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Physics Recalls

Key Points:
--Know HUDA well (read at least 3 times –one last time a day or two before the test)
--Read additional sources on SPECT, DSA and PET.
--Do at least 3 years of RAPHEX questions during studying to help know what type of questions they ask –the diagnostic
questions are better than the general questions.
--Search the Internet to see examples of US and MRI artifacts –it seems there is a picture of an artifact every year
--Know the QC for Mammography and the time intervals
--Know dose limits and thresholds (and conversions Rem – Seivert, Rad – Gray)
--Know half-lives and Energies of common radionuclides (Tc99m, Co57, I-131, I-123, Mo99, Xe33)

DISCLAIMER: The following answers may not be correct.

1. The focal spot is actually smaller than the setting due to…
+ line-focus principle

2. Biggest limiting factor with small anode angles?

+ heat-loading capabilities. ---not sure

3. What happens to the Energy of a photon after a photoelectron interaction?

+ it is absorbed locally in tissues.

4. What is the radiation emitted from the tube with collimators closed called?
+ Leakage radiation

5. What is the most important factor affecting contrast in Chest exams (120kvp)?
+ Electron density (due to Compton effect)

6. At what angle does Compton scattered photon retain most of initial Energy?
a. 10 degrees
b. 30 degrees
c. 90 degrees
d. 180 degrees

+ 10 degrees

7. What percentage of initial photons exit a patient in a KUB (20cm thick)?

a. 99%
b. 50%
c. 25%
d. 2%
e. 0.01%
+ Answer: 2% (HVL of soft tissue is 2.5-3.0cm)

8. What does ALARA stand for?

a. As Low As Reasonably Achievable

9. What is DICOM used for?

a. Protocol for digital image formats.

10. What are “fiber optic,” “coaxial,” and “twisted cable” used for?
a. For data transmission

11. What doesn’t affect image quality in Digital Radiography?

a. Transfer Rate
b. Matrix size
c. Window settings
d. Compression
+ Answer: transfer rate (will affect speed but not quality)

12. What do Hounsfield Units (HU’s) represent in CT?

a. linear attenuation coefficients

13. Decreasing FOV in MRI will also decrease what?

a. Signal to Noise Ratio
b. Spatial Resolution
c. T1 effects
d. T2 effects
+ Answer: Signal to Noise Ratio
14. Most important measurement for deterministic effects?
a. Dose Area Product
b. Dose
c. Dose Equivalent
d. Exposure
+ Answer: Dose Area Product?

15. What does adding filtration do to the Energy Spectrum Curves?

a. Shift curve down and to right (though max. E is same; charac. X-rays same)

16. 3 Gray (300 Rad) will cause what immediately?

a. Main Erythema
b. Epilation
+ Answer: erythema, I think though epilation is near this range as well

17. What is monthly dose limit for fetus in occupational worker?

a. 50mrem (units were in mSv).

18. 50rem is the annual dose limit for what?

a. Thyroid
b. Whole body
c. Lens
+ Answer: Thyroid (single organ, hands, feet, …)

19. A dose of 10mSv given to 1,000,000 people will cause how many cancers in their lifetime?
a. 40-80
b. 400-800
c. 4-8
d. 0.4-0.8
+ Answer: 400-800 (4%/Sv –do the math)

20. Two screens, same absorption efficiency. A has better Conversion Efficiency than B, what is the effect?
a. A requires half the time as B.
b. A has less noise than B.
+ Answer: half the time (A uses less photons; so more noise.)

21. Which is true regarding OD?

a. 10% transmittance requires a hot light
b. fluorescent lights lose luminance with time
+ Answer: Fluorescent light lose luminance –don’t they?

22. Advantage of screen-film radiography compared to direct?

a. Less noise ? --I think this is wrong because less photons are needed meaning more noise

23. A 10% increase in which of the following will have greatest affect on intensity?
a. kVp
b. MA
c. Time
d. Speed
+ Answer: kVp

24. Know that air gaps will result in greater entrance skin exposure in Mammography.

25. The cause of film being too light (or dark) with Automatic Exposure Control (AEC) on is?
a. wrong photocell selected

25. Why do techs shoot numerous low kVp, low mAs exposures in the morning?
a. To warm up the anode --only techs would know this

26. Increasing the OID with constant SID will do what?

a. decrease detected secondary radiation.
b. Decrease detected primary radiation.
+ Answer: decrease scattered radiation detected

27. What limits the noise seen using an Image Intensifier?

a. X-rays detected by the input phosphor
b. Light Photons emitted from TV
c. Electrons converted to light at Output phophor
d. Something about the Cable.
+ Answer: X-rays detected at input –this is definition of noise in x-ray (quantum mottle)

28. How do you get rid of the Flickering seen on monitors?

a. Interlace the fields to get a full frame
29. Using High Dose Fluoroscopy (HDF) requires all of the following except?
a. continuous audible monitor
b. measurement of cumulative dose to the patient
c. ABC to be on at all times
+ Answer: meas. of cum. Dose

30. At 110kVp, Barium is seen in GI exam while Iodine in vessels is not because?
a. barium is in a bigger lumen
b. Barium has a much greater Z than Iodine
c. Barium’s K-edge is much greater than Iodine’s K-edge
+ Answer: A, because it is bigger; the Z and K-edge are similar

31. Paramagnetic Contrast Agents ….

a. decrease T1 and to a lesser extent T2
b. decrease T1 and increase T2
c. other combinations
+ Answer: decrease T1, T2 lesser extent

32. Dose needed to make good exposure with Film-Screen system?

a. 50mR
b. 5mR
c. 0.5mR
d. 500mR
+ Answer: 0.5mR (5uGy)

33. If 95% of values are between 120 and 168, what levels will 68% be between?
a. 132 and 156 (1 S.D. of 144)
b. other values that didn’t compute

34. Two radioactive sources are given to a patient; compared to A, B has 2 x the photon energy, 2/3 the biological clearance, and
½ the uptake in the patient, what is the ratio of B:A?
a. 2:3
b. 1:6
c. 4:1
d. 6:1
+ Answer: 2:3 (I think)

35. Calculate Sensitivity: TP/TP + FN

36. On Receiver Operator Characteristic (ROC) curve, which line represents Sens. of 0.9 and Spec. of 0.7?
a. know that graph is Sens. vs. 1 – Spec.

37. A radioactive source with half life of 10 minutes has initial dose of 6 mR/hr as measured next door where a secretary
works. If the secretary is there for 2 hours, what dose does she receive?
a. 6mR
b. 12mR
c. 0.1mR
d. 2mR
+ somehow got 0.1mR or other low # (there were two problems relating to the cumulative dose ---know how to do these)

38. A 600 x 500 line Monitor can display all of the following except…
a. Chest X-ray
b. MRI
c. CT
d. Ultrasound
e. SPECT image
+ Answer: Chest X-ray needs 2000 x 2000 –at least

39. If a photostimulable phosphor plate is opened, then closed before a radiograph is obtained, what will happen?
a. black image
b. dust will get in
+ Answer: I put black image because light photons will stimulate it, but I’m not sure

40. Advantage of Digital Radiography

a. wider dynamic range

41. Know what low-pass spatial filtering, energy subtraction, and unsharp masking do.

42. Picture of Mammography Unit, with compression, on a plastic block … what is it doing?
a. checking glandular dose.
b. Measuring compression force
c. Obtaining an ACR phantom image
+ Answer: obtaining ACR phantom image (weekly)
43. If patient swallows during a carotid DSA, how can you improve the image?
a. use different mask

44. Why use Molybdenum filter with Molydenum target in mammography?

a. allows the k-shell characteristic photons to pass through

45. Grid lines are seen on a mammogram; what caused this?

a. too high a kVp for thin breasts
b. not enough mA for thick breasts
+ Answer: I think kVp (thin breasts don’t need grid)

46.Chest exams use what type of system?

a. two screens - double emulsion film
b. single screen – double emulsion film
c. two screens – single emulsion film
d. single screen – single emulsion film
+ Answer: two screens – double emulsion

47. SOD of 80, SID of 100, object size of 8cm, 20cm from focal spot (towards cathode)….. what is image size?
a. 10cm
b. 12cm
c. 20cm
d. 5cm
+ Answer: 10cm (SID/SOD = 1.25); though the 20cm adjacent to the focal spot confused me

48. Since 1992, all of the following effects were published due to fluoroscopy except ….
a. delayed facial bone growth in children
b. dry desquamation
c. erythema
+ Answer: facial growth delay? –never heard of it –but it may have been published in an obscure journal somewhere …

49. Which mammography QC is performed quarterly?

a. repeat analysis
b. average glandular dose
c. ACR phantom images
+ Answer: repeat analysis (know when QC steps are performed in mammography)

50. Which decay scheme shows a positron emission?

a. 18/9 Fluorine  18/8 Oxygen --others were negatron or isomeric transmission

51. Figure showing a Parent decaying to the left (Z-1) by two mechanisms; one is directly to the left, the other is straight down, then to the left.
How does it decay?
a. Positron Emission, Electron Capture
b. Positron Emission, Gamma Emission
c. Electron Capture, Gamma Emission
d. Negatron Emission, Positron Emission
e. Gamma Emission, Negatron Emission
+ Answer: Positron, EC ? ? --I thought straight down was gamma emission, but didn’t know how to differentiate EC from B+ when
drawing a line to the left; therefore, I put both EC and B+

52. A Fan collimator in SPECT is used to image what?

a. lung
b. heart
c. kidney
d. spine
e. brain
+ Answer: Brain –find another source than Huda on SPECT

53. Patient Couch Movement is a factor in what?

a. Pitch

54. Why use 360 degrees instead of 180 degrees in SPECT?

a. increase the count rate
b. factor the attenuation
c. blur out the center image
+ Answer: I don’t know –Huda only has a small section on SPECT –I recommend reading another source on this topic

55. Know that increasing pitch will decrease patient dose.

56. To better visualize a 4cm hepatoma (low contrast lesion) in CT, what should be done?
a. increase slice thickness (low contrast resolution is limited by noise --# of photons—increasing thickness increases
57. A 25cm image is obtained on a 512 x 512 image intensifier, what is the maximum line pairs/ mm?
a. 1.0
b. 1.25
c. 0.75
d. 0.5
+ Answer: 1.0 lp/mm (this may not be right because it is an I.I. which relates to a TV system and also you have to use the Kell factor
(0.7) and other factors to determine resolution.

58. Lateral resolution most affected by …

a. degree of focusing (more focusing gives better lateral resolution)

59. Axial resolution most affected by …

a. pulse length (shorter gives better axial resolution)

60. What does not affect the frequency shift in Doppler?

a. size of object
b. speed of object
c. resonant frequency
d. speed of US wave
e. angle
+ Answer: size of object (freq. Shift = 2 f v/c cos0)

61. Greatest contributor to effective dose in U.S.?

a. CT
b. Nuc. Med.
c. Chest X-rays
+ Answer: CT (65% of dose though only 10% of exams)

62. Excluding Radon, what is approximate Natural Background radiation?

a. 200mrem (in units of mSv) --though actually it is about 100mrem –other answers were a factor of 10 off this one

63. A woman at 8 weeks gestation gets AP and lateral radiographs of the L-spine. She did not know this at the time, what
should be done?
a. tell her that there is only a small risk
b. don’t do anymore exams until end of pregnancy
c. therapeutic abortion
d. tell her leukemia risk is increased 2x
+ Answer: only small risk (more exams may be necessary and outweigh the risks, therapeutic abortion should not even be considered
until 10rad is given –even then, most authorities won’t even talk about it)

64. What is the equation for effective half life (Teff)?

a. 1/Teff = 1/Tb + 1/Tp

65. Breast feeding should stop for 2 weeks following what radiopharmaceutical?
a. I-123
b. Tc99m DTPA
c. Tc99m DMSA
d. Xe-133
+ Answer : I-123 ?

66. Energy of gamma ray is determined by what?

a. average signal of all PMTs
b. signal of only the center PMT
c. signal from 7 PMTs
+ Answer: all PMTs?? (Huda says “several”)

67. Picture of a nuclear medicine image that is noisy, how would you improve it?
a. increase the counting time from 60 seconds to 120 seconds

68. For a High Tech (Space Age) Gamma Camera, what determines the limiting resolution?
a. collimator
b. crystal thickness
c. crystal diameter
+ Answer: collimator ??

69. What collimator will give the best resolution of a small object in nuclear medicine?
a. pinhole collimator
b. parallel Answer: pinhole
c. diverging
d. converging

70. Know radiochemical purity vs. chemical purity vs. radionuclide purity.
a. answer was radiochemical –about the chemical purity of a isotope

71. Know that Co57 is used to check constancy of the dose calibrator
- because it has a long half life (270 days or so)
72. Why can Co57 be used instead of Tc99m to check camera?
a. similar energies (Co57 emits a gamma with energy of 130keV)

73. Cold defect on flood image, what is the cause?

a. PMT failure
b. Cracked crystal
+ Answer: PMT failure; (cracked crystal gives a line)

74. Cellular damage is due to interaction of radiation with …?

a. DNA
b. Lysosome Answer: DNA
c. Mitochondria

75. Dicentric is a ….?

a. type of chromosome aberration
b. due to acentric formation
+ Answer: type of chromosome aberration

76. Which is a deterministic effect?

a. lens opacity
b. Cancer
c. Microcephaly
d. Mental Retardation
+ Answer: lens opacity (others are stochastic)

77. Limits of radiation have been set for the following population except.
a. over 65 years old
b. under 18 years old (occupational workers)
c. fetus
d. general public
+ Answer: over 65 years old

78. Who regulates an x-ray department that does not used radioisotopes?
a. the State
b. NRC
c. FDA
d. EPA
+ Answer: State

79. A dose of 10mrad to a 1000 people will cause how many genetic abnormalities in future generations?
a. less than 0.1
b. 1
c. 10
d. 100
+ Answer: less than 0.1 (risk is 0.8%/Sv)

80. Current studies on low dose, low LET diagnostic x-rays used in medicine show that the risk of genetic defects is …
a. negligible
b. increased significantly
+ Answer: no human studies have shown genetic effects (only on animals)

81. A woman declares pregnancy in 4th month. Her collar badge reads 400mrem retrospectively, what should be done?
a. give her another badge to wear on the waist
b. tell her to stop working
c. move the collar badge to the waist
+ Answer: a (seems like the right thing to do); dose limits do not apply until pregnancy is declared; therefore, what happened before
declaration is not counted; a badge should be worn at the waist, though the collar badge should be used as well.

82. The velocity of sound increases from 1450m/s to 1550m/s moving from fat to water, what happens??
a. wavelength increases
b. wavelength decreases
c. frequency increases
d. frequency decreases
+ Answer: Wavelength increases (freq. Constant); equation is velocity = frequency x wavelength

83. Objects below bone cannot be imaged with US because the sound is ..
a. Reflected
b. Absorbed
c. Refracted
d. Scattered
+ Answer: reflected
84. An echo is received 10msec after it is sent out in soft tissue, what is the distance in cm?
a. 0.77cm
b. 1.5cm
c. 15cm
+ Answer: 0.77cm (remember to use half the time because the wave traveled to-and-fro; 1540m/s = X meters / 5 msec)

85. Most important factor affecting the velocity of sound in material?

a. compressibility of tissue

86. To increase resonant frequency, one should …

a. decrease thickness of piezoelectric crystal
b. increase thickness of piezoelectric crystal
+ Answer: decrease thickness (just like thinner pipes have higher frequency –higher pitch)

87. Time Gain Compensation (TGC) corrects for what?

a. attenuation
b. velocity
c. frequency
+ Answer: attenuation

88. Compound Ultrasonography uses …

a. Doppler and real-time
b. Multiple planes of images to create a 3D image.
+ Answer: I never heard of this; it is a new technique called Sono-CT where 3D images are obtained by formatting multiple sonographic
planes –this type of question confirms that you can study as much as you want and still not get them all correct.

89. Ultrasound image with multiple dark and light bands behind an object …..
a. reverberation artifact
b. shadowing
c. enhancement
+ Answer: Reverberation –though you may learn it as only one hypoechoic spot behind (deep) to the image

90. Biologic effects of US are based on ….

a. temporal average intensity
b. cavitation
c. heating
+ Answer: I don’t remember the question and the answers exactly; I put that it had to do something with Temp. Avg. Intensity

91. Chemical Shift artifact caused by .

a. difference in frequencies of protons in fat and water

92. Contraindication to MRI

a. spinal fusion stimulator
b. Vascular clips are all ferromagnetic
+Answer: I put “a”; I think any type of implantable stimulator –for bone healing is contraindicated; also, most clips used today are not

93. 120 sec MRI scan with a 512 x 512 matrix; if decrease the matrix to 256 x 256, what happens to time?
a. 60 sec
b. 30 sec
c. 240 sec
+ Answer: I put 30, probably is 60 -- know that the time is related to TR, Nex, and N (phase encoding steps –matrix); however, I don’t
know if phase-encoding steps is in one direction only or two.

94. Picture of Short intervals between 90, 180, 90. what is the pulse sequence?
a. GRE
b. Fast Spin echo with T1 weighting Answer: don’t know, I put B
c. Fast Spin echo with T2 weighting
d. Inversion Recovery

95. Graph of # of Neutrons on Y-axis Vs. # of Protons on X-axis, Know that stable nuclei have N > P as Z increases.
Also know that to the left B- occurs, and B+ occurs to the right of the line.

96. (I) is measured on top of the patient, and (Io) is measured below the patient, which picture will maximize I/Io ratio?
Know that increased gap will decrease intensity and so will being further from the to x-ray tube.

97. 4 pictures of angiography suite. Patient is close to II or far from II, two are at angles which has highest entrance skin
a. I put the angled one with patient closer to II.

98. 2nd and 3rd degree burns on a worker in a radiopharmaceutical plant with an explosion and fire ..
a. Isolate the patient and treat in ER.
b. Shower the patient Answer: isolate him and treat in ER??
c. He probably received significant external radiation
99. An opaque “point” is located 2cm below the focal plane in conventional tomography, how will it look?
a. a line
b. a point
c. an ellipse
d. a rectangle
+ Answer: a line (will be blurred in z direction), this is the reason we used tomography –to blur out objects out of the
focal plane.

100. What is true about “S-factor?”

a. units are ….. Gy/mCi-hr
b. determines effective dose
+ Basically, know everything you can about the S-factor

101. 10% uncertainty if a sample is counted for 1 second. If increase to 100 seconds, what happens to uncertainty?
a. 0.01%
b. 0.1%
c. 1%
d. 10%
+ Answer: I put 0.01, don’t know why

102. What is the primary way heat dissipates from Anode?

a. radiation to tube housing
b. convection to oil
c. conduction in anode
+ Answer: Radiation to tube housing

103. What does milliAmperes measure?

a. amount
b. quality
+ Answer: amount (intensity)

104. Which exam will result in the highest patient dose?

b. CT Abdomen
c. IVP
d. BE
+ Answer: TIPS (fluoro –angio—gives at least 5R/min entrance skin dose; and TIPS takes tens of minutes (maybe even
an hour) of fluoro to complete.

105. What is not produced during isomeric transmission?

a. Beta Particles
b. Gamma Ray
c. Auger Electron
d. Characteric photons
e. Internal Conversion electrons
+ Answer: Beta Particles (I have seen this question with Auger photon in the answer –there is no such thing)

106.Question about what compensates when you decrease the size of an Image Intensifier, Automatic _____ Control
i. Brightness
ii. Gain

107.Know that PET does not require a collimator because it detects 180 degree photons in coincidence.