diagnostic questions

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

K - 69.5 keV
L -11 keV
M - 2.5 keV
DI. 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
D2. 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
D3. 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:
Electrons 6 X 0.000549 amu 0.003294 amu
Protons 6 X 1.007277 amu 6.043662 amu
Neutrons 6 X 1.008665 amu 6.051990 amu
Total 12.099006 amu
A. fluorescent yield
B. mass deficit
C. mass attenuafion coefficient
D. Bohr model of the atom
R a p h e x 2014 I
diagnostic questions
D4. A l l of the following are members of the electromagnetic spectrum EXCEPT:
A. gamma rays
B. x-rays
C. positrons
D. microwaves .
D5. Rank the following in terms of INCREASING LET (assume energy equal to 5 MeV).
A. alphas, protons, neutrons >
B. electrons, alphas, protons
C. protons, alphas, electrons
D. electrons, protons, alphas
D6. 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:
xlO»
2• ^
o4 , , , , , ,—
7 6 8 4 3 2 1 0
D«stanc« from End o4 Rang*, cm Mr
A. called the Bragg ionization peak
B. only caused by delta rays
C. only observed with alpha particles
D. observed at a greater depth in human tissue compared to air
D7. 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
D8. 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
2 Raphex 2014
 diagnostic questions
D9. In the chest radiograph shown below, the contrast between bone and soft tissue is primarily due to:
A. photoelectric effect
B. Compton scattering
C. pair production
D. annihilation
D10. 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.
D I I. 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
D12. The typical half value layer (HVL) of a non-dental radiographic x-ray tube operating at 80 kV is
mm aluminum.
A. 0.5-1.0
B. 1.2-2.5 - - .
C. 2.9-3.5
D. 4.5-5.5
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 3
diagnostic questions
D14. 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
D15. 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
D16. 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:
A. CT imaging; nuclear medicine imaging; radon and thoron
B. CT imaging; radon and thoron; nuclear medicine imaging
C. nuclear medicine imaging; radon and thoron; CT imaging
D. radon and thoron; CT imaging; nuclear medicine imaging
D17. Which of the following statements concerning absorbed dose in bone is FALSE?
A. expresses mean radiation energy deposited per unit bone mass
B. is directly measured with an ionization chamber
C. is related to radiation-induced biological effects
D. is reported in units of Gray (Gy)
4 R a p h e x 2014
 diagnostic questions
D18. 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
D19. 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
D20. The heel effect is caused by x-ray absorption in the .
A. anode
B. cathode
C. filter
D. x-ray tube housing
D21. 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
D22. 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
D23. 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
D24. 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
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diagnostic questions
D25. 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
D26. 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
D27. 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
D28. 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
D29. 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
D30. 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
6 R a p h e x 20 i 4
 diagnostic questions
D31. 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 ,
D32. 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
D33. 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
D34. 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
D35. 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
D36. Which of the following statements concerning radiation-induced skin damage is true?
A. Apparent threshold dose for radiation-induced skin cancer is -20 Gy.
B. Acute skin damage for radiation doses below 1 Gy is well documented.
C. The threshold dose for erythema is in the range of 2 to 6 Gy.
D. The onset of radiation-induced hair loss occurs at six months post irradiation.
Raphex 2014 7
diagnostic questions
D37. 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
D38. 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.
D39. 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
D40. 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.
A. 0.1%
B. 0.5%
C. 1%
D. 5%
D41. 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
D42. 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
8 Raphex 2014
 diagnostic questions
D43. 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%
D44. 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
D45. Genetic effects of radiation have been seen in the following groups:
A. atomic bomb survivors
B. patients with high numbers of CT scans
C. radiation therapy patients
D. radon-exposed miners
E. none of the above
D46. 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
D47. 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
D48. 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
Raphex 2014 9
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 5
Region 4
Region 6
Applied Voltage
D50. A nuclear medicine dose calibrator operates in:
A. region 2
B. region 3
C. region 4
D. region 5
D 5 I. A Geiger-Mueller counter operates in:
A. region 2
B. region 3
C. region 4
D. region 5
10 Raphex 2014
 diagnostic questions
D52. 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. 0.7%
B. 7%
C. 25%
D. 66%
D53. 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.
D54. 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
D55. 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
D56. The radiation dose limit for a patient undergoing a bone scan is:
A. 0.5 mSv
B. 5 mSv
C. 50mSv
D. not limited
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
D58. What x-ray phenomenon is depicted in the illustration above:
A. Gibbs
B. cavitation
C. aliasing
D. beam hardening
D59. The x-ray spectrum with the highest HVL is:
A.
B.
C. IV
D. i i
D60. For a 10 cm tissue, which x-ray spectrum gives the most dose?
A.
B.
C. IV
D. i i
12 Raphex 2014
 diagnostic questions
D61. For the two x-ray energy spectra below, which statement is correct regarding their clinical
applications?
30 kVp, Mo target, 0.025 mm Rh filter
30 kVp, Mo target, 0.03 mm Mo filter (superimposed on 0.03 mm Mo filter spectrum)
x-rays transmitted
r using Rh filter
10 20 30 40 10 20 30
Energy, (keV) Energy, (keV)
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. gamma camera contrast phantom
B. CT contrast and spatial resolution phantom
C. ACR mammography accreditation phantom
D. PET contrast and resolution phantom
Raphex 2014 13
diagnostic questions
D63. 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/mm-
D. are approved by the AAPM and ACR for mammography
D64. 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
D65. 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
D66. 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
D67. 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%.
14 R a p h e x 2014
 diagnostic questions
D68. A "radiation-conscious" radiologist is considering replacing the image intensifier on his one-year-
old 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%.
D69. The x-ray-sensitive layer in a flat-panel fluoroscopic detector is mainly:
A. AgBr •
B. Csl
C. NaT
D. ZnCdS
D70. 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
D71. 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
D72. 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
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
Raphex 2014 15
diagnostic questions
D74. 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
D75. 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
D76. 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.
D77. 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
D78. 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
D79. 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 radio-
sensitive 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.
16 Raphex 2014
 diagnostic questions
D80. For a CT image, as the pixel size decreases, the signal-to-noise ratio (SNR):
A. decreases
B. increases
C. remains the same "^^^ :
D81, 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 ,
D82. The bone thickening seen in the axial CT image on the left below is due to:
Thin slice
A. beam hardening
B. susceptibility artifact
C. partial volume artifact
D. aliasing
D83. 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. The image on the left is displayed with a higher-level setting.
B. The image on the left is displayed with a wider window setting.
C. The image on the left was obtained with a lower kV.
D. The image on the left was obtained with higher mAs.
Raphex 2014 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. low .
B. high
C. cannot be determined
D. medium
DBS. The frequency spectrum bandwidth for the transducer is:
A. low
B. high
C. broad '
D. narrow •
D86. 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
D87. 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
DBS. 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
IB Raphex 2014
 diagnostic questions
D89. Compared to image A (aorta) below, the frequency of the transducer used in image B (thyroid)
will be:
A. higher -
B. equal
C. lower
D. unable to determine
D90. With respect to the Doppler image shown below, which transducer angle IDEALLY should be used
to optimize the accuracy of the blood flow measurement?
A. 90°
B. 60°
C. 30°
D. 0°
Raphex 2014 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 1000 10000
Exposure time, minutes
A. 0.1 W/cm-
B. 1 W/cm^
C. 10 W/cm^
D. lOOW/cm^
D92. 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.
i 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.
D93. 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.
20 Raphex 2014
 1
diagnostic questions
D94. 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:
Image
Longitudinal recovery (11) Transverse decay (T2)
intensitv
0.9-1
10.8J f^.-'-'-j^^-;--'^'"-'
I 0.7- /White
M 0.6
0 1000 2000 3000 4000 5000 200 300
"PR Time (ms) Time (ms)
A. T l weighted
B. T2 weighted
C. proton density
D. T1T2 weighted
D95. 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.
D96. 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
D97. Which of the following is true about single-shot echo-planar imaging (SS-EPI)?
A. Its images are sensitive to motion.
I B. It permits a very short effective echo time. •
C. It is often used for diffusion-weighted imaging.
D. It has high spatial resolution.
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- _ 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. long TE, long TR
B. short TE, long TR
C. short TE, short TR
D. long TE, short TR
D99. 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 '
D100. 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?
A. perfusion MRI image of heart
B. T2* mapped vardiac image
C. T l weighted vardiac image
D. phase contrast image
22 Raphex 2014
 diagnostic questions
D101. 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. 150 7 80/3000 ms
B. 150 7 20/500 ms
C. 1000/80/ 10,000 ms
D. 2200 / 20 / 500 ms
E. 2200/125/ 10,000 ms
D102. Which of the following is true about the MRI artifact below?
A. The artifact can be reduced by increasing slice thickness. „
B. The artifact is caused due to susceptibility effects.
C. The artifact is caused due to T l effects. ^
D. The artifact occurs in the phase-encode direction. -\
E. The artifact is reduced by decreasing TE.
D103. 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. phase contrast imaging
B. perfusion weighted imaging
C. susceptibility weighted imaging
D. diffusion weighted imaging
E. MR relaxometry
D105. What is the prominent artifact around the image boundary shown by the arrows?
A. ghosting
B. fat water shift
C. moire fringe
D. DC offset artifact
E. eddy currents
24 Raphex 2014
 diagnostic questions
D106. 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. A l l lesions that enhance are probably malignant.
B. All lesions that enhance quickly are more likely malignant.
C. All lesions that enhance slowly are more likely malignant.
D. The measurement of T l allows for determination of benign or malignant.
E. The measurement of T2 allows for determination of benign or malignant.
D107. 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
D108. lodine-131 (physical half-life, Tp = 8.04 days) is eliminated from the body of a post-
thyroidectomy 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
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diagnostic questions
D109. For which of the following radioactive shipments would the following DOT label be appropriate?
A. Metastron^M (89Sr strontium chloride)
B. A Mo99-Tc99m generator
C. 131 -Iodide thyroid cancer treatment dose
D. a multi-patient vial of 18F-FDG ':
E. a 68Ge-68Ga cylindrical phantom for PET QC and calibration
D I 10. For a hypothetical 5 x 5 gamma camera flood image with the following numbers of counts in each
pixel, the integral uniformity (lU) is:
1000 1010 870 920 990
1060 940 940 1020 1030
890 1090 1120 1100 950
1010 880 920 1110 1120
880 990 1040 1040 1140
A. 1%
B. 3%
C. 7%
D. 10%
E. 13%,
26 R a p h e x 2014
 diagnostic questions
DIM. Based on the following modulation transfer fiinction (MTF) of an imaging system, what is the
approximate limiting spatial resolution?
Spatial Frequency (cy/mm)
A. 1 cycle/mm
B. 2.5 cycles/mm
C. 3.5 cycles/mm
D. 4 cycles/mm
E. 4.25 cycles/mm
D I 12. 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 13. 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
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diagnostic questions
D I 14. 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 15. 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 16. 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
28 Raphex 2014
 diagnostic questions
D I 17. 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. 6 fibers, 5 speck groups, and 5 masses
B. 3 fibers, 3 speck groups, and 3 masses
C. 1 fiber, 5 speck groups, and 5 masses
D. 2 fibers, 2 speck groups, and 2 masses
E. 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. breast CT
B. breast digital tomosynthesis
C. contrast-enhanced spectral mammography
D. breast infrared thermography
D119. 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. patient dose
B. magnification
C. patient motion
D. scatter radiation
E. none of the above
30 Raphex 2014