TEST TEST TEST TEST TEST TEST 3 Flashcards
a suspicious lesion that turns out negative after a diagnostic work up will be deemed
A false positive
A neoplasm that originates in lymph tissues, but is not actually breast cancer
lymphoma
Immediately behind the niple is the pouch like orfice called the ____ or____ ____
ampulla
lactiferous sinus
placement of the calcifications within the breast
distribution
a biopsy technique in which a fine needle is used to aspirate or remove cells from a localized breast lesion for pathological evaluation
fine needle aspiration
what is used in mammography to assure radiation dose not enter into the lung field
half field geometry
a female hormone which stimulates the development of the rbeast and later is essential for starting and continuing milk production
prolactin
all mammography machines are created to produce what
high contrast images at a low patient dose
Routine mammography work utlizes the __ focal spot
large
small clumps of immune celks that act as filters for the lymphatic system
lymph nodes
benign condition of fat cells beneath the skin
lipoma
The breast extends vertically from the clavicle at what rib?
2nd or 3rd
If microcalcifications are present in a specimen, they should be ____ and ___
counted and noted
pixel size determines
spatial resolution
consent given verbally
oral consent
the size of the image matrix is determined by the
number of pixels
calcifications that are often seen in the breast after surgery and radiation therapy
sutural calcifications
External beam radiation usually begins _____ ____ after surgery
1 month
what is the maximum allowable dose per view in mammography
300 mrad
3mGy
What QC test: assess the quality and consistency of images
phantom images
curved radiopaque line seen around lesions containing fat
halo sign
a thin flat triangular muscle that lies deep to the pectoraliz major muscle and covers the serratus anterior and the external oblique muscles
pectoralis minor
where is the lateral border of the breast
mid-axillary line
Which feature of calcifications would be least likely to be benign
a. clustered together
b. found in both breasts
c. scattered
d. well defined
clustered together
what is the kev of molybdenum
17.6-19.7
The repeat rate should be analyzed if the rate changes from the previous measure rate by more than
2%
The ACR and AMA recommend a SBE how often and starting at what age
every year at 40
Phantom imaging: if the same evaluation is reading the results the objects in each group should not decrease by more than ___form one pahtom evaluation to the next
1/2
what equipment is needed for viewing conditions
window cleaner, soft towels, illumination levels, and assure sources of bright light arent present
what benign feature are you looking for when you do a LM or an ML
milk of calcium
women with dense breasts are how muych more likely to develop breast cancer
1.5 to 2 times higher
calcifications >0.5 mm in diameter
coarse
the absorbed dose is ___ the entrance skin exposure
significantly lower than
lack of breast compression is most likely to cause
motion unsharpness
rare and aggressive cancer cells that block lymph vessels in teh skin of the breast that starts with reddenign and swelling of the breast
inflammatory carcinoma
accessory glands of the female reproductive system
mammary glands
how many pounds of pressure do you exert on the pahntom in teh spot compression indicator
10-15 lbs
What is the most common type of breast cancer
ductal carcinoma
True or false
monitor manufacturer automated QC is elective if offered with the monitor
false - if it is offered it its mandatory
pear-like densities resembling teacups or pearl drops on the lateral projections
milk of calcium
under MQSA how many mammograms must you perform every 2 years to stay legal
200
univeral language for the storage and transmission of images for the medical community
DICOM
a missed malignancy on a screening mammogram is referred to as a what
false negative
area of hardening can mimic malignancy
radial scar
radiolucent, low density, smooth boarders, halo sign and capsule are all characteristics of a ___ lesion
benign
true or false
failures of the critical visual checklist tests must be corrected before clinic use of the equipment
true
Computer aided detection (CAD) has 2 major roles
detection/classification
true or false
When evaluating the DBT phantom, scroll to the slice or slab in which the test objects are best visualized
true
smaller the pixel, the ____ the spatial resolution
higher
Surgery and reconstruction after breast cancer does not fall under ___ ____
cosmetic surgery
evaluation of lactiferous ducts when there is spontaneous nipple discharge
galactography or
ductography
which modality has greater accuracy in samplin dense masses and and requires only 1 pass
vacuum assisted biopsy
the larger focal spot may be ___ but is generally __ mm
- 4
- 3
what is the corrective action time frame of a failed compression thickness indicator
30 days
collimation should not extend beyond the detector edge by more than what percent
2% of the SID
The most substantial limitation for a FNB is
the rate of insufficient sampling
occur in the TDLU when the extralobular terminal duct becomes blocked and the normal ductal secretions are not reabsorbed quickly enough and fluid begins to accumulate
cysts
The principle of mobile versus fixed tissue is used in mammography positioning to image the maximum
medial breast on the MLO
the pathological examination of body tissue that has been removed from the body
biopsy
During pregnancy and lactations, the breast has an increased amount of
a. morgagnis tuberccles
b. glandular tissue
c. montgomery glands
d. all of the above
all of the above
what does the actual focal spot measure
the area on the anode that is exposed to electrons
line pairs per millimeter is the unit of
spacial resolution
What quadrant would 7:00 clock in the right breast lie
lower outer
symptoms of warm, orange peel, flattening or inversion of the nipple or aching and burning
inflammatory carcinoma
what is the advantage of proper compression
a. reduced motion
b. separation of glandualr tissue
c. lower dose
d. all of the above
all of the above
Breast entrance exposure, AEC reproducibility, average glandular dose and radiation output rate evaluation. Physicists test how often and what is it
annually
measure typical entrance exposure to calculate the associated average dose
What is the most common cancer killer in the United States
lung cancer
the greater the bit depth, the more accurate is the __ ___
digital signal
What hormone is reponsible for ductal proliferation
estrogen
what type of capture turns x-rays into light
indirect
Typically the breast is located on the thorax between the levels of
2nd and 3rd
6th and 7th ribs
Both the ___ ___ and the ___ ___ of lymphatic vessels drain the breasts lymph
superficial plesus
deep plexus
How odten should the detector valibration frequency be doen
weekly
what are the name of the artifacts that appear sas non uniformities, blotches or streaks
broad area artifacts
This technique is used to obtain cellular material from teh area in question fro cytological analysis
fine needle biopsy
parenchymal tissue in the breast that shows up black or dark
adipose tissue
calcifications forming multiple flake like irregular clusters that can be microcalcifications or macrocalcifications and typically of intermediate concern
amorphous or indistinct
this layer is a soft polymer that protects the back of the IP
backing layer
what blood vessels are larger and more superficially located
veins
The posterior region on the chest is located where
closest to the chest wall
Most palpable lesions are best sampled under ___ guidance
ultrasound
what is the interface material of mammogrpahy linear grids
carbon
How long do breast centers have to keep a returning patients mammograms
5 years
the breast is made up of ___ tissue, __ (secretory) components, ___ vessels and ___ vessels
adipose, glandular, lymphatic, blood
what are the hormone receptors on the surface and inside of ells
proteins
an adjuvant therpay that involves the use of drugs to treat cancer that may have spread beyond the breast
chemotherapy
With menopaise comes a drop in what hormones
estrogen and progesterone
what is the name of th erpay used to shrink tumors before surgery
neo-adjuvant therapy
which statement is true regarding magnification in mammography
a. grids are used to decrease scatter
b. dose to the breast is unchanged
c. dose is decreased to the breast
d. grids are not used in magnification
grids are not used in magnification
grids with strips arranged in straight lines in one direction
linear
The photo conductor converts __ to ___
xrays to electrons
Which of the following represents tea cups on the ML or LM view
milk of calcium
a visual change in either breast contour or the nipple, often caused by an alteration in the tension of a coopers ligament on the skin or nipple
retraction
The removal of the contents of a cyst for testing or analysis
aspiration or fine needle aspiration
consent assuemd in an emergency situation where the patient is unable to make a decision
implied consent
The detectors ability to respond to different exposure levels
dynamic range
___ removes a sample of tisue unlike a FNB which removes ____ and ____
core biopsy
fluid
cells
what is the ideal size paddle to use to compress the pahntom during the weekly phantom evaluation
the largest paddle used clinically
the minimum frequency for the phantom to be performed is
weekly
the most common disorder that results in excessive deveopment of the male breast as a result of physiologival, hormonal, or pharmacological factors
gynecomastia
artifact caused by dust is more common in
computer radiography systems
calcifications 1 mm in diameter and often associated with ducts are what shape
linear or rod-like
The anterior region on the breast is located where
located behind the nipple
What is the purpose of the image quality evaluation by the physicist
evaluation of the SNR and CNR
A follow up BIRAD recommendation: must indigate suggested biopsy method is what category
category 4
What is the recommendations of the USPSTF for screening mammogram
40-49 on individual basis
50-74 mammogram every 2 years
after 75 no screenings
what is the #1 diagnosed cancer in woen in the US each year
breast cancer
The cancer is confined to the duct and does not invade the duct walls
ductal carcinoma in situ (DCIS)
A category 3 BIRAD equates to
probably benign
Under MQSA which of the following is NOT mandatory
having an M as a mammogrpahy technologist
morgagni tubercles are formed by opening of the ducts of the ____ ____
montgomery glands
a single binary digit of data, such as “0” or “1”
bit
The most lateral aspect of the breast
axillary tail or tail of spence
What is the name of the drug that is used to combat HER2+ breast ancer
herceptin
What does the E in EQUIP stand for
enhancing
phosphor cystal in the flat panel detector system are classified as ___ phosphors
turbid
___ ___ and ____ ____ is controlled mainly by the processing software and the algortithms that can be applied
image brightness
image contrast
____ ___ or ___ ___ is usually a result of increased cellular activity in ducts and surrounding tissues
sclerosing adenosis
ductal hyperplasia
the compression thickness indicator QC performance criteria needs to be accurate to what degree
+/- 0.5cm
Core biopies are done under guidance fo what 3 modalities
mammo, US, MRI
What breast tissue is best visualized on the MLO view
lateral tissue
true or false
lateral tissue is at the highest risk of beign missed on the CC view
true
When positioning the MLO the height of the image receptor should be no higher than the patients what
axilla
the averaging of each pixels frequency with surrounding pixels values to remove high frequency noise
smoothing
what is an advantage of a honeycomb grid
less dose to patient
Indirect capture steps
- xrays to scintillator
- scinillator (cesium iodide) converts - xrays to light
- light to photo diodes
- converts light to electric signal
- electrical signal sent to workstation
true or false
neo-adjuvant therpay is indicated for large tumors to shrink the size and conserve tissue
true
What i the most common error in a core biopsy
understanding the multifocality
discrete calcifications with irregular margins, vary in size and shape. 30% are malignant
fine heterogenous
Weekly densities of the weekly test films are with ___ of the operation level
+/- 0.15
most side effects from radiation will occur in ___ -____ months
6-12
What has the lowest false negative rates but is the most invasive and highest complication rate
open surgical biopsy
is copious discharge of blood from the breast
mastorrhagia
often is the pectoral muscle seen on the CC view
30-40%
how many mammography credits are required by MQSA every how many years for mammography tehcnologists
15 credits every 3 years
malignant type calcifications are often _____
microcalcifications
DEL
detector element size
True or false
in an axillary tail view, the IMF is optimized
false- the axillary tail is optimized
The middle region on the brest is located where
middle of the breast
What type of chemotherapy treatment is geiven before surgery to help shrink the cancerous tumor
neoadjuvant
In what year did the final MQSA regulations go into effect
1999
“T” in cancer staging
grades the tumore size and the spread of the skin or chest wall under the breast. 0-4 higher numbers indicate a larger tumor
an examination of the breast by the patient
breast self exam
what are the two roles of filtration
remove soft photons that increase dose
remove high energy that decrease contrast
if borders are ___ or ____ more testing will be needed to determine benign or malignancy
irregular or obscured borders
focal spot measurements report the actual or effective focal spot
effective
the removal of a tumor with excision of surrounding tissue. Lymph nodes are sometimes removed during this procedure
lumpectomy
what type of breast would you use a rhodium/rhodium combination on
super thick
True or false
for a rolled MLO inferior, your top hand travels superiorly
false - it travels the direction of the view (inferiorly)
fibrous and glandular tissues is ____ rodiolucent and will show as lower optical densities on mammograms
less
if a radiologist sees a lesion in the MLO but no teh CC what could you be asked to perform
a 90 degree lateral
which of the following is a rare and very aggressive breast cancer in which the cancer cells block lymph vesseles
inflammatory carcinoma
a cancer with marked predominance of connective tissue
scirrhus
What are two things that influences noncompliance
painful experience
unsympathetic technologist
True or false
Breast cancer cells can be ER+ , PR+ or ER- and PR-
true
what is the corrective action for a visual checklist
immediate
a thin tough layer of plastic that protects the phosphor layer from damage
protective layer
the effective focal spot is ___ than the actual focal spot, this is known as the ___ ______ _____
smaller
line focus principle
which of the following can you NOT count toward your 200 mammograms required every 2 years
a. needle localization
b. magnification view
c. diagnostic views
d. spot compression view
needle localization
how often is the manufacture calibrations evaluations preformed
manufacturers recommendation
Which of the following procedures might be done for unilateral bloody nipple discharge
galactography
where are the largest number of breast cancers found in the breast
upper outer quadrant
According to the ACR, for the MLO view, what angle should be used for a patient taller and more slender
50-60 degrees
Treatment of breast cancer with high energy radiaton to destroy the cancer cells in teh chest wall, axilla and breast
radiation therapy
what is the atomic number of a molybdenum filter
42
which target filter combination woudl never be used in mammography
Rh/Mo
what type of breast would you use a moly/rhodium combination on
thicker
have a central fibrous core with radiating arms made up of benign epithelial growth and sclerosis
radial scars
what is used to indicate where a biopsy has occurred
clip placement
To increase the changes of an even intensity beam across the breast, the thinnest part of the breast (near the nipple) is positioned at the ___ side
anode
What is the most commonly performed minimally invasive technique for biopsy
core biopsy
The layer of adipose or fatty tissue that separates the breast from the pecoral muscle
retromammary space
when scoring fibers score as ___ point if ___ or more of the fiber is visible and ___ point if the fiber appears to be equal or greater than ___ mm and less than ___ mm in length
1 pt: 10-8mm
1/2 pt: 5-8mm
what therpay is used for tripe negative breast cancer
chemotherapy
what equipment is needed for a visual checklist
visual checklist
Most reports of patent dose involve a fact check of the ____ only
enterance skin exposure (ESE)
The majority of breast disease occur in the ____
TDLUs
When hanging a CC correctly, where is the lateral aspect of the breast
on the top of the image
which target filter combination is used for a larger than overage but not extremely dense breast
Mo/Rh
increase OID results in what two things
mag views
increased dose
light shining down on the viewboxes
illuminance
what is the best modality for evaluating implants
MRI
an open grid compression paddle is used for which view
tangential
calcifications of the skin
dermal calcifications
The ____ ___ is the area that electrons stikes on the target
focal spot
whatis the anem of the artifacts that appear as non-uniformities, blotches or streaks
broad area artifacts
waht are two types of implant ruptures
extracapsular rupture
incapsular rupture
situated or occuring immediately beneath the skin
subcutaneous
crystals that produce lateral spreading of light, which reduces spaital resolution
turbid phosphors
true or false
ER/PR negative tumors have few or no hormone receptors
true
a condition of carrying a pregnancy past the point of viability of delivery a child
parity
what is the advantage of a tungsten target
decrease dose
aluminum is used as the filtration in
digital breast tomosynthesis tubes with tungsten targets
maignant cells extend from the lactiferous ducts to the nipple with or without masses
pagets disease
true or false
the labeling code for magnification is MAG
false -M
____ tissue predominates in older women
fatty
according to the ACR, for the MLO view what angle should be used for a patiet shorter and heavier
30-40 degrees
viewbox luminance and room illuminate evaluation. Physicists test how often?
annually
___ can reduce the need for a surgical biopsy
fine needle biopsy
which of the following is only a diagnostic view
tangential
if the calcifications are <0.5 mm in diameter
round or punctuate
For needle localization procedures, which views are used to localize the lesion
the CC and 90 degree
___ ____ ___ irradiates less healthy breast tissue
internal beam radiation
ALND
axillary lymph node dissection
what is the purpose of a filter
remove soft photons that do not contribute to image quality and to remove higher energy which reduces contrast
what is the purpose of the viewign conditions
checking the radiologist viewing condition
between the nipple orfice and the ampulla is a connecting duct called the ____ ____
lactiferous duct
what is the name of the endocrine disorder found in males
gynecomastia
what is the most commonly diagnosed breast cancer in the US
invasive ductal carcinoma
True or false
The corrective action procedure has to be documented for an inspector
false
True or false
the procedure fo LIP oversight of the QA/AC records does not have to be written policy
True
what material is used in the xray tubes window to allow photons to pass through
berylium
What 3 factors determine the mammo spectrum
kvp
anode material
filter in the beam
what percentage of breast cancers occur in women with no family history
85%
the smaller the pixel the higher the ___ ___
spatial resolution
what are the rules for lossless compression
2:1 ratio
only format for FFDM
no data loss
what focal spot size is used for standard mammography imaging
0.3mm
true or false
Ideally the repeat rate should be between 2-5%
false - ideally the repeat rate will be <2%
True or false
if an artifact is noticed on the phantom evaluation and foudn to come from the monitor you have 30 days to fix it
false - it needs to be fixed before th monitor is used
beneath the nipple/areolar complex; subcutaneous
subareolar
what is a milk filled lesion
galactocele
True or false
ACS no longer recommends that all women routinely perform the BSE
true
In analog units, the filters used are often the same element as what
the xray tube target
can mimic a radial scar
postsurgical scarring
producing definitive slides of biopsied tissue for pathology; takes 24 hours
permanent section
the beryllium exit window on the x-ray tube enhances contrast by
transmistting more low energy photons
what is the k-edge of a rhodium filter
23.3 kev
As the size of the focal spot decreases, the heating of the target is concentrated into a ___ area
smaller
When do the ARRT required additional mammograms need to be supervised
if you perform all 200 mammograms before taking the 40 hour course
Which of the following is not considered to be a risk of developing breast cancer
a. alcohol conspuption
b. smoking
c. being diagnosed with a benign breast condition in one breast
d. being diagnoed with hyperplasia
smoking
a benign process consisting of widened ducts containing thickened material
duct ectasia
which of the following does NOT need to be on a medical report
a. the name of the patient
b. the name of the interpreting physician
c. the name of the mammography tech
d. the name of the facility
the name of the mammography tech
Coopers ligaments attach posteriorly to
deep facial tissue in front of the pectoral muscle
what is the k-edge energy of a molybdenum filter
20 kev
Which of the followign is a reason facilities are getting a level 2 violation
a. interpreting physician not included in teh EQUIP process
b. EQUIP procedure is only verbally explained to inspector - nothing written
c. QA/QC peer review
d. RT reviews done only quarterly
interpreting physician not included in the EQUIP process
what is the purpose of a repeat analysis
determine the number and cause of repeates
image brightness is adjusted by changing
window level
the muscle lying immediately posterior to the breast is the
pectoralis major muscle
what are the personnel requirements to remain legal in mammography
15 CEU every 3 years
200 mammograms every 2 years
difference between simple and modified mastectomy
lymph node removal
development of benign cystic spaces within the ducts as a result of monthly hormone fluctuations that cause cysts to form throughout the breast tissue
fibrocystic changes
breast cancer is hereditary in about __-__% of cases
5-10
ERT is used on women who no longer have a ____
uterus
Using ultrasound, a thin, watery fluid with smooth borders. Anechoic
cyst
automatic compression should never exceed __ lbs ( ____ N) on the intial power drive
45 lbs
200 N
True or false
breast cancer cells can be ER+, PR+ or ER-, PR-
true
A mass or fast growing tissue which may be either benign or malignant
tumor
in routine mammography the glandular dose per projection is generally about
1-2 mgray
what is the characteristic radiation range produced by a molybdenum target
17-19 kev
17.9-19.5
The ___ ___ in digital allows visualization of the skin and penetration of dense breast tissue
wide latitude
True or False
Bening lesion will not change much in size or shape over time or will grow evenly, whereas malignant lesions can grow significantly over a 1-year period.
true
in what year was the mammography quality standards act passed
1992
how often is the radioliogist review workstation QC performed
monthly
lesions with a halo sign usually indicated the presence of a ____ lesion
benign
the microscopic examination of tissue
histological analysis
breasts that are similar in size, shape and composition of anatomy so that one breast is a mirror image of the other
symmetry
what focal spot size is used with magnification
0.1mm
one individual cell in a matrix
pixel
the breast is supplied with ___ and ____ function by the anterior and lateral cutaneous branches of the 4th, 5th and 6th intercostal nerves
sensory
sympathetic
a term applied to tumors which on section show a lobulated cauliflower appearance
phylloides
an average womans breast will typically have how many lobes
15-20
coopers ligaments are also known as
suspensory ligaments
True or false
EQUIP does not require the lead interpretive physician to oversee the QA/QC
false - the LIP is ultimately responsible to make sure QA/QC is done and corrective action taken is necessary
factors perceived by the affected individual only
subjective data
in edge enhancement the more pixels involved in the averaging the ___ the image appears
smoother
What is the newest type of breast implant placement
subfacial
what size needle would be used for vacuum assisted core biopsy
7-14 guage
not aligned along the trabecular stucute of the breast
multiple lobulated
randomly orientated
was passed by the United States Congress in october 1994 to ensure quality mammography for all patients and to improve and standardize breast imaging
mammography quality standards act (MQSA)
ratio of the height of the lead strips to the distance between them
grid ratio
The compression paddle used for a magnification is what
spot compression paddle
The final stage of any interventionla process is the ____ ____
pathology review
the number of bits per pizel determines the __ ___
bit depth
Ultrasound characteristic of a benin lesion is ___(white) thin capsule
hyperechogenic
On the MLO view, the pectoral muscle should be visualized down to where
the level of the nipple (PNL)
fast growing tissues
proliferation
True or false
written documentation of the clinical image review is required
true
MQSA became a law on
10/27/1992
which form of mastectomy removes only the breast tissue
simple mastectomy
what is one of the roles of filtration in mammography
removes high energy photons which decreases contrast
looks like a random pattern
architectural distortion
This begins in the connective tissue and is a primary or secondary tumor. These tend to be large at diagnosis.
sarcoma
single or in clusters where a cluster of microcalcifications are described as three to five calcifications within an area no larger than 0.5 -1.0 cm
number
which compression paddle is used with the compression thickness indicator QC test
spot compression paddle
PSP is associated with
computed mammography
______ will reword the questions to clarify information and can be used to verify that the patient has not changed his or her mind
repetition
under the nipple, veins form a venous network called the ____
virculous venosus
During a CBE, lump are felt in the lower breast more easily when the patient is
supine
fine, linear, or branching calcifications that can be fragmented with irregular contours and are often malignant are what type of calcification
casting type
Which fo the following is not a lymph node location in the breast
a. clavicular
b. axillary
c. thoracic
d. intramammory
thoracic
molybdenum has characteristic radiation at what energies
17.9 and 19.5
amount of light coming out 3000 cd/m22
luminance
What type of view is done without the permission from a radiologist
supplemental
compression paddle alignment evaluation. Physicists test how often and what is it
annually
paddle is flat and parallel to the breast
A firm round lump that develops following surgery, reconstruction or a needle biopsy is called what
fat necrosis (oil cyst)
What type of therapy is administered after sugery to attempt to keep any outlying cancer cells
adjuvant therapy
The taking of a sample specimen for cytological or histological analysis
breast biopsy
which principle has to do with the actual focal spot and the effective focal spot
line focus principle
______ is used to give the patietn time to remember and ensure accuracy
silence
how often should the phantom imaging be done
weekly
the small focal spot ranges from __- to ___ but hte most common size is ___
- 15-0.1mm
- 1mm
According to the ACR for the MLO view what angle should be used of ra patient of average height and weight
40-50 degrees
Under breast ultrasound, a lesion that is taller than wide might indicate what
a suspicious lesion
2 linear grids with one placed on top of the other with the grid lines perpendicular to each other is called
crossed
What percentage of the lymphatic drainage travels through the axillary lymph nodes
75%
These glands secrete a fatty lubricant, which protects the nipples during nursing
montgomery glands
what is the main purpose of the cleavage view
to visualize medial tissue
calcifications that are sharply outlined, spherical or oval are typically
benign
How long should a facility maintain records of a serious complaint
3 years
true or false
survival rate is the same in early breast cancer whether you do a lumpectomy and radiation or a mastectomy
true
assessing the mammography site qc program should be done how often
annually
damaged or dead tissue. Firm and round, does not increase risk of breast cancer
fat necrosis (oil cyst)
how long are facilities required to keep records of a patient who died shorly after the 1st mammogram
10 years
True or false
failures of less critical visual checklist tests must be corrected before clinical use of the equipment
false - the less critical test must be corrected within 30 days
Borders that are ____ are a strong indication for malignancy
spiculated
Estrogen and progesterone are produce by the
ovaries
mammary glands are sometimes referred to as ___ ____ _____
modified sebaceous glands
the removal of the breast
mastectomy
what corrective action must be taken for viewing conditions
replace fluorescent tubes every 18-24 months and replace them all at once
the target is angled to allow a larger area for the electrons to strike while maintianing a small effective focal spot
line-focus principle
pertaining to neoplasm
neoplastic
Implants can be placed in front of the pectoral muscle ____ or ____ implants, or behind the pectoral muscle ___ or ___
retromammary/subglandular
subpectoral/retropectoral
what imaging procedure might be used when a summation artifact or superimposition is seen on a 2D screening mammogram
3D breast tomosynthesis
what is kev
photon energy
what size focal spot is used with magnification
0.1mm
what is the most common type of mastectomy
modified radical mastectomy
___ tissue predominates in younger women
glandular
what is the minimum number of test objects that need to be visualized in the phantom evaluation
2 fibers, 3 speck groups, 2 masses
DMIST
digital mammographic imaging screening trial
who wil oversee your proof of 15 mammography credits every 3 years to remain legal
your annual MQSA inspector
CA stands for waht in teh EQUIP section for mammography
corrective action
the process of lobular regression
involution
which non surgical treamtent uses a seed inserted into the breast
brachytherpay
secretion of fluid from the nipple; spontaneous or elicited with pressure
nipple discharge
what is a disadvantage of a linear grid
higher dose to patient
anechoic
no echoes (black)
the energy released from the metastable is the form on a ___ -___ light
blue-purple
What is the corrective action if an artifact is noticed on the phantom and found to come from the monitor
it needs to be fixed before it can be used
These usually form as a result of fat necrosis or are calcifying hematomas
oil cyst
True or false
the procedure for documenting procedures when images are of poor quality does not have to be a written procedure
true
The breast extends medially from the ____ to the ____
mid-sternum to mid axillary line
What feature of the high transmission cellular grid allows these grids to maintain equal or less radiation dose ot the patient compeared with linear grids
copper strips and air interspace
True or false
the base of the breast is the inframammary fold
false
Frequency processing or spatial frequency filter is the averaging of the signal strength of one pixel with the strength of adjacent pixel or neighboring pixels
edge enhancement
fibrous, glandular and fatty tissue surrounded by a thin capsule of connetive tissue. thought of as a breast within a breast
hamartoma
fibroadenolipoma
Monitor calibrations use what two patterns
SMPTE pattern
AAPM tasks group 18 pattern
k-edge is determined by what
atomic number of the filter material
what 2 imaging factors are grids used to control
scatter and contrast
The ducts gradually ___ in size as they approach the nipple
increase
Which of the followign would not be considered critical on the visual checklist QC test
a. cleaning solutions need to be available
b. the breast support must not be cracked
c. locks working correctly
d. collimator light working properly
collimator light working properly
what anode will result in more penetrating xray beam to penetrate through the large dense breasts
rhodium
what structure keeps the epithelial cell layer intact
basement membrane
FAD
focal architectural distortion
irregular conspicuous calcifications that are generally 0.5-1.0 mm. About 15% are malignant
course heterogeneous
what are the rules for lossy compression
30:1 ratio
not allowed for FFDM
some data is lost
what is the order the 3 views should be palced in triangulation
CC,MLO,ML
kVp accuracy and reproducibility evaluation. Physicist tests how ofte and what is it
annually
kvp within +/- 5%
What are the 5 general tests of QC
- phantoms images
- visual checks
- repeat analysis
- viewbox and viewing conditions
- compression force
The main direction of drainnage from teh central and lateral half of the breast tends to be into the ___ group of axillary lymph nodes
pectoral
name the characteristic of a lesion that is typically malignant
a. oval
b. circumscribed
c. found in both breasts
d. spiculated
spiculated
benign tumors composed of stromal and epithelial elements. May slightly increase risk for breast cancer
fibroadenoma
What are the layers of a detector
protective layer
phosphor layer
conductive layer
support layer
light shield layer
backing layer
SIEP
superficial inferior epigastric perforator
Excisional biopsy is used to remove
entire lesions
RWS MQSA MP requirements
3MP monitors
analog = 50 lux
digital = 20 lux or less
How do the mammography machines compression paddles accommodate breasts that dont compress flat
compression paddles tilt
The first menses is called
menarche
the breast extents to mee the adominal wall at the level of what rib
6th or 7th rib
calcification of different shapes, irregular in form, size and optical density and are typically malignant
pleomorphic or granular
why is the rhodium anode used in a mammography unit
larger breast that need a more penetrating beam
Ultrasound characterisitics of irregular boarders, taller than wide, hypoechoic, and blood flow indicated what
a suspicisous lesion
what very rare breast cancer (less than 1%) starts in the connective tissue of the breast
sarcoma
True or false
Daily image reading takes away the need for periodic clinical image review
false - thi is one of the reasons for level 2 violation
MQSA only allows what type of compression
lossless
tumor growing in the ducts inside the nipple. Finger like, may cause nipple discharge or bleeding
papilloma
The latent image on the PSP can last several hours but will lose __ of its energy in _ hours
25%
8 hours
RWS stands for
review workstation
looks like cancer cells growing in the lobules but do not grow through the walle. Does increase your risk of breast cancer
lobular carcinoma
DMIST showed what?
that digital mammo is better at finding cancer in pre-menopausal women with dense breasts
adenosis with sclerosing of the intralobular stroma. This can present as calcifications or masses and is considered a benign and not a premalignant condition
sclerosisng adenosis
what is the performance criteria for a visual checklist
they should all pass
Whta is the interface materia in mammography grids
carbon
air
which cancer is refered to as the “sleeper cancer” and patients will complain of breast thickening instead of a lump
invasive lobular carcinoma
True or false
EQUIP requires the need for a procedure to be in palce for corrective action when images are of poor quality
true
When is the best time to conduct BSE
few days after the end of the menstrual period or 5-10 days after the start of your period
External beam radiation treatments usually last how long
5-8 weeks
defined as a calcification that are <0.5 in in diameter seen with the acini or a terminal duct lobular unit. usually benign
round or punctate
The flap is completetly removed and microsurgery is neded to recreate blood supply when the flap is positioned as a breast mold
free flap
The ADC coverts ___ signal to ____ that can be read by a computer
analog
digital
___ rather than asking questions will allow patients to tell thier stories unasked.
listening
Internal beam radiation therapy usually lasts for how long
5-9 days
DIEP flap
deep inferior epigastric perforator
what percent of breast cancer is linked to BRCA
5-10%
What is the name of the wide duct behind the nippel that widents t act as a milk reservoir during lactation
lactiferous sinus
The compression thickness indicator QC performance cirteria needs to be accurate to what degree
+/- 0.5 cm
semi ridgid material provides the imaging sheet with strength and is a base for the other layers
support layer
A lesion located in the upper outer quadrant of the left breat is located what clock position
2:00
Any HVL assessment must include an assessment of both ____ and ___ filtration
inherent
added
the boundary between photons that are not attenuated and photons that iwll be attenuated
k-edge
True or false
lobular carcinoma in situ are cancer cells that live inside the lobule but never have the abilit to break out
true
With a HER2+ breast cancer, the ___ are over stimulated
protein receptor
how often should artifact evaluation be done
weekly
Where is the superior border of the breast
clavicle
what is something that mammography is better at seeing than breast ultrasound
calcifications
what is the performance criteria for the repeat analysis
ACR repeat rate should be 2% but lower than 5% passes
which diagnostic view is the best to image calcifications
magnification
radiation therapy to the chest before age __ poses an icreased risk
30
The supporting elements of an organ
parenchyma
when is the triangulation technique necessary
during spot mags
How many masses must be seen on a QC image
2 masses
True or false
written documentation of the clinical image review is required
true
In the PSP computer reader the photomultiplier tube
collects the blue/purple light given off by trapped electrons
grids are used to improve radiographic ____ by decreasing the amount of scatter radiation
contrast
how many days after a leveal 1 citation on a MQSA inspection does the facility have to correct
15 working days
the grid ratio of mammography grids usually varines from ___ to ___ with the average being ___
3: 1 - 5:1
4: 1
What corrective action is taken for failed repeat analysis
a reason must be documented for changes more than 2% from the last analysis
which view below would best demonstrate skin calcifications
a. tangential
b. XCCL
c. XCCM
d. rolled view
tangential
True or false
The corrective action taken for poor image quality has to be documented in the department
true
grids with linear strips but slanted to match the divergence xray beam are what kind of grid
focused
if a mammography technologist falls out of legal status, what must she do to become legal again
perform 25 supervised exams
bring mammography credits up to 15
what is the average kvp range of mammography
25-35 kvp
what is the performance citeria for viewing conditions
illuminance should be under 20lux
what is the minimum frequency of the compression thickness indicator
monthly
which breast cancer is difficult to treat
triple negative
what is the detector in indirect capture made of
cesium iodine scintillator
What are the standard magnifications
1.5 and 1.8
The removal of the entire breast, lymph nodes and chest wall inside under the breast
radical mastectomy
what vein in teh rbeast comes off the axillary vein and drains the lateral breast
lateral thoracic vein
The lobes contain numerous ____ ____ held together by connective tissues, blood vessels and mammary ducts
glandular lobes
what is a malignant condition of the nipple
pagents disease
tyepe of mastectomy where there is removal of the breast along
simple
The retromammary space is seen on the mediolateral projection in mammography imaging but only on ___ of the CC projections
20%
what is the name of the drug tha tis used to combat HER2+ breast cancer
herceptin
star shaped referring to an unusual arrangement of breast fibers sometimes seen on mammography suspicisous for breast cancer, although it occurs with benign conditions also
stellate
Tamozifen is recommended as a single therapy for how many years
5
what is considered the blind ending of the duct and is where most breast cancers begin
terminal ductal lobular unit
in full field digital mammography, what determines which light field will be chosen to use with each patient
the size of the compression paddle
visibility of antomy can be affected by 5 characteristics
- artifacts
- geometry
- blur
- contrast sensitivity
- noise
what are the steps of direct capture
- xrays
- photoconductor - xrays to electrons
- TFT
- workstation
If a lesion is nonpalpable what type of imaging is an option to determine its exact locaton before biopsy
stereotactic breast biopsy
True or false
there is required quarterly frequency of LIP oversight of QA/QC records
false- quarterly is recommended byt there is no required frequency
Rhodium has bremstrauling radiation at what energies
20
23.22
Device used to convert films to an analog system to a digital image is called
film digitizer
What modality is used for assisting with NON-vacuum core biopsy
breast ultrasound
what is the preferred method of treatment for post menopausal women who are ER+ or PR+
aromotase inhibitors
___ as it relates to calcifications describes the form and structure of the calcifications
morphology
describes milk secretion from the breast
lactation
what is another name for a linear grid
focused
Identification of the nature of the cancer
breast cancer staging
___ ___ controls the brightness displayed
window level
what cell layer lies between the epithelium and the basal memebrane
myoepithelium
what type of breast would you use a moly/moly combination on
average
what are the two type of targeted treatments
molecular
hormonal
what is the interspace material of a honeycomb grid
air
Collimation assessment: physicists test how often and what is it
annually
assures xray field aligns with light fields
Minimum automatic compression not be less than ___lbs ( ___ newtons (N))
25lbs
111 newtons
crystals growing in column and have less lateral spread of light and better spatial resolution
needle phosphores
small,hazy, faint calcifications with no clearly defined shape or form . About 20% are malignant
amorphous or indistinct
What is another term for brachytherapy
internal beam raidation
in what part of the breast do most breast cancers arise
terminal ductal lobular unit
what layer of the plate reduces static electricity and absorbs light to increase sharpness
conductive layer
grid ratio is the
height divided by the distance
during the anode heel affect a portion so the xray beam at the anode side of the tube will pass through the anode, resulting in
a lower intensity beam
stereotactic equipment uses ___ to determine location
triangulation
what is the purpose of the visual checklist
lights, locks, dentents all working
What therapy is used for 5 years following breast cancer treatment for women who are premenopausal and ER+ or PR+
Tamoxifen
true or false
The labelign code for a rolled medial view is RM
true
Calcifications are best sampled with _____ with ___ guidance
stereotactic
mammography
What is the universal language used for storage and transmission of patient information
HL7
the pigmentation of the areola is dependent on ___ ___
estrogen levels
The size and shap eof the focal spot can be affect by what 3 factors
- size and shae of electron beam hitting the anode
- design and relationship of the filament coil to the focusing cup
- angle of the anode
______ _______ use non directed or non leading methods to avoid leading the patient to give onyl certain reposnses and to allow unbiased input
open ended questions
how often does ACR accreditation need to happen
every 3 years
how often should the compression thickess be done
monthly
tumor made of closelt stromal or mesenchymal cells as opposed to epithelial cells (carcinoma) usually highly malignant
sarcoma
which of the following is an indications of cyst aspiration
a. posterior enhancement
b. lesiosn with thick walls/separtion
c. macrolobulation
d. hyperechoic
lesions with thick walls/separation
A high DQE means the system is more efficient in converting ___ ____ ___ or the system has a high ___ __ on the TFT array
input xray signals
fill factor
The breast receives its arterial supply from the
axillary artery
Fatty tissue is ____ radiolucent and therfore shows a higher optical density areas on a mammogram
more
How often do the physicists test the AEC
annually
Artifact Evaluation. Physicists test how often and what is it
annually
assess degree of sources of artifacts
true or false
ultrasound is a good way to measure changes in masses treated with neo-adjuvant therapy
true
the process of testing and maintaining the highest possible standards of quality in equipment performane and the acquistition of radiographic images
quality control
Modern mammography units utilize a ___ grid to improve contast
moving
abnormal depression of the sternum; funnel breast
pectus excavatum
what is the name of the principle that allos a large area of coal spot heating while keeping the effective spot small
line focus principle
what characteristic of a stellate lesion leads to suspicion
dense center
Between the ages of 20-39 the ACS recommends CBE every
3 years
bluish purple liht from electrons as the transition from higher energy to a lower energy is the
phtostimulable luminesence (PSL)
Which compression paddle is used with the compression thickness indicator test
spot compression paddle
what glands secrete a lubricating and abcteriostatic solution during pregnancy and lactation
montgomery glands
in triangulation if a lesion moves down on the ML comprared to teh MLO where will the lesion be on the CC view
lateral
What is the frequency of the repeat analysis
as needed, on at least 250 patients
fibrous bands that predominate in teh upper parts of the breast
coopers ligament
Type of reconstruction where a flap of skin fat and muscle are taken from the back
lat dorsi flap recontruction
A typical lymph node is less than __ in size and is ___ shaped in appearance
2cm
kidney shaped
full field digital mammography machine QC must use the QC manual from the
manufacturer
The main direction of drainnage from the medial half of the breast tends to be into the ___ __ lymph nodes
internal mammary
produces large calcifications, whether peridcutal or intraductal and are the result of secretions within dialted ducts
ductal ectasia
plasma cell mastitis
overall, which race statistically will be more likely to develop breast cancer
caucasion
The subareolar region on the breast is located where
lies immediately beind the areola
PNL
posterior nipple line
The flap reamains attached to its orginal blood supply and it is tunneled under skin ot the breast area
pedicle flap
what is the term for a woman who has given birth to one child only
primiparity
what is the difference between kvp and kev
kvp : max kilovoltage
kev: intensity
Defines information collected from the patient and can be seen, heart or felt
objective data
Chemotherapy is a ____ treatment
systemic
True or false
tamoxifen is a form of chemotherapy
false - it is a receptor modulator
Nomial focal size of 0.3mm means
that the effective focal spot is 0.3mm
What is the #1 risk factor in the developing breast cancer
gender
what is the atomic number of a rhodium filter
45
what are the 3 advantages of tube tilt
allow smaller target angle
allows greater anode heating capacity
reduces anode heel effect
man made object which simulates the average composition of the breast.
phantom
___ is the term used to indicate pregnancy beign carried to a point of viability (24-26 weeks)
parity
The general term used when describing reshaping of the breast
mammoplasty
___ ___ controls the ratio of black to white displayed and therefore contrast
window width
contrast can be altered after the exposure by altering the ___ ____ and is independent of the kVp used to acquire the image
window width
OID should be as small as possible to minimize ____
magnification
___ can be performed to evaluate suspicious nipple discharge
ductography
how many openings to milk ducts are there in a nipple
5-15
Hormone replacement therpay will do what to the breast
increase glandular breast tissue
the circulus venosus drains into the ____ and ___ veins
axiallary vein
internal mammary vein
SOD should be as long as possible to reduce ___ ____
skin dose
Incisional biopsies are used to remove
parts of the lesion
an area of fibroglandular tissue seen on two projections
focal asymmetry
describes a woman who has never given birth to a vialble offspring
nulliparity
The skin of the breast is ____ at the base and ___ at the nipple
thickest
thinner
What is the ideal shap eof the pectoral muscle on the MLO view
convex
illuminance should be close to ____ or under ____
0
20 lux
a circumscribed growth of skin, congenital orgin; a mole
nevus
What is the equation for the magnification factor
SID/SOD or
image size/object size
What are the most commona circular oval lesion
cysts and fibroadenomas
this layer holds and traps excited electrons at higher energy levels
conductive layer
which of the following would be a lesion that is caused by trauma to the breast
a. galactocele
b. fibroadenoma
c. hematoma
d. hamartoma
hematoma
Radiolucent or radiopaque and any combination in between is called ____ _____
optical density
which of the following is a surgical treamtent for the breast
a. chemotherapy
b. radiation
c. TRAM
d. non-adjuvant therapy
TRAM
involves applying radiation from the inside out
internal beam radiation
what percent of breast cancer is found in males
1%
2470
a surgical procedure in whcih the entire breast, the pectoral muscle underneath and the lymph nodes in the axilla are removed
radical mastectomy
compression allows reduced radiation to the breast by
decreasing breast thickness
if your laser printer fails and starts to fall into a warming trak what do you do ? can you still use it?
contact service
may continue to use
what 3 factors determine the mammography x-ray spectrum
kv, anode, filter material
what is the frequency of the repeat analysis QC test
as needed
When scoring the phantom always count the number of visible objection until ____ or ____ is reached then stop counting
0 or 0.5
the scintillator converts ___ to ___
xray to light
How often is the acquisition monitor QC performed
monthly
a surgical procedure in which ony a portion of the breast is removed, including the cancer and a surrounding margin of health breast tissue
partial or segmental mastectomy
acts as an activator and is reposible for the storage properties of the PSP
phosphor layer
with CNR as contrast increase noise ___
decreases
in a flat panel detetor spatial resolution is controleld by the
detector element size
What is the name of the duct that transports the milk from the lobes to the nipple
lactiferous duct
retromammary space is filled with
adipose tissue
____ _____ are used to get more details about the problem
probing questions
AEC system performance: physicists test how often and what is it
annually
checks AEC function
controlled by digital acquisition and the capabilites of the monitor
resolution
Name the duct that is inside the lobule
intralobular terminal duct or subsegmental duct
many small protrusions on the surgace of the areola
morgagni tubercles
evaluations of mammography equipment is performed by the
medical physicist
on the CC view, the central rays exit the breat where
inferiorly
What does RIS stand for
radiology information system
On breast ultrasound, which of the following would be an indication of a simple cyst
a. posterior enhancement
b. smooth borders
c. anechoic
d. all of the above
all of the above
The fibrous and glandular tissues within the breast are described as
fibroglandular densities
___ filtration includes the glass or metal window of the xray tube, oil in the tube house the mirror of the collimation assembly and the compression paddle
inherent
Mammography grids generally have a ___ grid ratio than general radiography grids
lower
AJCC
The american joint committee on cancer
____ ___ is the dose of choice when calculating radiation doses associated with mammography
glandular dose
The upper outer quadrant whcih extends inot the axilla
tail of spence
muscle, fat, and skin from abdomen used to create a new breast mound
TRAM flap
Moly filters attenuate all kevs above
20
what diagnostic procedure is used to dianose a papilloma
ductogram
how mmay years must a breast center keep a serious complaint
3 years
What is the corrective action for a failed phantom image QC
immediate
The greater the magnification factor, the great is the ___ ___ to the patient
skin dose
____ is used to verify the accuracy of the information
summarization
How many pounds of pressure should be exerted on the phantom during evaluation
12 pounds of pressure
what is kv
voltage applied to the generator
What are 7 major risk factors for breast cancer
abnormal breast biopsy
age
gender
genetic risk factors
family hx
personal hx
radiation therapy
HRT is used by women who still have a ___
uterus
the process of removing tissue and fat from teh abdomen and transferring that tissue to recontruct the breast is called
DIEP: deep inferior epigastric perforator flap
You can count a fiber as a full point if you see at least how many millimeters of the fiber
8mm
which breast imaging study is expensive, has high false positive rates and only detects 50% of early breast cancer
breast MRI
When imaging a speciment for calcifications _____ and _____ should always be used
compression
magnification
In a flat panel detector, the spatial resolution is controlled bu the
DEL
HIS stands for
hospital information system
What do we used DICOM for
a. storing images
b. randmistting images
c. printing images
d. all of the above
all of the above
mobile borders, fat containing, smooth, circumscribed
benign
what is the largest field of view in mammography
24 x 30 cm
The __ the grid ratio the __ the contrast and the ___ the dose
higher
higher
higher
what muscle lies immediately below the breast
pectoralis major
Of the 8 imaging evaluation criteria, which 2 are the ones failed most often
positioning/compression
The muscle that runs from the lateral aspect of the breast across the mid-axillary line to the lower back
latissimus dorsi
There are a total of ____ specks per group, ___ form a ____ with __ in the middle
6 specks
5
pentagon
1
this layer prevents light fron erasing the data on the image recorder or strikign through the backing layer
light shield layer
what is the purporse of the compression thickness indicator
ensure the indicated scompression thickness is within tolerance
what grid reduces scatter in two directions
honeycomb
what is the name of the breast anatomy that attaches the breast to the abdominal wall
inframammary fold
how many specs must be seen on QC image
3
During a CBE, lump are felt in the upper breast more easily when the patient is
upright
how many days does a breat center have to take corrective action after a level 2 FDA violation
30 working days
the final MQSA regulations went into effect
04/28/1999
80% of all breast cancer is
invasive ductal carcinoma
If a radiologist sees a lesion on the MLO but not the CC, what coudl you be asked for perform
ML for triangulation
Preprocessing is automatic and occurs before the image is visualized at the AWS, enhancing of the ___ and ___ ___ occurs
contrast
image sharpness
what type of grid reduces scatter in one direction
linear
True or false
ductal carcinoma in site (DCIS) in invasive
false
what is the true detail QC test
MTF (modulation transfer function)
a malignant neoplasm or growth that can be visualized on mammography
carcinoma
variation in optical density, distributation, number, morphology, or size over time
change over time
is inflammation of the breast tissue
mastitis
evenly scattered, homogenous calcifications are generally
benign
what is the minimum frequency of the commpression thickness indicator
monthly
what two imaging factors are grids used to control
scatter and constrast
____ is most often used because a regular glass or metallic window would harden the emerging beam by eliminating the low photons needed for breast imaging
beryllium
What percentage of breast cancers can be linked to a BRCA gene mutation
5-10%
fat and skin from the abdomen (no muscle ) are used to make a flap
DIEP
How much compression should be applied to the breast
until the breast is taut
the breast extends laterally to the ____ ___
latissimus dorsi
True or false
On the MLO view, the receptor should be placed posterior to the latissimus dorsi mucle
false - it should be placed anteriorly
The average female breast will evenutally develops how many lobes
15-20
Who recommends fewer instance of mammgrpahy screenings because too many may lead to overdiagnosis and over treatment
USPSTF
What is the most common supplemental view
XCCL
The breast tissue removed during a biopsy is called a ___
specimen
What type of implants are no longer allowed in the USA
silicone injections
How many fibers, speck groups and masses are embedded in the ACR DM phantom
6 fibers, 6 speck groups, 6 masses
2 type of radiation in mammography
bremmstrauhling
characteristic
The overall process of testing and maintaining the highest possible quality in the acquistion and interpretation of radiographic images
quality assurance
why are MA stations fixed in mammograph
to prevent tube burn out
Mammography is generalyl ackowledeged to have a ___ - ___ error rate
10-15%
MQSA requires RWS monitors to be at least how many megapixels
5
True or false
It is acceptable to perform an axillary trail view when you performed a poorly positioned MLO on an average patient
false
True or false
written documentation of the IPs oversight of the QC/QA program is required
false
what is the main purpose of performing the CC view
to visualize the medial portion of the breast
the design of the lip of the compression paddle affects all of the followign 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 compession paddle
d. ensures greater compression of the anterior breast tissue
ensures greater compression of the anterior breast tissue
which type of implant has a greater risk of capsular contracture
silicone gel
As the xray beam leaves the target of the anode, it is filtered in what two ways
inherent filtration
added filtration
Refers to treatment of postmenopausal women with hormones to maintain thier hormone levels to decrease symptoms and complicatiosn that could arise from declining estrogen levels
hormone replacement therapy
what cell layer does breast cancer begin
epithelial cell layer
What are the two main criteria in breast examination
looking for changes
feeling for changes
a female hormone produced by the ovarys corpus luteum only during specific time of a womans menstrual cycle
progesterone
circular or oval in size/shape with smooth borders
circumscribed
abnormal prominance of the sternum; pigeon chest
pectus carinatum
name the characteristic of a lesion that is most likely to be considered benign
a. irregular borders
b. well circumscribed
c. painless
d. hard and fixed
well circumscribed
which breast cancer is thought to be the earliest form of breast cancer and is confined to a duct
ductal carcinoma in situ
what needle size is used in a fine needle aspiration
18-25 guage
What alertnative projection could be used in addtion to CC when imaging at patient with a pacemaker
LMO
what is the purpose of the artifact evaluation
looking for dead pixels, banding, ghosting
To increase the changes of an even intensity beam across the breast, the thickest part of the breast (near the chest wall) is positioned at the ___ side
cathode
the formation of fibrous tissue stemming from connective and supportive stroma
fibrosis
a mehtod for performing high resolution limited angle tomography at mammagraphic dose levels
tomosynthesis
True or false
a periodic clinicalimage rewview of all active RTs and IPs is required at least quarterly
false - it is recommended to be quarterly but only required annually
What focal spot is used for mag views
small
according to MQSA standards, teh collimation should not extendbeyond any eduge of the image receptor by more than ___ of the SID
2%
the amount of sound passing through when using ultrasound
acoustic enhancement
which views are used to separate superimposed tissues
rolled view
how many years must a breast center keep a non-returning patietns mammograms
10 years
The ACR recommends tha the average glandular dose on a single mammogram projection shoul dnot be greater than
3mGy (0.3 rad or 300 millirad) with a grid
1mGy (0.1 rad or qoo mrad) without a grid
The two most prominent hormones tha tare active in breast development are ____ and ___
estorgen and progesterone
The anatomic structures that support the breast are
coopers ligaments
Rules for scoring specks
How many for a full point?
How many for a half point?
4-6 = 1 pt
2-3 = 0.5 pt
1= 0 pt
What separates the epithelial cell layer from basement membrane
myoepithelial cells
the condition of having carried more than 1 pregnancy past the point of viability (24-26 weeks) regardless of the outcome
multiparity
Who standardizes staging
the american joint committee of cancer
The central axis of the xray beam runs ___ to the place of the detector at the chest wall
perpendicular
Mammography tubes have anode angles ranging from, ___ degree to __ degrees
0-16
the two main classificatiosn of breast cancer are ____ and ___ carcinoma
ductal
lobular
which of the following increases a womans risk of developing breast cancer
a. early menstruation and late menopause
b. having her first child before age of 30
c. removal from hormone replacement therapy
d. having multiple children
early menstruation and late menopause
What has the most rapidly dividing cells
those of the terminal ductal lobular units (TDLUs)
a benign, lobulated neoplasm composed of bening epithelial tissue and located in the walls of dcuts of the breast. Has a “berry like” shape
intraductal pipilloma
what exam is the best way to look for an implant rupture
breast MRI
what is a disadvantage of a tungsten target
lowers contrast but can be brought back through digital processing
what two types of grids are used in mammography
linear
honeycomb
How many fibers must be seen on a QC image
2
what muscle lies to the lateral aspect of the breast
serratus anterior
calcification with smooth contours and high uniform optical density are usually
benign
what causes the heel effect
the angling of the anode
f you are diagnosed with a BIRAD D breast composition, your breast composition is
extremely dense
a lobulated benign tumore derived from the epithelium; usually inside the mammary duct near the nipple; may produce clear or bloody discharge
papilloma
where should you stand when positioning the CC view
on the medial side of the patient
milk production begins in the ___ or the ___ ____ ___ ___
lobules
terminal ductal lobular units (TDLUs)
What type of theraoy slows or stops the growth of hormone sensitive tumors by blocking the bodys ability to produce hormones
Hormone therapy
True or False
a woman diagnosed with certain benign conditions has a slightly higher risk of developing breast cancer
true
True or false
most MQSA inspection violations are related to image quality
true
Increased or decreased glandularity of the breast can be related to ___ or ____ ____
menarche
hormonal fluctuations
lobular carcinoma accounts for ___ to ___ % of all breast cancer
5-10
Evaluation of system resolution: what is it
evaluation of limiting resolution
if you are diagnosed with a BIRAD C breast composition, your breast composition is
heterogenously dense
a condition when the lactiferous duct becomes blocked and causes a greenish discharge
ductal ectasia
the ___ ____ of the system is controlled by the number of pixels
image resolution
abnormal cells inside the milk duct
ductal carcinoma in situ (DCIS)
a high DQE means a ____ dose
lower
rhodium produces characteristic radiation in what kev range
20-23 kev
brightness can be altered after expusre by altering the ___ ___ and is independent of the mAs used to acquire the image
window level
which of the following would be anindication of a suspicious lesion
a. posterior shadowing
b. smooth borders
c. hypoechoic
both A and C
what type of radiation is determiend by the anode material and is confied to a few photon energies only.
characteristic radiation
True or false
On the MLO view, it is acceptable not to demonstrate the IMF
false
what is the performance criteria of the phantom image
2 fibers, 3 specks, 2 masses
a stereotactic biopsy is typically used when a radiologist sees what
suspicisous calcification
pocket of fat thar is encapsulated by a thin fibrous capsule common in post- menopausal women
lipoma
smoothing reduces ____ and ____
noise and contrast
what technique is used to get the breat pulled onto the image receptor for the CC view
bi maual pull
approximately how many women will die from breast cancer
female: 40,000
male: 460
substatial and has volume
a mass
What is the lifetime risk of contracting breast cancer for a woman
1 in 8
the cancer has spread form the ducts into the surrounding stromal tissue and may or may not extend into the pectoral fascia and muscle
invasive or infiltrating ductal carcinoma (IDC)
what is the grid inerspace material of a linear grid
carbon
decreasing the target angle will further decrease the ___ ____ ___
effective focal spot
mens lifetime risk of breast cancer
1 in 1000
___ uses gestures such as a head nod, or saying “yes” or “okay” to encourage elaboration
facilitation
Matching the filter to the same element as the xray tube target will allow what
k-characteristic xrays to pass while blocking thehigher and lower energy bremsstrahlung xrays
what can help lesses the recurrence rate following lumpectomy
chemotherapy
what is the frequency of the viewing conditions
monthly
what tissue is lost on the MLO if the image receptor is too high
inframammary fold
what are the mobile borders of the breast
inferior and lateral
Women who do not have regular menstruation should perform BSE when
on the same day every month
what is the grid ration used in mammography
3:1 - 5:1
What happens to a womans risk of developing breast cancer if she has 2 first degree relatives with breast cancer
triples
___ ___ of the imaging system is the minimum separation between two objects at which they can be distinguished as two separate objects in the image
spatial resolution
True or false
a womans breast cancer risk is 2-3 times higher than normal if she has proliferative lesions with atypia
false - its 4-5 times higher
skin, fat and muscle from the upper back or thighs or buttocks are used to make a flap
latissimus flap
what is the lifetime risk for women
1 in 8
a clip is placed after a breast biopsy if
a. a mass is small
b. to continue surveillance
c. lesion is suspicious
d. all of the above
all of the above
in what cell layer does breast cancer begin
epithelial cell layer
what is the most common placement type for implants
subglandular
what is the most common diagnostic view
medial lateral (ML)
Together the lobule and the extra lobular terminal duct make up the
TDLU: terminal ductal lobular unit
true or false
the lateral medial view maximizes visualization visualization of the lateral tissue
false - the medial side is closest to the detector and best visualized
perforating (artery) branches of the ____ and the ___ also supply the breast
internal thoracic artery
intercostal artery
short exposure times minimize ___ ___
motion blur
As MTF increases, resolution ___
increases
____ filtration is usually an Al equivalent material positioned in the path of the emerging beam, thus affecting its penetrating power, which is defined by HVL
added
Universal language at the storage and transmission of patient information for the medical community
HL7
most common radiatio in the form of a broad spectrum of photon energyies, the max energy is determined by the kv selected
bremsstrauling
abnormal growth of tissue
tylectomy
A bunch of eight bit is called a __
byte
the smaller the pixels, the greater the ___ ____
spatial resolution
Preprocessing is automatic and occurs before the image is visualized at the AWS, ___ ____ is used to correct the raw data
automatic rescaling
the sentinel node biopsy is performed to determine what
if the breast cancer has metastisized
Which part of the breast is best visualized on SIO
upper inner and lower outer
Consent given by the patient before any invasive procedure or a proceudre of significant risk
informed consent
____ treatment will determine the exact genetic profle of the altered cancer cells and design a treatment plan bsed ont eh nature of these cells
molecular
what are 4 indications for a breast MRI
- new cancer staging
- implants
- evaluation of scarring
- evaluation of high risk patient
show mammogrpahically as high optical density tumors with lucent cetners and eggshell like calcifications.
oil cysts
What is the number 1 advantage of screening mammography
it is the most effective tool for early detection of breast cancer
How often is the radiologist monitor suppose to be cleaned
daily
What kind of chemotherapy is given in addition to another breast cancer treatment
adjuvant chemotherapy
true or false
4 specks visible in a speck group iwll count as 1/2 of a full point
false - 4-6 specks is a full point
what condition occurs when there is an overgrowth of cells in the lobules
lobular hyperplasia
consent signed at the time of admission to a hospital or health care setting
general consent / authorization for treatment
Each lobe can have ___ to ___ terminal ductules
10 to 100
mastectomy patients have what change of reurrence, if zero axillary nodes were involved originally
6
Compression of a specimen reduces tissue thickness, thus improving ____ ____
subject contrast
irregular, speculated margins, with prior surgery, fixed
malignant
what are two things that influence compliance
pleasant experience
understanding technologist
what is the most common supplemental view
XCCL
an enlargement and or devleopment of new lobular units
adenosis
what is the kev range of rhodium anode
20.3-22.7
what is the frequency of the visual checklist
monthly and after any service
increased cellular activity in ducts or lobes. Not a form of breast cancer but is a risk factor
atypical ductal or lobular hyperplasia
The TFT collects what
electrons
wihtout modification magnification will reduce the ___ of the image beause of geometric unshaprness
resolution
Change occuring in the epithelial cells, which exhibit characteristics of apocrine sweat glands
apocrine metaplasia
what type of radiation is important for determining xray beam penetration through the breast and optimal constrast
characteristic
what maneuver is used to open the IMF on the MLO view
the up and out maneuver
Breast tissue consists mostly of adipose, fibrous and glandular tissue, all of which have relatively low ___ ___
atomic number
what is the main difference between the acquisition monitor and rewview workstation monitor QC
the RWS QC contains a phantom evaluation
mammography tends to understate the _____ of a lesion
multifocality
a term used to describe generalized skin thickening
peau d’orange
what is the earliest form of breast cancer
ductal carcinoma in situ (DCIS)
A tracking system to track positive pathology is required to comply with ___ regulations
MQSA
What equipment is needed for the phantom image QC
ACR DM phantom
what is the tube angle for a sterotactic and on what axis
15 degrees
x-axis
Preprocessing is automatic and occurs before the image is visualized at the AWS, aplication of processing algorithms to generate a ____
histogram
HIS is a data infomration system that manages what
a. legal
b. financial
c. medical
d. all of the above
all of the above
TRAM reconstruction stands for transverse rectus abdominus
myocutaneous
what is the typical SID in mammography
65-66 cm
What does angling the anode do
creates the anode heel effect and creates a bigger field of view
The abdnomal cells grow withing the lobules but do not penetrate through the lobule walls and often is not seen mammographically
lobular carcinoma in situ (LCIS)
which type of biopsy device would you used if the patient has a blood clotting disorder
core biopsy - non vacuum
what would the recommendation be for a category 0 BIRAD
must indicate what additional imaging study is recommended
a technique used to reduce toral breast size for cosmetic or medial reasons
reduction
Why would we never use a Rh/Mo target
it filters out the needed bremsstrauling radiation needed
What is the name of the lateral border of the breast that we use to position the MLO
mid axillary line
an area of fibroglandular tissue seen onlu in one projection
asymmetry
These lesions can have a solid central tumor with radiating structures and ill defined borders
spiculated or stellate lesions
what are the back up tomes for grid and non grid
600 mAs -grid
300 mAS - non grid
The biological effect of mammography is assuemd to be more closely associated with the ___ ___ ___ by the glandular tissue
total energy absorbed
true or false
most local recurrences occur in the first 5 year
true
which of the following would not count as a repeat
a. good images in retrospect
b. poor positioning
c. additional viws needed to visualize the entire breast
d. patient motion
additional views needed ot visualize the entire breast
True or false
ER/PR negative tumors have few or no hormone receptors
true
the axillary artery gets its blood supply from teh ____ and the ____
lateral thoracic artery
acromiothoracic branches
what type of anode is used in mammo because they produce characteristic radiation at optimal energies to penetrate the average non dense breast with optimal contrast
molybdenum
On the MLO view, what breast tissue is at risk of being missed
medial
the emission of the bluish -purple light from electrons as they transition from higher to lower energy
photostimulable luminescence
cancer that begings in the lobules of the breast
invasive lobular carcinoma
a conical projection in the center of the areola which acts as the outlet of milk
nipple
describes an increase in the number of eptithelia cells lining the duct
epithelia hyperplasia
The main direction of drainnage from teh central and lateral half of the breast tends to be into the ___ group of axillary lymph nodes
pectoral
What hormone is responsible for lobular proliferation and growth
progesterone
what is the result of an improper up and out maneuver on the MLO
camels noes
The posterior nipple lline (PNL) should be no more than how many cm difference between the CC and MLO
within 1 cm
in direct capture what is the photoconductor made of
amorphous selenium
molybdenum target produces what type of interaction
photelectric
characteristic
the first lymph node that drains lymph from a specific area of the body
sentinal node
AWS stands for
acquisition workstation
a radiographically dense, encapsultated round and movable benign tumor seen frequently in women <30 years of age and developes from epithelia and fibroblastic tisues
fibroadenoma
fibroadenomas are caused by higher than normal ___ level
estrogen
descriptive term used for the plates used in both idrect and indirect DR digital systems
flat panel detector
Where does the resolution measure the sharpest
anode
what is the best way to get rid of skin folds on the CC
the fingerprint roll
4 specks visible in a speck group will count as how many points
1
layer of fat directly beneath the skin
subcutaneous fat layer
True or false
hormone receptors are proteins found on the surface and inside of some cancer cells
true
Which is a indication for chemotherpay
positive lymph nodes
what equipment is needed for the repeat analysis
all rejected mammos
Are minute calcium deposits in the breast that could indicate the presence of malignancy, although they can be benign
microcalcifications
a box of cells with numeric values arranged in rows and columns
matrix
What is the reason why moly anode is used for the average breast size
characteristic radiation
Mammary glands are a specific type of ____ or ___ sweat glands that are specialized to manufacture colostrum and milk
sudoriferous
aprocrine
which of the following would be used to evaluate breast problems at a cellular level
a. FNA
b. galactogram
c. cyst aspiration
d. core biopsy - no vacuum
FNA
mammography grids absorb what percentage of scatter
75-85%
TRAM flap
transverse rectus abdominis myocutaneous glap
beam quality assessment/half value layer evaluation. Physicists tests how often and what is it
annually
assure half value layer
DELs are located within the
TFT
The lowest attachement of the breast to the anteiror chest wall.
inframammary fold
why should the detector caibration frequency be done weekly
individual elements of the detector matrix may drift in sensitivity to different x-ray intensities
to feel; examine by touch
palpation
what happens if you get a repeat of an EQUIP violation level 2 the following year
you receive a level 2 violation that must be corrected within 15 days
a non invasive nuclear medicine examination that may be used to investigate a breast abnormality that has been discovered on mammography
scintimammography
Cancer that begins growing in the duct, but then gorws into the fatty tissues on the breast
invasive/infiltrating ductal carcinoma
Greater number of pixels equals greater ___ ____
image resolution
ACR guidelines for when women should start mammograms
40
30 if high risk
The number of shades of gray demonstrated
bit depth
true or false
tamoxifen is a hormone inhibitor that blocks estrogen from attaching to the cancer wall
true
when imaging the CC view you bring the height of the image recetor to what level
the level of the inframammary crease
what is the difference between indirect caputre and direct digital capture
indirect - light
direct - no light
what is another name for a honeycomb grid
HTC (high transmission cellular)
what is another name for asymmetrical breast tissue
focal architectural distortion (FAD)
the amoutn of aluminum it takes to cut an xray beam by 50% is called
half value layer
Grids are not used with ___ mammography
magnification
How often do physicists test the mammogrpahy unit assembly and what do they do
annually
check all locks, detents and mechanical devices
Breast cancer staging N1 means
1 or 2 lymph nodes invovled
a benign condition that looks like a breast within a breast
hamartoma
Rules for scoring masses
if they are not circular but visible or 1/2 moon shaped they are scored a
0.5
A common tube tilt is __degrees
6
The AJCC standardized staging
T
N
M
T - tumor size
N- denotes lymph node spread
M- assesses distant metastasis
In the United States, what percentage of breast cancers are found in males
1%
what is the space that lies between the glandular tissue and the pectoral muscle
retromammary fat space
____ can be used for diagnosis both cystic and solid lesions
fine needle biopsy
Consent given in writing
written consent
an inflammatory cancerous affection of the areola and nipple; usually associated within underlying ductal carcinoma
pagets disease
what cancer does not typically form a lump but feels more like thickening or fulness
invasive lobular carcinoma
ACS guidlines for MRI on a high risk patient are
once a year, 6 months apart from a mammogram
what is the best view for visualizing milk of calcium
ML or LM
If a patient is a returning patient, how long does the facility have to retain images for
minimum of 5 years
the process of increasing the size of the breast is termed
augmentation
the amount of light (PSL) emitted by the PSP during the reading process is related to the level of ___ received by the receptor, knonw as __ ____
exposure
speed class
True or false
a periodic clinical image review of all active RT and IPs required at least quarterly
false - it is required annually
__–___% of normal breasts will show asymmetrical densities in the outer
3-5%
Rules for scoring masses
If a small part is missing, or if there are different dnesities in the whole mass or 75% of the circular border is visible it is scored as
1
the greater the number of pixels the great the ____ ____
image resolution
ACS guidlines for breast cancer screening
30-44 informed consent
45-54 yearly
55+ every other year
from the internal mammary nodes, drainage tends toward the ___ ____ and others may cross the ___ margin thus comminucating with the opposite breast
mediastinal nodes
costal margin
What is the frequency of the the phantom image QC
weekly
Which of the following would typically be found in the axilla
a. fibroadenoma
b. oil cyst
c. lymph nodes
d. lipomas
lymph nodes
The ACS recommeneds a CBE how often and at what age
every 3 years from 20-39
every year after 40
