diagnostic questions

For questions Dl and D2, refer to the diagram below.

K - 69.5 keV
L -11 keV
M - 2.5 keV

By definition, the mass of a carbon-12 atom equals exactly 12.0 amu. Yet, the sum of the masses of
the constituent particles in a stable carbon-12 atom (see table below) are greater than 12.0. The
apparent discrepancy is explained by the:

D3.

I f an electron vacancy were created in the K shell and filled by an electron transition from the
L shell, a resulting Auger electron emitted from the M shell would have a kinetic energy o f
A. 67.0 keV
B. 58.5 keV
C. 56.0 keV
D. 8.5 keV

D2.

The figure above shows a simplified representation of electron shells and corresponding electron
binding energies in a tungsten atom. A characteristic x-ray produced by an L shell to K shell
transition would have energy equal to:
A. 69.5 keV
B. 67.0 keV
C. 58.5 keV
D. 8.5 keV

DI.

A.
B.
C.
D.

6 X 1.008665 amu

Neutrons

6 X 1.007277 amu

Protons

6 X 0.000549 amu

Electrons

0.003294 amu
6.043662 amu

12.099006 amu

Total

6.051990 amu

fluorescent yield
mass deficit
mass attenuafion coefficient
Bohr model of the atom

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diagnostic questions

The specific ionization of alpha particles increases as they approach the end of their path in a
medium (see graphic below). The marked increase in ionizations is:

D6.

Rank the following in terms of INCREASING

A. alphas, protons, neutrons
B. electrons, alphas, protons
C. protons, alphas, electrons
D. electrons, protons, alphas

D5.

A l l of the following are members of the electromagnetic spectrum EXCEPT:

A. gamma rays
B. x-rays
C. positrons
D. microwaves
.

D4.

LET (assume energy equal to 5 MeV).

>

xlO

o4

,
8

,
4

,
3

,
2

,
1

Dstanc from End o4 Rang*, cm Mr

A.
B.
C.
D.

called the Bragg ionization peak

only caused by delta rays
only observed with alpha particles
observed at a greater depth in human tissue compared to air

When traversing matter, x-ray photons interact in four major ways. The most prevalent type of
interaction in human soft tissue for 100 kV x-rays is:
A. photoelectric effect
B. Compton scattering
C. pair production
D. annihilation

D8.

Which of the following radioisotopes emits particles having the highest probability of producing a
bremsstrahlung interaction?
A. Y-90
B. Tc-99m
C. F-18
D. Ra-223

D7.

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2014

D9.

diagnostic questions

In the chest radiograph shown below, the contrast between bone and soft tissue is primarily due to:

A.
B.
C.
D.

photoelectric effect
Compton scattering
pair production
annihilation

The typical half value layer (HVL) of a non-dental radiographic x-ray tube operating at 80 kV is
mm aluminum.
0.5-1.0
1.2-2.5
.
2.9-3.5
4.5-5.5

D12.

Select the photon interaction that does NOT produce secondary photons and secondary electrons:
A. Compton scattering
B. photoelectric effect
C. pair production
D. coherent scattering

D I I.

Rank bone, lead, sodium iodide, and human tissue in terms of INCREASING amount of Compton
scattering per unit mass of material for 100 kV x-rays:
A. bone, lead, Nal, tissue
B. tissue, bone, Nal, lead

C. lead, Nal, bone, tissue

D. There is no appreciable difference in Compton scattering for any of the absorbing
materials.

D10.

A.
B.
C.
D.

DI3.

The half-value of layer of fluorine-18 annihilation photons is a thickness of 7.5 cm in soft tissue.
The percentage of fluorine-18 photons expected to penetrate 30 cm is approximately:
A. 6.25%
B. 12.5%
C. 25.0%
D. 50.0%

Raphex 2014

diagnostic questions

In 2006, the NCRP estimated an average resident of the United States received an annual effective
dose of 6.2 millisieverts (mSv). The chart below describes the three principle contributors. In order
of DESCENDING contribution, A, B, and C represent:

D16.

In fluoroscopically guided interventional (FGI) procedures, air kerma at the reference point {K^
A. includes the effect of backscatter radiation
B. is the total number of photons emitted by the x-ray tube during an FGI procedure
C. is an estimate of dose or air kerma from the x-ray tube (excluding backscatter from the
patient) where the x-ray beam enters the patient
D. has a median value of 15 Gy for FGI procedures

D15.

In the United States, diagnostic reference levels (DRL) are:

A. a maximum allowable dose for CT imaging protocols (i.e., 75 mGy for adult head)
B. set at approximately the 75'^ percentile of measured patient or phantom data
C. set at the median (50'*^ percentile) of the study dose distribution
D. dependent upon image quality

D14.

A.
B.
C.
D.
D17.

Which
A.
B.
C.
D.

CT imaging; nuclear medicine imaging; radon and thoron

CT imaging; radon and thoron; nuclear medicine imaging
nuclear medicine imaging; radon and thoron; CT imaging
radon and thoron; CT imaging; nuclear medicine imaging
of the following statements concerning absorbed dose in bone is FALSE?
expresses mean radiation energy deposited per unit bone mass
is directly measured with an ionization chamber
is related to radiation-induced biological effects
is reported in units of Gray (Gy)

R a p h e x 2014

diagnostic questions

The purpose of a rotating anode in an x-ray tube system is to:

A. allow a smaller effective focal spot size
B. decrease heat load on the anode
C. decrease the heel effect
D. increases the maximum energy (kV) of the x-ray beam

D24.

In an x-ray tube, decreasing the size of the focal spot:

A. increases the number of x-ray photons generated
B. decreases the heat load
C. decreases image blurring
D. increases magnification

D23.

I f the kV for an x-ray tube (tungsten target) is increased from 100 kV to 150 kV and the mAs are
held constant, which of the following phenomena will NOT occur:
A. the maximum energy of the x-rays will increase
B. the average energy of the x-rays will increase
C. the average energy of the characteristic x-rays will increase
D. the heat units generated will increase

D22.

The discrete energies of the k-characteristic peaks found on the spectra of a molybdenum (Mo)
target have energies of approximately
keV.
A. 6-14
B. 17-20
C. 47-52
D. 67-70

D21.

The heel effect is caused by x-ray absorption in the

A. anode
B. cathode
C. filter
D. x-ray tube housing

D20.

Due to the line focus principle and anode angle, the effective focal spot size is smallest:
A. perpendicular to the anode-cathode axis
B. on the anode side of the x-ray field
C. on the cathode side of the x-ray field
D. along the central ray

D19.

In fluoroscopically guided interventional procedures (FGI), the peak skin dose:

A. does not include contribution of scattered radiation
B. is the total amount of energy imparted to the patient's skin during the procedure
C. is the highest dose to any portion of the patient's skin during the procedure
D. is reported in units of mGycm

D18.

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diagnostic questions

The major difference between an x-ray tube used for general projection imaging and one used in a
multi-slice helical CT scanner is:
A. The CT tube can be operated at much higher kV
B. The general-purpose tube has higher anode rotation speed
C. The CT tube is much smaller in size so that it will fit into the CT gantry
D. The CT tube has much higher heat capacity

D30.

Which of the following components is NOT part of the material that would make up the fixed
(non-removable from the beam path) filtration of a special procedures fluoroscopy unit?
A. the plastic window of the x-ray tube housing
B. the copper filter(s) used to harden the beam during special procedures
C. the insulating oil in the x-ray tube housing
D. the aluminum filter which guarantees minimum required HVL

D29.

In order to take advantage of the heel effect in posterior-anterior chest radiography, the x-ray tube
should be oriented in the following way:
A. cathode toward the head, anode toward the feet
B. cathode-anode axis perpendicular to the head-to-foot axis
C. anode toward the head, cathode toward the feet
D. cathode-anode orientation has no clinical implication on heel effect

D28.

A 90 keV electron strikes the tungsten target of an x-ray tube. Which of the following can be
produced by the associated interaction? [Assume binding energies for tungsten of 69 keV
(K shell), 12 keV (L shell), and 2 keV ( M shell).]
A. 57 keV Bremsstrahlung radiation and 57 keV characteristic radiation
B. 95 keV Bremsstrahlung radiation and 67 keV characteristic radiation
C. 85 keV Bremsstrahlung radiation and 85 keV characteristic radiation
D. 15 keV Bremsstrahlung radiation and 15 keV characteristic radiation

D27.

The ratio of secondary winding to primary windings in the transformer of a diagnostic x-ray
machine is in the range of:
A. 5:1
B. 50:1
C. 500:1
D. 5000:1

D26.

For an x-ray tube operating at maximum kV and maximum continuous mA, U.S. federal
regulation requires x-ray tube leakage at a distance of 1 meter to be less than:
A. 1 mR in one hour
B. 100 mR in one hour
C. lOOmR/year
D. 5,000 mR/year

D25.

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diagnostic questions

Which
A.
B.
C.
D.

D36.

With respect to the effect of oxygen during irradiation events:

A. lower oxygen levels increase radiation damage for low-LET radiation
B. the oxygen enhancement ratio (OER) is 2 3 for low-LET radiation
C. higher oxygen levels cause more biological damage for high-LET radiation compared to
low-LET radiation
D. hypoxic cells are more sensitive to radiation than well-oxygenated cells

D35.

Which of the following types of ionizing radiation has the highest relative biological
effectiveness?
A. cobalt-60 gamma rays
^
B. diagnostic x-rays
C. iodine-131 beta particles
D. alpha particles

D34.

A cobalt-57 sample containing 3.7 x lO'^ Bq of activity is assayed in a sodium iodide well counter,
yielding a net count rate of 199,800 cpm. The approximate efficiency of the detector is:
A. 0.3
B. 0.5
C. 0.7
D. 0.9

D33.

The power rating of an x-ray tube can be increased by:

A. increasing focal spot size
B. decreasing anode rotation speed
C. increasing anode angle
D. decreasing the mass of the anode

D32.

In traditional radiography, increasing x-ray tube technique from 60 kV to 80 kV, the radiation
output of the tube will increase by about a factor o f
A. 1.16
B. 1.33
C. 1.78
D. 2.00
,

D31.

of the following statements concerning radiation-induced skin damage is true?

Apparent threshold dose for radiation-induced skin cancer is -20 Gy.
Acute skin damage for radiation doses below 1 Gy is well documented.
The threshold dose for erythema is in the range of 2 to 6 Gy.
The onset of radiation-induced hair loss occurs at six months post irradiation.

Raphex 2014

diagnostic questions

Analysis of existing epidemiological studies of irradiated populations derives an approximate risk

of
increase in fatal cancer following a whole body dose of 1 Sv.
0.1%
0.5%
1%
5%

D40.

The doubling dose is the dose of radiation expected to double the spontaneous mutation rate. The
doubling dose to human populations is approximately:
;A. 0.1 Gy
B. 1 Gy
C. 10 Gy
D. 100Gy

D39.

Epidemiological data from the Chernobyl nuclear accident in 1986 suggest:

A. No excess cancer risk was associated with the accident.
B. Neuroblastoma was the most common cancer associated with pediatric exposure to
fallout.
C. Thyroid cancer was the most common cancer associated with pediatric exposure to fallout.
D. The study population was too small to infer statistically significant conclusions regarding
the effect of the accident on cancer incidence.

D38.

The hematopoietic syndrome is the primary clinical consequence of acute doses:

A. in the range of 0.5 to 10 Gy
B. in the range of 20 to 50 Gy
C. greater than 100 Gy
D. greater than 200 Gy

D37.

A.
B.
C.
D.

Based on estimates from the International Commission on Radiation Protection, for a nuclear
accident where two million people are exposed to an average dose of 3 mSv, the number of excess
cancer deaths would be:
A. 5
B. 30
C. 150
D. 300

D42.

Repair of which of the following types of DNA damage is closely associated with cell survival
after exposure to ionizing radiation?
A. single base damage
B. single strand damage
C. double-stranded breaks
D. pyrimidine dimers

D41.

Raphex 2014

diagnostic questions

A pregnant diagnostic radiology imaging technologist declares her pregnancy to the radiation
safety officer. For the entire gestation period, the allowable dose equivalent to the embryo-fetus is:
A. 0.5 mSv
B. 5 mSv
C. 50mSv
D. 500 mSv

D48.

For radiation biology studies, L D 5 0 is the radiation dose that kills

A. 50% of exposed cells
B. 50 exposed cells
C. A l l exposed cells within 50 days
D. 10-50 of exposed cells

D47.

All of the following studies have shown evidence of increased risk of radiation-induced cancers
EXCEPT:
A. diagnostic bone scans
B. atomic bomb survivors
C. chest fluoroscopy for tuberculosis
D. radium dial painters

D46.

Genetic
A.
B.
C.
D.
E.

D45.

For a fetal dose of 100 mGy, what stage of embryonic development is most likely to resuh in gross
malformation?
A. preimplantation
B. early organogenesis
C. late organogenesis
D. early embryonic development
E. late fetal period

D44.

What is an estimate of the probability of a live birth without malformation or without childhood
cancer if the conceptus receives 5 mGy?
A. 10%
B. 25%
C. 50%
D. 75%
E. 95%

D43.

effects of radiation have been seen in the following groups:

atomic bomb survivors
patients with high numbers of CT scans
radiation therapy patients
radon-exposed miners
none of the above

Raphex 2014

diagnostic questions

D49.

A nurse stands at a distance of 1 meter from a patient undergoing an interventional procedure. The
entrance skin dose rate for the patient is 20 mGy/minute. With NO shielding in place, the scatter
radiation level where the nurse is standing is approximately:
A. 0.002 mGy/minute
B. 0.02 mGy/minute
C.
0.2 mGy/minute
D.
2 mGy/minute
"

The figure below represents a characteristic curve for gas detectors. Use the graph to answer
questions D50 and D51.
Region 4

Region 5

Region 6

Applied Voltage

A Geiger-Mueller counter operates in:

A. region 2
B. region 3
C. region 4
D. region 5

D 5 I.

A nuclear medicine dose calibrator operates in:

A. region 2
B. region 3
C. region 4
D. region 5

D50.

10

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2014

D52.

diagnostic questions

The graph below depicts an energy spectrum for Cesium-137 collected on a sodium iodide
detector. The energy resolution of the displayed system is approximately
FWHM at the
662 keV photopeak;

1
I
I

A.
B.
C.
D.

0.7%
7%
25%
66%

The radiation dose limit for a patient undergoing a bone scan is:
A. 0.5 mSv
B.
5 mSv
C. 50mSv
D. not limited

D56.

What limit applies for the general public in corridors or waiting rooms adjacent to an x-ray room?
A. 0.1 mSv/y
B.
1 mSv/y
C. lOmSv/y
D. lOmSv/h

D55.

Nuclear cardiology stress tests using 30 mCi of 99mTc sestamibi will result in approximate
effective dose of about:
A. 0.04 mSv
B. 0.4 mSv
C.
4mSv
D.
40mSv

D54.

Assuming identical acquisition parameters and field dimensions, which of the following
statements is TRUE for projection radiography of the chest?
A. The effective dose for an AP acquisition is higher than a PA acquisition.
B. The effective dose for a PA acquisition is higher than an AP acquisition.
C. The effective dose for AP and PA acquisitions are the same.
D. Effective dose cannot be calculated for projection radiography of the chest.

D53.

Raphex 2014

diagnostic questions-

D57.

Fetal doses from a CT of the mother's abdomen can result in doses in the following range:
A. 0.10-0.50 mGy
B. 1-5 mGy
C. 10-50 mGy
D. 100-500 mGy

Use this graphic for questions D58 through D60.

lOcmMJi*

lOcmtlMoe

10cint*u

X-fay>(jE

IV

For a 10 cm tissue, which x-ray spectrum gives the most dose?

A.
B.
C. IV
D. i i

D60.

The x-ray spectrum with the highest HVL is:

A.
B.
C. IV
D. i i

D59.

What x-ray phenomenon is depicted in the illustration above:

A. Gibbs
B. cavitation
C. aliasing
D. beam hardening

D58.

12

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D61.

diagnostic questions

For the two x-ray energy spectra below, which statement is correct regarding their clinical
applications?
30 kVp, Mo target, 0.03 mm Mo filter

30 kVp, Mo target, 0.025 mm Rh filter

(superimposed on 0.03 mm Mo filter spectrum)

x-rays transmitted
r using Rh filter

10

20
Energy, (keV)

30

40

10

20
Energy, (keV)

30

A. Both spectra could be used for general radiographic application.

B. The left-hand spectrum would be used for mammography of women with smaller/thinner
breasts, while the right-hand spectrum would be used for mammography of women with
larger/thicker breasts.
C. The right-hand spectrum would be used for mammography of women with smaller/thinner
breasts, while the left-hand spectrum would be used for mammography of women with
larger/thicker breasts.
D. Both spectra would be used head CT exclusively.
E. Neither spectrum would be used clinically.
D62.

Identify the image below.

A.
B.
C.
D.

gamma camera contrast phantom

CT contrast and spatial resolution phantom
ACR mammography accreditation phantom
PET contrast and resolution phantom

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13

diagnostic questions

A very busy female interventional radiologist routinely wears both an above-lead collar and
below-lead body radiation badge. Her average annual readings over the past five years have been
20 mSv to the collar badge and 3 mSv to the body badge. She declares that she is three months
pregnant. What should happen based on NCRP recommendations?
A. She may maintain her current procedure volume.
B. She should reduce her procedure volume by 25%.
C. She should reduce her procedure volume by 50%.
D. She should reduce her procedure volume by 75%.

D67.

An interventional system performs fluoroscopy at 15 fps, DSA at 7.5 fps, and cine at 10 fps. Rank
the patient entrance dose rates (mGy/min) in ascending order for a 20 cm thick patient:
A. fluoro, DSA, cine
B. fluoro, cine, DSA
C. DSA, fluoro, cine
D. DSA, cine, fluoro
E. cine, fluoro, DSA F. cine, DSA, fluoro

D66.

The FDA requires that all fluoroscopes sold in the United States after May 2006 have the
following radiation monitoring technologies:
A. effective dose indicator
B. focal spot-to-skin indicator
C. peak skin dose indicator
D. total air kerma at the reference point indicator

D65.

Mammography digital tomosynthesis:

A. employs a moving x-ray tube and moving image receptor
B. provides a series of thin slices with about the same total dose as a conventional
mammogram
C. employs standard CT x-ray detectors
D. most commonly uses a projection angle of 180 degrees

D64.

Diagnostic interpretation of digital mammograms should be performed on display monitors that:

A. have a contrast ratio of at least 10:1
B. have a minimum of 5 megapixels
C. have a luminance of at least 40 cd/mmD. are approved by the AAPM and ACR for mammography

D63.

14

R a p h e x 2014

diagnostic questions

In multi-detector helical CT scanning, the detector pitch:

A. is the table movement (mm) per 360 rotation divided by detector width (mm)
B. is the table movement (mm) per 360 rotation divided by collimator width at isocenter
(mm)
C. has a typical value between 2.0 and 3.0 for clinical imaging
D. is associated with partial scanning for values less than 1.0

D72.

A major objective in many examinations is optimizing the visibility of iodine-based contrast

agents and patient dose. Which of the following measures is most effective:
A. adding 1.0-10.0 mm A l to the beam while adjusting x-ray factors
B. adding 0.1-1.0 mm Cu to the beam while adjusting x-ray factors
C. increasing mAs while reducing kV without changing the x-ray beam filter
D. increasing kV while reducing mAs without changing the x-ray beam filter

D71.

For an image intensifier-based system, the limiting spatial resolution of a neurointerventional

examination is NOT influenced by the:
A. active field size of the image intensifier
B. examination magnification factor
C. radiafion dose per frame
D. x-ray tube focal spot size

D70.

The x-ray-sensitive layer in a flat-panel fluoroscopic detector is mainly:

A. AgBr
B. Csl
C. NaT
D. ZnCdS

D69.

A "radiation-conscious" radiologist is considering replacing the image intensifier on his one-yearold Gl fluoroscope with a flat panel. (The system is in excellent condition.)
A. Only the fluoroscopic patient dose rate can be expected to decrease by at least 75%.
B. Only the "spot film" patient dose rate can be expected to decrease by at least 75%.
C. Both the fluoroscopic and "spot film" patient dose rates can be expected to decrease by at
least 75%.
D. Neither the fluoroscopic nor the "spot film" patient dose rates can be expected to decrease
by at least 75%.

D68.

D73.

In CT imaging, provided the kV and effective mAs are held constant, increasing the slice thickness
will:
A. decrease image contrast
B. increase spafial resolution
C. increase the number of detected x-ray photons
D. reduce partial volume averaging

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diagnostic questions

Which of the following statements about organ-based tube current modulation is FALSE?
A. It is an AEC feature that allows tube current to be decreased or turned off over radiosensitive organs.
B. It may require an increase in mA for certain tube angulations.
C. It employs CT localizer radiograph to estimate patient attenuation.
D. It may result in a higher dose to certain organs.

D79.

An increase in which of the following variable parameters of a CT acquisition will J V O J result in

an increase in patient dose?
A. kV
B. mA
C. noise index
D. tube rotation time

D78.

In CT, relative to a standard patient size, automatic exposure control (AEC):

A. tends to decrease C T D I ^ Q I in large patients
B. tends to decrease CTDI^ol in small patients
C. tends to increase CTDI^oi in small patients
D. does not affect CTDI^ol

D77.

Which of the following statements about the changing of single CT scan parameters without
automatic exposure control (AEC) is TRUE:
A. Doubling the pitch will double the CTDI^g].
B. Doubling the pitch will cut the CTDI^Q, in half.
C. Doubling the tube rotation time from 0.5 to 1.0 second will cut the CTDIy^i in half.
D. CTDI^^oi is indirectly proportional to tube current.

D76.

TheCTDI^o,:
A. is equal to the DLP scan length
B. is measured by placing a dose meter in a phantom, measuring a large series of scans of the
phantom, and adding up the dose from all the slices
C. measures air kerma in a plastic phantom and is reported in units of mGy
D. is independent of pitch

D75.

When compared to traditional radiography, CT has:

A. superior spatial resolution and superior image contrast
B. inferior spatial resolution and inferior image contrast
C. superior spatial resolution and inferior image contrast
D. inferior spatial resolution and superior image contrast

D74.

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16

diagnostic questions

The bone thickening seen in the axial CT image on the left below is due to:

D82.

For a CT image, as the x-rays per projection increase, the signal-to-noise ratio (SNR):
A. decreases
B. increases
C. remains the same
,

D81,

For a CT image, as the pixel size decreases, the signal-to-noise ratio (SNR):
A. decreases
B. increases
C. remains the same

D80.

"^^^ :

Thin slice
A.
B.
C.
D.
D83.

beam hardening
susceptibility artifact
partial volume artifact
aliasing

The two CT scans of the thorax shown below are from the same location in the patient. What is the
difference between the two images?

A.
B.
C.
D.

The
The
The
The

image
image
image
image

on the
on the
on the
on the

left
left
left
left

is displayed with a higher-level setting.

is displayed with a wider window setting.
was obtained with a lower kV.
was obtained with higher mAs.

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17

diagnostic questions

Use the graphic below to answer questions D84 through D86.

D84.

The Q factor for the transducer below is:

Light damping, high Q
SPL long

Damping block

A.
B.
C.
D.

low
.
high
cannot be determined
medium

In ultrasound imaging, lateral resolution is primarily dependent on which of the following?

A. depth
B. frame rate
C. line density
D. spatial pulse length

DBS.

In ultrasound imaging, the HVT or half value thickness, in soft tissue is the thickness of tissue
necessary to attenuate signal intensity by how many decibels?
A. 0.3
B. 3
c. 30
'
D. 300

D87.

I f the spatial pulse length (SPL) shown in the image is 3.0 mm, the axial resolution for the
transducer is:
A. 6.0 mm
B. 3.0 mm
C. .5 mm
D. 1.0mm

D86.

The frequency spectrum bandwidth for the transducer is:

A. low
B. high
C. broad
'
D. narrow

DBS.

IB

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2014

D89.

diagnostic questions

Compared to image A (aorta) below, the frequency of the transducer used in image B (thyroid)
will be:

A.
B.
C.
D.
D90.

higher
equal
lower
unable to determine

With respect to the Doppler image shown below, which transducer angle IDEALLY
to optimize the accuracy of the blood flow measurement?

A.
B.
C.
D.

should be used

90
60
30
0

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19

diagnostic questions

D91.

In the diagnostic range (dashed line below), the intensity limit for prolonged use of ultrasound is
closest to which of the following (in W/cm)?

-r

10

100
Exposure time, minutes

1000

10000

A. 0.1 W/cmB. 1 W/cm^

C. 10 W/cm^
D. lOOW/cm^
D92.

D93.

A patient previously underwent a brain MRI scan on a 1.5 Tesla scanner. His next brain MRI will
take place on a 3 Tesla scanner. Which one of the following statements is TRUE?
A. The identical pulse sequence parameters can be safely used on the 3 Tesla scanner.
B. Larger fields of view must be used on 3 Tesla scanners.
C. The pulse sequence parameters may need to be adjusted because of RF heating/SAR
limitations.
D. T l contrast properties will not change because proton T l values are independent of field
strength.
A patient previously underwent a brain MRI scan on a 1.5 Tesla scanner. A follow-up brain MRI is
scheduled to take place on a 3 Tesla scanner. He has an implanted stent which was labeled by the
manufacturer as safe at 1.5T. Which one of the following statements is TRUE?
A. I f the implant was safe at 1.5T, then it is non-ferrous and is safe at 3.0 Tesla.
B. The MRI personnel should scan the patient with a hand-held metal detector, and i f the
stent is not detected, it is safe for the patient to be scanned at 3.0 Tesla.
C. The MRI personnel should only image the patient at 3.0 Tesla i f the patient's physician
verbally states that it is safe.
D. The MRI personnel should only scan the patient at 3.0 Tesla i f they are able to find
documentation of the implanted stent's safety at 3.0 Tesla.

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D94.

1
diagnostic questions

The relative signal intensity for a spin-echo image is shown with TR and TE as indicated in the
graph below. The image contrast obtained will be:
Longitudinal recovery (11)

Transverse decay (T2)

Image
intensitv

0.9-1

10.8J
I

0.7-

f^.-'-'-j^^-;--'^'"-'
/White

M 0.6

1000

2000

3000

4000

5000

200

300

Time (ms)

Time (ms)

"PR

A.
B.
C.
D.

T l weighted
T2 weighted
proton density
T1T2 weighted

Which of the following is true about single-shot echo-planar imaging (SS-EPI)?

A. Its images are sensitive to motion.
B. It permits a very short effective echo time.

C. It is often used for diffusion-weighted imaging.

D. It has high spatial resolution.

D97.

Which of the following techniques are used to reduce respiratory motion artifacts in MRI?
A. diffusion weighting
B. cardiac gating
C. inversion recovery
D. navigator echo

D96.

Parallel imaging techniques such as SMASH, SENSE, and GRAPPA employ a multi-coil receiver
array. Which of the following statements is FALSE?
A. Using multiple receiver coils requires a longer TR.
B. Prior knowledge of the parallel coil geometry permits a reduction in the number of phase
encode steps needed.
C. Parallel imaging usually requires a calibration scan.
D. Parallel imagine permits shorter effective TE values in fast spin-echo sequences.

D95.

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21

Al

diagnostic questions

D98.

The image below is a proton-density-weighted image of the knee. Which M R I parameter

combination will generate a proton-density-weighted spin-echo image?

A.
B.
C.
D.

long TE, long TR

short TE, long TR
short TE, short TR
long TE, short TR

The image below left is a cardiac sagittal image used to plan an oblique slice perpendicular to the
aorta to generate the image on the right. What kind of MRI image is shown on the right?

D100.

A single-slice spin-echo MR image is acquired using the following parameters: FOV = 360 mm,
matrix = 256 x 256 voxels, number of acquisitions = 2. Which parameter combination would
result in increased SNR assuming all other parameters are kept constant?
A. FOV = 320 mm, matrix = 256 x 256, acquisitions = 2
B. FOV = 180 mm, matrix = 256 x 256, acquisitions = 4
C. FOV = 360 mm, matrix = 256 x 256, acquisitions = 1
D. FOV = 360mm, matrix = 256 X 128, acquisitions = 4
'

D99.

A.
B.
C.
D.

perfusion MRI image of heart

T2* mapped vardiac image
T l weighted vardiac image
phase contrast image

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D101.

diagnostic questions

On images with a fluid attenuated inversion recovery (FLAIR) sequence as shown in figure below,
typical values for TI/TE/TR on a 1.5 Tesla scanner might be:

A.
B.
C.
D.
E.
D102.

150 7 80/3000 ms
150 7 20/500 ms
1000/80/ 10,000 ms
2200 / 20 / 500 ms
2200/125/ 10,000 ms

Which of the following is true about the MRI artifact below?

A.
B.
C.
D.
E.
D103.

The artifact can be reduced by increasing slice thickness.

The artifact is caused due to susceptibility effects.
The artifact is caused due to T l effects.
^
The artifact occurs in the phase-encode direction.
The artifact is reduced by decreasing TE.

-\

The toxicity of commonly used, FDA-approved, gadolinium-based contrast agents has been
generally considered negligible. Recently, however, concerns have been raised for patients
with renal deficiency due to a correlation between contrast agent administration and the
development of:
A. neuroplactisty
B. nephrogenic systemic fibrosis
C. rickets
D. renal cancer
E. nausea

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diagnostic questions

D104.

The image on the left below is a 3D gradient echo image which utilizes only magnitude data to
produce contrast. The image on right is from the same scan, but it uses both magnitude and phase
information to produce image contrast, which enhances microbleeds and venous architecture.
What is the technique called?

A.
B.
C.
D.
E.
D105.

phase contrast imaging

perfusion weighted imaging
susceptibility weighted imaging
diffusion weighted imaging
MR relaxometry

What is the prominent artifact around the image boundary shown by the arrows?

A.
B.
C.
D.
E.

ghosting
fat water shift
moire fringe
DC offset artifact
eddy currents

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D106.

diagnostic questions

MR dynamic Gd-enhanced 3D T l gradient echo as shown below is performed routinely for the
detection of breast malignancy. Which of the following is true?

A.
B.
C.
D.
E.

A l l lesions that enhance are probably malignant.

All lesions that enhance quickly are more likely malignant.
All lesions that enhance slowly are more likely malignant.
The measurement of T l allows for determination of benign or malignant.
The measurement of T2 allows for determination of benign or malignant.

lodine-131 (physical half-life, Tp = 8.04 days) is eliminated from the body of a postthyroidectomy thyroid cancer patient with a biological half-time, Tp, of 2.0 days. What is the
effective half-time, Te, of iodine-131 in this patient?
A. 0.8 days
B. 1.6 days
f:^"
C. 3.2 days
D. 4.8 days

D108.

The beta-ray emitted by yttrium-90, used in the form of microspheres for radioemboiic therapy of
liver tumors, has a maximum energy of 2.3 MeV. The average energy of the yttrium-90 beta-ray is
therefore approximately:
A. 0.23 MeV
B. 0.47 MeV
C. 0.77 MeV
D. 1.15 MeV

D107.

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diagnostic questions

D109.

For which of the following radioactive shipments would the following DOT label be appropriate?

A.
B.
C.
D.
E.
D I 10.

Metastron^M (89Sr strontium chloride)

A Mo99-Tc99m generator
131 -Iodide thyroid cancer treatment dose
a multi-patient vial of 18F-FDG
a 68Ge-68Ga cylindrical phantom for PET QC and calibration

':

For a hypothetical 5 x 5 gamma camera flood image with the following numbers of counts in each
pixel, the integral uniformity (lU) is:

A.
B.
C.
D.
E.

990

880

880

1010

1090

890

940

1060

1010

1000

870
940
1120
920
1040

920
1020
1100
1110
1040

990
1030
950
1120
1140

1%
3%
7%
10%
13%,

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DIM.

diagnostic questions

Based on the following modulation transfer fiinction (MTF) of an imaging system, what is the
approximate limiting spatial resolution?

Spatial Frequency (cy/mm)

A.
B.
C.
D.
E.

1 cycle/mm
2.5 cycles/mm
3.5 cycles/mm
4 cycles/mm
4.25 cycles/mm

For a controlled (or restricted) area, such as a radiopharmacy in a nuclear medicine department,
radiation surveys (i.e., measurement of the ambient exposure rates) must be performed:
A. daily
B. weekly
"
/
C. monthly
_ /
'
D. yearly
E. at the discretion of the licensee

D I 13.

For an intrinsic gamma camera uniformity measurement ("daily flood"), which of the following
is true?
A. Use a Co-57 sheet source with collimators on.
B. Use a Co-57 sheet source with the collimator removed.
C. Use a Tc-99m point source in a syringe at a distance more than 3x the diameter (or largest
dimension) of the detector with the collimator on.
D. Use a Tc-99m point source in a syringe at a distance more than 3x the diameter (or largest
dimension) of the detector with the collimator removed.
E. Use a four-quadrant bar phantom.

D I 12.

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diagnostic questions

MQSA regulation requires that dose to FDA-accepted phantom simulating the attenuation
characteristics of a standard breast shall not exceed
mGy per exposure. The dose shall be
determined with technique factors and conditions used clinically for a standard breast.
A. 0.2 mGy
B. 1.0 mGy
C. 2.0 mGy
D. 3.0 mGy
E. 5.0 mGy

D I 16.

Mammography is the technique of choice for detecting non-palpable breast cancers. However, the
risk of carcinogenesis in screening mammography is a concern. Mammography Quality Standards
Act (MQSA) requires monitoring the dose annually for a typical patient. What is the legally
required dose index in mammography dose monitoring?
A. committed dose
B. peak skin dose
C. deep dose
D. average glandular dose
E. dose area product

D I 15.

The exposure rate measured at 1 m from the surface of a package containing radioactivity is
0.006 R/hr. The transport index (Tl) of this package is therefore:
A. 0
B. 1
C. 3
D. 6
E. 10

D I 14.

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D I 17.

diagnostic questions

The figure below shows the image of a mammography ACR accreditation phantom for screen-film
mammography. The phantom contains 6 nylon fibers, 5 simulated calcification groups (specks)
and 5 low-contrast disks (masses). To pass MQSA image quality standards for screen-film
mammography, what is the minimum requirement of visualized objects?

A.
B.
C.
D.
E.

6 fibers, 5 speck groups, and 5 masses

3 fibers, 3 speck groups, and 3 masses
1 fiber, 5 speck groups, and 5 masses
2 fibers, 2 speck groups, and 2 masses
4 fibers, 3 speck groups, and 3 masses

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diagnostic questions

D I 18,

In x-ray mammography, overlaying and underlying anatomy often obscures visualization of

pathology. A 3D x-ray mammography technique alleviates this issue by imaging the breast at
multiple angles (angular range 15*^ to 60) as shown in the figure below with low dose and 1 mm
reconstructed slices. This technique is called:

A.
B.
C.
D.
D119.

breast CT
breast digital tomosynthesis
contrast-enhanced spectral mammography
breast infrared thermography

Compression is essential in mammographic studies, whether using screen film or digital detectors.
Compression is achieved using a compression paddle attached to a mechanical assembly
compressing the breast from the top as shown below. Breast compression in mammography would,
however, result in an increase in
.

A.
B.
C.
D.
E.

patient dose
magnification
patient motion
scatter radiation
none of the above

30

Raphex 2014