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Diagnostic Imaging
How are radiographs produced? - X-ray tube produces x-rays --> x-rays ionize atoms (net charge) --> pass through patient, beam is attenuated --> reduction of x-ray photons --> remnant beam passes through patient --> captured by image receptor --> radiograph Which of the following is INCORRECT about radiodensity? a) it is the degree of attenuation of the x-ray beam b) it has an inverse relationship with radiographic density c) an object with high radiodensity appears dark on imaging d) an object with high radiodensity is radiopaque - c) an object with high radiodensity appears dark on imaging Objects with high radiodensity also have a low radiographic density. This would make the image radiopaque, which means more x-rays are attenuated from the beam --> appear white on imaging Which of the following is CORRECT about radiographic density? a) it has a direct relationship with radiodensity b) an object with high radiographic density appears white/bright on imaging c) an object with high radiographic density is radiopaque d) it is the degree of blackening on a radiograph - d) it is the degree of blackening on a radiograph Radiographic density has an inverse relationship with radiodensity (meaning if one increases, the other decreases). Which of the following describe(s) an object that attenuates very high amounts of x-rays from the beam and appears white on imaging? (HINT: There may be more than one correct answer)
a) radiolucent b) radiopaque c) high radiodensity, low radiographic density d) high radiographic density, low radiodensity - b) radiopaque and c) high radiodensity, low radiographic density An object with high radiodensity and low radiographic density is radiopaque. These objects attenuate high amounts of x-rays from the beam, meaning less x-rays reach the image receptor, causing the object to appear white on imaging. Which of the following objects will usually appear radiopaque on radiographs? a) cortical bone b) air c) metal and calcified gall/kidney stones d) fat - c) metal and calcified gall/kidney stones Objects that are truly radiopaque are usually make of heavy metal (i.e. fillings, surgical appliances, etc.). The only time we may see a human tissue appear radiopaque is with calcified gall/kidney stones. Which of the following describe(s) an object that attenuates very small amounts of x-rays from the beam and appears dark on imaging? (HINT: There may be more than one correct answer) a) radiolucent b) radiopaque c) high radiodensity, low radiographic density d) high radiographic density, low radiodensity - a) radiolucent and d) high radiographic density, low radiodensity
When you increase the radiographic density, a radiograph will be _________________, making it appear darker. a) underexposed b) overexposed c) properly exposed d) distorted - b) overexposed Increasing radiographic density makes an image darker (remember: high radiographic density, low radiodensity = radiolucent). This will make a radiograph overexposed When you decrease the radiographic density, a radiograph will be _________________, making it appear brighter. a) underexposed b) overexposed c) properly exposed d) distorted - a) underexposed Decreasing radiographic density makes an image brighter (remember: low radiographic density, high radiodensity = radiopaque). This will make a radiograph underexposed When you an increase radiographic contrast, what type of structures are you able to visualize better? a) fat b) metal c) soft tissue d) bone - d) bone
By increasing radiographic contrast, the bone margins will be highlighted more easily visualized When you an decrease radiographic contrast, what type of structures are you able to visualize better? a) fat b) metal c) soft tissue d) bone - c) soft tissue By decreasing (or having low) radiographic contrast, the different shades of soft tissue (radiodensities) are more easily visualized Which of the following is NOT am important factor affecting recorded detail of a radiograph? a) motion b) distance from image receptor c) use of a contrast medium d) angle relative to the central ray - c) use of a contrast medium Recorded detail refers to the sharpness of a radiograph. If someone is moving, the image may be distorted. Also, remember that the closer to the image receptor, the more defined the image. Structures that are at a right angle to the central ray are accurate and not distorted as well. Which of the following describes radiographic distortion? a) the difference between the actual image and the radiographic image b) the manipulation of an image based on settings on the monitor c) an error in production of x-rays from the tube that causes a radiograph to be distorted
d) light grey e) white - a) air b) fat c) water d) cancellous bone e) cortical bone How are CT scans produced? - X-ray tube moves in a circle around patient while they are moved into gantry at a predetermined rate --> x-rays pass through subject --> recorded on multiple image receptors --> data is obtained to produce image What are the benefits of producing multiple projection angles in a CT scan? a) allow for calculation of volumetric radiodensities b) allow for 3D reconstruction of structures c) both A + B d) none of the above - c) both A + B Which of the following is INCORRECT regarding windowing with CT scans? a) it involves selecting a range of radiodensities to display on an image b) when selecting to amplify soft tissues, it would be difficult to view bone margins c) when selecting to amplify bone, it would be difficult to view soft tissues d) it can also be done on radiographs - d) it can also be done on radiographs By selecting to amplify certain radiodensities, either bone OR soft tissues have improved visualization, but the other type of tissue would be difficult to visualize
What are the two main factors that affect image quality on a CT scan? a) slice thickness b) injection of a contrast medium c) differences in radiodensities of structures contained within a volume d) both A + C - d) both A + C Slice thickness affects spatial resolution of the image and ability to identify structures. Having a thinner slice can improve anatomical detail. When the radiodensities contained within a volume are very similar, it can be difficult distinguishing between tissues. Which describes the proper viewing of an axial view CT/MRI? a) perspective of x-ray tube, feet and hands are viewed as if you are looking down at them b) viewed as if you are looking from the feet up c) viewed as if you are facing the patient (i.e. their R is your L) d) it doesn't matter - b) viewed as if you are looking from the feet up What is the name of the type of CT view used to localize the structure to scan (orient yourself to where you are in the sequence of images)? a) axial b) T c) scout film d) pilot film - c) scout film A scout film is a type of 2D CT view that can be used to orient yourself to where you are in the sequence of images with dashed lines representing slices/scans that were taken
c) clotting phase --> assess blood clotting, taken 10-15min after injection There are three phases: flow phase, blood pool phase, and delayed phase Which of the following correctly describes how a bone scan is taken? a) beta camera is passed over subject, detects beta rays emitted by the radionuclide b) alpha camera is passed over subject, detects alpha rays emitted by radionuclide c) gamma camera is passed over subject, detects gamma rays emitted by radionuclide - c) gamma camera is passed over subject, detects gamma rays emitted by radionuclide The radionuclide emits gamma rays, which are then detected by the gamma camera to produce the bone scan image Which of the following indicates increased bone turnover + hyperfunction on a bone scan? a) black appearance b) gray appearance c) white appearance d) transparent appearance - a) black appearance Normal bone appears gray or transparent. Areas appearing black indicate increased uptake which is due to increased bone turnover and hyperfunction TRUE OR FALSE: Bone scans are specific but not sensitive - False Bone scans are sensitive to detecting increased bone activity but not specific to a certain pathology Which of the following correctly describes a PET/CT scan?
a) combines the use of a radiopharmaceutical with a CT scanner, provides a visualization of function at a molecular level b) whole-body imaging technique that uses a radiopharmaceutical which is injected into a patient c) imaging modality which uses radiofrequency waves to disrupt hydrogen molecules d) imaging modality that uses an ultrasound imaging device that emits low intensity, high frequency sound waves - a) combines the use of a radiopharmaceutical with a CT scanner, provides a visualization of function at a molecular level How is a MRI produced? - H+ molecules align in direction of magnetic field, radiofrequency pulse applies --> H+ go out of alignment, at right angle to magnetic field --> radiofrequency pulse ends --> protons align in direction of magnetic field, energy is released --> current in radiofrequency coils --> MR image produced Which of the following is INCORRECT in describing the T1 phenomenon? a) best for visualizing anatomical detail b) shows high signal intensity from fat c) occurs because of return of protons to longitudinal alignment d) slower than T2 - d) slower than T The T1 occurs faster than T2, leaving fluid to appear brighter on T2 since fat has already lost its energy Which of the following is INCORRECT in describing the T2 phenomenon? a) best for visualizing fluid, edema, etc. b) shows high signal intensity from fluid c) occurs because of return of protons to longitudinal alignment d) slower than T1 -
d) echogenicity - d) echogenicity Which of the following is INCORRECT regarding echogenicity and US? a) hyperechoic --> appear bright on images b) hypoechoic --> appear dark on images c) anechoic --> appear completely dark on images d) none of the above - d) none of the above Hyperechoic structures reflect a lot of sound, hypoechoic reflect little sound, and anechoic reflect no sound at all Select all of the following structures that are normally HYPERECHOIC on US imaging. a) cortical bone b) tendons and ligaments c) muscle d) bursa e) hyaline cartilage f) nerve g) cysts - a) cortical bone, b) tendons and ligaments, f) nerve Select all of the following structures that are normally HYPOECHOIC on US imaging. a) cortical bone b) tendons and ligaments c) muscle d) bursa
e) hyaline cartilage f) nerve g) cysts - c) muscle, d) bursa, and e) hyaline cartilage Select all of the following structures that are normally ANECHOIC on US imaging. a) cortical bone b) tendons and ligaments c) muscle d) bursa e) hyaline cartilage f) nerve g) cysts - g) cysts Which of the following are true about the longitudinal plane of view on US? (HINT: There may be more than one correct answer) a) the long axis of the transducer is in line with the long axis of the structure b) the long axis of the transducer is at a right angle to the long axis of the structure c) typically produces a sagittal slice d) typically produces an axial slice - a) the long axis of the transducer is in line with the long axis of the structure and c) typically produces a sagittal slice Which of the following are true about the transverse plane of view on US? (HINT: There may be more than one correct answer) a) the long axis of the transducer is in line with the long axis of the structure b) the long axis of the transducer is at a right angle to the long axis of the structure c) typically produces a sagittal slice
d) pleural effusion e) acute respiratory distress syndrome (ARDS) - c) pneumothorax A pneumothorax causes an abnormally dark lung field due air being trapped in the pleural cavity The following findings are consistent with what CXR diagnosis? Lung fields abnormally white, silhouette sign and air bronchogram present a) pneumonia b) pneumothorax c) CHF d) aortic dissection - a) pneumonia See image on p.9 of study guide The following findings are consistent with what CXR diagnosis? Lung fields abnormally white, lifting of hemidiaphragm, silhouette sign present a) atelectasis b) pneumothorax c) heart valve disease d) mediastinal lymphadenopathy - a) atelectasis See image on p.9 of study guide The following findings are consistent with what CXR diagnosis?
Complete white-out of lungs, silhouette sign, loss of visualization of any structures a) pneumonia b) ARDS c) heart valve disease d) aortic dissection - b) ARDS See image on p.9 of study guide Which of the following is NOT a cause of an abnormally black lung field? a) pneumothorax b) COPD c) emphysema d) congestive heart failure - d) congestive heart failure This causes an abnormally shaped heart. With an exacerbation, it could lead to pleural effusion which would make the lung field abnormally WHITE The following findings are consistent with what CXR diagnosis? Lung fields abnormally black, flattening of diaphragm, loss of costophrenic angles, hyperinflation of lungs a) pneumonia b) pneumothorax c) COPD d) aortic dissection - c) COPD
Which of the following is NOT a cause of an abnormally shaped heart? a) aortic dissection b) congestive heart failure c) heart valve disease - a) aortic dissection This causes an abnormally wide mediastinum Which of the following is true about the cardiothoracic ratio? (HINT: There may be more than one correct answer) a) volume of blood in the ventricle after systole divided by volume of blood in the ventricle after diastole b) less than 40% indicates pathology c) greater than 50% indicates pathology d) width of the heart divided by width of the chest wall at level of diaphragm - c) greater than 50% indicates pathology and d) width of the heart divided by width of the chest wall at level of diaphragm Often seen in patients with CHF (see image p.10 of study guide) Which of the following is not a standard mode of echocardiogram? a) 2D b) M-mode c) Doppler d) 3D - d) 3D This is the form of ECG which produces a standard 2D image, the same that we view with typical US imaging
a) 2D b) M-mode c) Doppler d) 3D - a) 2D Can produce either a sagittal, frontal, or transverse slice This is the form of ECG which produces a 1D representation of a one scan line of the 2D image a) 2D b) M-mode c) Doppler d) 3D - b) M-mode Used to measure chamber dimension, ejection fractions This is the form of ECG which measures the relative change of frequency of the transmitted and received US wave a) 2D b) M-mode c) Doppler d) 3D - c) Doppler TRUE OR FALSE: Structures moving towards the US transducer in an ECG produce a higher frequency than those that move away - True
