
(D) hematomas
(C) oil cysts
- The thin-film transistor (TFT) in the flat panel detector systems collects
(A) light
(B) pixels
(C) electrons
(D) xrays
(C) electrons
- In general, the ID series are taken using the
(A) AT and MLO projection
(B) CC and ML projections
(C) CC and MLO projections
(D) CC and LM projections
(C) CC and MLO projections
- Currently, all technologists or radiographers performing mammography independently must have
(A) satisfied the final requirements of the US Food and Drug Administration (FDA)
(B) completed at least 20 hours of documented training in mammography
(C) performed at least 75 examinations under direct supervision of a qualifed technologist
(D) none of the above
(D) none of the above
- The criteria for a properly positioned MLO projection includes
- concave pectoral muscle on the anterior border
- fat visualized posterior to the fibroglandular tissues
- an open IMF
(A) 1 and 2
(B) 2 and 3
(C) 1 and 3
(D) 1,2,3,
(B) 2 and 3
- A benign inflammatory conidtion of the lactiferous ducts leading to nipple discharge, nipple inversion or periareolar sepsis is called
(A) ductal ectasia
(B) Paget’s disease of the breast
(C) peau d’orange
(D) ductal papilloma
(A) ductal ectasia
- The cells lining the alvoli in lobules are called
(A) epithelial cells
(B) myoepithelial cells
(C) basement cells
(D) superficial cells
(A) epithelial cells
- Informed consent imploes that the patient
- has already signed the authorization for treatment
- was informed on the procedure or operation, its risks, possible consequence , and any alternative options
- the patient was given information about the procedure in his or her language
(A) 1 and 2
(B) 2 and 3
(C) 1 and 3
(D) 1,2,3
(B) 2 and 3
- The technique for reshaping of the breast is called
(A) reduction mammoplasty
(B) mammoplasty
(C) breast augmentation
(D) breast biopsy
(B) mammoplasty
The detector elements (DELs) are located within the
(A) scintillator
(B) TFT
(C) CCD
(D) complementary metal oxide silicon (CMOS)
(B) TFT
- The CC projection in males will present the same difficulty as imaging small, firm breasted females. An added problem may be that
(A) male patients have more problems with compression
(B) the amle breast is smaller than the smallest female breast
(C) males have more muscular breast tissue
(D) hair on the chest of males makes compression difficult
(D) hair on the chest of males makes compression difficult
- Which of the following are considered agencies granting accreditation under FDA regulation
(A) state of california
(B) ACR
(C) New York State Department of Health
(D) State of Florida
(B) ACR
- Which alternative projection could be used, in addition to CC, in imaging a patient with a pacemaker
(A) ML
(B) lateromedial oblique (LMO)
(C) XCCL
(D) MLO
(B) lateromedial oblique (LMO)
- In addition to the patietns name, all mammographic reports should have the
(A) final assessment of findings
(B) hospital number or additional patient identifier
(C) name of the radiologist
(D) all of the above
(D) all of the above
Breast cancer is the number one killer in the ____ and the second in the ____
world
united states
What hormone increases cancer
estrogen
What type of exame is done when the patient is having no issues and its been at least 1 year since her last screening exam and she is 40 or older.
screening mammogram
_____ ____ screenins may be done on patiets as young as 30 but not younger than 25
high risk
What type of exam are done when the patient is complaining of an issue with her breast or her physician feels somethign in the breast
diagnostic exam
Anyone under 25 years old will get what type of exam
ultrasound
Acording to the ACS Women ages 40-44 consult with their physician so they can obtain _____ _____
informed consent
According to the ACS women 45-54 should undergo ____ ____ mammography
anual screening
According the the ACS women ages ___ and older can transition to every other year or continue anual screening
55
According the ACS women should continue screening mammography as long as their overall health is good and they have a life expectancy of ___ years or longer
10
True or False
The ACS recommends self breast exams and clinical breast exams
false
According to the ACR screening mammograms should starte at age ____ for average risk
40
According to the ACR women at higher risk should begin by age ___ but no sooner than ___
30
25
What percent of palpable lumps are not visualized on a mammogram
15%
_____ % of the time nipples arent in profile on both views
10%
You mark up to how many moles on one breast
7
scar tissues can grow and cahnge for up to __ years after surgery
2 years
The second most common spot for cancer to grow is where?
behind the nipple
What are the 3 distinct patterns for BSE
wedge
spiral
up and down
What part of your hand should be used for a BSE
2,3,4th pads of the fingers with light and deep touch
What are the 9 signs and symptoms
pain
lump
thickening
nipple discharge
skin changes
nipple and areolar changes
edema
erythema
dimpling
True or False
pain is not typically associated with breast cancer
true
When does pain in the breast become a concer
when the pain is focal (less than a quadrant of the tissue) and is severe
True of False
Lumpiness that occurs in both breast is normal for many women
true
Where does most of the glandular tissue reside
upper outer quadrant
True or False
A firm lump or area of thickening that suddenly presents in one breast is a concern
true
What are 3 reasons that a clear milky discharge may be present
nursing
breast stimulation
hormones
When is nipple discharge a concern
When it is bloody or milky and occurs without stimulation
What is the difference between and inverted nipple and a retracted nipple.
a retracted nipple will not come back out when stimulated
Aging, duct ectasia and breast cancer are all causes of
nipple retraction
What is the largest organ of the body
skin
What is the function of the skin
to protect the body
Where is the thickest skin of the breast
at the base (closest to the chest) (2mm)
Where is the thinnest skin of the breast
around the nipple (0.5 mm)
What are the 3 layers of the skin
epidermis
dermis
hypodermis
What is the outer layer of the breast called
epidermis
What is the iddle layer of the breast that consists of blood vessels, elastin fibers, lymphatic channels, oil/sweat glands
dermis
The circular colored skin around the nipple
areola
Lives in teh center of the areola
nipple
The areola contains what three things
nipple
montogmery glands
hair follicles
The areola contain between __ - __ opening of milk ducts
5-15
the small bumps on the ksin of the areola that enlarge durigng pregnancy
montgomery glands
The montgomery glands are a tyepe of ____ ____ gland that surrounds the nipple
modified sebaceous
The name for the opening of the montgomery gland
morgagni tubercles
what do the montgomery gland secrete? why?
bacteriostatic lubrictation to keep the areola and nipple lubricated and protected from infection during lactation
What glands secrete a bacteriostatic lubrication to keep the areola and nipple lubricated and protected from infection during lactation
montgomery glands
What is the angle of deflection where the breast tisse meets the chest wall below the breast
inframammary fold
What is the superior border of the breast
clavicle
Where does the superior border of the breast attach
2nd or 3rd rib
What is the inferior border of the breast
inframammary crease
Where does the inferior border of the breast attach
6th or 7th rib
What is the medial border of the breast
sternum
What is the lateral border of the breast
mid axillary line
What is the portion of the breast that is nearest the nipple
anterior
What is the breast nearest the chest wall
posterior
what is the middle portion of the breast called
central
The breast lies on top of what muscle
pectoralis major
How many facscial layers are there in the breast
2
The facial layers are made up of what?
connective tissue
What is the purpose of the fascial layers
sepearates the breast from the skin and separates the breast from the muscle
what are the two fascial layers
superficial fascia
deep fascia
what fascial layer separates the rbeast from the skin
superficial fascia
what fascial layer separates the breast from the muscle
deep fascia
in between the deep fascia and the rbeast tissue is an area call the
retro-mammary fat space
Beneath the skin is what type of fat
subcutaneous
The breast is firmyl attached to the deep fascia via suspensory ligaments called
coopers ligament
what is the order of the breast layers moving from the nipple back
skin
subcutaneous fat
superficial fascia
breast tissue
retromammary fat space
deep facia
pectoralis major
what is the extension of the breast tissue that extends into the axilla
axillary tail or tail of spence
Where is the largers portion of glandular tissue found
in the central and upper outer quadrant, extending into the tail of spence
Where is the largest number of cancers found
central and upper outer quadrant
What is the name of the ligaments that run under the skin of the breast through and aroudn the breast tissue and connect to the deep facia in from of the pec muscle
coopers ligaments
What are responsible for maintaining the shape and configuration of the breast
coopers ligaments
What plays a major role in preventing breast ptosis
coopers ligament
Appears on mammograms as liens from skin projecting to the chest wall
coopers ligament
Coopers ligaments are easiest to see on what views
lateral
MLO
Coopers ligament are easier to see on ____ breast
dense
The milk line extends from teh ___ to the ___
axilla
groin
Definition of polythelia
extra nipple
What is the term for an extra nipple and where do they usually develop
polythelia
milk line
What is the most common breast anomaly
polythelia (extra nipple)
Polythelia occurs in what percent of the population
10%
what are two other terms used for an extra nipple
accessory nipple
supernumerary
Extra nipples generally occur along the milk line but they can develop anywhere along the ___ ___
embryonic ridge
The glandular tissue holds ____ ___ cells
milk producing
Mammary glands are considered modified ____ ____
subaceous (sweat) glands
Fills the space between fibrous and glandular tissue, giving the breast its size
fatty tissue
What tissue gives breasts its size
fatty tissue
Holds the reast tissue in place
fibrous tissue
_____ ______ tissue and fat are surrounded by connective tissue and held up between the skin and pec muscle by coopers ligaments
fibro-glandular
Many breast lumps turn out to be caused by what
fibrosis tissue changes and cysts
Each mammary gland consists of a series of ___ that produce milk
lobes
Within the lobes of the breast are many ____ which conect to smal ducts that connect to bigger lactiferous ducts
lobules
The ___ ___ are repsonsible for delivering the milk to the nipple
lactiferous ducts
Each breast consists of how many lobes
15-20
Each lobe consists of many ___
lobules
What do lobules look like
grapes
Lobules vary in size during life due to
hormone changes
The extra lobular terminal duct is also known as
segmental duct
What is the duct that is outside of the lobule called
extra- lobular terminal duct
or
segmental duct
What is another name for the intra-lobular terminal duct
sub-segmental duct
What is the ducts called that is inside the lobules
intra-lobular terminal duct
or
sub-segmental duct
Together the lobule and extralobular terminal duct makes up what
TDLU (terminal ductal lobular unit)
Where specifically does cancer begin?
TDLU (terminal ductal lobular unit)
What takes the milk to the nipple
lactiferous duct
The lactiferous duct is connected to the
extra lobular terminal duct
_____ ____ is directly inside the nipple
lactiferous sinus
What happens to the lactiferous sinus when nursing
it dialates and acts as a milk reservoir
What is used to classify how big the cancer is
staging
what is used to classify how fast the cancer is growing
grade
Refers to cancer inside the milk ducts
ductal carcinoma
What is the most common form of breast cancer
ductal carcinoma
Refers to cancer in the lobules
lobular carcinoma
Subgroup of cancer that remains in the area it originated
in situ
Subgroup of breast cancer that have spread to neighborign regions from where it began
invasive
What is the smallest functional unit of the breast
acini
what small units are found in the TDLU and help produce milk
acini
What are the three layers of the cells in a duct
luminal epithelium
myoepithelium (Muscle)
Basement or basel membrane
The inner layer of a cell that actually secrets cells of the TDLU
luminal epithelium
What layer of the cell do cancers begin on a cellular level
luminal epithelium
What is the middle layer of the cell that acts as a barrier to keep everything inside the duct
myoepithelium
What is the outer layer of the cell that holds it all together and responds to hormonal fluctuation
basement or basel membrane
The ____ brest receives 60% of the blood supply via the ___
medial
internal thoracic (mammary) artery
The medial breast receives ___ % of the blood supply fromt he internal thoracic mammary artery
60
The internal thoracic mammary arter is a branch of the
subclavian artery
The ___ breast receives 40% of the blood supply from four cessels coming off the ____
lateral
axiallary artery and the intercostal artery
The lateral breast receives ___ % of the blood supply from four vessels coming off the axillary artery and the intercostal artery
40
What are the 4 vessels that supply the lateral breast
lateral thoracic branches
thoracoacromial branches
lateral mammary branches
mammary branch
What two branches of the axillary artery help supply the lateral breast with blood
lateral thoracic branches
thoracoacromial branches
What two branches of the intercostal artery help supply the lateral breast with blood
lateral mammary branches
mammary branch
What vein drains the medial breast
internal thoracic mamary vein
the internal thoracic mammary vein drains the ___ breast
medial
The axillary vein drains what portion of the breast
lateral
What drains the skin over the breast of lymp
superficial lymphatics
The superficial lymphatics drain what?
the skin over the breast
The __ ____ drain the parecnchyma glands of the breast, the nipple and areola
deep lymphatics
The deep lymphatics drain what?
the parenchyma gland of the breast, the nipple and areola
____ ____ receive 75-90% if lymph drainage
axiallary nodes
Axillary nodes receive what percent of lymph drainage
75-90%
___ ___ receive 10-25% of lymph drainage
parasternal nodes
Parasternal nodes receive what percentage of lymph drainage
10-25%
what 4 areas are lymphnodes found in the breast
clavicular
axillary
intramammary
parasternal
Why is the lymphatic drainage of the breast of great clincal importance
it helps in the spread (metastasis ) of breast cancer
the more glandular tissue you have the more ___ your breast are
dense
BIRADS A
fatty
BIRADS B
scattered
25-50%
BIRADS C
heterogeneous
BIRADS D
Dense
Central ray enters superiorly and exits inferiorly, what view?
CC
(craniocaudal)
what view can you see the breast medial/lateral top to bottom
CC
what view do you see the breast inferior/ superior and anterior/posterior
MLO
Cental ray enters medialy and exits laterally and the patient is obliqued with an angle on the machine
MLO
What are the fixed anatomical borders
medial
superior
What are the mobile anatomical borders
lateral
inferior
What are the two benefits of using the mobility principles
- minimal tissue is displaced during compression
- maximizes the amount of tissue visualized
What view best demonstrates the medial tissue
CC
What is a projection limitation of the CC view
You might miss the tail of spence in the lateral tissue
Other than the medial tissue, what tissue will you see on the CC view
central, retroareolar and some lateral
What is the criteria in determining if you have an optimal CC view
- all posterior tissue visualized
- poertior nipple line (PNL) measures withing 1 cm of MLO
- nipple in profile and ventered
How do you know if you have all the posterior tissue visualized in the CC view
the retromammary spcae is seen
Pectoral muscle is seen in teh CC view on what percent of patients
30-40%
True or False
If the patien has an active infection in the IMF she will need to reschedule her mammogram
True
Where does the technologist stand for the CC view
medial side of the breast she is imaging
Which way should the patients head be turned for CC view
toward the medial side of the breast being imaged
When brigning the patient in for the CC view, you want to elevate the breast until what point
the PNL is perpendicular to the chest wall
In the CC view you want to elevate the IR to what level
The elevated inframammary crease
What type of pulling in method do you want to use when doing a CC
bi-manual pull-lift (lift up and over the IR)
During a CC view, after you have pulled and lifted you want to slide your ____ hand out toward the nipple and your ___ hand anchores the breast down
bottom
top
In the CC view the nipple will always point towards what?
missing tissue
In the CC view you should have a ____ light field across the posterior portion of the breast
straight
What can a dark black line on a CC view indicate
that you have air gap
How can you avoid airgap in a CC view
push the abdomen back and down
In the CC view, an arm around the back will encourage what 3 things
- straight shoudlers
- softened shoulders
- posterior tissue inclusion
In the CC view lifting up on the skin under the clavicle will help what
lighten the tugging sensation on the chest wall
To help with lateral fold in the CC view what can be done
palce hand on the side of the IR
what view best demonstrates the lateral tissue
MLO
the MLO view best demonstrates what tissue
lateral
The CC view best demonstrates what tissue
medial
In the MLO you see tissue from the ___ to the ___
axilla
IMF
What criteria helps determine if you have an optimal MLO view
- all posterior tissue is visualized from the axilla to IMF
- convex pectoral muscle to level of the nipple (PNL)
- breast lifted up and out
- IMF visualized and open
In the MLO you want to angle the IR so that it is
parallel to the pec muscle
In the MLO when the correct angle is used optimal ____ is achieved
compression
The ACR recommened what angle for shorter, heavier people
30-40
The ACR recommened what angle for average height and weight
40-50
The ACR recommened what angle for tall and slender people
50-60
In the MLO view you want the IR to line up with the
mid axillary line
In the MLO the corner of the IR is between the ____ ___ and the ___ ___
latissimus dorsi
pectoral muscle
What will squeezing the handrails in a MLO view do ?
make the muscle concave
In the MLO, when sweeping behind the lateral breast to the ___ ____ ____ , lift the breast tissue away from the IR using a ___ hand
mid axillary line
flat
Airgap in the MLO view will cause what
folds
In the MLO view allow the abdomen to be ___ ___ of the IR
in front
In the MLO view the paddle should fall just below the ____ and on the edge of the ___
clavicle
sternum
In the MLO view you want to ___ the belly down but do not push it off
elongate
In the MLO, improper stance can cause what
droopy or camels nose
Optimal compression is reached when
the breast feels taught
or
slightly less than painful, whichever comes first
Adequate compression is determeied by the patients __ ___ and its ___ ___
tissue type
maximum compressibility
which portion of the breast will compress more rapidly
posterior
Where should tautness of the breast be checked
anteriorly
when the IR is up too high on the CC what tissue will you lose
posterior /inferior
When the IR is down too low in the CC view what tissue is lost
superior
Other than superior tissue loss, what other issue is created when the IR is down to low on a CC view
air gap
When the IR is up too high on an MLO what tissue is lost
inferior
When the IR is too low on an MLO what tissue is lost
superior
In the MLO view, if the pectoral muscle is vertical what is wrong
IR too high
In the MLO view, if the pectoral muscle is concave what is wrong
grippling or angle
In the MLO view, if you have inadequate muscle what is wrong
not stepped forward enough
What are the 3 main reasons for quality control
- reduce exposure to the patients and personnel
- ensure adequate and consistent patient image quality
- detet and correct for potential problem
what is the goal for screening mammography
find breast cancer in asymptomatic women early enough to optimize a womans chance of a full recovery
Find breast cancer in asymptomatic women early enough to optimize a womans chance of a full recovery - what is this done with
screening mammograms
To assure very lin in the mammogrpahy imaging chain is workign optimally in order to ensure images of diagnostic and final interpretive quality at the lowest possible radiation dose is ____ ____
quality control
what are 3 things that quality control is not
- detailed technical evaluation of the unit
- detailed measure of limits of a unit
- not the optimization of the unit
- detailed technical evaluation of the unit
- detailed measure of limits of a unit
- the optimization of the unit
These are all asses on what?
The annual medical physicist survey
According to MQSA, full field digital mammogrpahy machines QC must use the quality control manual from
the manufacturer
FFDM Quality Controls is ___ for every manufacturer
different
What are the 8 QC tests done by mammographers
- phantom image
- compression thickness
- viusal checklist
- acquisition and radiologist workstation monitors
- repeat analysis
- viewing conditions
- compression fprce
- manufacturer detector calibration
what two things does the phatom image QC test check for
quality
artifact
what two things does the acquisition and radiologist workstation monitors QC test look for
- monitor cleanliness
- monitor calibration and test pattern
What QC test ensures that he image acquisition chain is consistenly producing adequate image quality and that artifacts are not clinically significant
Phantom image
What is the performance criteria for the phantom evaluation
2 fibers, 3 speck groups, 2 masses
no artifacts that interfer with image quality
How often is the phantom evaluation QC test performed
weekly
what equipment is needed for the phantom image evaluation QC test
2016 ACR DM phantom
ACR DM phantom image quality form
The ACR DM phantom used for the phantom image QC test simulates what
a 4.2 cm compressed breast iwth 50/50% fat/glandular tissue
What is the corrective action for a failed phantom evaluaiton
before clinical use
For the phantom image QC test what IR and paddle size do you want to use
the largest available that is used for imaging
How many lbs of pressure is used for the phantom image QC test
approximately 12 lbs or 5 daN
In the phatom image QC test you are evaluating for both ____ ____ ____ and ___ ___
broad area artifacts
detailed artifacts
non-uniformities, blotches and streaks that are usually best seen while observing the phantom image as a whle and not in peices
broad area artifacts
black and white pixels, clusters of pixels, lines or dust particles that are suaully best seen while observing the phantom image at full spatial resolution, where one pixel on the display matches one pixel in the image or with magnificaiton, using a zoom factor greater than 1.0
detailed area artifacts
Banding its a type of what kind of artifact
broad area artifact
ghosting is a type of what kind of artifact
broad area artifact
Dead pixels are a type of what kind of artifact
detailed area artifact
Artifact evaluations are assigned as a ____ if the artifacts are present that impeded clinical interpretation
fail
Artifact evaluation fail if
the artifacts impede clinical interpretation
Artifact evaluations ___ if the image is free of artifacts or artifacts are clinically insignificant
pass
Artifact evaluations pass if
if the image is free of artifacts or artifacts are clinically insignificant
3 reasons an artifact evaluation would fail is if
- artifacts are as promiment as the visible test object
- artifact obscure test objets in the phantom
- artifacts could affect clinical interpretation
In the phantom image QC test he artifact should eb identified and isolated to dertmine it it orginiated from what 3 areas
- monitor
- detector
- xray system
Test that ensures compression thickness is within tolerance
compression thickness
How often should the compresion thickness be performed
monthly
What equipment is needed for the compression thickness test
an object aht is < 10 cm wide and long and 4-6 cm thick
What is the criteria for performance of the compression thickness test
accurate to +/- 5cm
If the compression thickness test fails when should it be corrected
within 30 days
When counting fibers what counts as a full length fiber for a full point
> or = 8 mm
When couting fibers what counts as half of a point
at least half of the length (> or = 5 mm and <8 mm)
When couting speck groups how man specks need to be visible to count as a full point
4-6 points
When counting speck groups, how many specks need to be visible to count as a half point
2-3 specks
When counting masses what counts as a full point
- density difference is visible
- continuous border (> or = 3/4)
- circular
when counting masses what counts as a half point
- density difference is visible
- border not continuous ( > or = 1/2)
When counting fibers, if there is a break in the fiber if its less than ____ it still is counted
the width of the fiber
When scoring fibers, specks and masses you count until reaching
0 or 0.5 then stop
When scoring the phantom evaluation how many fibers, specks and masses must be present
2 fibers
3 specks
2 masses
When doing the compression thickness test, the phantom should be flush with the ___ ____ and centered ____
edge wall
laterally
What compression paddle is used for the compression thickness indicator
spot compression paddle
When performing the compression thickness QC test, if a spot compression paddle is not available what paddle should be used
the smallest non-flex compression paddle available
True or False
The flex function is on during the compression thickness indicator test
false
How much force should be applied during the compression thickness indicator test
10-15lbs
The compression thickness indicated must be accurate to ____ from the actual thickness of the phantom
+/- 0.5cm
What QC test ensures that digital mammography x-ray system indicator lights, displays, mechanical locks and detents are working properly and that the mechanical rigidity and stability of the equipment is optimum
visual checklist
How often should the visual checklist be performed
monthly
What equipment do you need for the visual checklist
visual checklist form
What is needed for the visual checklist to pass
checkmarks in all the boxes indicating that everything is working properly
What things in the visual checklist are considered critical and need to be repaired or replaced before clinical use
- cleaning solution must be available
- all locks must work properly
- paddles/faceshields must not be cracked
- the breast support must not be cracked
- the DBT assembly must move as designed (through range of motion)
The following are considered _____ on the visual checklist and must be repaired _______
- cleaning solution must be available
- all locks must work properly
- paddles/faceshields must not be cracked
- the breast support must not be cracked
- the DBT assembly must move as designed (through range of motion)
critical
before clinical use
What things in the visual check list are considered less critical and need to be rapaired within 30 days
- magnfication stands and paddles must be dust free
- indicators must be working
- the collimator light must be working
- cables must be safely positioned
- The c arm motion must be smooth
- the compression paddle motion must be smooth
- Items missing from the room should be replaced
The following are considered ____ ____ on the visual checklist and need to be repaired ___
- magnfication stands and paddles must be dust free
- indicators must be working
- the collimator light must be working
- cables must be safely positioned
- The c arm motion must be smooth
- the compression paddle motion must be smooth
- Items missing from the room should be replaced
less critical
within 30 days
What is the purpose of the technologist acquisition (AW ) and Radiologist Review (RW) workstation monitor QC test
to ensure that:
- monitors are clean
- monitros are calibrated (brightness/contrast appropriate)
- monitros meet manufacturere specifications
How often do the AW and RW workstation monitor QC need to be done
monthly
What equipment is needed for the AW and RW workstation monitor QC tests
- dry soft lint free cloth
- AAPM TG18-QC pattern or SMPTE test pattern
- for RW an ACR digital mammogrpahy (DM) phantom image
For the AW/RW testing what pattern do we use in our facility
SMPTE
During the AW and RW monitor testing, what three things need to be evaluated on the test pattern image
- are the 0-5% contrast boxes visble (grey in white box)
- are the 95%-100% contrast boxes available (grey in black box)
- are the line pair imags at the cnter and four corners visible and clearly distinguishable
If the test image quality and monitor manufacturer automated test fails when does it need to be corrected
within 30 days
What QC test ensures that the mammogrpahy system can provide adequate compression in both manual fine adjustment and hands free, intial power drive moes, that the quipment does not allow too much compression to be applied when used in initial power drive mode and that adequate copresion can be maintained throughout image acquisition
compression force
How often is the compression force test done
every 6 months (semi-annually)
What equipment is needed for the compression force test
- calibrated, flat analog bathroom scale
- towels
What amount of force do you use during the compression force test
between 25-40lbs or
111-200 newtons or
11.1 - 20 daN
If the compression force does not pass when does it need to be repaired
before clinical use
What two modes do you need to test the compression force
inital power drive and manual fine adjustment mode
What QC test is used to determine the number and cause of repeated mammograms
repeat analysis
What does the analysis of the repeat analysis provide
Identify ways to improve efficiency and reduce patient exposure
How often should a repeat analysis be performed
as needed
How many patients should a repeat analysis be done on
at least 250 patients
What is the criteria for a passing repeat analysis
The overal repeat rate should be 2% or less, but a rate of 5% is adequate if the radiologist and physicitst agree this is a reasonable amount based on body habitus of patients seen
What 3 things are not considered in a repeat analysis
- wire or other localiztion images
- additional views needed to image the entire breast for larger breasted women
- quality control images
Poor positioning, patient motion, patient caused artifacts, incorrect patient ID are all forms of what type of repeat
patient related repeats
Exposure too low (excessive noise), exposure too high (image saturation), equipment caused artifacts, x-ray equipment failure, software failure, aborted automated exposure control exposure are what types of repeats
technical repeats
Blank images, good image ( no apparent reason), other-miscellaneous
miscellaneous repeats
Wire localizations, 1-125 seed localization, additional views to image the entire breast, quality control are considered what kind of repeats
They do not count as repeat
What is the repeat analysis performance criteria
The overall repeat rate should be below 2% or less but a rate of 5% is adequate
What does too low or a no repeat rate indicate during a repeat analysis
that poor image quality is being tolerated
What does a reason for repeat that is significantly higher indicate
that there is an area for potential improvement
If the repeat rate exceeds the selected acceptance level of either 2% or 5% or if it changes by 2% from the previous measured rate what should happen
it should be investigated and corrective action shuld be taken
Any corrective action should be recorded on the ____ ___ ____
corrective action log
The effectiveness of the corrective actions should be assessed by another repeat analysis how soon after
the next quarterly repeat analysis
How soon should corrective action on a repeat analysis be done
within 30 days
What QC test ensures optimal viewing condition in teh radiologist reading room
viewing conditions
How often does the viewing condition QC need to be done
daily
What equipment is needed for viewing condition
viewing conditions check and setting form which is posted in teh reading room during the most recent meidcal physicist evaluation
What performance criteria must be met for viewing conditions
viewing conditions must meet medical physicist requirements
If the viewing conditions dont meet the performance criteria how soon must corrective action be taken
before diagnostic reading of images
When viewing diagnostic images ___ contast and ___ resoluation is optimal
high
high
When viewing diagnostic images high ____ and high ____ is optimal
contrast
resolution
___ is the maount of light coming out of the monitor
luminance
____ is the amount of ambient room light shining down on the review workstation (you want this as close to zero as possible)
illuminance
In reading rooms the illuminance shoud be
under 20 lux
___ ___ or high ____ decreases contrast
ambient light
illuminance
Ambient light or high illuminance decreases ____
contrast
ACR DM phantom image evaluation is done how often
weekly
How often should the compression thickness indicator be done
monthly
How often should the visual checklist be done
monthly
How often should the acquisition workstation monitor QC be done
monthly
How often should the review workstation monitor QC be done
monthly
How often should the compression force QC test be done
semi-annually
How often should the repeat analysis be done
as needed
How often should the manufacturer calibration QC be done
manufacturers recommendations
How quickly should corrective action be taken with a failure in the ACR DM phantom image evaluation QC test
immediate
How quickly should corrective action be taken with a failure in the acquisition workstation monitor QC test
immediate
How quickly should corrective action be taken with a failure in the review workstation monitor QC test
immediate
How quickly should corrective action be taken with a failure in the compression force QC test
immediate
How quickly should corrective action be taken with a failure in the visual checklist critical tests
immediate
How quickly should corrective action be taken with a failure in the Visual checklist less critical tests
30 days
How quickly should corrective action be taken with a failure in the compression thickness indicator
30 days
How quickly should corrective action be taken with a failure in the repeat analysis
as needed
How quickly should corrective action be taken with a failure in the manufacturer calibration
manufacturers recommendation
What does BIRADS stand for
Breast Imaging reporting and data system
What is a BIRAD
a quality assurance tool published and trademarked by the ACR
BIRADS satared our for use in mammography and later adapted to what two other modalities
ultrasound
MRI
What are the assessment categories for BIRADS
0-6
What is the BIRAD category for someone that needs addiational imaging evlauation and or prior mammograms for comparison
Category 0
What is the likelihood of cancer with someone with a BIRAD of 0
n/a
What is the BIRAD for a negative exam
category 1
What is the managment of someone with a category 1 BIRAD
routine mammography screening
What is the likelihood of cancer with someone with a BIRAD 1
essentially 0% chance of malignancy
What is the BIRAD of a probably benign exam
category 3
What is the management if somone with a category 1 BIRAD
routine mammography screening
What is the management of someone with a category 3 BIRAD
shrot interval (6 month) followup or continued survelliance mammography
What is the likelihood of cancer with someone with a BIRAD 2
essentially 0% likelihood of malignancy
What is the likelihood of cancer with someone with a BIRAD 3
>0% but = 2% likelihood of malignancy
What is the BIRAD for a suspicious mass
category 4
What are the 3 subcategories of a BIRAD 4
4A
4B
4C
A BIRAD 4 of low suspicion for malignancy is subcategorized as
4A
A BIRAD 4 of moderate suspicion for malignancy is subcategorized as
4B
A BIRAD 4 of high suspicion for malignancy is subcategorized as
4C
What is the management for a BIRAD 4
tissue diagnosis
What is the likelihood of malignancy for a BIRAD 4
> 2% but <95%
What is the likelihood of malignancy for a BIRAD 4A
>2% but = 10%
What is the likelihood of malignancy for a BIRAD 4B
>10% to =50%
What is the likelihood of malignancy for a BIRAD 4C
>50% to <95%
What BIRAD is highly suggestive of malignancy
category 5
What is the management of a BIRAD 5
tissue diagnosis
What is the likelihood of malignancy for a BIRAD 5
>/= 95%
What is the BIRAD for a known biopsy proven malignancy
category 6
What is the management for a BIRAD 6
surgical exision when clinically appropriate
BIRAD 0
need addiation imaging evaluation and or prior mammograms for comparison
BIRAD 1
Negative
BIRAD 2
Benign
BIRAD 3
probably benign
BIRAD 4
suspicious
BIRAD 5
highly suggestive of malignancy
BIRAD 6
known biopsy proven malignancy
What are the mammographic appearance in order of severity
asymmetry
focal asymmetry
mass
calcifications
architectural distortion
An area of fibro-glandular tissue seen on only one projection is known as
asymmetry
asymmetry
an area of fibro-glandular tisse seen on only one projection
asymmetry is mostly caused by what
superimposition of normal breast tissue
focal asymmetry
an area of fibro-glandular tissue seen on two projections but only on one side
an area of fibro-glandular tissue seen on two projections but only on one side
focal asymmetry
What QC test corrects for non uniformities in the detector matrix
detector calibration
Detector calibration should be done how often
per manufacturer
What corrective action should be taken if a detector calibration fails
per manufacturer
What is the performance criteria for the detector calibration QC test
per manufacturer
When should corrective action be taken if the detector calibration fails
per manufacturer
mass
something a little more substantial and has volume and occupies space
something a little more substantial and has volume and occupies space
mass
Masses can be many things including ____, ____, _____
cyst
noncancerous tumors
or a sign of cancer
When is a mass suspicious
when its denser in teh middle than towards the edges
A mass found during a mammgraphy will be described according to its ___ , ___ and ___
shape
density
margins
____ of a mass refers to the amount of fatty elements present
density
Density of a mass refers to what
the amount of fatty elements present
When the density of a mass is high (little evidence of fatty tissue), what does that indicate
highly suspicous of cancer
If there is very little fatty tissue in a mass this indicated that the mass has a ___ ____
high density
Breast cancers are never ___ ___
fat containing
It is rare but not impossible for breast cancer to be ____ _____
lower density
What 5 shapes can a mass be decribed as
round
oval
irregular
architectural distortion
lobulated
What are the 5 margins that a mass can be described as
circumscribed
indistinct
spiculated
obscured
mico-lobulated
Describe the mass shape
round
Describe the mass shape
oval
Describe the mass shape
lobulated
Describe the mass shape
irregular
Describe the mass shape
architectural distortion
Describe the margin shape
circumscribed
Describe the margin
obscure
Describe the margin
microlobulated
Describe the margin
indistinct
ill defined
Describe the margin
spiculated
What does circumscribed mean
smooth and well rounded
Malignant or benign
hard painless lumps
malignant
Malignant or benign
masses with irregular edges
malignant
Malignant or benign
lumps that are fixed to skin or the chest wall
malignant
Malignant or benign
skin changes such as dimpling
malignant
Malignant or benign
Nipple discharge that is bloody
malignant
Malignant or benign
nipple retraction
malignant
Malignant or benign
smooth and rubbery painful lumps
benign
Malignant or benign
masses with well defined edges
benign
Malignant or benign
lumps that move under skin or in tissue
benign
Malignant or benign
no skin changes
benign
Malignant or benign
nipple discharge is more more likely to be colored
benign
Malignant or benign
no nipple retraction
benign
What mass shapes are considered to be benign
round
oval
lobulated
What mass shapes are considered malignant
lobulated
irregular
architectural distortion
what mass margins are considered benign
circumscribed
obscured
micro-lobulated
what mass margins are considered malignant
micro lobulated
indistinct /ill defined
spiculated
Calcification are present in what percent of mammograms
85%
Calcifications increase with what
age
What percent of calcifications are associated with breast cancer
50%
Calcifications are described according to what 4 things
location
distribution
morphology (shape)
udnerlying etiology (cause of)
What 5 things do radiologist look for in calcifications
density
distribution
change over time
number
size
What is the term used for the palcement of calcifications in the breast
distribution
Distribution of calcifications randomly through the breast is called
diffuse
Distribuation of calcifications occupying a large portion of the breast is called
regional
Distribution of calcifications with few calcifications occupying a small portion of the breast is called
grouped
Distribution of calcifications arranged in a line is called
linear
Distribution of calcifications that are deposits in a duct or ducts and their branches
segmental
What is the standard imaging for calcifications
mag views
Calcifications can vary in size from ___ to ___
mm to cm
What are the three different mag views that are used to image calcifications
spot mag
regular mag
tangetial mag
When is the tangential mag used
for skin calcifications
Calcifications that are poorly defined, clustered, variable densities, varialble shapes, and in only one breast are considered
suspicious for malignancy
calcificaitons that are well defined, scattered, same density, ring like, round and in both breasts are considered
benign
Dystriohic, skin calcificaitons, vascular calcifications, milk of calcium, rod like and popcorn calcifications are considered
benign
What 6 types of calcifications are considered benign
dystrophic
skin calcificaitons
vascular calcifications
milk of calcium
rod like
popcorn
___ ___ ___ layers in the lateral view like a teacup
milk of calcium
Term used for calcifications that are so small and/or hazy in appearance that a more specific shape cannot be determined
amorphous or indistinct
Calcifications that are termed amorphous or indistinct are what
so small and or/hazy in appearance that a more specific shape cannot be determined
What percent of biopsied amourphous/indistinct calcifications are malignant
20 %
Calcifications that are irregular, clearly visible and are between 0.5mm and 1mm are termed
coarse heterogeneous
What type of calcifications are irregular, clearly visible and are between 0.5mm and 1mm
Coarse heterogeneous calcifications
What percent of biopsied coarse heterogeneous calcifications are malignant
15%
Calcifications that are defiend as discrete calcifications with irregular margins, vary in size and shape, and usually smaller than 0.5mm are termed
fine heterogenous
Fine heterogenous calcifications are defined as
discrete calcifications with irregular margins, vary in size and shape and are usually smaller than 0.5mm
Calcifications that are usually more clearly visble than amorphous forms and are seen to have individual, separate and distinct shapes, without fine linear and linear branchign forms and are usually <0.5mm are called
fine pleomorphic
What percent of biopsied fine heterogenous are malignant
30%
What percent of biopsied fine pleomorphic calcifications are malignant
25-40%
Calcifications that are thin, linear irregular and may be discontinuous with occasionally branching forms that can be seen and are usually <0.5 mm are termed
fine linear or fine linear branching
A sac-like picket of tissue that contains fluid, air or other substances
cyst
What type of cyst has smooth thin walls that are filled with fluid. Ultrasound waves pass through them indicating there are no solid areas
simple cysts
What type of cycts are always benign
simple cysts
What type of cyst contains somethign besides clear fluid.
complex or complicated cyst
What type of cyst usually needs close follow up and somtimes a biopsy
complex (complicated) cysts
A milk filled cyst common in young pregnant or breast feeding women
galactocele
What is a galactocele
a milk filled cyst common in young pregnant or breast feeding women
When do galactoceles most commonly occur
when breast feeding has stopped
What causes a galactocele
when milk become stagnant within the breast ducts
True or False
Galactoceles are always benign and does not increase your of breast cancer
true
Benign tumors composed of stromal and epithelia elements
fibroadenoma
True or False
Multiple or complex fibroadenomas may indicate a slightly increased risk for breast cancer
true
The relative risk is approximately ____ of a patient of similar age without firoadenoma
twice
A pocket of fat that is encapsualted by a thin fibrous capsuel
lipoma
A slow growing tumor that most commonly occur in post-menopausal women
lipoma
True or False
Lipomas are extremely rare and only occur in the breast
false - they are very common and can occur in many areas of the body
What results from a benign proliferation of fibrous glandular and fatty tissue
hamartoma (fibroadenolipoma)
What is another term used for a hamartoma
fibroadenolipoma
Hamartomas are surrounded by a thing capsule of
connective tissue
Hamartomas are thought of as a ____ within a ____
breast
breast
What term describes when the lactiferous duct widens, the duct wlals thicken and the duct fills with fluid
ductal ectasia
During ducatal ectatia, the lactiferous duct ____ and duct walls _____ and the ducts fill with ____
widens
thicken
fluid
Ductal ectasia can cause ____ nipple discharge
green
Ductal ectasia occurs in ___ or ____ menopausal women
peri or post
True or False
Ductal ectasia does not increase breast cancer
True
Ductal ectasia causes the milk duct to become ____
blocked
A blood filled swelling caused by trauma to the breast
hematoma
____ are common after breast bopsies
hematoma
Hematomas can also cause _____, ____ and ____ ____
inflammation
fever
skin discoloration
Hematomas may leave behind ____ tissue that can mimic what
scar
the shape of a breast tumor
a bacterial infection that causes th breast to become red and inflammed
mastitis
Most breast abscesses occur due to complications of ____
mastitis
Mastitis most commonly affect _____ women
breastfeeding
Women who ____ habe an increased risk of developing non-breastfeeding mastitis
smoke
True or False
Mastitis will affect both breastfeeding and non-breastfeeding women, with breastfeeding women being affected more often
true
Damaged or dead tissue
fat necrosis
___ ____ can occur following a needle biopsy, and breast surgery (including recondrutction or radiotherapy)
fat necrosis
What does fat necrosis feel like
firm round lump that is generally painless
What is another term used for fat necrosis
oil cyst
Does fat necrosis (oil cyst) go away on their own
yes, but sometimes need surgery to remove them
Small clumps of immune cells that act as filters for the lymphatic system
lymph nodes
The lymphatic system rusn throughotu the body like the _____ system and carries ____ and ___
circulatory
fluid and cells
The ____ lymph nodes are the first-place breast cancer is likely to spread
axillary
A common disorder of the endocrine system in whcih there is a noncancerous increase in the size of male breast tissue
gynecomastia
True or False
Gynecomastia can be unilateral or bilateral
true
____ use can be a cause gynecomastia
marijuana
An are of hardening of the breast tissue that can occur as the breast ages
radical star
A radial scar can mimic ____
malignancy
What is another term for a radial scar
complex sclerosing lesion
Having a radial scar causes and ___ - ___ % higher risk of breast cancer
8-30%
How is a radial scar removed
surgically
It is not unusual for a radial scar to contain a small amount of
malignant cells
Benign or Malignant
Cyst
benign
Benign or Malignant
galactocele
benign
Benign or Malignant
Fibroadenoma
benign
Benign or Malignant
Lipoma
benign
Benign or Malignant
Hamartoma ( fibroadenolipoma )
benign
Benign or Malignant
ductal ectasia
benign
Benign or Malignant
Hematoma
benign
Benign or Malignant
Breast absecess
benign
Benign or Malignant
Fat necrosis (oil cyst)
benign
Benign or Malignant
Gynecomastia
benign
Benign or Malignant
Radial scar
benign
Benign or Malignant
Papilloma
benign but high risk
A tumor growing in the ducts inside the nipple with finger like frond
papilloma
What does a papilloma feel like, and what can it cause
small lump near the nipple
nipple discharge and bleeding
How are papillomas diagnosed
with ultrasound or ductogram
Papillomas can be with ____
atypia
How is a papilloma removed and what will happen
surgically and it will be tested for atypical cell growth
Benign or Malignant
Lobular carcinoma
malignant
LCIS
lobular carcinoma
Cells that look like cancer cells are growing in the lobules but they dont grow through the wall of the lobules
lobular carcinoma
LCIS is not considered to be ____
cancer
Having lobular carcinoma ____ your risk of breast cancer
increases
True or False
LCIS (lobular carcinoma) does not cause a lump that can be felt or changes that can be seen on a mammogram
true
How are most lobular carcinomas found
when doing a biopsy for another breast issue
Benign or Malignant
Atypical ductal hyperplasia
Atypical lobular hyperplasia
benign
Increased cellular activity in the ducts or lobes and surrounding tissue
atypical ductal hyperplasia
atypical lobular hyperplasia
How to the cells appear in atypical ductal hyperplasia and atypical lobular hyperplasia
irregular non-standard structure
Atypical ductal hyperplasia and atypical lobular hyperplasia is not a form of ___ ___ but ____ your risk
breast cancer
increases
Benign or Malignant
Ductal carcinoma in situ (DCIS)
malignant
Benign or Malignant
Invasive/Infiltrating ductal carcinoma
malignant
DCIS
ductal carcinoma in situ
The presence of abnormal cells inside a milk duct
ductal carcinoma in situ (DCIS)
What is considered the earliest form of breast cancer
Ductal carcinoma in situ (DCIS)
DCIS that has not spread out of the milk duct to invade other parts of the breast
non-invasive
Cancer that began growing in the duct and breaks the wall of the duct and grows into the fatty tissue of the breast
Invasive /Infiltrating ductal carcinoma
IDC
Invasive/ infiltrating ductal carcinoma
What is the most common form of breast cancer
invasive / infiltrating ductal carcinoma
Invasive/ infiltrating ductal carcinoma represents ___% of all breast cancers
80%
Benign or malignant
Invasive lobular carcinoma
malignant
What breast cancer begins in the lobules of the breast
invasive lobular carcinoma
What type of malignancy doesnt typically form a lump
invasice lobular carcinoma
What breast changes occur in the breast with invasive lobular carcinoma
thickening or fullness in one part of the breast that is different from the surrounding tissue
A raare and very aggressive disease in which cancer cells block lymph vessels in the skin of the rbeast
inflammatory carcinoma
Most inflammatory breast cancers are what kind of cancer
invasive ductal carcinoma
What type of cancer usually starts with reddenign and swelling of the breast instead of a distinct lump
inflammatory carcinoma
Orange peel skin is an indication of
inflammatory carcinoma
Malignant cells extend from the lactiferous ducts to the nipple
Pagets disease
A patients with pagets disease will present with
nipple and areolar thickening
with and without a palpable lump
What is rare and accounts for only 1% of all breast cancers
pagets disease
Pagets disease can be either in-situ or ___
invasive
Pagets disease accounts for __% of all the breast cancers
1%
True or False
Pagets diesase of the breast isnt related to pagets disease of the bone
true
Breast ___ refers to a relative group of rare breast tumors
sarcoma
What are 5 types of sarcomas
angiosarcoma
pleomorphic sarcoma
fibrosarcoma
myxofibrosarcoma
leiomyosarcoma
primary osteosarcoma
Breast sarcomas begin where
in the connective tissue that supports the ducts and lobules
Sarcomas can be _____ or _____ tumors
primary or secondary
What term is used to describe a tumor that occurs from previous radiation to the chest
secondary tumor
Sarcomas tend to be ____ than other types of breast tumors and can show up int ____ women
larger
younger
Benign or Malignant
Pagets disease
malignant
Benign or malignant
sarcoma
malignant
Sarcomas present how
as large non-spiculated dense masses
A neoplasm which originate in lymph tissue
lymphoma
What is the the most common symptoms of lymphoma and where is it generally located
painless breast mass located in the outer quadrants
Lymphoma can cause enlarged lymph nodes in the ___ and ___-
neck
armpit
Is lymphoma considered to be cancer?
no, but its difficult to distinguish in the early stages
All components of our equipment are based on what principle
low dose, high contrast
The primary radiation that goes int the patient, get partially absorbed as it travels through the patient and hits the IR
attenuation
The ___ ___ produced by an object depends on its attentuation of the x-ray beam
image contrast
Breast masses often has the same ___ as the surrounding tissue making them difficult to see
attenuation
What 3 materials are the targets (anodes) made out of in mammography
molybdenum (Mo)
Rhodium (Rh)
Tungsten (W)
The system will choose the target thats best for the _____ ____ and ___
tissue type and thickness
What are filters generally used for? and what does mammography use them for
to reduce scatter
enhance contrast
What are the 4 types of filters used in mammography
Molybdenum (Mo)
Rhodium (Rh)
Aluminum (Al)
Silver (Ag)
In general what two type of filtration does mammography have
inherent
added
What type of filtration includes parts of the x-ray tube and tube housing
inherent
The exit window of the tube housing is made of
Beryllium
What 4 things (parts of the tube) are included in the inherent filtration
exit window
oil in the tube
mirror assembly
compression plate
What type of filtration has thin sheets of metal inserted in the x-ray beam
added filtration
Rhodium, silver, molybdenum, and aluminum are what type of filtration
added
What are the two roles of added filrations
- removes soft photons which add dose
- removes higher energy photons which reduce contrast
What are the 6 target/filter combinations that can occur
Molybdenum/Molybdenum
Molybdenum/Rhoidum
Rhodium/Rhodium
Tungsten/Silver
Tungsten/Rhodium
TUngsten/Aluminum
What is the best target/filter combination for average breasts
Molybdenum/Molybdenum
A grid is used to ____ ____and _____ ______
absorb scatter
improve contrast
Grids absorb what percentage of scatter
75-85%
What is the downfall to using a grid
increase patient dose
Why does the grid move during the exposure
to blur and reduce the visibility of grid lines
The working ability of the grid is described by the ___ ____
grid ratio
The ratio of height of the lead strips to the distance between the lead strips (the interspace)
grid ratio
The higher the grid ratio the better the ____ ____ but at a cost of ____ ____ ___
image contrast
increased patient dose
What grid ratios are used in mammography
3:1 to 5:1
What grid frequency is used in mammography
30-50 lines per cm
What are the two types of grids that are used in mammography
linear/focused
honeycomb/ HTC
What is another name for a linear grid
focused
What is another name for a honeycomb grid
HTC
True or False
Grids are always used in routine mammography imaging
true
What views NEVER use a grid
magnification views
HTC
high transmission cellular
What type of grid reduces scatter in two directions
HTC
HTC grids reduce scatter in how many directions
two
what type of grid results in less radiation to the patient
HTC
What is the interspace material in HTC grids
air
What type of grid reduces scatter from only one direction
linear
Linear-focused grids reduce scatter in how many directions
one
What grid results in higher radiation to a patient
linear-focused grid
What is the interspacing material of a linear-focused grid
carbon
What is one of the essentials of effective mammography
compression
The compression paddle shall ot extend beyond the chest wall edge of the image recptor by more that what percent when compressing an average breast
1%
How far should the breast be compressed
unitl its taut or slightly less than painful (whichever comes first)
What are the 6 benefits from compression
- more uniform breast thickness
- better visualization of chest wall tissue
- better exposure
- reduced blurring from patient motion
- reduced scatter radiation dose
- improved contrast
What are used to accomodate a breast that wont compress flat
flex and curved paddles
True or False
The shadow of the vertical edge of the compression paddle shall not be visible on the image
true
In mammography the exposure field is chosed by what
the size paddle you have attached
What is the biggest field of view that is used in mammography
24cm x 30 cm
True or False
collimation is used in mammography
false- paddle size determines the light field
The light field will come all the way to the ____ ____ and not exceed the edge by more than ___%
chest wall
2%
The light field brightness should provide an average illumination of not less than ___ ___ (____ ___ ) at ____ ____ or the maximum SID whichever is less
160 lux (15foot candles) at 100 cm
The light field is checked how often and by who
annually
physicist
The radiation shield in front of the operator station must have an equivalent attenuation of at least ____ mm of lead at __ kVp to limit operators exposure to below __ mSv per week
0.08
35
1
The area of the anode (target) bombarded by electrons
actual focal spot
What focal spot doesnt change
actual focal spot
The downward projection of the actual focal spot is called the
effective focal spot
The effective focal spot is dependent upon what
the steepness of the anode angle
The steeper the angle the ___ the effective focal spot
smaller
The steeper the angle the better the ____
detail
The smaller the effective focal spot the better the ___
detail
To produce a sharp image, focal spots need to
be small but able to withstand heat without melting the anode
A large focal spot is used when a ___ ___ ___ is priority
short exposure time
Mammography tubes have how many focal spots
2
A mammography tubes large focal spot measures ____ and is used for ___ ___
0.3mm
standard imaging
Mammographys small focal spot measures _____ and is used for ______ _____ only
0.1mm
magnification imaging
Mammography focal spots are generally ___ than other modality focal spots
smaller
Why are mammogaphy focal spots smaller than other modality focal spots
because of the requirements for minimal blurring and good visibility of detail
Who will run tests for estimating the size of your effective focal spot
physicist
When a physicist tests the size of the focal spot what do they base it off of
what the manufacturer states the sizes are
The steep (Verticle) target creates a ___ xray field where the CR is not in the _____
narrow
center
When we tilt the mammography tube (with a less steep angle) we get a ____ xray field
wider
When the x-ray tube is tilted and the field is wider the CR is in the ___
middle
When tilting the anode and creating a wider field of view the beam is not all uniform, what is this called
anode heel effect
The intesnsity of the x-ray beam which is ot all uniform in all portions of the beam
anode heel effect
The anode acts as a filter, which we refer to as ___ ___
self filtration
The rays towards th cathode end of the tube have ___ __
more intensity
Why does the cathode side rays have more intesity
because they have less of the anode to travel through
Which side of the tube has more dose
cathode
The rays towards the anode side are ___ ___
less intense
Why are the rays on the anode side less intense
beacuse they have more anode to travel through and are more absorbed
What side of the xray tube has less doese
anode
How do we use the anode heel effect in mammography? The stronger part of the beam is aimed towards what part
the thickest part (chest wall)
The focal spot measures the ____ on ___ side nearest the _____
smallest
anode
nipple
Whereever the focal spot measurese the smallest will proivide the _____ ____
highest resolution
If the CR is in the center of the body what tissue is missed
posterior
In half field geometry, if the tube is moved closer to the patient it prevents the beam from getting into the ___ ____
lung field
What controls the wavelength of the x-ray beam
kVp
kVp is the ___ ___ of the beam
penetrating power
kVp influences ____ and ___ ____
contrast
exposure latitude
Determinng proper kVp depends on what 3 things
breast composition
thickness
target/filter
A unit of radiographic exposure equal to the product of milliamperage (mA) and the exposure time in second (S)
mAs
What controls the xray beam intensity
mAs
mAs conrols the xray beam
intensity
The mA is used to control the image
blackening
mA stations are ____
fixed
Why are mA stations fixed?
Because the focal spots are so small that the anode could get burnt out if the mA was too high
What is the typical mA selection is
20-100 mA
What are typical times that are used in mammography exposures
0.4 to over 1 second
If calibration is not maintained what can happen to the mA
could drift out of acceptable tolerances
Back up timers are needed to avoid what
gross overexposure
What is the maximum back up time for grid and non-grid work
600 mAS (grid)
300 mAs
How can you avoid the back up timer
using higher kVp
The back up timer will kick in if we try to photo time what an
implant
dense fluid/filled breast
The functionality of the AEC depends on
manufacturer
The emerging x-ray beam is determined by 3 factors
kV
anode material
filter material
kV is the kilovoltage the generator supplies to the what
cathode
What does the kV supplied to the cathode do
causes it to heat up and send electrons toward the anode
What are the varying energies of xrays called
keVs (kiloelectron volts)
The higher the kV the ___ the keV
higher
The kV applied to the generator is chosen by the ____
operator
What two types of radiation are produced by the emerging xray beam
bremsstrahling
characateristic
What type of radiation is produced in the form of multiple energies (keV)
bremmstrahling
What is the most common type of radiation produced
bremsstrahling
The maximum energy (keV) is determiend by the selected ___
kV
What type of radiation is confed to 2 energy spikes that are determined by the anode material
characteristic radiation
What radiation is most important for determining x-ray beam penetration and giving us optimal contrast
characteristic
Why have molybdenum anodes traditionally been used in mammography
because Mo produces the characteristic radiation that is optimal to penetrate an average breast resuling in optimal contrast
Which target material produces the most optimal contrast
molybdenum
Molybdenum anodes produce characteristic radiation spikes of ____ and ____
- 6 keV
- 7 keV
Rhodium andoes are used for what type of breasts
larger and denser breasts
Rhodium produces characterisitc radiation of ____ and ___
- keV
- 7 keV
Tungsten produces characteristic radiation of ___ and ___
59
68
____ targets have super high energies
tungesten
What is the downfall with using a tungsten target
its high energies obliterate contrast
What target material couldnt be used with film but is used with digital
tungsten
When using a tungsten target, the contrast can be brought back by ___ and ____ and dose can be ____ with a higher penetrating beam
window and level
lowered
What is insereted into the x-ray beam to block the higher energies of the bremsstrahlung radiation that would cause a decrease in constrast
filter
The filters ____ is how the filter is able to achieve its filtration of the beam
k-edge
The boundary between photon energies that are not attenuated and the photon energies that will be attenuated is the ___
k-edge
The k-edge is determined by the ___ ___ of the filter material
atomic number
Molybdenums k-edge is ___
20
Molybdenums k-edge is 20 keV which means what
it filters xprays with energies above 20 keV
MO filter supresses energies lower than __ keV which would only add ___
15
dose
When the Mo filters otu energies above 20 keV, it acts to ___ ___
decrease contrast
Rhodium filters have a k-edge of _____ which means it filters x-rays with energies ___ ____
23.22
above 23.22
The rhodium filter is used with what kinds of breasts and why
larger breasts that need higher penetration
Rh filters supresses engeries lower than ___ keV which would only add ___
15
dose
Achieving the correct x-ray specturm is critical to optimizing ___ and ___
contrast
dose
what 3 steps are there to achieving optimal x-ray spectrum
- choose appropriate anode
- choose appropraite filter materia
- choose appropriate kV
The MQSA law state the maximum permissible dose for one view of an average breast is ____ or ____
300 mRad
3mgy
The distance between the xray source and the imaging receptor
SID
What is the average SID in mammography
65-66 cm
What constitutes as an average breast
50% dense 50% fatty compressed to 4.2 cm
SID is determined by what 3 things
- geometry of the tube
- tube angle
- machine design
The distance from the breast to the imaging receptor
OID (object to image distance)
An increase in OID will result in____ of an area of breast tissue
magnification
Magnificatoni increases the possibility of ____ , how do we compensate for this
unsharpness
use a small focal spot to gain detail
With magnification our techniqed has a reduced ____ and increased ____ to not burn out the tube
mA
time
What is the typical time for Mag views
2-4 seconds
Most units have Mag factors of what
1.5 and 2.0
The larger the magnification factor the ____ the image, but what decreases ______ _____
larger
image resolution
Why are grids never utlized with magnification views
the air gap reduces scatter so the grid isnt needed
What imaging views never use a grid
magnification
True or false
dose is abotu the same as regular mammogram images
true
Who performs the mammgraphy equipment evaluation (MEE)
physicists
What test is to ensure that mammography equipment meets section 900.12(b) of FDAs final rule for mammography and complies with MEE- only required tests
mammography equipment evaluation (MEE)
What is the frequency of the mammography equipment evaluation test (3)
new units
after relevant service
after component replacement
What tests purpose is to ensure that the xray field aligns with the light field, ensure tha thte collimartor allows for full coverage of the image receptor (while not allowing significant radiation beyond its edges) and to ensure tha tthe chest wall edge of the compression paddle aligns acceptable with the chest wall edge of the image receptor
collimattion assessment
Who performs the collimation assessment
physicist
What is the frequency in with the collimation assessment should be done
For 2D:
- as part of MEE for new units
- after relavent service
- after component replacement
For DBT
- as part of MEE
- after relaveant service
- annually
Who performs the spatial resolution (line pair) test
physicist
What test is used to measure the limitng spatial resolution as an indicator of detector performance
System resolution and spatial resolution (line pair) test
How often should the system resolution and spatial resolution test be done
- MEE of a new unit
- after a relavant service
- annually
Who performs the room illuminance (ambient light) test
physicist
What test is used to evaluate the reading room environment where the RW resides for appropariate ambient light levels for mammography interpretation
room illuminance (ambient light)
___ is extremely important in mammography image and is degraded by extraneous ___
constrast
ligher
How often should the room illuminance (ambient light) be tested (4)
- RWS QC
- MEE of new equipment
- after relavant service
- annually
Who performs the evaluation of technolgists QC program
physicist
What test ensures that technologists QC is being perfoemd correctly, to compare the QC technologists and the medical physicists ACR digital mammogrpahy phantom scores and to identify areas where image quality and QC testing can be improved. To enable the medical physicist to provide an external assessment of quality and possibly compare image quality and WC practives with those of other mammography tests and to present an opportunity for the medical physicist to provide or recommend further eduction to the QC tech
evaluation of technologist QC program
How often should the evalutation of technologist QC program be done
annually
What test ensures tht mammography equipment meets section 900.12 (b0b of FDAs final rule for mammography and complies with MEE -only required tests
application of compression
Who does the applications of compression testing
physicist
How often should the application of compression test be done (3)
- MEE of new units
- after relavant service
- after component replacement
What test ensures that adequate compression is applied uniformly over the breast for paddles tha tare designed to be flat and parallel to the breast support
compression paddle deflection
Who does the copression paddle deflection test
physicist
How often should the compression paddle deflection test be done (4)
MEE of new units
after relevant service
after component replacement
annually
What test states the following
the compression paddle shall be flat and parallel to the breast support table and shall not defelct form parallel by more than 1 cm at any point on the surface of the compression paddle when compression is applied
compression paddle alignment according to MQSA
Paddles that are designed to not be flat and parallel to the breast, shall mee what requirements
manufacturers design specifications and maintenance requirements
The chest wall edge of the compression paddle shall be ___ and _____ to the edge of the image receptor
straight
parallel
The chest wall edge may be bent upward for patient _____ but shall not appear on the image
comfort
What test is done to ensure that AW monitors are clean and free from dust, fingerprints other marks that may interfere with clinical information. To ensure that monitors are calibrated correctly and brightness and contrast settings are set correctly and that mintors meet manufacturer specifications via the conduct of monitor manufacturer automated testes
AWS QC
Who performs th AWS QC
physicist
How often should the AWS QC be done
MEE of new equipment
after relevant service
annually
What test is the same as the RWS
interpretation RWS QC
How often should the interprestation RWS QC be done (3)
- MEE of new equipmemt
- after relvant service
- annually
IRSD
image receptor support device (ie. IR, detector)
What type of view may be needed to include normal anatomy and may be obtained at the time of screeing without radiologist approval
supplemental views
What is the most common supplemental view
XCCL
What type of exam views are used for detailed imaging evaluation of a specified area, trying to locate or triangulate a specific lesion and are radiologist directed
diagnostic view
what is the most common diagnostic view
90 degree lateral
What is the labeling code for a mediolateral (90 degree)
ML
What way does the CR travel for a mediolateral
medial to lateral
What view best demonstrates the lateral lesions
ML (mediolateral )
What are the 4 purposes of a mediolateral view
- orthoganal view used in triangulation of a lesion
- demonstrates benign milk of calcium
- resolves superimposition of glandular tissue
- demonstrates lateral lesions
In a mediolateral view what side of the breast is closest to the IR
lateral
What is the labeling code for a lateromedial (90 degree)
LM
What direction is the central way traveling for a lateromedial view
lateral to medial
What are the 4 purposes of a lateromedial view
- orthognal view used to triangulated lesion location
- demonstrates benign milk of calcium
- resolve superimposition of glandular structures
- demonstrates medial lesions
what view demonstrates medial lesions the best
lateromedial view
When doign 90 degree laterals how much time should you wait to allow for fluid to settle
2 minutes
What portion of the breast is closest to the IR in a lateromedial projection
medial
Benign sedimented calcifications in macro or micro cysts
milk of calcium
In milk of calcium, a typical feature is apparent chane in ___ on different projections
shape
When a lesion is seen on MLO but not on a CC, what projection should be done to help determine location on a CC using triangulation principles
90 degree lateral
What is the order of images in triangulation to determine lesion location
CC, MLO, ML
If the lesion moves down in the ML compared to the MLO where is the lesion located
on the lasteral aspect
If the lesion moves up on the ML compared to the MLO then the lesion is located where
on the medial side of the CC breast
Using triangulation if the position of the lesion does not shift significantly on the ML when compared to the MLO what is the location of the lesion
it is located central on the CC breast
When a lesion is seen on the CC and not seen on the MLO , what views can be done
15 degree obliques
90 degree lateral
When a lesion is seen on a CC and not the MLO, instead of doing 15 degree obliques some radiologists may decided to do what other imaging
tomogram
ultrasound
What is the labeling code for an exaggerated craniocaudal lateral
XCCL
What direction does the CR travel for a exaggerated craniocaudal alteral
superior to inferior
During an XCCL you may angle the IR toward the lateral side __ - ___ degrees
0-10
During a XCCL the nipple points toward the
opposite corner of teh IRSD
During a XCCL the compression paddle should fit tightly against the _____ _____ just anterior to the _____ ________
chest wall
humeral head
During the XCCL if the humerial head is in the way how can you compensate
use angle
What are the two purposes of a exaggerated craniocaudal laterl (XCCL)
- demonstrates anatomy that may extend to the outer aspect of the breast not visualized by a standard CC
- ideal for patietns with prminent tail of spence and glandular extensions
What view demonstrate the following
- orthognal view used to triangulated lesion location
- demonstrates benign milk of calcium
- resolve superimposition of glandular structures
- demonstrates medial lesions/lateral lesions
LM (lateromedial)/ML (mediolateral)
XCCLs are needed on what percent of screenings
10%
Most patiets have some ___ ___ in the tail of spence, some more _____ and some more ____
glandular tissue
lateral
posterior
What is the labeling code for exaggerated craniocaudal medial
XCCM
What direction does the CR travel for a exaggerated craniocaudal medial
superior to inferior
In an XCCM you want to exaggerate the patients body so the ___ portion of the breast is centered
medial
IN a XCCM, the nipple points toward the
lateral corner of the IR
What view is ideal for visualizing extreme medial anatomy and pathlogy
exaggerated craniocaudal medial (XCCM)
What is the purpose of the XCCM
ideal for visualizing extreme medial anatomy and pathology
What is the labeling code for the cleavage view
CV
What direction does the central ray travel for the cleavage view
superior to inferior
What views purpose is to visualize anatomy and pathology in the deep posterior and medial aspects of both breasts
cleavage view
The cleavage views purpose is to visualize anatomy and pathology in the ___ ___ and ___ aspects of both breasts
deep posterior
medial
What two things do you want to make sure to do when performing a cleavage view
- ensure ther eis no tissue overlapping before applying compression
- separate the breasts slightly
In the CV (cleavage view) you may use a ____ ____ paddle if ROI is included
spot compression
What is the labeling code for the axillary tail
AT
What direction is the CR traveling in the axillary tail view
medial to lateral
The axillary tail view is used as a supplemental view for greater tissue inclusion for patients with _____ ____ but shouldnt be used as a supplemental view for a ______________
special circumstance
poorly positioned MLO
What is the labeling code for a rolled medial
RM
What is the labeling code for a rolled lateral
RL
what direction is the CR traveling in a rolled medial view
superior to inferior
what direction is the CR traveling in a rolled lateral view
superior to inferior,
What are the 3 purposes of rolled medial and rolled lateral view
- separate superimposed breast tissue
- confirm the presence of an abnormality
- determine the location of fiding seen on only one view (CC)
What view demonstrates the following
- separate superimposed breast tissue
- confirm the presence of an abnormality
- determine the location of fiding seen on only one view (CC)
rolled medial and rolled lateral
What does the rolled medial and rolled lateral view help determine
if the lesion is superior or inferior
In a rolled medial view, what tissue is rolled medially
superior
In a rolled lateral view, what tissues is rolled laterally
superior
In a rolled medial view what direction is the inferior tissue rolled
lateral
In a rolled lateral view what direction is the inferior tissue rolled
medially
In a rolled CC view (RM/RL) if the lesion rolls in the same direction as the superior hand what portion of the breast is the lesion in
superior
In a rolled CC view (RM/RL) if the mass rolls in the opposite direction of the superior hand where is the lesion
in the inferior tissue
What is the labeling code for a rolled superior view
RS
What is the labelling code for a rolled inferior
RI
What direction is the CR traveling for a rolled superior view
medial to lateral
What direction is the CR traveling for a rolled inferior view
medial to lateral
What view is used to
- separate superimposed breast tissue
- confirm the presence of a lesion
- determine the leacion of finding seen on only 1 view (MLO)
RI
RS
The rolled inferior and rolled superior views are used to determine if a lesion is
in the medial or lateral tissue
In a rolled MLO view, the lesion is in what area if the lesion rolls in the same direction as the top hand
medial
In a rolled MLO view, the lesion is in what area if the lesion rolls in the opposite direction as the top hand
lateral
In a rolled superior view, the top hand is rolled ____ and the bottom hand is rolled ____
superior
inferior
In a rolled inferior view, the top hand is rolled ____ and the bottom hand is rolled ____
inferior
superior
When is the anterior compression used
on a MLO when the portion of the breast is not compressed until it is taut
According the ____ at least ___ view on each side must have the nipple in profile
ACR
one
The term used when it is only seen on one view (CC or MLO)
asymmetry
The term used when it is seen on both view (CC and MLO)
focal asymmetry
What is the purpose of a spot compression
- greater reduction in thickness reduces OID
- displaces tissues overlying ROI
- improves definition for more dtailed evaluation of asymmetry, architectural distortion of density
What view does the following
- greater reduction in thickness reduces OID
- displaces tissues overlying ROI
- improves definition for more dtailed evaluation of asymmetry, architectural distortion of density
spot compression
ROI
region of interest
What are the 3 measurements needed to determine a lesion location for a spot compression
- depth relative to a line drawn directly poseriot from the nipple
- distance from line one to the lesion in the superior/inferior (ML)/LAT) OR medial lateral direction (CC)
- distance from the lesion to the skin
Additional focal compression is ___ uncomfortable
more
What is the labeling code for magnification
M
What paddles are used during magnification
spot compression
smaller MAG paddle
What are the different sizes of mag stands (3) and what are they influenced by
- 5
- 8
- 0
IP preference
True magnification is determined by two things
breast thickenss
lesion location
Mag ML views are best done with how much of a delay
2 minute
What is the purpose of magnification views
- evaluation of characteristics of calcification
- used to characterize masses, asymmetries or architectural distortion
- may reveal unexpected findings not evident on standard views
What view determines the following
- evaluation of characteristics of calcification
- used to characterize masses, asymmetries or architectural distortion
- may reveal unexpected findings not evident on standard views
magnification
During the magnification view, the exposure time is ____ and the focal spot is ___
longer
.1mm
How do you determine the lesion location for the mag view
with the 3 measurement technique
What pathology can a tangential be used for
when there is a palpable lump or skin calcifications
What is the labeling code for a tangential
TAN
What is the purpose of a tangential for a palpable lump
- for palpable lesions that are not visualized or are obscured by breast tissue
What view is done for palpable lesions that are not visualized or are obscured by breast tissue
tangential
During a tangential the CR travels in what direction
perpendicular to the BB-nipple line
What is the process for a tangential view
- place a BB directly over the lump
- Rotate the IR approximately parallel to line from BB to nipple
In a tangential view how far do you rotate the IR
until it is parallel to the BB to nipple line
The tangential maneuver places the palpable lump directly over the ____ ____ which allows ____
subcutaneous fat
visualization
What is the purpose of a tangential for calcification
To verify whether mammographic calcifications are located in the skin
What view is done to verify whether mammographic calcifications are located in the skin
tangential for calcification
During a tangential for calcification what type of compression paddle needs to be used
open grid compression
During a tangential for calcification you should position the skin with the calcifications closets to what
the grid window of the compression paddle
During a tangential for calcifications the IRSD is rotated to what position
parallel to the BB to nipple line
During a tengential for calcifications the breast is rotated until
the BB is tangent to the beam
Labeling code ML
90 degree mediolateral
Short purpose of an ML
localize define
LM
lateromedial
Short purpose of LM
localize define
XCCL
exaggerated craniocaudal lateral
short purpose of the XCCL
localize supplement
XCCM
exaggerated craniocaudal medial
short purpose of XCCM
localize supplement
CV
cleavage
short purpose of CV
localize
AT
axillary tail
short purpose of AT
localize define supplement
Women with ___ glandular tissue have a higher risk of breast cancer
dense
women who used ____ (medication) during pregnancy have a higher risk of breast caner
diethylstilbestrol (DES)
What are the 4 major factors affecting dose
- xray beam energy
- imgaing chain
- compression
- patients breast tissue type
Enterance skin exposure from a single exposure should be what dose
800-1200 mrad (812 mGy)
___ mammography is administered to detect breast cancer in wmen who have osymptoms
diagnostic
___ mammgraphy is typically administered when a woman has no known symptoms of breast cancer
screening
The microscopic examination of cell samples
cytological analysis
The part of the breast that makes the milk
glandular tissue
