Mock Registry

Compared to the trunk, the collar region is exposed to radiation levels

20 times greater Studies have shown that the collar (thyroid) region is exposed to about 20 times more radiation than the trunk (C). Therefore, personnel monitoring devices should be worn routinely at the collar level. It is also important to note that dosimeters should be worn outside of protective equipment to give an accurate reading for areas potentially unprotected. Choices (A), (B), and (D) are incorrect as per the previous explanation. (Bushong, 11th ed., p. 610)

For the AP axial projection of the skull, when utilizing the IOML as a landmark instead of the OML for positioning, what difference exists in the CR angulation?

7 degrees caudal The OML is the most commonly used landmark for positioning of the AP axial skull projection. When patients are unable to flex their cervical spine for this projection, placing the IOML perpendicular to the IR can be a sufficient substitute. In this scenario, the CR must be angled an additional 7 degrees caudal to account for the 7-degree difference between the OML and IOML (D). Choices (A), (B), and (C) are incorrect as per previous explanation. (Bontrager and Lampignano, 9th ed., pp. 407, 415)

Which of the following projections demonstrates the pisiform free of superimposition? 1. AP oblique of the wrist 2. Carpal tunnel projection of the wrist 3. Carpal bridge projection of the wrist

1 and 2 only The pisiform is located on the medial aspect of the wrist. In order to free the pisiform from superimposition, the wrist can either be semi-supinated to bring the medial aspect of the wrist closest to the IR, or a tangential projection of the carpal tunnel can be performed to project the pisiform away from overlapping carpals (A). The carpal bridge projection best demonstrates the following distal carpals: scaphoid, lunate, and triquetrum (B, C, and D). (Bontrager and Lampignano, 9th ed., pp. 155-163)

In the scapular Y lateral shoulder projection, which bony structures would be projected medial to the humeral head? 1. Coracoid process 2. Acromion 3. Clavicle

1 and 3 only In the scapular Y view of the shoulder, the patient is positioned in a 60-degree oblique position, which places the scapula in a true lateral. In this position, the humeral head will be projected superimposed over the base of the Y anatomical structure, which is formed by the acromion, coracoid process, and body of the scapula. The coracoid process will be located medially, partially over the upper ribs, while the acromion will be lateral to the humeral head. (Bontrager and Lampignano, 9th ed., p. 201)

Glandular dose is what percentage of the entrance skin exposure (ESE)?

15% Glandular dose, or the average radiation exposure to glandular tissue, is easy to measure. Glandular dose is measured at 15% of the entrance skin exposure (ESE), which can be calculated from established nomograms (C). Choices (A), (B), and (D) are incorrect as per the previous explanation. (Bushong, 11th ed., pp. 588-589)

When performing radiographic exams on a patient after pacemaker placement, the radiographer should avoid abducting or elevating the left arm for how many hours after the pacemaker placement procedure?

24 To avoid dislodging the pacemaker or catheter after placement, the patient's movement of the left arm is restricted for 24 hours (D). The radiographer should be especially conscious of this restriction when positioning the patient for the post-operative chest radiograph that checks pacemaker and lead positioning. Choices (A), (B), and (C) are incorrect as per the previous explanation. (Ehrlich and Coakes, 9th ed., p. 388)

What is the correct central ray placement for the AP projection of the thoracic spine?

3 to 4 inches below the jugular notch The central ray should be directed to the seventh thoracic vertebra. T7 is located approximately 3 to 4 inches below the jugular notch, or 1 to 2 inches below the sternal angle (C). Choices (A), (B), and (D) are incorrect as per the previous explanation. (Lampignano and Kendrick, 9th ed.)

Injection of iodinated contrast media may be contraindicated when a patient's creatinine level is

Above 2.0 mg/dl Blood chemistry should always be checked before administration of iodinated contrast media. High levels of creatinine indicate impaired renal function and may result in a toxic response to iodinated contrast media. The normal range for creatinine is 0.6-1.5 mg/dl (A). Choices (B), (C), and (D) are incorrect as per the previous explanation. (Ehrlich and Coakes, 9th ed., p. 359)

Which of the following responses is most likely to occur if the fetus is exposed to at least 250 mGy of radiation during the first two weeks of the first trimester?

Embryo resorption During the first two weeks of the first trimester, the most likely biologic response to at least 250 mGy of radiation exposure has been embryo resorption or spontaneous abortion (C). After the first two weeks, responses have been skeletal deformities in early organogenesis, followed by neurological deficiencies later in the first trimester (B and D). During the second and third trimesters, the most likely biological response has been the occurrence of malignancies in early childhood (A). (Bushong, 11th ed., pp. 592-593)

What may occur if a high-pass filtering function is used on an image with high contrast?

Excess noise The use of high-pass filtering, or edge enhancement, may increase the amount of image noise (A and B). Long-scale contrast is the increase in overall grays in an image, but these characteristics are synonymous with low frequencies or long wavelengths, which are filtered out during the process of edge enhancement (C and D). (Carroll, Quinn B., 2nd ed., p. 521)

Administration of food or fluid high in sugar content and administration of glucagon is the treatment for which diabetic emergency condition?

Insulin reaction Insulin reaction occurs when insulin is administered to a diabetic patient, followed by insufficient food consumption or excess exercise (C). Hypoglycemia, or low blood sugar, results. Hyperglycemia is a condition of excess blood sugar. Hyperosmolar hyperglycemic nonketotic syndrome or HHNK results from neglected type II diabetes mellitus when a patient becomes dehydrated and hyperglycemic (A and B). Ketoacidosis results when the muscles are unable to use the sugar in the blood for fuel, and instead break down fat for energy (D). (Ehrlich and Coakes, 9th ed., p. 297-298)

Which of the following is responsible for correcting the brightness and contrast of an image, regardless of the technique used?

Rescaling Rescaling is a pre-processing function that automatically adjusts the brightness and contrast of an image (A). Smoothing is a function of correcting data for processing. The edges of structures are smoothed out so that they blend into the image (B). Edge enhancement is a function of correcting data for processing. The edges of a structure are accentuated so they are more visible (C). Quantization is a pre-processing function where a gray value is assigned to each pixel (D). (Carroll, 2nd ed., p. 489 & 509)

When positioning for the lateral upper airway projection, where should the CR enter if the area of interest is the distal larynx and trachea?

T1-2 Clinical indications for the lateral upper airway projection include epiglottitis and lodging of foreign objects in the larynx or esophagus. For the general upper airway, centering is at the level of C6-7. When the area of interest is the upper trachea and larynx, the centering should be at the laryngeal prominence, or the level of C5. For pathology of the distal larynx and trachea, centering should be at the level of T1-2, or the jugular notch (C). Choices (A), (B), and (D) are incorrect as per the previous explanation. (Bontrager and Lampignano, 9th ed., p. 102)

Which type of seizure is sometimes preceded by an aura?

Tonic-clonic seizure A tonic-clonic seizure, also known as grand mal or major motor seizure, is the most severe type of seizure and is sometimes preceded by an aura, a premonitory sign (D). A focal seizure is less intense than a tonic-clonic seizure (A). A petite mal, otherwise known as an absence seizure, is characterized by a brief loss of consciousness, which the patient may or may not be aware of (B and C). (Ehrlich and Coakes, 9th ed., p. 299)

A dose of 0.25 Gy to the fetus during the early part of the first trimester of pregnancy can potentially cause

skeletal anomalies During the first trimester, specifically the 2nd to 8th weeks of pregnancy (during major organogenesis), if the radiation dose is at least 0.2 Gy fetal anomalies can be produced. Skeletal anomalies usually appear if irradiation occurs in the early part of this time period (B). Neurologic anomalies are formed in the latter part; mental retardation and childhood malignant diseases, such as cancers or leukemia, can also result from irradiation during the first trimester (C). Fetal irradiation during the second and third trimesters is not likely to produce anomalies, but rather, with sufficient dose, some type of childhood malignant disease. Fetal irradiation during the first 2 weeks of gestation can result in spontaneous abortion (A). It must be emphasized that the likelihood of producing fetal anomalies at doses less than 0.05-0.15 Gy is exceedingly small and that most general diagnostic examinations are likely to deliver fetal doses of less than 0.01-0.02 Gy (D). (Saia p. 250)

All of the following can be used in image intensification systems except

Photostimulable phosphor plate Flat panel detectors (B), charge coupled devices (C), and complementary metal oxide semiconductors (D) can all be used in fluoroscopy systems instead of the traditional image intensifier. A photostimulable phosphor plate, normally used in computed radiography, is not used in place of the traditional image intensifier (A). (Carlton and Adler, 6th ed., p. 450-453)

Select the 4 statements below that are NOT correct regarding x-ray characteristics

- X-rays are focused using collimators - The x-ray beam is monoenergetic - X-rays are negatively charged - X-rays travel at the speed of sound X-rays cannot be focused The x-ray beam is polyenergetic X-rays are electrically neutral X-rays travel at the speed of light

Which of the following examinations is/are likely to increase personnel dose? 1. Remote fluoroscopy 2. Mobile imaging 3. General radiography

2 only While fluoroscopy does increase personnel dose due to the proximity to the patient and x-ray beam, remote fluoroscopy does not require the technologist to be in the room with the patient during the exam and results in low personnel dose risk similar to that of general radiography. Mobile imaging, however, poses a higher risk to personnel due to the limited availability or use of protective barriers. Ways to reduce personnel exposure during mobile imaging include long exposure cords to increase distance from the beam, personnel protection such as lead aprons and goggles, and practice of ALARA techniques. (Bushong, 11th ed., pp. 599-600)

How much barium would be required for an 8-month-old patient undergoing a upper GI series?

2-4 oz Each department has their own protocols to follow for barium preparation; however, a general guideline for age-to-volume requirements is as follows: newborn to 1 year: 2-4 oz (B), 1 to 3 years: 4-6 oz (C), 3-10 years: 6-12 oz (D), 10 years or older: 12-16 oz. When a child is being fed through a bottle, the barium may be diluted for ease of flow. Choice (A) is incorrect as per the previous explanation. (Bontrager and Lampignano, 9th ed., p. 475)

The weight of a full-body protective apron with 1 mm lead equivalent is approximately

25 lbs While the 1 mm lead equivalent aprons provide the most protection for personnel, their weight is a large drawback for those working in fluoroscopy. A full-body apron can weigh up to 25 lbs (D). 0.5 mm of lead equivalent is the most common thickness used for personnel aprons, which provide 88% attenuation at 75 kVp while weighing between 6‒15 lbs. Choices (A), (B), and (C) are incorrect as per the previous explanation. (Bushong, 11th ed., p. 609)

What is the LD 50/30 for adult humans without medical support?

3-4 Gyt LD 50/30 refers to that dose of ionizing radiation that will be lethal to 50% of the population in 30 days. It is estimated that, without medical support, that dose is 3-4 Gyt (C). This can be expressed as 3-4 Sv for x and gamma radiations. Depending on the type of data collected and reported, lethal dose can also be expressed as LD 50/60 or LD 100/60—the top figure always refers to the percentage of the population and the bottom figure refers to the length of time in days. Choices (A), (B), and (D) are incorrect as per the previous explanation. (Sherer, Visconti, Ritenour, Haynes 8th ed., p. 149)

Which of the following is an acceptable form of electronic data manipulation?

Adding annotation when the lead marker is collimated out of the image field Although every attempt should be made to have a lead marker completely visible in the final image, adding an electronic marker to clarify if initials or part of the marker is obscured, or other annotation (such as time on timed images) according to institutional policy is acceptable (B). Overwriting the original image with an image processed under an alternative processing algorithm or applying smoothing to an image with excessive quantum mottle causes image detail loss and can obscure pathology, such as hairline fractures (A, C, and D). Processing under an alternative algorithm can also change the DICOM tag, which would be problematic if the image were used as evidence in any type of legal action. (Carroll, 2nd ed., p. 547-553)

Which imaging informatics system is a universal standard regarding how images are communicated between PACS and imaging modalities?

DICOM Digital Imaging and Communications in Medicine (DICOM) is a universal standard regarding how information is communicated between PACS and imaging modalities (A). Hospital Information System (HIS) is similar to the RIS but is for the entire institution and not just the radiology department (B). Health Level 7 (HL7) is a standard for transferring text information within an institution (D). Radiology Information System (RIS) is the system used to schedule medical imaging exams, view orders, track patients, and store imaging reports (C). (Carroll, 2nd ed., p. 632 & 633)

The process by which a contaminated object, such as a portable x-ray machine, is cleaned, first by mechanical means and then by wiping or soaking in chemical solutions is called what?

Disinfection Disinfection is the process by which a non-human object is cleaned if it cannot be sterilized (B). Antisepsis and Asepsis are techniques of removal of pathogenic microorganisms from the body surfaces (A and D). Sterilization is a method of heat or chemical cleaning that removes all pathogenic microorganisms and their spores (C). (Dutton, Linn-Watson, and Torres, 8th ed., pg. 115)

Which of the following abdomen projections will best demonstrate an umbilical hernia?

Dorsal decubitus In a dorsal decubitus abdomen projection, the patient is supine and a horizontal central ray is used. An umbilical hernia protruding anterior to the body will be best demonstrated on this projection (D). Other possible reasons for this projection include air-fluid levels, aneurysms, abdominal masses, or calcification of the aorta. The AP supine abdomen will provide a general assessment of the abdominal region (A). The AP upright abdomen is commonly used to assess for free air under the diaphragm (B). The lateral decubitus of the abdomen is typically used to assess for abdominal masses, air-fluid levels, and possible intraperitoneal air (C). (Lampignano and Kendrick, 9th ed.)

There are many terms related to grids used in radiography. Which term describes the relationship of the lead lines being parallel or angled to each other?

Grid focus Grid ratio describes the height of the lead strips compared to the distance between them (A). The grid pattern options include linear grid and crossed grid or cross-hatched grid (B). Grid conversion factor is used to modify the mAs when changing from either non-grid to a grid, from a grid to non-grid, or between different grid ratios (D). Grid focus options include parallel or non-focused grids and focused grids. The lead lines in a parallel or non-focused grid run parallel to each other. The lead lines in the focused grids are angled to match the divergent x-ray beam (C). (Fauber, 5th ed., p. 190-194)

Which of the following combinations will provide better visibility of detail and the least amount of noise in a digital image?

High SNR and high CNR SNR is the abbreviation for signal-to-noise ratio and refers to the amount or strength of the signal received by the IR. If there is more signal received, less noise will occur in the image. Decreasing the SNR results in more noise in the image compared to the signal. The same correlation happens with contrast-to-noise ratio (CNR). As CNR increases, the longer scale of contrast (low contrast) will increase the visibility of detail compared to the amount of noise. Using these descriptions, the best combination to have is a high SNR and high CNR (D). (Fauber, 5th ed., p. 85 & 86)

Consider the following scenario and determine which would apply. The radiographer receives an order for a chest x-ray on a patient whose name he remembers from high school. He is curious about his former acquaintance's condition and decides to examine the patient's medical history. On discovering that the patient was diagnosed with hepatitis C, he immediately sends a text message to another friend who knows the patient.

Libel and HIPAA violation The radiographer violated HIPAA by exploring more of the patient's chart than he needed to perform the chest x-ray and disclosing that information. Had the radiographer disclosed the patient's socially stigmatized condition by spoken word, he would have committed slander (A). Since he disclosed it by written word, it would be termed libel (D). Choices (B) and (C) are incorrect as per the previous explanation. (Ehrlich and Coakes, 9th ed., p. 78)

Compared to centering for the lateral cervical spine, centering for the lateral upper airway is

Lower and more anterior The centering for the lateral cervical spine should be directly to C4 at the MCP, which would place the cervical spine in the center of the IR. For the lateral upper airway, the area of interest is the larynx and trachea, requiring the CR to enter lower and more anterior than cervical spine centering (B). Proper alignment for the lateral upper airway is CR centering at the level of C6 or 7, entering anterior to the cervical spine. Choices (A), (C), and (D) are incorrect as per the previous explanation. (Bontrager and Lampignano, 9th ed., pp. 102, 313)

Which of the following conditions presents as reduced bone mass?

Osteopenia Osteopenia is any decrease in bone mass below normal (A). The rate of bone synthesis is too low to compensate for the normal process of bone resorption. Osteopenia is often a precursor for osteoporosis, a more severe condition of low bone density and deterioration of bone structure. Osteomyelitis is a bone infection caused by bacteria that results in fever, chills, pain, edema, and warmth over the affected bone (B). Osteoarthritis is the degeneration of articular cartilage at the ends of large bones causing swollen and painful joints (C). Rheumatoid arthritis is found in small joints. Osteomalacia is a disorder in which bone fails to calcify during remodeling causing painful and tender "soft" bones to form (D). This disorder is termed rickets in children when growing bones fail to ossify and become deformed. (Grabowski and Tortora, 10th ed., p. 181)

Failing to properly identify the patient before an exam could put the radiographer in violation of

Patient's Bill of Rights and Patient Care Partnership The Patient's Bill of Rights and Patient Care Partnership guarantee the patient the right to safe care practices and the use of policies and procedures to avoid mistakes (C). One of these procedures is using a double identification process (usually name and date of birth) to properly identify a patient before any exam is performed. The Health Information Portability and Accountability Act (HIPAA) protects patient privacy and electronic data security and portability (A). OSHA (Occupational Safety and Health Administration) is a government organization that deals with workplace safety (B). Good Samaritan laws are enacted on the state level and protect those who offer emergency aid, such as CPR, from liability for the outcome or errors and omissions (D). (Dutton, Linn-Watson, and Torres, 8th ed., pg. 30-34)

Radiographers must have an awareness of cultural groups in order to achieve professional and effective communication. Select the three cultural groups identified below:

Perceived gender Generational Religious Culture can affect a patient's needs, expectations, compliance with procedures and regimens, and much more. It is important not to make assumptions about a person's culture based solely on appearance only. (Ehrlich and Coakes, 9th ed., p. 92-93)

For the posterior oblique pelvis, during the Judet method, when the anatomy of interest is the anterior rim of the acetabulum, proper positioning requires the CR to enter

Perpendicular to the IR and centered 2 inches distal and 2 inches medial to the downside ASIS The Judet method for an oblique pelvis can demonstrate the anterior and posterior rim of the acetabulum, dependent on CR centering. For the anterior rim and posterior ilioischial column, the CR will be centered 2 inches distal and 2 inches medial to the downside ASIS (B). For the posterior rim of the acetabulum and anterior iliopubic column, the CR will be centered 2 inches directly distal to the upside ASIS (A, C, and D). (Bontrager and Lampignano, 9th ed., p. 283)

Organize the steps in a patient transfer from a radiographic exam table to a wheelchair in order from start to finish.

Preparation is key in the facilitation of a safe transfer of a patient with mobility issues. For a patient who can be transferred in a wheelchair, always make sure that the patient is wearing non-skid slippers before beginning any transfer. After the exam, make sure that the slippers are still in place and have not slipped down before transferring back to the wheelchair. As soon as possible after the exam, bring the table to its lowest position to avoid potential falls. Always lock both wheels of the chair before beginning to transfer the patient. After everything else is in place for the move, assist the patient into a sitting position to begin the transfer. (Dutton, Linn-Watson, and Torres, 8th ed., pg. 75-76)

Which of the following digital imaging post-processing functions provides quantitative information of the pixels in a defined area?

Region of interest The value of pixels in a specific area of the image can be calculated using the region of interest (ROI). The ROI is a post-processing function in digital imaging (A). Values of interest (VOI) is the section of the histogram that will be included in the displayed image. The VOI usually excludes anything to the left of SMIN and the right of SMAX of the histogram. This section is where a majority of the image information is located (B). Dynamic range refers to the range of image signals that an IR is able to detect. The greater the IR's dynamic range, the greater number or variety of photon intensities the IR can detect (C). Window level is the midpoint in the window width range of the digital image. As the window level increases, the image becomes less bright. As the window level decreases, the image becomes brighter (D). (Fabuer, 5th ed., p. 102)

Which of the following is a nonfunctional examination used to demonstrate the urinary system?

Retrograde urography Following a cystourethrography, a patient may be asked to void while images are taken (A). This is a functional study of the bladder and urethra, evaluating the patient's ability to urinate. Retrograde studies do not assess the physiologic processes that normally occur in the body. Retrograde urethrography is used to assess the urethra (B). Retrograde cystography is a nonfunctional examination used to assess the urinary bladder (D). During a retrograde urography study, contrast is injected into the pelvicalyceal system to assess the urinary system (C). (Lampignano and Kendrick, 9th ed.)

For the AP axial projection of the skull, if the patient extends their neck, how would the dorsum sellae appear in the radiograph?

Superior to the foramen magnum Extending the neck would move the posterior anatomy of the skull distally, and the anterior structures proximally. Without adequately compensating with CR angulation, extension of the neck would result in the foramen magnum to be projected distal to the petrous ridges. Therefore, the dorsum sellae would appear superior to the foramen magnum (A). (Bontrager and Lampignano, 9th ed., p 415)

Centering for the AP projection of the upper airway is at the level of

T1-2 The AP projection of the upper airway is used to demonstrate pathology of the larynx and trachea. Since the proximal larynx is superimposed by bony structures of the skull and facial bones, centering for the AP projection requires lower centering. The CR should enter at T1-2 to include more of the distal air-filled larynx and trachea (D). Choices (A), (B), and (C) are incorrect as per the previous explanation. (Bontrager and Lampignano, 9th ed., p. 103)

The xiphoid tip of the sternum is located at approximately what corresponding vertebral level?

T9-T10 The xiphoid tip or xiphoid process is at approximately the level of T9-T10 (C). C1 and the mastoid process are at the same approximate level. T4-T5 is at the level of the sternal angle. C5 is the thyroid cartilage. T12-L3 is used to identify the level of the kidneys. Anatomical landmarks are useful positioning aides. Choices (A), (B), and (D) are incorrect as per the previous explanation. (Lampignano and Kendrick, 9th ed.)

Which of the following methods of radiation dosimetry is most commonly used for patients and personnel?

Thermoluminescence dosimetry (TLD) TLD dosimetry has the sensitivity and accuracy required to serve as both personnel monitor and patient dose measurement (A). Geiger-Muller counters are used for radiation surveys and contamination control rather than specific body dose (B). Photographic emulsion, the method used in film badges, is only for personnel when applied as a method for radiation detection (C). (Bushong, 11th ed., pp. 564)

Which of the following statements is false regarding TLD?

They are more accurate than OSL, measuring exposures as low as 10 µGya TLD badges have many advantages over film badges, such as increased durability, sensitivity to exposure, and duration of use (B). Even though they are more expensive than film badges, when monitored every 3 months rather than every month, the cost is roughly the same (A). They utilize lithium fluoride, which has a similar attenuation factor as soft tissue, which provides fairly accurate readings (D). However, TLD badges only measure exposures as low as 50 µGya, while OSL badges can detect exposures as low as 10 µGya (C). (Bushong, 11th ed., pp. 605-606)

Which of the following is an advantage of crossed grids?

They have a higher contrast improvement factor than parallel grids Crossed grids have few advantages: they have a higher contrast improvement factor than parallel grids due to their increased grid strip count and they are easy to produce (C). However, the clinical applications of crossed grids are limited due to their precise positioning requirements; the tube must be exactly centered to the grid both longitudinally and transversely to avoid grid cutoff (A). These requirements eliminate the use of angled-tube imaging (B). Additionally, due to their increased absorption, they require higher patient dose because of increased technique factors (D). (Bushong, 11th ed., pp. 199-200)

All of the following are typical ways to express patient dose except

Thyroid equivalent There are three typical terms to describe patient dose: bone marrow dose, gonadal dose, and entrance skin exposure (A, B, and D). The entrance skin exposure (ESE) is an easy-to-calculate and readily available measurement. Gonadal dose can be directly measured and helps estimate risk of genetic responses to radiation. Bone marrow dose, while it can only be estimated from ESE, is an important tool because of the high association between bone marrow and radiation-induced leukemia. Thyroid equivalent is not a typical way to express patient dose (C). (Bushong, 11th ed., pp. 569-573)

If a structure having less tissue density than the part of interest is positioned over the AEC detector, which of the following will result?

Underexposure AEC is used to automatically regulate the amount of ionizing radiation delivered through the anatomic part to the IR, thereby serving to produce consistent and comparable radiographic results with minimum patient exposure. Exact positioning and centering are critical when using AEC. The anatomic part of interest must be aligned accurately with the AEC sensors; otherwise, the result can be over- or underexposure. The correct AEC sensors must be selected. If the AEC detectors are incompletely covered by anatomy, premature termination of exposure will likely result, resulting in quantum noise. If a structure having less tissue density than the part of interest is incorrectly positioned above the detector, or if the detector is incompletely covered, the detector will terminate the exposure more quickly and the area of interest will be underexposed (A and D). Similarly, if the incorrect sensor for the anatomic part is selected, a receptor exposure error will result (C). In each case, the error is likely to be reflected by the exposure index (EI). A large metal orthopedic prosthetic should not be positioned directly over an AEC sensor because an excessive exposure time can result, causing patient and image overexposure (B). (Carlton and Adler 6th ed., p. 113)

Which of the following is the post-processing function responsible for adjusting the brightness of a digital image?

Window level Smoothing is used to decrease the amount of noise in an image (A). The purpose of edge enhancement is to make small, high-contrast structures more visible (B). Window width controls the amount of contrast in the image (C). Adjusting the window level alters the brightness in the image (D). Whether the image becomes brighter or darker is dependent on the direction (either up or down), which is also dependent on the manufacturer. (Lampignano & Kendrick, 9th ed., p.53)

Which of the following is the post-processing function responsible for adjusting the contrast of a digital image?

Window width Smoothing is used to decrease the amount of noise in an image (A). The purpose of edge enhancement is to make small, high-contrast structures more visible (B). Window width controls the amount of contrast in the image (C). Adjusting the window level alters the brightness in the image (D). Whether the image becomes brighter or darker is dependent on the direction (either up or down), which is also dependent on the manufacturer. (Lampignano & Kendrick, 9th ed., p.53)

The AP projection of C1-C2 (dens) Fuchs method requires a CR angulation

to be parallel to MML The AP projection of C1-C2 Fuchs method is used to demonstrate the pathology of the superior portion of the odontoid and adjacent structures when not well-visualized on the AP open-mouth projection. For this projection, the patient is supine with their neck extended to bring the MML perpendicular to the IP. If necessary, a parallel CR angulation can be applied to match the MML (D). Note that a cervical collar should not be removed and physician should pre-approve performance of this position. Choices (A), (B), and (C) are incorrect as per the previous explanation. (Bontrager and Lampignano, 9th ed., p. 317)

Select 3 body mechanics practices used to reduce possibility of injury.

- Bend from the knees and lower back instead of from the waist - Change foot position, rather than twisting the body - Moving heavy objects is safer when objects are held closer to center of gravity Always pull instead of push, when possible (i.e. sliding board or pull sheet). The biceps are the strongest arm muscle group and pulling makes best use of them. A wide base of support makes a body more stable; standing with the feet further apart increases the base of support and improves stability. Be certain to move potential tripping hazards out of the way before initiating a transfer (D). (Dutton, Linn-Watson, and Torres, 8th ed., pg. 70)

Which 4 of the following topics are covered in the AHA Patient's Bill of Rights?

- Involvement in your care - Protection of your privacy - Discussing your treatment plan - Understanding your healthcare goals and values The American Hospital Association (AHA) adopted the Patient's Bill of Rights first in 1973. The Bill of Rights outlines the rights and responsibilities of the patient (A, B, D, and E). Death with dignity (control over when and how a terminally ill person will die) is not covered in the Patient's Bill of Rights (C). The Patient's Bill of Rights discusses privacy but was written before the adoption of the Health Insurance Portability and Accountability Act, enacted in 1996 (F). (Erlich and Coates, 9th ed., p. 72-73, 75)

It is essential to be certain that the x-ray tube is in the proper detent locks before making an exposure because 1. Improper alignment of the tube and IR could cause incorrect exposure when utilizing AEC 2. Having the tube out of detent could cause anatomy cutoff 3. If the tube is not locked in the transverse position grid cutoff could occur, resulting in overexposure of the part

1 and 2 only The detent locks function to assist the technologist in proper alignment of the tube to the Bucky and IR. If the tube is not locked in the correct detent positions, the primary beam could be offset to the AEC ionization chambers and result in either over- or underexposure of the part. Additionally, the incorrect alignment of the tube could cause anatomy cutoff since the light field would not be centered to the IR. While being offset in the transverse position could cause grid cutoff, the exposure would be insufficient rather than an overexposure, since the grid would end up absorbing more of the useful beam. (Bushong, 11th ed., pp. 190-196)

Which of the following statements is/are false regarding occupational exposure during fluoroscopy? 1. Radiation exposure to the radiologist is higher when the tube is positioned below the patient 2. Beam-on time is directly proportional to occupational exposure 3. Remote fluoroscopy is preferable to reduce occupational exposure

1 only In fluoroscopy, the radiographer and radiologist are at higher risk when the tube is positioned above the patient due to increased scattered radiation (A). Beam-on time, or the time that x-rays are being delivered, is directly proportional to dose: the longer the exposure, the higher the dose (B and C). Remote fluoroscopy reduces occupational exposure because the radiographer is behind a protective barrier and is not located in the examination room with the patient (D). (Bushong, 11th ed., pp. 605-609)

In scoliosis imaging, breast tissue dose for PA imaging is approximately ____ of the dose for AP imaging

1% Scoliosis imaging is most often performed on pediatric patients. Therefore, the use of dose-reduction techniques is a crucial factor in these examinations. By positioning the patient for a PA projection, the dose to breast tissue is reduced to approximately 1% compared to the AP projection, with little impact on image quality (A). Choices (B), (C), and (D) are incorrect as per the previous explanation. (Bushong, 11th ed., p. 591)

Which of the following factors can affect patient ESE? 1. Efficiency of x-ray production 2. Technical factors 3. OID 4. SID

1, 2, 3, and 4 The choice of technical factors and efficiency of x-ray production determine the quantity and quality of the x-ray beam. An increase in mAs will increase patient dose, while an increase in kVp will lower patient ESE. SID and OID have opposite effects on ESE: as SID increases, patient ESE is decreased; however, if OID is increased, the ESE will be higher. (Bushong, 11th ed., pp. 570-573)

The erect abdomen position is utilized to visualize air/fluid levels in the abdomen. Which other body position(s) could be utilized to demonstrate air/fluid levels if the patient is too weak or is unable to stand for longer than 5 to 10 minutes? 1. Left lateral decubitus 2. Right lateral decubitus 3. Lateral 4. Supine

1, 2, 3, and 4 When assessing air/fluid levels, the patient must be in the desired position for at least 5 minutes; if possible, 10 minutes or more is preferable to allow fluid to settle and air to rise within the abdomen. When in the prone, supine, or lateral positions, the fluid will fall towards the surface against the table. Therefore, all of the options could properly demonstrate air-fluid levels depending on the beam/IP relationship (D). Choices (A), (B), and (C) are incorrect as per the previous explanation. (Bontrager and Lampignano, 9th ed., p. 116-121)

In the PA oblique projection of the wrist, which of the carpals will be demonstrated distal and lateral to the lunate? 1. Scaphoid 2. Trapezium 3. Trapezoid 4. Triquetrum

1, 2, and 3 In the PA oblique projection of the wrist, the hand is laterally rotated 45 degrees. This projects the carpals so that the trapezium and scaphoid are well visualized. The scaphoid, trapezium, trapezoid, and capitate will be projected distal and lateral to the lunate, while the hamate and triquetrum will be proximal to the lunate. (Bontrager and Lampignano, 9th ed., p. 156)

Which of the following are functions of the National Council on Radiation Protection and Measurements (NCRP)? 1. To provide the public with data involving radiation measurement and protection methods 2. To organize and support studies surrounding radiation protection 3. To create guidelines in which radiation protection should be applied

1, 2, and 3 The NCRP serves to inform, educate, and enforce radiation protection guidelines. While the main function of the NCRP is to provide data to the public regarding radiation measurement techniques and radiation protection methods, the council is also responsible for: supporting studies on radiation measurement and protection through networking of organizations, the development of radiation protection and measurement practices and their clinical applications, and collaboration with both public and private organizations on radiation protection and measurement guidelines and applications. (Gurley and Callaway, 6th ed., pp. 249-250)

Which of the following shoulder projections is/are contraindicated when a fracture or dislocation is suspected? 1. AP Projection-External Rotation 2. AP Projection-Internal Rotation 3. Inferiosuperior Axial Projection-Lawrence Method

1, 2, and 3 When imaging the shoulder, it is imperative to avoid rotation of the arm if a fracture or dislocation is suspected. In both the AP internal and external projections, the arm needs to be rotated to better visualize the lesser and greater tubercles respectively. For the inferiosuperior axial projection (Lawrence), the arm is externally rotated. All three projections are contraindicated for fractures and dislocations. More appropriate projections would include transthoracic lateral and scapular Y (D). Choices (A), (B), and (C) are incorrect as per the previous explanation. (Bontrager and Lampignano, 9th ed., p. 193)

Which of the following situations could arise from over-flexing the knee in the lateral projection? 1. Obscured soft tissue 2. Fat pad displacement 3. Patellar fracture separation 4. Increased joint space visualization

1, 2, and 3 only Flexing the knee beyond 20-30 degrees could cause the patella to move into the intercondylar sulcus; in addition, soft tissue visualization decreases and fat pads can be pushed out of place. If there is a risk for patellar fractures, full extension laterals must be performed to avoid displacement or separation. Lastly, over-flexion can decrease the appearance of joint spaces, leading to inaccurate diagnoses. (Bontrager and Lampignano, 9th ed., p. 249)

In what ways can a radiographer reduce patient dose? 1. Improve technical factor selection through observation of patient habitus, positioning, and department protocols 2. Increase positioning accuracy with use of radiopaque sponges under the area of interest to reduce motion 3. Properly dress-down the patient for the exam, including removal of any jewelry or clothing items that could cause an artifact 4. Use clear breathing instructions to improve patient compliance and decrease motion

1, 3, and 4 only Proper technique selection, positioning accuracy, patient preparation, and concise breathing instructions all reduce patient exposure through the reduction of repeat images. However, the use of sponges must be limited to those that are radiolucent, not radiopaque, if they will be utilized under the area of interest. Otherwise, they would cause an artifact that could increase the number of repeat exposures and cause a subsequent increase in patient dose. (Bushong, 11th ed., pp. 588-594)

An increase in technical factors is likely to be required for the following condition(s) 1. Emphysema 2. Atelectasis 3. Ascites

2 and 3 only Body parts undergoing additive or destructive pathologic changes can require exposure modification to obtain the IR exposure and image quality. Different exposures will be required for extremities with and without casts. Body position can also play an important role in obtaining the expected radiographic results. The presence of pathology often modifies tissue composition. Changes that occur are generally spoken of as additive or degenerative. Additive pathology is that which increases tissue density, requiring an increase in technical factors (e.g., ascites, pulmonary edema, rheumatoid arthritis, pneumonia, Paget's disease, CHF) (C). Degenerative pathology involves deterioration of the part (e.g., osteoporosis, emphysema, osteomalacia, pneumoperitoneum) and requires a decrease in technical factors (A, B, and D). (Saia p. 332)

What disadvantages come with the use of TLD personnel monitoring? 1. Loss of information when exposed to heat and moisture 2. Cost compared to film badges when read monthly 3. Decreased sensitivity to film badges

2 only Some of the advantages of TLD personnel monitoring is the ability of the dosimeters to attenuate radiation similar to tissue, therefore increasing the accuracy of readings compared to film badges (C). TLD also offers increased protection from the elements and is less sensitive to heat and humidity, which would cause fogging on film badges (A and D). The major disadvantage of TLD is their cost; when read monthly, the cost is roughly double compared to film badges. However, their level of accuracy permits quarterly readings thereby decreasing the cost (B). (Bushong, 11th ed., p. 606)

What is the correct angulation for an AP axial sacroiliac image on a male patient?

30-degrees cephalad Typically, the central ray is angled 30 degrees cephalad for the AP axial sacroiliac image on a male patient (A). The central ray is increased to 35 degrees cephalad for a female patient (B). If the patient is in a PA position, the central ray is angled 35 degrees caudad (C and D). (Long, Rollins, and Smith, 13th ed., vol.1, p. 427)

What is the percentage of occupational exposure for personnel resulting from fluoroscopy and mobile imaging?

95% Personnel exposure during general radiography is incredibly low due to stationary barriers and short exposure cords. However, with both fluoroscopy and mobile imaging, personnel exposure is increased due to a decreased distance from both the x-ray beam and the scatter radiation produced by the patient. It is estimated that fluoroscopy and mobile imaging provide at least 95% of personnel occupational exposure (D). Choices (A), (B), and (C) are incorrect as per the previous explanation. (Bushong, 11th ed., p. 605)

Which of the following projections does not demonstrate the olecranon process free of superimposition?

Acute flexion of the elbow for the proximal forearm The olecranon process is located on the posterior proximal ulna. This process is best visualized in the lateral projections of the elbow, including the radial head series and trauma laterals (A, B, and D). The olecranon process can also be well visualized on the acute flexion series of the elbow in the distal humerus projection only; when performing the acute flexion series for the proximal forearm, the olecranon will be superimposed by the distal humerus (C). (Bontrager and Lampignano, 9th ed., pp. 168-174)

Which of the following is an SI quantity that can be used for radiation concentration transferred to a point that may be at the surface of a patient's or radiographer's body?

Air kerma Air kerma is an SI quantity that can be used to express radiation concentration transferred to a point, which may be at the surface of a patient's or radiographer's body (D). Air kerma identifies calculation of radiation intensity in air and replaces the traditional quantity, exposure. The absorbed dose is defined as the amount of energy per unit mass absorbed by an irradiated object (A). Equivalent dose is the product of the average absorbed dose in a tissue or organ in the human body and its associated radiation weighting factor (B). Effective dose provides a measure of the overall risk of exposure to humans from ionizing radiation (C). (Sherer, Visconti, Ritenour, Hayes, 7th ed., p. 67, 70, 72, 75)

There are several types of DR image receptors used in digital imaging. All of the following use indirect capture except

Amorphous selenium flat panel detectors Amorphous selenium is a type of flat panel detector that uses direct capture. The x-ray photons are converted directly into electrical signals (A). Both types of amorphous silicon flat panel detectors, gadolinium and cesium iodide, require two steps to convert the x-rays into light and into an electrical signal (B and C). A charge couple device (CCD) also uses indirect capture to produce the electrical signal (D). (Orth, 2nd ed., p. 273 )

In the context of a trauma situation, order the following in highest to lowest priority for evaluation when a patient reaches a trauma center.

Because of the possibility of paralysis, spinal fracture is evaluated immediately following the more life-threatening respiratory arrest and cardiac arrest. Evaluation for respiratory arrest and cardiac arrest are performed immediately on the arrival of a trauma patient to a trauma center by a physician. Open fractures are serious but are rarely immediately life-threatening and are evaluated after respiratory arrest, cardiac arrest, and spinal fracture. (Ehrlich and Coakes, 9th ed., p. 269)

A patient arrives at the emergency room following a motor vehicle accident and is complaining of pain in the mid-chest region. The emergency room physician orders a sternum x-ray but the patient must remain supine on the cart due to a possible spinal injury. What is the correct angle for the central ray to obtain the equivalent of an RAO sternum projection?

CR angled 15 to 20 degrees across the right side of the patient If the patient can stand for the oblique projection of the sternum, the patient is positioned in an RAO position with 15 to 20 degrees obliquity. If the projection must be completed supine and the patient cannot be positioned in an LPO position, the CR can be directed 15 to 20 degrees across the right side of the patient. Angling across the right side of the patient will place the sternum in the heart shadow just as it would in the RAO position (B). Angling the central ray across the left side of the patient will project the sternum into the right lung field (A). Choices (C) and (D) are incorrect as per the previous explanation. (Lampignano and Kendrick, 9th ed. p 364)

Which of the following is increased when image latitude is decreased during post-processing?

Contrast Decreasing image latitude will produce an image with higher contrast (A). Image latitude and window width are directly related (B). An image with higher contrast will have less overall grays and short-scale contrast (C and D). (Carroll, Quinn B., 2nd ed., p. 551)

Which of the following will result if magnification is used in a 20/9/6 inch image intensifier? 1. Spatial resolution improves 2. Patient dose increases 3. Focal point shifts closer to the output phosphor

1 and 2 only If magnification is used with an image intensifier, spatial resolution will improve and smaller structures will be more visible. The downside when using magnification is that patient dose increases. When magnification is used in an image intensifier, the focal point shifts closer to the input phosphor. Spatial resolution is not the only correct option in the question (A). Spatial resolution will improve and patient dose will increase when using magnification (B). Patient dose will increase but the focal point shifts toward the input phosphor (C). Option D is incorrect as the focal point would shift closer to the input phosphor during magnification (D). (Carlton and Adler, 6th ed., p. 452)

The base of the fifth metatarsal should be well visualized on which of the following projections? 1. AP foot 2. Medial oblique foot 3. AP ankle 4. Mortise oblique ankle

1 and 2 only The base of the fifth metatarsal is a common fracture site. It is well visualized in the AP and medial oblique projections of the foot, and in the mortise oblique of the ankle; however, in the AP projection of the ankle the base of the fifth metatarsal is superimposed by the tarsals and other metatarsals. Fractures of the base of the fifth metatarsal can cause swelling in both the foot and the ankle, therefore it is important to ensure that it is included in all ankle imaging as well as foot imaging. (Bontrager and Lampignano, 9th ed., pp. 232-241)

Select the 3 correct statements regarding molecular effects of ionizing radiation

- Potential molecular effects include impaired function and cell death - Cell death or impaired function occurs as a result of damage to chemical bonds - The indirect effect usually occurs with low LET radiations Interactions between x-ray photons and matter occur randomly but can lead to molecular damage in the form of impaired function or cell death (D). The target theory specifies that DNA molecules are the targets of greatest importance and sensitivity, that is, DNA is the key sensitive molecule and photon damage to it can cause impaired function or cell death (B). However, because 65%-80% of the body is composed of water, most interactions between ionizing radiation and body cells will involve radiolysis of water rather than direct interaction with DNA. The two major types of effects that occur are the direct effect and the indirect effect (E). The direct effect occurs when the ionization interacts directly with the key molecule (DNA) or another critical enzyme or protein (A). Chemical damage can occur as chemical bonds are broken and the chemical structure is changed. This can result in impaired function or cell death. Direct effect occurs at the DNA molecule itself with high-LET radiations. The more frequently occurring indirect effect happens when ionization takes place away from the DNA molecule, in cellular water (C). Ionization of water molecules in the body (i.e., radiolysis of cellular water) breaks water molecules into smaller molecules, often producing one or more atoms having unpaired electrons (free radicals). A free radical is very short lived but highly reactive; it can break chemical bonds in an effort to pair with another electron and can even travel a considerable distance from its source. The indirect effect is predominant with low-LET radiations such as x-rays. (Saia, PREP, 9th ed., p. 247)

Which three of the following diseases are spread by vector transmission?

- malaria - bubonic plague - Lyme disease Plasmodium species cause malaria and is transmitted by the vector mosquitos. Yersinia pestis is carried by fleas and causes bubonic plague. Borrelia burgdorferi causes Lyme disease and is carried by the vector ticks. Neisseria gonorrhea and Treponema pallidum are transmitted by direct (sexual) contact and cause gonorrhea and syphilis, respectively. Tinea pedis causes athlete's foot and is also transmitted by contact. (Ehrlich and Coakes, 9th ed., p. 140-141)

Select the three correct statements below regarding fixed vs. variable kV technique charts

- the fixed kV chart is most commonly used - kV is increased by 2 for each cm increase in thickness when using a variable kV chart - accurate caliper measurement is required when using a variable kV chart In a variable kV technique chart, the mAs is fixed and the kV is increased as part thickness increases (A). For each centimeter increase in thickness, the kV is increased by two (D). For every 4-5 cm increase in thickness, the mAs is doubled. Accurate measurement with calipers is required (E). The variable kV technique chart is not frequently used in formulating manual techniques today because it is associated with increased scattered radiation production and inconsistent contrast and receptor exposure. A fixed kV technique chart specifies a particular kV for each body part or type of examination (B and C). A kV is selected that will provide adequate penetration; mAs is used to compensate for variation of patient size and condition (F). This type of chart is most often used today. Accurate caliper measurement of the part to be imaged is essential with the variable kV technique chart because the kV increases by two for every 1-cm increase in part thickness. Fixed kV charts may specify a specific kV for the "small," "medium," or "large" patient, which corresponds to measurements within a particular range (e.g., 10-12 cm = small; 13-15 cm = medium; and 16-18 cm = large). Accurate measurement may be essential for the correct application of each method. Structures imaged using AECs do not require measurement because the AEC automatically adjusts the exposure for tissue variations. (Saia p. 339)

Federal law requires that all patients have access to effective communication, regardless of language or communication barriers. Which 3 of the following situations would require a certified interpreter?

A 22-year-old deaf patient presents in the emergency room with her mother, who is fluent in American Sign Language. A patient who speaks only Vietnamese is being given discharge instructions without a family member present. A radiographer must obtain informed consent from a patient, but only speaks a little of the patient's preferred language. Translation is not required while a patient is being transported (B). A translator is required, even if there are family members who can translate. Family members may summarize information or translate inferences, and do not provide for patient privacy. Although speaking a few essential words and phrases in a foreign language common to the area can be useful, it must be understood that informed consent requires an explanation of the procedure in a language that the patient can easily understand (A, C, and D). (Ehrlich and Coakes, 9th ed., p. 103-105)

Low-pass filtering is another name for which processing function?

Smoothing Another name for edge enhancement is high-pass filtering (A). Low-pass filtering is another name for smoothing (B). Quantization is the process of assigning a discrete value to each pixel (C). Equalization is responsible for adjusting the image brightness. This is used when underexposure or overexposure occurs on the IR (D). (Orth, 2nd ed., p. 301)

Which of the following is a low-pass filtering function that can make images appear more blurry?

Smoothing Smoothing results in the loss of fine edges during the process of filtering out noise (B). Equalization is the compression of the gray scale, which will increase image details (A), quantization is the process of determining brightness or grayscale of pixels (C), and subtraction is the process of overlaying images to find the differences between them (D). (Carroll, Quinn B., 2nd ed., p. 507, 521)

Which of the following combination of factors will cause the anode heel effect to be more pronounced?

Smaller anode angle, shorter SID, and larger field size The anode heel effect will become more pronounced when a smaller anode angle, shorter SID, and larger field size are used (B). If a longer SID or smaller field is used, the anode heel effect will be reduced (A and C). The anode heel effect will be reduced with a larger anode angle as the actual focal spot will be decreased, allowing fewer x-ray photons to be absorbed by the anode (C and D). (Orth, 2nd ed., p. 104)

When performing a portable AP chest projection on a patient who is semi-upright, what is the correct angle for the central ray?

Tube is angled and CR directed perpendicular to the long axis of the sternum When performing an AP chest projection, the central ray should be angled to match the angle of the long axis of the sternum. If the patient is in a semi-upright position, the central ray usually requires a caudal angle (from the vertical) to prevent superimposition of the clavicles on the apices (B). If the exam was being performed to demonstrate air/fluid levels, no CR angle should be used (A). The CR is kept parallel to the floor. (Lampignano and Kendrick, 9th ed.)