RADIOLOGICAL PHYSICS _ Ra hex =r Published far: RAMPS (Radiological and Medical Physics Society of New York)~ Preface a RAPHEX 2005 was prepared by members of the Radiological and Medical Physics Society of New York (RAMPS, Inc.}, the New York chapter of the American Association of Physicists in Medicine (AAPM). Contributors to this exam were: General: Eugene Lief, Ph.D., Editor Susan Brownie, M.Sc., Reviewer Diagnostic: Adel Mustafa, Ph.D., Editor Steven Balter, Ph.D., Reviewer/Contributor John Humm, Ph.D., Reviewer/Contributor Pat Zanzonico, Ph.D., Reviewer/Contributor Kristen Zakian, Ph.D., Reviewer/Contributor Maynard High, Ph.D., Reviewer Lawrence Rothenburg, Ph.D., Reviewer Therapy: Susan Brownie, M.Sc., Editor Robert Barish, Ph.D,., Reviewer If you are taking RAPHEX under exam conditions, your proctor will give you instructions. ~ You have 3 HOURS to complete both sections: the GENERAL section, and your SPECIALTY section. % Non-programmable calculators may be used. % Choose the most complete and appropriate answer to each question. We urge residents to review the exam with their physics instructors. Any comments or corrections are appreciated and should be sent to: Susan Brownie, M.Sc. Maimonides Cancer Center Radiation Oncology Department 6300 8th Avenue Brooklyn, NY 11220 E-mail: sbrownie @ maimonidesmed.org Copyright © 2005 by RAMPS, Inc., the New York chapter of the AAPM. All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission from the publisher or the copyright holder. Published in cooperation with RAMPS by: Medical Physics Publishing 4513 Vernon Boulevard Madison, WI 53705-4964 1-800-442-5778 www.medicalphysics.orgGeneral “ Questions In all questions of matching type, the same answer could be used multiple times or not used at all. Gl. The quality factor (Q) or radiation-weighting factor (WR) in radiation protection is most closely related to: A. Roentgen to cGy conversion factor. B. Half-value layer. C, Electron equilibrium. D. Mass attenuation coefficient. E. Relative biological effectiveness. G2-7. Match the unit with the quantity it measures. (Answers may be used more than once or not at all.) A. Equivalent dose. B. Exposure. C. Absorbed dose. D. Activity. E. Energy. G2. Gray G3. Becquerel G4, Rem G5. Sievert G6. Curie G7. Roentgen G8. Which of the following is not an SI unit? Meter. Kilogram. Second. Rad. Becquerel. MOOD > G9-13. Match the charge carried by each of the following: (Answer may be used more than once.) +4 +2 +I 0 -] > MOB G9. Alpha particle G10. Neutron G11. Electron G12. Positron G13. Photon Ree ee eee ee ee eee eee eee ree eee ere Raphex 2005 IGeneral “* Questions + Gli4. GI5. Glé. GI7. G18. Elements which have the same Z but different A are called: A. Isotopes. B. Isomers. C. Isotones. D. Isobars. Which of the following is true? Elements can only have one stable isotope. Elements can only have one radioactive isotope. Isotopes of the same element have the same chemical properties. Isotopes of the same element have the same number of neutrons. Stable elements have equal numbers of protons and neutrons. MOOn > In stable isotopes with heavy nuclei: The number of protons equals the number of neutrons. The number of protons is higher than the number of neutrons. The number of neutrons is higher than the number of protons. The numbers of neutrons and protons are unrelated. The number of electrons equals the number of neutrons. MOOW pS A neutral atom has 6 electrons and a mass number of 13. The number of neutrons in the nucleus is: A. 13. B. 6. Cc. 7. D, 19, E. None of the above. A proton captures a neutron to create a deuteron. The energy of the y-quantum emitted is MeV. (ft amu = 931.50 MeV) particle amu proton 1.00727 neutron 1.00866 deuteron 2.01355 1.88 2.02 2.22 2.38 4.03 MOOR > Raphex 2005General “ Questions GI9. G20. G72. G22. G23. Electron binding energy in the outer atomic shell depends upon: Atomic number. Total number of shelis. Number of electrons in the outer shell. Charge of nucleus. All of the above. ROO > The maximum number of electrons in the outer shell of an atom is: 2n?, where n is the principle quantum number. 8. Depends on atomic weight. Depends on chemical properties of an atom. 18. moO Ow > Which of the following is a true statement regarding atomic shell filling: A. As the atomic number increases, the next atomic shel! always starts to fill when the previous one has been completely filled. B. Electrons in the outer shell are more strongly bound than those in the inner shell. C. The chemical properties of an element depend upon the number of electrons in the outer shell. D. All of the above. E. None of the above. In the equation describing the number of radioactive atoms left as a function of time t, N(t}=Np*exp(-t/T), constant T represents: Decay constant. Initial activity. Initial number of radioactive atoms. Half-life of radioactive atoms. Average lifetime of a radioactive atom. MOOS In the case of simultaneous physical and biological clearance, when T, and T, are the physical and biological half-lives respectively, the effective half-life Tg is generally equal to: T+T,. VT,+1/T,,. T,*Tp. T,.*T (LAT). VU, x T° moaPS Raphex 2005 3General “* Questions + G24-27. Match the mode of decay and the change in atomic number (7): (Answers may be used more than once.) A. Z3Z+2. B. Z>2Z+1. Cc. £252. D Z>5Z~1. E. Z>2Z-2. G24. a G25. Br G26. Bt G27. Isomeric G28. Which of the following is not a method of medical radioisotope production? A. Separation from spent reactor fuel rods. B. Bombarding with neutrons in a reactor. C. Bombarding with protons in a cyclotron. D. Elution of a metastable daughter from a parent. E. Bombarding with neutrons in a cyclotron. G29-33. Match the method of radioisotope production with the isotope. A. Sample bombarded with charged particles in a cyclotron. B. Naturaily occurring in uranium ore. C. Sample placed in the neutron flux of a reactor. D. Separated from used reactor fuel rods. E. Eluted from the column of a generator. G29. Cobalt-60 G30. Oxygen-15 G31. Radium-226 G32. Technetium-99m G33. Cesium-137 G34. If a sample of parent nuclei is sealed in a vial, radioactive equilibrium will be eventually achieved: A. Only if the daughter nuclei have a much shorter half-life than the parent. B. Only if the parent nuclei have a much shorter half-life than the daughter. C. Only if the half-lives are comparable. D. Always. ° E. It will never be achieved, since there were no daughter nuclei at the beginning. 4 Raphex 2005General “* Questions G35. It takes approximately hours for "Tc to be in equilibrium with its parent °’Mo (half- lives are 67 hours for °°Mo and 6 hours for Tc). CoOwP 1 6 24 54 G36. One microCurie (1 wCi) is equal to: ROO S 3700 Ba. 37000 Bq. 3.7 10!" Ba. 3.7«107 Bq. 0.37x10* disintegrations per second. G37. According to the original definition, 1 Ci is equal to the activity of 1 g of which isotope: MOOD Uraniam-235. Polonium-210. Radium-226. Iodine-125. Rhodium-104. G38. The exposure rate at 1 meter from a point source of 10 mCi of '*’Cs is (T for Cs is 3.3 R.cm’/mCi-hr ) MOO o> 3 mR/min 3.3 Rémin 3.3 mR/hr 3.3 R/hr 33 Réhr G39. The exposure rate constant for a radionuclide is 12.9 Rem?/mCi-hr. How many HVLs of shielding are required to reduce the exposure rate from a 19.5 mCi source at 2 m to less than 2 mR/hr? Raphex 2005 moaw> 1 2. 3. 4 6General * Questions + G40. The smaller of the filaments in the x-ray tube has the following properties with respect to the larger filament: Higher heat capacity. Ability to support higher currents. Enables sharper image. Lasts longer. All of the above. mow > G4l. Which type of x-ray circuit provides the best image quality: Single-phase. Three-phase. Constant voltage. Aor B. A, B, and C provide the same image quality. MOOR > G42. Tungsten has the following binding energies: K 69keV L 12 keV M 2 keV. Which of the following projectile electron energies can cause tungsten to emit a 57 keV Kat x-ray? 57 keV 58 keV 67 keV 80 keV 1, 2, 3. 1,3. 2,4. 4 only. All of the above. MOOP> RYN 6 Raphex 2005G47. Raphex 2005 General “* Questions + Compare spectra I and II, for the same target, in the diagram below. Choose the most appropri- ate answer from the list below for the following questions. Spectrum I. Spectrum II. Both. Neither. Cannot be determined. MOO > G43. Low-energy photons have been removed by filtration. G44. Minimum photon energy is 50 keV. G45, The K characteristic x-rays have been removed by filtration. G46. Higher HVL. Intensity 0 20 40 60 80 100 keV For a beam of monoenergetic photons (such as gamma rays or characteristic x-rays) which of the following is true: The second HVL is thicker than the first. The first HVL is thicker than the second. All HVLs are equal. The relationship between the first and second HVL depends upon the beam energy. The relationship between the first and second HVL depends upon filtration. MOOSGeneral “* Questions ~ G48. Intensity KV The two x-ray spectra shown have the same UN D> Awe Filtration Target material HVL kVp 1,2,3,4 1,3 2,4 4 only G4$-53. Match the type of radiation with its description. G49. GSO. G31. G52. G53. oe moAD > Ionizing elementary particles. Non-ionizing elementary particles. Ionizing photons. Non-ionizing photons. Other, Betas Heat radiation Visible light X-rays Ultrasound Raphex 2005General “ Questions G54-55. Match the following types of clectromagnetic radiation with their properties: MOOS Visible light. Ultraviolet light. Infrared light. Microwaves. X-rays. G54, Can be blocked by a wire mesh. G55. Have the highest penetration in tissue. G56. For a 100 keV photon the dominant mechanism of attenuation in muscle tissue would be: MOOD > Pair production. Coherent scatter. Photoelectric. Compton interaction. None of the above. G57. If the linear attenuation coefficient is 0.05 cm™, the HVL is: MOOW > 0.0347 cm. 0.05 em, 0.693 cm. 1.386 cm. 13.86 cm. G58. The photoelectric mass attenuation coefficient is proportional to MOOm> ZE Z.E* BE Z.E* Ze? G59. Regarding photoelectric interactions, all of the following are true except: A. B. Cc. D. Raphex 2005 K, L, and M characteristic x-rays may be emitted if the photon energy is greater than the K shell binding energy, and L and M shells are at least partially filled. The photoelectron’s energy is the energy of the incident photon less the binding energy of the emitted electrons. The probability is greatest when the photon energy is a little less than the electron binding energy. In tissue, most of the released energy is locally absorbed.General ~* Questions # Gé0. Gél. G62. Gé3. Gé4. The ratio of Compton interactions in one gram of hydrogen to one gram of carbon is approximately: 0.5:1. 11. 2:1. Dependent on the photon energy. The ratio of the density of hydrogen to water. MOO WS For radiation scattered from a patient at an angle of 90° from the incident photon beam direc- tion, the ratio of scatter at 1 meter from the patient to the entrance dose to the patient is approximately: [:1. [:10. 1:100. 1:1,000. 1:10,000. moO wD A 3 MeV photon interacts by the pair production process. What is the combined initial kinetic energy of the positron and electron pair? 1.02 MeV 1.98 MeV 2.49 MeV 3.00 MeV 4.02 MeV MOOD > The pair production mass attenuation coefficient is proportional to Z MOOw > NS But independent of 7. The mass attenuation coefficient for photons: Is the linear attenuation coefficient divided by the density. Has units of cm. Varies with photon energy. Represents the probability per unit mass that photons will be scattered but not absorbed. 1,2, 3 1,3 2,4 4 only All of the above. RwN AOD > Raphex 2005General “> Questions G65. G66. G67. G68, Gé9. Which type of nuclear radiation has the shortest range in tissue? (Assume equal energy) mow S Gamma rays Betas Neutrinos Alphas Neutrons When protons interact with soft tissue, all of the following are true except: DOD Linear energy transfer (LET) increases toward the end of the proton track. Protons have a finite range. Protons undergo exponential attenuation. The proton track ends in a “Bragg Peak.” Which nuclei provide the best protection against neutrons: MOOD > Which of the following is mot tre regarding neutrons: A. Yaw The threshold for neutron emission as a product of photon interaction is about 8 MeV. Neutrons are directly ionizing. Neutron interactions with matter can cause gamma ray emission. Neutron interactions with matter can cause proton emission. An x-ray film has an optical density (OD) of 1.5. This means that: A. B. Cc. D. Raphex 2005 The transmitted intensity is reduced by a factor of 1.5. The film is completely black. The film attenuates light by a factor of 10'°. 85% of the light from a viewbox will be transmitted,General * . * ** Questions + G70-71. 1 A 10 B 1.0 Cc 10 i 0.5 2 1 0.1 0 0 10 20 10 100 1000 1 10 100 | Days keV cycles/mm ) i 2 D 1 E | 1 50 2 0 0 1 10 100 9 50 100 mR keV G72. G73. G70. Which graph represents the shape of an H&D curve? G71. Which graph represents radioactive decay? A radioactive sample is counted many times, yielding a mean of 1000 counts. The most probable distribution is that 68% of the measurements fall between: 990 and 1010 counts. 968 and 1032 counts. 936 and 1064 counts. 900 and 1100 counts, 800 and 1200 counts. moUOmS Concering the Poisson distribution, all of the following are true except: It is an approximation to the binomial distribution for small sample sizes. It describes rare and random events, Radioactive decay as a function of time fits the Poisson distribution. The standard deviation 6 increases as the number of measurements increases, The percent standard deviation decreases as the number of measurements increases. MO > Raphex 2005General * Questions G74. In a chi-square test, looking for a statistically significant difference between two experimental results, claims of such a difference with a p value of 0.01: Means there is unquestionably a difference between the two results. Allows the experimenter a wider latitude of error than would a p value of 0.05. Means there is a 99% chance that the claim is true. Means there is a 99% chance that the claim is incorrect. GOP G75-77. For the following questions, select one of the computer storage devices (answers may be used more than once). RAM Magnetic tape Hard disk CPU Optical disk MOO Wb G75. Which device has the longest access time? G76. Which device has the largest capacity? G77. Which storage device will lose information when the power goes off? G78-81. Match the following prefixes with the correct power of 10: 19° !2 10% 106 10° 10!2 MOOD > G78. micro G79. giga G80. tera G81. pico G82. The most significant source of “man-made” radiation dose to the U.S. population as a whole is from: High-altitude air travel. Television receivers and other consumer products. Fallout from nuclear weapons exploded in the atmosphere. Diagnostic radiological examinations. Nuclear reactor effluents. MOOD > Cn Raphex 2005 13General +, . %, “* Questions G83. Concerning radiation induction of thyroid cancer, which of the following is true? A. Tncrease in thyroid cancer frequency is greater in men than in women. B. mo 4 Both benign and malignant thyroid tumors have increased in frequency after X-Tay exposure. There is strong evidence of greater susceptibility of the infant thyroid for carcinogenesis compared to adults. An increase in the incidence of thyroid cancer exists only above thyroid doses of about 20 Gy. Evidence from children given thymic irradiation shows that more malignant thyroid cancers than benign lesions were induced from radiation to the thyroid. Ga4. The currently accepted model of radiation dose versus effect used by regulatory agencies in determining dose standards is: MOOw > Linear quadratic. Exponential. Gaussian. Linear, threshold. Linear, no threshold. G85. Perinatal death (at or around the time of birth) is mrosf likely to occur as a result of irradiation in humans occuring in the gestational period of: > Implantation of the embryo. B. Major organogenesis (21-40 days). c. D. Just before birth (30-36 weeks). Second trimester, G86. In radiation protection the embryo/fetus is considered more vulnerable to radiation than an adult, for all of the following reasons except: A. Ina given volume, more embryonic cells are proliferating than adult cells. B. Ina given volume, more embryonic cells are differentiating than adult cells. C. An embryo consists of fewer celis, making the loss of cells by radiation injury potentially more damaging. D. The higher oxygen tension of the embryo/fetus results in a higher oxygen enhancement ratio (OER). G87. Which of the following is true about film badges? A. Can measure total dose, but cannot distinguish between high- and low-energy X-rays. B. Can measure exposures of 2 mR. C. Are insensitive to heat. D. Are used to determine exposure by measuring the optical density of the film. E. None of the above is true. Raphex 2005General “+ Questions + GBs. G89. G90-93. G94. G95. If one lead apron attenuates 95% of an x-ray beam, two aprons will transmit approximately % 10 5 2.5 1.25 0,25 HOARD When calculating room shielding, the use factor U refers to: A. The weekly dose at the isocenter. B. The fraction of operating time that the area in question is occupied. C. The fraction of operating time that the beam is directed toward the barrier. D. The fraction of the workweek that the machine is in operation. Match the most appropriate instrament to the procedure in each question. Liquid scintillation counter. Nal well counter. Geiger-Miiller (GM) counter. Thermoluminescent dosimeter (TLD). Jonization chamber survey meter. HOOw> G90. Gamma ray sealed source wipe test G91. Contamination survey for "Tc G92. Radiation survey of a diagnostic x-ray installation G93. Personnel monitoring The basic consideration in setting limits for disposal of radioactive materials into the sewer system Is: Contamination of the sewer. Risk to swimmers. Fish death. Entrance into the food and fresh water chains. Evaporation into the air. Zoey “ALARA” stands for: A. As Long As Reasonably Allowable. B. As Low As Responsibly Attainable. C. As Low As Reasonably Achievable. D. As Little As possible RadioActivity. Raphex 2005 ISDiagnostic + Questions + DI. A film-sereen AP lumbar spine radiograph is acquired on a small adult patient. Which one of the following is most likely to be true regarding the radiation dose to the patient? A. Itis higher than that for a CT examination of the abdomen. B. Ifa phototimer is used, the dose would be the same as that for a large adult patient. C. It is independent of the speed of the film-screen system. D. It is uniform from entrance to exit within the patient. E. It is too low to cause non-stochastic biological effects. D2. A system is utilized for general radiographic imaging. Regarding the x-ray system, which of the following is correct? A. The predominant mechanism of x-ray production is characteristic emission from the anode. B. An increase in the kVp will increase the number of x-ray photons produced. C. The Heel Effect results in greater x-ray intensity at the anode end of the anode-cathode axis. D. Increase in tube current (mA) will increase the half-value layer (HVL) thickness of the X-ray spectrum. E. Approximately 99% of energy consumed by the x-ray tube is converted to x-rays. D3. The resolving capability of the focal spot is best: A. Toward the anode side of the field. B. Directly under the centrai axis (center of the field). C. Toward the cathode side of the field. D. Toward the left side of the field perpendicular to the anode-cathode axis. E. Toward the right side of the field perpendicular to the anode-cathode axis. D4. The difference between kVp and keV is the difference between: A. Exposure and dose. B. Monoenergetic and heterogeneous photon beams. C. Potential difference and energy. DB, Gamma rays and x-rays. E. lonizing and non-ionizing radiation. DS. For a given x-ray tube, the anode angle is 12°. If a substantially smaller angle is used, with no other changes, the: A. Average x-ray energy will increase. B. Effective focal spot size will increase. C. Field size coverage at the same distance from the focal spot will decrease. D. Tube output will increase. 16 Raphex 2005D9-I1. D12. Diagnostic “* Questions Select the appropriate x-ray generator type and power requirements for the following applications: Generator Type Typical Power Requirement (kW) A. Single pulse, one phase <2 B. Two pulse, one phase > 10 and < 50 C. Twelve pulse, three phase = 50 and < 150 D6. Interventional and cardiac angiography D7. Dental radiography D8. General fluoroscopy and radiography For the x-ray tube output intensity spectra shown in the figure below, the different spectra are obtained using: (Use A for True and B for False) D9. Different target material but the same kVp. D10. Different kVp and similar tube filtration. D11. Similar target material and similar mA. X-ray output spectrum (Equai tube current) 100000 8 60000 N » Oo a o a Qa Qo o o Relative photon fluence Energy (keV) The first half-value layer (HVL) for an 80 kVp x-ray beam is about equal to: A. 20-40 mm AL. B. 2-4 cm soft tissue. C. 2-4 mm lead. D. 2-4 cm bone. Raphex 2005 17Diagnostic “* Questions + DI3-15, DI6. DI7. DI8s. DI. To determine the safe operating condition of portions of the x-ray tube assembly, which of the following charts would be the most appropriate to consult in each of the following situations? Anode cooling chart. Housing cooling chart. Radiographic ESE chart. Radiographic technique chart. Single exposure rating chart. MOOD > D13. Number of exposures allowed in 20 minutes. D114. Number of exposures allowed in 2 minutes. D15. Number of exposures allowed in 0.2 minutes. Breast microcalcifications are seldom seen on routine chest radiographs because: The film size is too large. Of an increased mass attenuation coefficient for soft tissue. Of a decreased mass attenuation coefficient for soft tissue. Of an increased mass attenuation coefficient for calcium. Of a decreased mass attenuation coefficient for calcium. MOOS In screen-film radiography, which system has the highest noise and the highest resolution? Thin GdOS screen with slow film. Thin GdOS screen with fast film. Medium GdOS screen with medium speed film. Thick GdOS screen with slow film. Thick GdOS screen with fast film. MOO > A newly installed bucky radiographic system produces abdominal images that are of acceptable density over the spine and progressively lighter toward both lateral edges of the film. The most likely reason for this finding is improper: Collimator tracking. Focal distance for grid. Gnid ratio. kVp calibration of the system. Programming of the AEC system. MOO > If the absorption efficiency of each intensifying screen in a dual-screen system is 30%, what percentage of x-rays is stopped by the screens together? 9% 30% 51% 60% 70% MO Om > Raphex 2005Diagnostic “ Questions D720. Which one of the following procedural changes increases the likelihood of occurrence of motion artifacts in a conventional mammographic screening exam’? mMUAD> Increase in breast compression force. Switch from large focal spot to small focal spot. Use of a moving grid rather than a stationary grid. A higher mA setting. A higher anode rotation speed. D2\. A screening mammography exam is acquired on a patient with a compressed breast thickness of 4.2 cm and a breast composition of 50% glandular and 50% adipose tissues. Regarding the acquisition, which of the following is correct? A, B C D. EB The mean glandular dose for a single view is 4 to 6 mGy. . A single-emulsion screen-film cassette is typically used. . Using a film with wider latitude would result in increased image contrast. The anode-cathode axis of the x-ray tube is parallel to the anterior chest wall. ._ Federal regulations (MQSA) require use of a rhodium (Rh) x-ray filter. D22. Scatter-removing grids are least useful in magnification studies because: A. . Reciprocation of the bucky would be too slow. B Cc. D E Scatter reaching the film is reduced by the air gap. The small focal spot would resolve the grid lines too easily. . Not as much scatter is produced because of the small focal spot. . A proper optical density could not be obtained. D23. Stereotactic biopsy systems use geometric triangulation to determine lesion depth by using a tube shift closest to MOO n > ge 30° 60° 90° 120° D24. A typical half-value layer (HVL) for a screen-film mammographic unit is: MOOS Raphex 2005 0.03 mm Mo. 0.30 mm Mo. 2.5 mm Al. 0.30 mm Al. 0.10 mm Cu.Diagnostic * Questions D25. Ideally, the AEC (phototimer) sensor in mammography should be placed: A. As close to the chest wall as possible. B. Under the densest portion of the breast. C. Under the least dense portion of the breast. D. Under the most anterior portion of the breast. E. In the center of the breast. D26. Mammography screen/film speed A. Has no impact on image noise. B. Is not influenced by processor temperature. C. Increases with push processing techniques. D. Is greater than that of a conventional rare-earth film/screen cassette. E. Determines the average gradient of the film response. D27. A film processor with extended processing and normal development capabilities is used. The technologist acquires an image for extended processing settings, but unknowingly processes the film with normal processor (90 sec) throughput. The processed film will be: A. Extremely dark. B. Somewhat dark. C. The correct optical density. D, Somewhat light. E. Extremely light. D28. The imaging system which is best for visualizing small differences in the physical density of objects is: A. CT. B. Film-screen radiography. C. Image intensifier fluoroscopy. D. MRI. E. Ultrasound. D29. The penumbra associated with the image of the edge of an object placed 50 cm above the film plane, for an SID of 100 cm, and a focal spot size of 1.0 mm is mm, A. 0.01 B. 0.1 C. 1.0 D. 10 D30. The resonant frequency of an ultrasonic transducer is determined by the A. Thickness of the piezoelectric crystal. B. Frequency of the applied voltage pulse. C. Material surrounding the transducer. D. Transducer material. E. Backing block. 20 Raphex 2005Diagnostic “- Questions D31. D372. D33. D34. D35. D36. In ultrasound imaging which of the following is the most likely result of switching to a higher frequency transducer? MOOR} Increased ultrasound attenuation. Increased maximum depth of penetration. Longer ultrasound wavelength in tissue. Requires lower pulse repetition frequency. Increased speed of sound in soft tissue. The resolution of a diagnostic ultrasound system is mOOWD Independent of the frequency of operation. Usually better along the axis than perpendicular to the axis. Independent of the length of the ultrasound pulse. Independent of the slice thickness. All of the above. In comparison with conventional ultrasound images, tissue harmonic images have all of the fol- lowing characteristics except: MOOS Improved lateral spatial resolution. Faster image acquisition. Reduced side lobe artifacts. Removal of reverberation artifacts caused by anatomy adjacent to the transducer. Enhanced contrast agent imaging. Acoustic exposure to the patient will be increased by increased: MOOW > Receiver amplification. Transmit power. Frame averaging. TGC settings. Threshold levels. Which of the following best describes Power Doppler ultrasound? CLO OO It is less sensitive than color Doppler but provides better directionality of blood flow. It requires a major hardware upgrade to implement on modern US equipment. It delivers significantly more power deposition than standard Doppler techniques. It cannot be used with existing transducers because directional information is lost. It is chiefly implemented by software changes on existing US equipment. In an ultrasound transducer one quarter-wavelength refers to the thickness of the: moOW> Backing material. Electrical insulator. Matching layer. Radiofrequency shield. Transmit crystal. ee Raphex 2005 21Diagnostic “* Questions + D37. Aliasing in real-time ultrasound may be reduced by: A. Increasing transducer frequency. B. Decreasing transducer diameter. C. Increasing the number of scan lines. D. Increasing the frame rate. D38. All of the following are types of ultrasound transducer except: A. Coded aperture. B. Rotating sector. C. Phased array. D. Linear array. E. Annular ring. D39-43. Match the ultrasound artifact with its mechanism: A. Occurs distal to objects of high attenuation, resulting in a hypointense signal. B. Occurs distal to objects of low attenuation, manifested by a hyperintense signal. C. Occurs between two strong reflectors, resulting in equally spaced signals of diminish- ing amplitude in the image. D. Variation of the speed of sound in the tissues causes displacement of returning echoes from distal anatomy. E. Anatomy outside the main beam is mapped into the main beam. D39, Mismapping D40, Shadowing D4l1. Side-lobe energy emission D42. Enhancement D43. Reverberation p44. In a CT examination which of the following changes can be made at the scanner console to reduce image noise? A. Narrower reconstructed slice width. B. Larger acquisition field of view. C. Image display setting adjusted to a narrow window (at the same level). D. Smaller display field of view. E. Reconstruction algorithm with a lower spatial frequency cutoff. D45. A helical CT examination is performed, The radiation dose is: A. Directly proportional to the pitch. B. Reduced by choice of a narrower slice thickness. C. Independent of kVp. D. Proportional to the cutoff spatial frequency of the reconstruction filter. E. Independent of choice of image reconstruction interval. 22 Raphex 2005Diagnostic “ Questions D46. Concerning image formation in a non-contrast CT, which of the following is true? MOO mM > Image contrast is mainly derived from tissue atomic number variations. The linear attenuation coefficient tracks linearly with tissue physical density. The tissue linear attenuation coefficient is independent of the tissue electron density. Photoelectric effect is the dominant interaction in soft ussue. The linear attenuation coefficient for tissues with negative Hounsfield number is higher than that for water. D47. Concerning Multiple Detector Array (MDA) CT scanners: A. The slice width is determined by the tube collimation. B. They make use of non-radioactive xenon-gas detectors. C. Most use fan beam geometry. D. E A scanner with a 16-detector array employs a total of 16x16 detectors. The slice width can be smaller than the detector size. D48. One of the disadvantages of helical (spiral) CT scans over axial CT slices of the same tissue volume is: A. Increased slice profiles. Increased radiation dose. B Cc. Increased scatter radiation. D. E Longer scan times. Higher k¥p. D49. Chest fluoroscopy is performed on an adult patient using a 25-cm diameter image intensifier system equipped with an automatic brightness control (ABC) system. As you pan from the lung fields to the mediastinum, the ABC system increases: SOO R> The patient’s skin dose. The image intensifier’s entrance dose. Subject contrast by decreasing kVp. A, B, C are true. A, B, C are false. DSO. The use of pulsed fluoroscopy in place of continuous fluoroscopy: A. mo Of Always increases patient and staff exposure. Always increases patient exposure. May increase or decrease patient and staff exposure depending on equipment design and configuration. Always decreases patient exposure. Always decreases patient and staff exposure. a Raphex 2005 23Diagnostic | 2, ® 2, + Questions + : DSI. The main source of radiation to the staff during fluoroscopy is: | A. Leakage through the x-ray tube housing. | B. Scatter from the collimator assembly. , C. Scatter from the patient. 3 D. Scatter from the image intensifier. } E. Leakage through the image intensifier. | D5z2. Typical scatter air kerma rates next to the table while performing lateral fluoroscopy are: | A. 0.01-0.1 mGy/minute on the x-ray tube side of the patient. , B. 0.1-1.0 mGy/minute on the x-ray tube side of the patient. | C. 1.0-10 mGy/minute on both sides of the patient. } D. 0.1-1.0 mGy/minute on the image intensifier side of the patient. FE, 0.01-0.1 mGy/minute on the image intensifier side of the patient. | D53. A prolonged fluorescopically guided intervention is performed on a patient. Multiple DSA runs | were also required. The risk of deterministic injury is minimal as iong as the fluoroscopic time is less than 30 minutes. Is minimal as long as less than 100 DSA frames are acquired. Is not dependent on patient size, Increases in direct proportion to the amount of beam motion during the procedure. None of the above are true. MOODS D54. An interventional procedure is performed with a c-arm flucroscopy system. Regarding radia- tion exposure, which one of the following is correct? A. Occupational radiation dose is predominantly due to x-ray scatter from the collimator. B. The radiation dose to the radiologist is reduced by 90% if a dosimeter badge is properly worn. C. Occupational dose is reduced by use of a lower fluoroscopic frame rate. D. Shielding regulations require that radiation dose to the occupant of the control room be zero. E. The total exposure time for the procedure is limited to 5 minutes by federal regulation. D55-59, Concerming digital subtraction angiography (DSA): (Answer A for True and B for False.) D55. X-rays exiting the patient are normally captured in a cesium iodide input phosphor to produce a visible image. D56. The TV cameras used for DSA normally have a signal-to-noise ratio of about 100:1. D57. The video signals from the TV camera are processed in a digital-to-analog converter to obtain a matrix of numbers corresponding to the image. D58. Systems with the greatest capability for re-masking are those which store the subtracted image in analog form on a video disk. D59. Compared with film subtraction images, electronically subtracted images normally have somewhat poorer spatial resolution, but better todine contrast resolution. 24 Raphex 2005D60. Dél. Dé2. Dé63. Dé4. Diagnostic “ Questions A chest radiograph is obtained with computed radiography (CR). Regarding image quality, which one of the following is correct? mow > Contrast is independent of kVp. Spatial resolution is better than that of conventional film-screen technique. Contrast resolution is independent of mAs. Over-exposure results in reduced noise. Contrast is unaffected by the display window and level. Place the following in increasing order of digital image storage requirements, in their uncom- pressed form. UND > UAWNS Chest radiographs (PA, Lat., 2kx2k) Thalium-201 myocardial perfusion SPECT study Cardiac catheterization study (coronary and LV images) Ultrasound (60 images to PACS archive) Typical computed tomography (120 images) 2.4,1,5,3 5,3,2,1,4 1,2,3,5,4 3,2,1,5,4 In Picture Archiving and Communication Systems, which of the following is a mass storage device? HOW > DICOM NEMA RAID ISDN LAN How much time would be required to transmit a pair of chest images (2048x2048 pixels, 2 bytes per pixel) to a radiologist’s home using ISDN (128 kbits/sec) and a compression ratio of 15:1? MOOW > 20 minutes § minutes 1.2 minutes 30 seconds 10 seconds In practice, gamma camera intrinsic spatial resolution and linearity is evaluated weekly using: MOOW > A four-quadrant bar phantom. An Alderson phantom. A NEMA phantom. A Rando phantom. A point source. ee a Raphex 2005 25