ABD Sonography: Physics
Which of the following parameters will change when the Sonographer decreases the imaging depth? A. improved elevational resolution B. increased PRF C. decreased PRF D. decreased frame rate
B. increased PRF Decreased depth = increased pulse repetition frequency = faster pulse to and fro time. The faster the pulses are sent and received, the higher the frame rate. The faster the frame rate, the better the temporal resolution. Elevational resolution is usually set by the manufacturer.
Which of the following will not improve the color Doppler visualization of flow in the arcuate arteries? A. larger packet size B. increased PRF C. increased color gain D. increased transducer frequency
B. increased PRF Packet size refers to the number of lines of information used to create the color displayed on the image. The more lines of data used, the larger the packet size, the better the color display. Decreasing the PRF or scale will assist in visualization of slower flow.
If there is no diastolic flow demonstrated on a Doppler tracing of the arcuate artery of the upper pole of the right kidney, what will the resistive index be? A. 1.0 B. 0 C. unable to calculate the RI, not enough information given D. 0.5
A. 1.0 The resistive index is calculated using the peak and end diastolic velocities measured on a Doppler tracing. PSV - EDV / PSV Example: PSV 50cm/s, EDV 0cm/s; 50 - 0 / 50 = 1.0
Which type of transducer would be used to evaluate a palpable lump in the neck? A. 12MHz linear phased array B. 3MHz curvilinear sequential array C. 12MHz curvilinear phased array D. 12MHz sector phased array
A. 12MHz linear phased array Superficial imaging is best performed with linear transducers. The large near field and rectangular FOV provide improved imaging of superficial structures. Higher frequencies also provide the best resolution.
Which of the following probe frequencies should be used when trying to evaluate the pancreas in an obese patient? A. 3MHz curvilinear B. 5MHz curvilinear C. 3MHz linear D. 5MHz phased
A. 3MHz curvilinear Lower probe frequencies provide better penetration.
______________________ resolution is defined as the ability of an ultrasound system to differentiate structures on an image based on variations in the brightness of the echo/pixel. A. Contrast B. Axial C. Lateral D. Elevational
A. Contrast Contrast resolution is defined as the ability of an ultrasound system to differentiate structures on an image based on variations in the brightness of the echo/pixel. Axial resolution refers to the ability of an ultrasound system to distinguish two structures that lie parallel to the ultrasound beam as separate and distinct. Lateral resolution refers to the ability of an ultrasound system to distinguish two structures that lie perpendicular to the ultrasound beam as separate and distinct. Elevational resolution is also called slice thickness and is usually set by the manufacturer.
Put the following in order in decreasing echogenicity: A. Renal sinus, pancreas, liver, spleen, renal parenchyma B. Renal sinus, renal parenchyma, liver, spleen, pancreas C. Pancreas, spleen, liver, renal sinus, renal parenchyma D. Renal parenchyma, spleen, liver, pancreas, renal sinus
A. Renal sinus, pancreas, liver, spleen, renal parenchyma The order of echogenicities in the abdomen from most echogenic to least echogenic. S P L S P = renal Sinus > Pancreas > Liver > or = Spleen > renal Parenchyma
Posterior shadowing can be helpful in the diagnosis of all of the following, except: A. Steatosis B. Nephrocalcinosis C. GB calculi D. Choledocholithiasis
A. Steatosis Steatosis refers to: fatty infiltration. All other choices involve the formation of a "stone" which are extremely dense and cause "posterior shadowing". The shadowing helps to distinguish the stones from mass formation.
Harmonic imaging will: A. allow for deeper penetration with improved lateral resolution B. degrade lateral resolution and improve axial resolution C. improve temporal resolution D. reduce the appearance of microbubble contrast on a contrast echo
A. allow for deeper penetration with improved lateral resolution Harmonic Imaging uses a low frequency beam transmitted into the patient and the system displays the received information as double the frequency; EX: transmitted 2MHZ, received/displayed 4MHZ Allows for deeper penetration with lower transmitted frequency and improved lateral resolution with increased received frequency. Improves contrast resolution also. Provides narrower beam width to reduce side lobe/grating lobe artifact.
Which Doppler artifact is demonstrated on the image? Left DPA waveform (above and below baseline) A. cross talk B. reverberation C. side lobes D. aliasing
A. cross talk The Doppler tracing displays a mirror image of the waveform on the opposite side of the baseline. This commonly occurs when sampling vessels adjacent to a highly reflective structure like a bone.
If the entire image is too bright, what console adjustment should you make first? A. decrease the output power B. adjust the near field TGC C. decrease the overall gain D. adjust the far field TGC
A. decrease the output power If the entire image is too bright, always adjust the output power to reduce patient exposure. If only the fair field is bright, adjust the far field TGC settings. If only the near field is bright, adjust the near field TGC settings.
Harmonic imaging leads to: A. decreased lobe artifact B. increased image noise C. reduced signal to noise ratio D. improved axial but degraded lateral resolution
A. decreased lobe artifact Tissue harmonic imaging reduces noise and clutter by improving signal to noise ratio and resolution. As an ultrasound wave propagates through the media, a change occurs in the shape and frequency of the transmitted signal. The change is due to the normal resistance of tissue/particles to propagate sound energy. This resistance and the resulting signal change is called a harmonic oscillation. The input frequency doubles the output frequency in harmonic imaging. EX: transmit frequency of 4.0 MHz for maximum penetration with a return harmonic frequency of 8.0 MHz for improved resolution. The returning higher frequency signal has to only travel one direction to the probe. The advantages of high frequency imaging and the one-way travel effect are decreased reverberation, beam aberration, and side lobes, as well as, increased signal to noise ratio, improved spatial and contrast resolution.
Power Doppler: A. display is not dependent on incident beam angle B. is preferred for evaluation of blood flow in a patient with suspected portal HTN C. is less sensitive than color Doppler when evaluating renal transplant perfusion D. is preferred for evaluation of blood flow in a TIPS shunt
A. display is not dependent on incident beam angle Power Doppler usually only displays the presence or absence of blood flow and does not indicate flow direction, therefore it is not affected by the incident beam angle. Any exam that relies on determining flow direction in a vessel should be performed with color Doppler. Power Doppler is more sensitive than color Doppler in detecting low velocity flow.
What acoustic artifact is demonstrated by the red arrow? Right and Left Scrotum A. edge shadowing B. reverberation C. ring down D. mirror imaging
A. edge shadowing Edge shadowing occurs due to diffraction of sound as it strikes a rounded border/structure.
Which of the following will improve the color display in the abdominal aorta? A. increase frame rate B. decrease color threshold C. decrease color gain D. increase sample size
A. increase frame rate Increased frame rate will improve temporal resolution that may reduce any visible delay in displayed information. Smaller sample sizes will increase frame rates. Color threshold determines the limit of when color is displayed over the 2D image. Increasing the threshold allows for more color to be displayed.
If the entire image is too dark, what console adjustment should you make first? A. increase the overall gain B. adjust the far field TGC C. increase the output power D. adjust the near field TGC
A. increase the overall gain If the entire image is too dark, always adjust the overall gain before output power. If only the fair field is dark, adjust the far field TGC settings. If only the near field is dark, adjust the near field TGC settings.
Which of the following machine adjustments will produce a more black and white 2D image? A. increased log compression B. decreased overall gain C. decreased monitor contrast D. increased dynamic range
A. increased log compression As log compression increases, the dynamic range decreases. The lower the dynamic range, the smaller number of shades of gray that are displayed on the image. Overall gain would adjust the brightness of all shades on the screen and will not affect contrast.
All of the following can cause artifactual debris within a simple cyst, except: A. increased rejection settings B. superficial location of the cyst C. small size of the cyst D. improper gain settings
A. increased rejection settings Increased gain settings can cause fill in of anechoic structures. Small cysts may demonstrate artifactual echoes from surrounding tissues. A very superficial cyst can demonstrate range resolution artifact in the anterior cyst. Increased attenuation of the sound beam would actually help to remove artifactual echoes because it will lead to a decreased amount of reflections that reach the probe.
Which acoustic artifact is demonstrated on the image? BRIGHT Round hyperechoic mass (hydrocele), scrotal sac reflection A. mirror imaging B. posterior shadowing C. range resolution D. comet tail
A. mirror imaging Note the faint duplicate image of the hydrocele and testicle posterior to the scrotal sac reflection.
Which acoustic artifact will be seen with hydrocele formation? A. posterior enhancement B. comet tail artifact C. posterior shadowing D. edge shadowing
A. posterior enhancement The fluid will act as an acoustic window and cause posterior enhancement of the tissues behind the fluid.
Potential bioeffects of ultrasound can be minimized by which of the following? A. reduce exam time B. increase PRF C. using a lower frequency transducer D. decrease overall gain
A. reduce exam time Reducing overall exam time will reduce patient exposure. Adhering to the ALARA principle will also reduce exposure by limiting power output increases and using TGC controls instead.
Which of the following will reduce anisotropy artifact? A. rocking the transducer B. dual screen imaging C. turn of harmonic imaging D. reduce color Doppler gain
A. rocking the transducer Anisotropy Artifact refers to falsely hypoechoic areas of a tendon. This occurs when the transducer is not completely parallel to the tendon. It can be reduced by rocking the transducer to make the face of the transducer more parallel to the tendon. Curved tendons can be straightened by muscular contraction to make the face of the transducer more parallel to the tendon.
What type of transducer produced the image? Sharp pointy top, more hyperechoic in the middle A. sector phased array B. linear sequential array C. curvilinear phased array D. phased sector array
A. sector phased array The phased sector array uses electronic steering to create the sector shaped image.
Which acoustic property causes the echogenic appearance of the diaphragm related to surrounding structures? A. specular reflection B. non-specular reflection C. refraction D. attenuation
A. specular reflection Specular reflection occurs with a large smooth structure = diaphragm
You are scanning the liver of an average sized patient with known cirrhosis. You complete the exam using a 3.5MHz curvilinear transducer but the doctor would like a better evaluation of liver surface nodularity. Which of the following transducers would provide the best evaluation of the liver surface? A. 3.5MHz linear B. 5MHz linear C. 8MHz curvilinear D. 12MHz linear
B. 5MHz linear In order to balance resolution and penetration a 5-7MHz transducer should work best for liver surface evaluation in an average sized patient. The linear array works best due to its large near field and rectangular field of view.
All of the following techniques will aid in the visualization of a small renal calculi with questionable shadowing, except? A. Decreasing the dynamic range B. Decreasing transducer frequency C. Using multiple scanning planes to evaluate the kidney D. Rescanning the patient in the decubitus position
B. Decreasing transducer frequency Increased transducer frequency will improve resolution of smaller objects.
All of the following are characteristics of Power Doppler, except: A. Demonstrates presence or absence of flow B. Demonstrates velocity of flow within the organ C. Demonstrates organ perfusion better than Color Doppler D. More sensitive to slow flow than Color Doppler
B. Demonstrates velocity of flow within the organ Pulsed wave Doppler demonstrates the range of peak flow velocities and flow direction of the blood in a vessel. Color Doppler demonstrates the average flow velocity of the blood in a vessel and flow direction. Power Doppler usually does not demonstrate flow direction but does demonstrate the presence/absence of flow.
_______________________ may be a cause for liver echoes distal to the GB to appear brighter than the surrounding parenchyma. A. Decreased gain settings B. Posterior enhancement C. Posterior shadowing D. Portal venous reflections
B. Posterior enhancement The GB is a fluid filled structure that will demonstrate posterior enhancement. No sound is reflected from the bile in the GB, therefore more sound waves reach the posterior wall/tissues than other adjacent areas. There is an increase in the reflections from the tissues causing an increase in brightness of the area on the image.
Which statement is true about the image? Left Posterior Knee/ AOC Sag (top of image), Bright edge A. The red arrows are pointing to the anterior wall of the Baker's cyst and the associated shadowing. B. The red arrows are pointing to the anterior wall of the Baker's cyst and the associated enhancement. C. The red arrows are pointing to the posterior wall of the Baker's cyst and the associated shadowing. D. The red arrows are pointing to the posterior wall of the Baker's cyst and the associated enhancement.
B. The red arrows are pointing to the anterior wall of the Baker's cyst and the associated enhancement. The popliteal fossa is evaluated with a posterior transducer approach. The posterior border of the Baker's cyst is demonstrated most anterior on the image. The anterior border of the Baker's cyst is demonstrated posteriorly on the image with increased posterior enhancement.
Increasing the wall filter setting could reduce the display of all of the following, except: A. beam width artifact B. aliasing artifact C. clutter artifact D. cross talk artifact
B. aliasing artifact Beam width, clutter and cross talk all involve the incorrect display of lower level Doppler shifts. Increasing the wall filter can reduce the appearance of the "weaker" Doppler shifts on the image.
Increasing the imaging depth will: A. improve temporal resolution B. decrease frame rate C. increase the pulse repetition frequency D. decrease the beam intensity
B. decrease frame rate The deeper the structure you are imaging, the longer the time the pulse needs to reach it and return. The pulses are emitted at a slower rate because they need to travel a longer distance. If the pulses are transmitted and received at a slower rate, the rate that the image is produced (frame rate) will also be reduced.
What system control can reduce the appearance of color ghosting? A. increasing color threshold B. decreasing color priority C. increasing persistence D. decreasing PRF
B. decreasing color priority Color Priority: Adjusts the threshold setting; Determines if a pixel is displayed as shade of gray, black or white or as a color; Lower threshold settings reduce the display of color (lower color priority); Higher threshold settings display more color (higher color priority); Necessary to minimize color ghosting and improper placement of color on vessel walls
When you change the angle on the Doppler cursor, the ________________ also changes. A. the volume of flow interrogated B. flow velocity displayed C. amplitude of the reflected signal D. the wall filter settings also change
B. flow velocity displayed Changing the Doppler angle will change the velocity that is calculated from the frequency shift detected in a vessel. The angle is part of the Doppler equation used to calculate the flow velocity from the frequency shift.
What is the twinkle artifact? A. varied brightness of vascular calcifications causes a twinkling effect on 2D B. mosaic color pattern displayed in a linear pattern posterior to a dense object, such as a renal stone C. thin line of reverberation artifact that is caused by calcium deposits in the renal parenchyma D. describes the color display seen as urine is entering the bladder during real time imaging
B. mosaic color pattern displayed in a linear pattern posterior to a dense object, such as a renal stone The twinkle artifact is a mosaic color pattern displayed in a linear pattern posterior to a dense object, such as a renal stone.
What can be used to alter the displayed brightness of the image after it has been stored in the memory? A. rejection B. post-processing C. compression D. pre-processing
B. post-processing Post-processing is the only control that will adjust the brightness of the image AFTER the data is stored in the digital memory (when the image is frozen).
What acoustic artifact can be seen in the liver with dilated intrahepatic ducts caused by extrahepatic obstruction? A. comet tail artifact B. posterior enhancement C. posterior shadowing D. mirror imaging
B. posterior enhancement The bile within the ducts demonstrates decreased attenuation which causes posterior enhancement.
_____________________ occurs posterior to highly attenuating structures. (stones) A. enhancement B. shadowing C. speckle D. refraction
B. shadowing A highly attenuating structure (stones) inhibits the transmission of sound which produces an anechoic area posterior to the structure (shadowing).
Harmonic Imaging: A. is not recommended for use on fetal exams due to increased beam intensity. B. uses information from reflections created by the non-linear behavior of sound waves to form the image C. improves spatial resolution but causes degradation of temporal resolution. D. improves spatial resolution but causes degradation of contrast resolution.
B. uses information from reflections created by the non-linear behavior of sound waves to form the image Harmonic imaging does not affect the beam intensity, so there is no restriction of its use. The process is performed by the machine processing more reflections to improve the spatial and contrast resolution on the image.
While performing a Doppler evaluation of the main renal arteries, multiple patient positions may be required in order to maintain a Doppler angle of __________ degrees or less. A. 0 B. 30 C. 60 D. 90
C. 60 While performing a Doppler evaluation of the renal arteries, multiple patient positions may be required in order to maintain a Doppler angle of 60 degrees or less.
A patient presents with a palpable lump adjacent to the umbilicus. Which of the following transducers would be best to use for this exam? A. 3.5 MHz Curvilinear Array B. 3.5MHz Linear Array C. 7 MHz Linear Array D. 7MHz Phased Array
C. 7 MHz Linear Array High frequency linear arrays are preferred for superficial imaging.
Which of the following statements is true regarding the Doppler tracing from the renal artery? PSV 320 cm/s, EDV 89 cm/s, A. The renal/aortic ratio will be below 3.5 B. Normal flow pattern and velocity are demonstrated but an incorrect Doppler angle is used to assess the flow causing aliasing to occur C. According to RAS diagnostic criteria, Stenosis > 60% is demonstrated D. Normal flow pattern and velocity are demonstrated
C. According to RAS diagnostic criteria, Stenosis > 60% is demonstrated Renal artery stenosis > 60% is indicated when the PSV is greater than 1.8m/s and the renal aortic ratio is over 3.5. A 60% stenosis is considered significant and treatment is required. There are no other diagnostic criteria used to stage RAS at 75% and 85% stenosis etc.
The ultrasound image demonstrates an anatomical variant of two renal arteries. One artery demonstrates a mosaic color Doppler pattern within the lumen. Which of the following adjustments would most improve the image while maintaining the diagnostic quality? A. Reducing the color Doppler gain is the preferred method to remove the appearance of color aliasing on the image. B. Repositioning the patient and scanning through the anterior abdominal wall will reduce or eliminate the color aliasing C. Increasing the color scale velocity setting is the preferred method to reduce the aliasing in the renal artery. D. Increasing the color priority setting is the preferred method to reduce the aliasing in the renal artery.
C. Increasing the color scale velocity setting is the preferred method to reduce the aliasing in the renal artery. Reducing the color gain will adjust the amount of aliasing color displayed but will not remove it from the image. Increasing color priority will increase the amount of color (and aliasing) displayed. Increasing the color velocity setting can reduce the amount of aliasing while maintaining the color fill in the vessel.
You are currently using a curved probe with a 3.5MHz frequency to evaluate a patient's liver. What can be done to better visualize the area indicated by the arrow? (image: top of liver) A. Switch to a 12MHz linear probe B. Switch from a curved array to a vector array of the same frequency C. Switch to a 5MHz linear probe D. Switch to a 2.5MHz curved probe
C. Switch to a 5MHz linear probe The linear probe would provide the largest near field. A 12MHz may be too high of a frequency to penetrate the abdominal wall into the liver. Note the amount of skin/fatty tissue on the current image. The best choice is a 5MHz linear transducer.
Which of the following best describes the probe position used to evaluate the long axis of the pancreas? A. Sagittal probe position just to the left of midline with notch rotated slightly to the left side of the patient. B. Transverse oblique probe position at the midline with notch side of the probe rotated slightly superior to the side of the probe without the notch. C. Transverse oblique probe position at the midline with notch side of the probe rotated slightly inferior to the side of the probe without the notch. D. Sagittal probe position just to the left of midline with notch rotated slightly to the right side of the patient.
C. Transverse oblique probe position at the midline with notch side of the probe rotated slightly inferior to the side of the probe without the notch. The pancreas lies across the abdomen with its long axis best demonstrated in a transverse plane. The tail lies slightly superior to the head and body which requires an oblique transverse probe position.
Which of the following techniques will lead to degraded lateral resolution? A. none of the above B. increase number of focal zones C. trapezoidal field of view on linear array D. increased probe frequency
C. trapezoidal field of view on linear array Increasing the size of the FOV by steering the beam into a trapezoidal shape will lead to increased beam divergence. Lateral resolution is reduced with wider beams
While performing color Doppler on a routine renal ultrasound, extreme turbulence is noted at the right renal artery origin. How should your exam change to evaluate the finding? A. Ask the patient to return on a different day after taking their prescribed HTN medication. B. Have the patient perform the Valsalva maneuver and reassess the vessel for changes. C. Use PW Doppler to record a flow pattern in the area of turbulence. D. All of the above
C. Use PW Doppler to record a flow pattern in the area of turbulence. A standard renal ultrasound does not include Doppler evaluation. If aliasing is noted on a routine renal exam, the Sonographer should obtain a sample velocity. If the velocity is elevated, a renal Doppler exam can be performed instead.
Which of the following correctly describes why the arcuate arteries are not easily or accurately evaluated by PW Doppler? A. because the flow is very low resistance B. because the blood flows parallel to the Doppler sound beam C. because the blood flows perpendicular to the Doppler sound beam D. The renal capsule attenuates the Doppler signal so only limited information is reflected to the probe.
C. because the blood flows perpendicular to the Doppler sound beam Blood flow is best evaluated when it flows parallel to the US beam.
Which imaging plane is most commonly used to obtain the length of the spleen during an abdominal ultrasound? A. sagittal B. transverse C. coronal D. axial
C. coronal A left lateral approach is commonly used to obtain a longitudinal image of the spleen. This coronal view is used to assess the length of the spleen.
The use of multiple focal zones will improve _______________ but degrade ________________. A. axial resolution, lateral resolution B. temporal resolution, lateral resolution C. lateral resolution, temporal resolution D. lateral resolution, axial resolution
C. lateral resolution, temporal resolution Lateral resolution improves as the beam becomes more narrow. Adding a focal zone will narrow the beam and improve the lateral resolution. As the number of focal zones increases, the temporal resolution will be degraded. Degraded temporal resolution causes the image to appear to "drag" when scanning in real time
Which probe can best evaluate the surface nodularity of the liver in a patient with cirrhosis? A. curved 8MHz B. curved 5MHz C. linear 7.5MHz D. vector 10MHz
C. linear 7.5MHz A linear probe provides the largest near field. The linear array allows for a more perpendicular interface of the US beam and the surface of the liver. Frequencies of 5-10MHz will allow for the necessary balance of penetration and resolution in patients of varied sizes.
All of the following acoustic artifacts can lead to false echoes filling a simple cyst, except: A. lobe artifact B. volume averaging artifact C. mirror image artifact D. slice thickness artifact
C. mirror image artifact A mirror image artifact refers to a second copy of a structure placed on the image. The duplicated structure is caused the beam striking a highly reflective structure.
Which of the following operator controls adjusts the beam intensity? A. dynamic range B. overall gain C. output D. TGC
C. output The output control will increase/decrease the voltage applied to the transducer which affects the intensity of the beam accordingly. Harmonic imaging is a frequency compounding technique used to improve image resolution of the displayed information. The TGC and overall gain controls are used to amplify the reflected signal.
A large angiomyolipoma in the right kidney can cause what acoustic artifact? A. posterior enhancement B. reverberation C. propagation speed artifact D. comet tail artifact
C. propagation speed artifact The difference in the speed of sound in the tumor can lead to posterior displacement of structures due to slower acoustic velocity in this fatty mass.
Time gain compensation is necessary due to: A. the inability of high frequency transducers to penetrate the body effectively B. sound impedance difference between transducer and skin C. reflection, refraction and scatter D. the non-linear behavior of sound waves
C. reflection, refraction and scatter Reflection, refraction and scatter are all components that lead to beam attenuation. Time gain compensation is used to increase the amplitude of reflections to compensate for beam attenuation as it travels through tissue.
Which of the following acoustic artifacts is identified on the image? Needle A. misregistration B. mirror image C. reverberation D. lobe artifact
C. reverberation The highly reflective properties of the needle lead to reverberation.
B-color can be helpful in the evaluation of: A. high velocity blood flow B. anechoic fluid/cysts C. subtle differences in tissues D. low velocity blood flow
C. subtle differences in tissues B-color is the colorize function on the 2D image. The different shades of a single color are used to display the reflected information on the image. Changing from grey scale to shades of a color can change the contrast resolution.
Increasing the ___________________ will aid in the ability to properly trace the contour of the Doppler waveform. A. velocity scale B. baseline C. sweep speed D. wall filter
C. sweep speed Increasing the sweep speed will decrease the amount of Doppler information displayed over a shorter time. This will reduce the number of cardiac cycles demonstrated on the display and spread out the waveforms for easier tracing.
Why did the Sonographer steer the US image during the thyroid biopsy? *Needle A. to make the US beam more perpendicular to the nodule B. to reduce the side lobe artifact C. to make the US beam more perpendicular to the long axis of the needle D. to better visualize the borders of the nodule
C. to make the US beam more perpendicular to the long axis of the needle The purpose of the image is to document needle location within the nodule. The best reflection occurs when the US beam is "perpendicular to the needle". The beam is steered to better visualize the needle and adjust the *angle of incidence to closer to 90 degrees.
Which type of transducer would be used to evaluate a patient with increased LFTs and height 5'3" and weight 275lbs? A. 5MHz sector phased array B. 5MHz linear phased array C. 10MHz vector array D. 3MHz curvilinear phased array
D. 3MHz curvilinear phased array Deep abdominal imaging is best performed with low frequency, curvilinear phased array transducers. The larger footprint and near field provide improved imaging FOV for abdominal structures. Lower frequencies also provide the best penetration.
An average sized patient presents with a fever, acute RLQ pain and vomiting. The ER physician wants to rule out appendicitis in this patient. Which transducer would best be suited for the exam? A. 3MHz curvilinear B. 12MHz linear C. 5MHz curvilinear D. 5MHz linear
D. 5MHz linear In the average size patient, a 5-7MHz linear probe will usually provide the appropriate level of penetration for the exam. The linear array is preferred for its footprint and large near field.
All of the following controls affect the amount of color fill in a vessel evaluated with color Doppler, except? A. Color Doppler scale settings B. Sample angle C. Sample size D. Color Doppler baseline
D. Color Doppler baseline The sample size and scale are directly related to the amount of color fill in the vessel. The larger the size and greater the scale, there will be a corresponding decrease in the color fill. As the angle of Doppler insonation increases from 0 - 90 degrees, it will result in a decrease in color flow. The color baseline merely sets the 0 point for the positive and negative shifts and determines which color corresponds as toward and away from the probe. Adjusting the baseline would affect what color was displayed, not how much color is displayed.
What is the name of the universally accepted image file type that is used by a PACS system to store and view images? A. MPEG B. AVI C. JPEG D. DICOM
D. DICOM DICOM - Digital Imaging & COmmunications in Medicine provides a standard for handling, storing, and transmitting information in medical imaging.
You are evaluating an obese patient with a known AAA. While using color Doppler to assess flow within the aneurysm, minimal flow is detected in the anechoic lumen. You decrease the color scale and increase the color gain but there is no improvement. Which of the following adjustments will most improve the color display on this exam? A. Switch from a 4MHz curved array to a 4MHz linear array B. Increase color sample size C. Decrease the color threshold D. Increase the color threshold
D. Increase the color threshold Color threshold (aka priority) determines the limit of when color will be displayed over the gray scale image. Decreasing the threshold would reduce the amount of color displayed in slow flowing vessels. Increasing the color threshold will increase the amount of color displayed. Smaller sample sizes produce better color display.
You are scanning the gallbladder and there appears to be sludge within the lumen. Which of the following will aid in differentiating the sludge from artifact? A. Apply color Doppler. B. Ask the patient to perform the Valsalva maneuver. C. Ask the patient to fast for 3-4 more hours and rescan the GB for changes. D. Increase the transducer frequency.
D. Increase the transducer frequency. Higher frequency probes provide better resolution images.
A patient presents for a liver ultrasound with contrast to evaluate a tumor. Which of the following lists the correct machine settings needed for the exam? A. Low mechanical Index, harmonics off, and focal zone at the abdominal wall B. Mechanical Index over 1.5, harmonics off, and focal zone at the abdominal wall C. Highest output power setting available, harmonics on, and at least three focal zones surrounding the area of interest D. Low mechanical Index, harmonics on, and focal zone placed at the area of interest
D. Low mechanical Index, harmonics on, and focal zone placed at the area of interest The mechanical index should be low, 1.0 or less, to decrease cavitation and decrease the potential to burst the microbubbles. Harmonics will assist in visualizing the contrast in the microvascularity. The focal zone should always be placed at or just below the area of interest.
Color Doppler demonstrates the ________________________________. A. average velocity of the blood flow only B. direction of flow only C. peak velocity of blood flow only D. average velocity and direction of flow E. peak velocity and direction of flow
D. average velocity and direction of flow Pulsed wave Doppler demonstrates the range of peak flow velocities of the blood in a vessel. Color Doppler demonstrates the average flow velocity of the blood in a vessel. Both techniques demonstrate flow direction. Power Doppler usually only displays the presence or absence of blood flow and does not indicate flow direction.
Which acoustic artifact can be identified on an image of the right kidney with emphysematous pyelonephritis? A. side lobe B. misregistration C. propagation speed error D. comet tail artifact
D. comet tail artifact The air producing organisms in the kidney cause the comet tail artifact due to gas production.
Which imaging plane can demonstrate the IVC and the aorta on the same image in a normal patient? A. mid sagittal only B. transverse only C. coronal only D. coronal and transverse
D. coronal and transverse A transverse view can demonstrate a transverse image of both great vessels on the same image. To obtain a longitudinal view of the aorta and IVC on the same image, position the patient in a decubitus position. Use a coronal approach to angle through the abdomen to visualize the aorta and IVC simultaneously. A right coronal approach will demonstrate the aorta as the posterior vessel. A left coronal approach will demonstrate the IVC as the posterior vessel.
Which imaging plane can produce a longitudinal image of the IVC and the aorta on the same image? A. coronal and transverse B. transverse only C. mid sagittal only D. coronal only
D. coronal only Placing the patient in the decubitus position and placing the probe on the lateral aspect of the abdomen will demonstrate a longitudinal view of the aorta and IVC side by side on the image. A transverse view can also demonstrate both great vessels on the same image but will not provide a longitudinal view.
Which supplemental technique, used to better visualize the size of a large hydrocele, is demonstrated on the image? A. harmonic imaging B. vector array imaging C. extended field of view D. curved array imaging
D. curved array imaging The curved array can be used to provide a larger footprint and near field size. A vector array would have a very small near field with a pie shaped sector. This is helpful for the assessment of superficial structures of significant size. Harmonic imaging is helpful to evaluate the fluid for debris but is not helpful in evaluating the size of the hydrocele.
What type of transducer produced the image? A. sector phased or curvilinear sequential array B. linear phased or curvilinear phased array C. vector phased array or mechanical sector D. curvilinear phased or curvilinear sequential array
D. curvilinear phased or curvilinear sequential array A phased transducer fires groups of elements in a pattern to create the image. A sequential array fires elements in sequential order to create the image. The image demonstrated could be produced by a phased or sequential curvilinear transducer.
Increasing the size of the field of view will _____________ the frame rate. A. increase B. have no effect on C. cause a 50% decrease D. decrease
D. decrease Increasing the area to be scanned will require an increase in time to process the increased # of reflections for display causing a decreased frame rate. Frame rate is indirectly related to the size of the field of view. Increased size of the FOV = slower (decreased) frame rate. If the question read "If the size of the field of view doubled, how would the frame rate be affected?" Then the answer could be more specific to say that the frame rate would decrease by 50%.
In order to assess low velocity flow, which of the following operator adjustments should be made? A. decrease wall filter setting and compression B. increase scale setting C. decrease compression D. decrease the rejection and wall filter setting
D. decrease the rejection and wall filter setting Decreasing the wall filter and rejection settings will increase the amount of low level Doppler shifts displayed on the tracing. Venous flow is low velocity and demonstrates low level Doppler shifts.
The artifact that is produced when the incident beam hits a curved surface and produces an acoustic shadow is referred to as: A. posterior shadowing B. comet tail artifact C. lobe artifact D. edge shadowing
D. edge shadowing Edge shadowing is also termed defocusing and refers to shadowing caused by the beam hitting the curved edge of a round object. (SCROTAL SAC)
What is the cause of the vertical acoustic shadow seen on the images? (Same location of the Vertical black stripe on different images) A. electrical interference B. patient motion C. air in the trachea D. element damage
D. element damage Note the "vertical black stripe" that originates at the face of the transducer. It is located in the same place on the image as you scan different anatomy.
No flow is detected while performing a Color Doppler evaluation of a normal splenic vein. What will improve the color display? A. increase the sample size B. increase the PRF C. increasing angle of insonation D. increase the color packet size
D. increase the color packet size A color packet refers to the number of lines of info in each sample taken. The more lines in the sample, the better the display. Larger packet size = better color. The color sample size refers to the size of the color Doppler field of view. Smaller sample sizes produce better color display.
Which of the acoustic artifacts is demonstrated on the image? (Image of the hemangioma and liver tissues above the diaphragm) A. range resolution B. volume averaging C. posterior shadowing D. mirror image E. side lobes
D. mirror image Note the duplicated image of the hemangioma and liver tissues above the diaphragm.
What acoustic artifact is demonstrated on the image by the red X? Hypoechoic round cyst in posterior right liver, reflected under diagphragm A. posterior enhancement B. speed error C. edge shadowing D. mirror imaging
D. mirror imaging Note the second copy of the cyst indicated by the red X. Mirror imaging artifact is caused by a highly reflective structure. The diaphragm is causing the appearance of the second cyst.
Overgaining on an US exam can cause ________________________. A. underestimation of arterial stenosis B. increased posterior shadowing C. blood to appear anechoic D. overestimation of Doppler velocity
D. overestimation of Doppler velocity Overgaining on a Doppler exam will cause a false increase is the peak velocity of the flow.
Most ultrasound systems send their exams to a digital image storage server called PACS. What does PACS stand for? A. privacy administration and charting system B. patient archival and charting system C. picture accessibility and communication structure D. picture archiving and communication system
D. picture archiving and communication system PACS - picture archiving and communication system
A large ___________________ could lead to propagation speed artifact. A. simple cyst B. cavernous hemangioma C. complex cyst D. renal angiomyolipoma
D. renal angiomyolipoma The speed of sound in "fatty tissue" is slower than in soft tissue. A large *fatty tumor* could lead to structures posterior to the mass being displayed deeper on the image than they actually are located within the body.
