The ACS recommends that (A) women older than 40 years should have a yearly magnetic resonance imaging (MRI) (B) women younger than 40 years should have screening mammography every year (C) new masses or lumps in the breast should be checked by a health care provider (D) women between ages 20 and 39 years should have a CBE every year

(C) new masses or lumps in the breast should be checked by a health care provider

TEST TEST TEST TEST TEST TEST Flashcards by Shaylynn Giroir

The biggest risk factor for breast cancer is

(A) a family history of breast cancer

(B) a personal history of breast cancer

(D) not breastfeeding

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One of the minor risk factors for breast cancer could be

(A) gender

(B) aging

(D) not breastfeeding

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What is the approximate risk of developing breast cancer for a woman whose sister has the disease?

(A) higher than normal risk

(B) no significant change in risk

(D) none of the above

(A) higher than normal risk

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A woman with the greatest risk of developing breast cancer is

(A) age 30 years or below

(B) above age 50 years

(D) above age 20 but below age 30 years

(B) above age 50 years

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Symptoms of a possible breast disease that will not be demonstrated on the mammogram may include

(A) nipple discharge

(B) skin thickening

(D) stellate lesions

(A) nipple discharge

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Symptoms of very early DCIS may include

(A) skin thickening

(B) nipple discharge

(D) none of the above

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Skin thickening can be malignant but could also be caused by nonmalignant factors, such as

(A) esophageal metastases

(B) bronchial cancer

(D) sarcoidosis

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Risks factors associated with taking hormone replacement therapy (HRT) include

(A) early menopause

(B) late menopause

(D) increased risks for breast cancer

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The ACS recommends that

(A) women older than 40 years should have a yearly magnetic resonance imaging (MRI)

(B) women younger than 40 years should have screening mammography every year

(D) women between ages 20 and 39 years should have a CBE every year

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A health care provider should evaluate which of the following breast changes?
lumps or swellings
skin irritation or dimpling
milky discharge from the nipple

(A) 1 only

(B) 1 and 2 only

(D) 1, 2, and 3

(B) 1 and 2 only

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It is necessary for the technologist to document which of the following?

(A) edema

(B) dimpling of the skin

(D) all of the above

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Pre-examination instructions that can be given to the patient include

(A) remove all clothing from the waist down

(B) remove deodorant

(D) A and B

(B) remove deodorant

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Benefits of communication with your patient include

(A) helps identify sensitive breast and the reason for the sensitivity

(B) educates the patient

(D) all of the above

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In developing patient rapport, the technologist should strive to enhance the patient’s self-esteem. This means that the technologist should

(A) reflect the patient’s emotions to show understanding

(B) agree unconditionally with anything the patient says

(D) offer reassurance and encouragement if the patient is confused or unable to help herself

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The two-step method of BSE is to

(A) look and feel for changes in the breast

(B) examine the breasts and undergo regular mammography

(D) examine the breasts and nipples

(A) look and feel for changes in the breast

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The patient’s medical history and documentation will

provide the radiologist with information on the patient’s risk factors for breast cancer
give the radiologist information about general symptoms of breast cancer
provide information about possible benign breast conditions of the patient

(A) 1 and 2 only

(B) 2 and 3 only

(D) 1, 2, and 3

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Stressing the importance of the BSE can be controversial because

(A) BSE tends to detect only benign breast cancer

(B) BSE will help in the detection of malignant breast conditions

(D) BSE can cause unnecessary anxiety in women

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Which of the following are methods used in BSE?

using the pads of the three middle fingers to palpate the entire breast
palpating around the breast in a vertical pattern
using varying degrees of pressure while palpating of the breast

(A) 1 only

(B) 1 and 2 only

(D) 1, 2, and 3

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Which of the following statements is true?

Breast cancer death rates in the United States are going down.
Breast cancer is the leading cause of cancer-related deaths among women in the United States.
The second leading cause of cancer-related deaths among women in the United States is breast cancer.

(A) 1 and 2 only

(B) 2 and 3 only

(D) 1, 2, and 3

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Postmenopausal obesity is associated with

(A) a relatively high risk of developing breast cancer

(B) overall reduction in breast cancer risks

(D) a lower overall estrogen level

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In routine mammography, the glandular dose per projection is generally about

(A) 1–2 mGy (0.1–0.2 rad)

(B) 10–20 mGy (1.0–2.0 rad)

(D) 2–3 mGy (0.2–0.3 rad)

(A) 1–2 mGy (0.1–0.2 rad)

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Which age group is likely to get the most radiation dose during mammography?

(A) 20 to 35 years

(B) 40 to 50 years

(D) above 70 years

(A) 20 to 35 years

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The 5-year survival rate for a patient with stage 0 breast cancer is about:

(A) 22%

(B) 72%

(D) 100%

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During mammography, which of the following will affect the average glandular dose per breast?

degree of breast compression
the half-value layer (HVL) of the x-ray beam
breast size and composition

(A) 1 only

(B) 2 only

(D) 1, 2, and 3

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Patients who are allowed to play an active role in applying compression are usually 1. less likely to tolerate the compression 2. more likely to tolerate the compression 3. more relaxed during the compression (A) 1 only (B) 2 only (C) 1 and 3 only (D) 2 and 3 only

(D) 2 and 3 only

In breast imaging, the dose calculation is based on (A) the entrance skin dose (B) dose absorbed by the glandular tissue of the breast (C) the average skin dose (D) chest wall radiation dose

(B) dose absorbed by the glandular tissue of the breast

What is the purpose of requesting the patient to provide prior mammograms before starting the mammogram examination? (A) to see if the patient has breast cancer (B) to assess the exposure technique (C) to provide the radiologist with an additional aid (D) to verify the correct patient

The age of a woman taking HRT is likely to be: (A) under 40 years (B) 25 to 35 years (C) over 40 years (D) under 20 years

The term primipara refers to a woman who (A) has had multiply pregnancies (B) was pregnant once but lost the baby at 6 weeks (C) carried a pregnancy to over 20 weeks but had a stillbirth (D) was never pregnant

In mammography, information included on the medical history documentation includes which of the following as they relate to the breast? 1. patient’s history of trauma 2. history of surgery 3. unusual skin condition (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3

(D) 1, 2, and 3

All of the following are forms of subjective patient data except (A) patient has a palpable lump in the right breast (B) patient complains of severe pain during breast compression (C) the mood or demeanor of the patient (D) patient’s complaints of pain and tenderness in the left breast

(A) patient has a palpable lump in the right breast

When questioning a patient to obtain an accurate patient history (A) keep questions general in nature so as not to offend the patient (B) start with open-ended questions and then follow up with more direct inquiries (C) do not let the patient talk too much in order to keep the examination moving (D) use medical “jargon” to impress the patient with your expertise

(B) start with open-ended questions and then follow up with more direct inquiries

Which of the following are positive questioning skills that the radiographer can use when verifying the accuracy of patient information? (A) leading questions (B) open-ended questions (C) repeating information (D) facilitation

What is the purpose of “probing” questions used when interviewing patients? (A) clarifies information by asking for specific details (B) gives the patient time to remember details (C) allows the patient time to tell his or her story (D) summarizes the accuracy of the information

(A) clarifies information by asking for specific details

In gathering more information on a patient’s complaint of pain, a good probing question to ask would be (A) “How would you describe the pain?” (B) “When did the pain first occur?” (C) “If the pain comes and goes, how often does it occur, and what is the time span between occurrences?” (D) All of the above are good questions to ask.

There are two types of data collection processes. If your patient says he or she has a bruise on the left breast, this information is regarded as (A) objective (B) subjective (C) open-ended scenario (D) probing

(A) objective

When questioning your patient, what is the purpose of repetition? (A) to give the patient time to remember details (B) to get more detail (C) to summarize (D) to allow the patient to tell his or her story

“Where is your pain?” is an example of (A) a probing question (B) repetition (C) summarization (D) an open-ended question

(D) an open-ended question

Which of the following will not result in increased breast cancer risks? (A) having a mother who took diethylstilbestrol (DES) while pregnant (B) having a first child before age 30 years (C) history of Hodgkin lymphoma (D) menarche at age 10 years

An informed consent is required before performing which of the following examination? (A) ultrasonography (B) mammography (C) fine-needle biopsy (FNB) (D) MRI

Phone consent is an example of (A) written consent (B) oral consent (C) implied consent (D) expressed consent

(B) oral consent

The patient has to sign an informed consent 1. when there are significant risks associated with the procedure or test 2. for all diagnostic examinations in the imaging department 3. if the procedure is invasive (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

45. Which kind of consent is binding but difficult to prove? (A) oral (B) written (C) implied (D) printed

(A) oral

Which of the following is not required information that must be included on any informed consent? (A) name of the procedure (B) risks and benefits of the procedure (C) patient height and weight (D) possible alternative procedure

Methods of acknowledging the patient and treating the patient courteously can included all of the following except (A) using greetings (good morning, good afternoon, etc.) (B) avoiding eye contact (C) giving your full attention (D) introducing yourself

(B) avoiding eye contact

Two disadvantages of mammography screening include 1. the granularity of the breast can impact visualization of cancers 2. mammography will not image all cancers 3. the radiation dose from mammography is dangerous (A) 1 and 3 only (B) 1 and 2 only (C) 2 and 3 only

(B) 1 and 2 only

The glandular dose is (A) received on the skin of the breast (B) the significant background dose recorded by ultrasonography (C) associated with dose to the radiosensitive cells of the breast (D) a record of the dose to the gonads

Having a dense breast will (A) increase the risk of breast cancer (B) reduce the risk of breast cancer (C) result in breast cancer (D) help combat breast cancer

(A) increase the risk of breast cance

The technologist should review the previous mammography report to (A) verify the physician’s signature (B) verify the technologist’s initials (C) provide the radiologist an additional aid (D) confirm the type of exam (screen or diagnostic) needed

(D) confirm the type of exam (screen or diagnostic) needed

Why should the patient remove deodorant before mammography?

Deodorant can mimic malignant calcifications.

Preoperative localization will 1. direct the surgeon to the area requiring biopsy 2. help the surgeon excise a smaller specimen 3. ensure that the correct area is removed (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3

(D) 1, 2, and 3

The specimen is compressed to reduce (A) motion unsharpness (B) radiation exposure (C) tissue thickness (D) magnification factor

Which procedure is performed to obtain cellular material from a suspicious area for cytological analysis? (A) ductography (B) needle localization (C) pneumocystography (D) fine needle biopsy (FNB)

(D) fine needle biopsy (FNB)

The core biopsy technique was developed as an alternative to surgical biopsy because this technique provided a larger sample of the area of suspicion and thus more information than (A) ductography (B) needle localization (C) pneumocystography (D) FNB

(D) FNB

Ultrasonography of a lesion showed a spherical mass with smooth regular borders, anechoic interior, and acoustic enhancement. The lesion is likely to be a (A) fibroadenoma (B) abscess (C) simple cyst (D) ductal carcinoma

In ultrasonography, the term acoustic enhancement refers to (A) a structure without internal echoes (B) a structure with internal echoes (C) the amount of sound passing through an anechoic structure (D) few echoes within a structure

A procedure whereby the lactiferous duct is cannulated and a small amount of contrast agent is injected into the duct is termed (A) ductography (B) needle localization (C) pneumocystography (D) FNA

(A) ductography

A patient underwent ultrasonography, which confirmed the presence of a cyst in the breast. The radiologist wished to assess the contents of the cyst. What additional study could be recommended? (A) ductography (B) needle localization (C) pneumocystography (D) FNA

(D) FNA

Biopsy performed using a 14-gauge needle to remove tissue samples from the breast is termed (A) core biopsy (B) cytology (C) ductography (D) aspiration

(A) core biopsy

Stereotactic breast localization is used to (A) obtain two-dimensional information on palpable breast lesions (B) calculate the vertical position of nonpalpable lesions (C) obtain a three-dimensional image of the breast (D) calculate the horizontal, vertical, and depth of nonpalpable lesions

(D) calculate the horizontal, vertical, and depth of nonpalpable lesions

Which of the following biopsy techniques is most accurate? (A) FNB (B) open surgical biopsy (C) core biopsy (D) MRI core biopsy

(B) open surgical biopsy

In general, the optimal duration of tamoxifen treatment is (A) 2 years (B) 3 years (C) 4 years (D) 5 years

(D) 5 years

“Lumpectomy” describes the process of (A) removing the entire breast, including the nipple (B) removing the breast cancer tumor and margins of surrounding normal breast tissue (C) making a small incision over or near the site of the breast lesion (D) removing benign lumps from the breast

(B) removing the breast cancer tumor and margins of surrounding normal breast tissue

Radiation therapy can be used 1. with other treatment options 2. to kill any remaining cancer cells in the breast or the chest wall area 3. to shrink the size of a tumor before surgery (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3

(D) 1, 2, and 3

Chemotherapy comprises a class of drugs that can be used to (A) kill cancer cells in other parts of the body (B) block estrogen from cancer cells (C) reduce estrogen levels in the body (D) kill cancer cells by using high-energy radiation

(A) kill cancer cells in other parts of the body

Breast reconstruction can involve the placement of small fluid-filled sacs behind the pectoral muscle. Two common types of such implants are (A) saline and flap surgery (B) TRAM flap and silicone implant (C) silicone or saline implants (D) saline-filled implant and latissimus dorsi flap implant

Chemotherapy (A) involves the use of drugs to treat cancer that may have spread (B) is the destruction of cancer cells using estrogen receptor drugs (C) involves mapping the area around a tumor with the injection of a radioactive tracer (D) is the removal of the cancerous tissue from the breast

(A) involves the use of drugs to treat cancer that may have spread

A process of removing tissue and fat from the abdomen and transferring that tissue to reconstruct the breast is called (A) deep inferior epigastric perforator (DIEP) flap (B) latissimus dorsi flap (C) Transverse rectus abdominus myocutaneous (TRAM) flap (D) transverse upper gracilis (TUG) flap

(A) deep inferior epigastric perforator (DIEP) flap

Antiestrogen drugs, such as tamoxifen, can be used to 1. slow or stop the cancer’s growth 2. prevent breast cancer in high-risk women 3. prevent the recurrence of breast cancer (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3

(D) 1, 2, and 3

MRI (A) uses the complex magnetic properties of elements (B) explores the behavior of liquids or solids in metal (C) images the patient in less than 15 minutes (D) is less sensitive than mammography

(A) uses the complex magnetic properties of elements

Most of the risks of MRI of the breast are associated with (A) the magnetic properties of the patient (B) ferromagnetic metals (C) technologist errors (D) radiologist errors

(B) ferromagnetic metals

In breast cancer staging, the patient was rated N1. This means that (A) the cancer has not spread beyond the breast (B) the cancer is confined to one or two lymph nodes (C) the patient has a small tumor (D) there is no evidence of metastasis

(B) the cancer is confined to one or two lymph nodes

Cyst aspiration describes the removal of (A) a sample of the content of a cyst for biopsy (B) cell samples taken from a cyst for analysis (C) fluid from a cyst (D) any mass from the breast

If a breast lesion is seen only on breast ultrasonography, which modality should be used when performing a biopsy of the lesion? (A) mammography (B) ultrasonography (C) MRI (D) nuclear imaging

(B) ultrasonography

A pathology review is (A) a method of tracking and reviewing all positive findings (B) a process of eliminating all positive findings (C) a method of tracking cosmetic intervention (D) a process of identifying all cancers

(A) a method of tracking and reviewing all positive findings

The technique whereby contrast is injected into the ducts to check for an abnormality is called (A) augmentation (B) ductography (C) biopsy (D) mammoplasty

(B) ductography

A process by which the breast size is increased using implants is called (A) augmentation mammoplasty (B) ductography (C) needle biopsy (D) needle aspiration

(A) augmentation mammoplasty

The removal of one to three axillary nodes for testing is included in a/an (A) axillary node dissection (B) sentinel node mapping (C) sentinel node biopsy (D) lumpectomy

Specimen radiography confirms that (A) a biopsy is not necessary (B) the patient has no malignancy (C) the patient needs a mastectomy (D) the suspected lesion is in the tissue that was removed

(D) the suspected lesion is in the tissue that was removed

Which of the following are side effects of radiation treatment? 1. loss of appetite 2. fatigue 3. heaviness of the breast (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3

(D) 1, 2, and 3

A big advantage of brachytherapy over traditional radiation therapy treatments is (A) reduced time of treatment (B) ability of brachytherapy to treat larger tumors (C) ability to give more radiation to healthy tissue (D) more convenience because of the longer treatment times

(A) reduced time of treatment

The side effects of chemotherapy include (A) nausea and or vomiting (B) reduced white blood cell (WBC) count (C) none of the above (D) A and B

(D) A and B

What is tamoxifen treatment? (A) an adjuvant therapy using drugs to reduce the risk of certain cancers (B) a drug regimen that will effectively block certain hormones in the body (C) an external method of killing cancer cells (D) the removal of all cancer cells from the body, thereby reducing cancer risks

(A) an adjuvant therapy using drugs to reduce the risk of certain cancers

Which of the following biopsy techniques is the most accurate? (A) FNB (B) core biopsy (C) stereotactic breast biopsy (D) open surgical biopsy

(D) open surgical biopsy

Which of the following is the least expensive and least invasive method of breast biopsy? (A) FNB (B) core biopsy (C) open surgical biopsy (D) stereotactic breast biopsy

(A) FNB

A technique used to assess and evaluate nipple discharge by checking for defects or wall irregularity is called (A) ductography (B) interventional radiography (C) aspiration biopsy (D) lumpectomy

(A) ductography

“Neoadjuvant chemotherapy” refers to treatment (A) before surgery to help shrink the size of cancerous tumors (B) after mastectomy to slow the growth of cancer (C) before surgery utilizing an antiestrogen drug (D) after surgery that involves radiation

(A) before surgery to help shrink the size of cancerous tumors

Preoperative localization is (A) stereotactic breast localization of a palpable abnormality (B) used to locate palpable breast lesions (C) a technique used to locate nonpalpable lesions (D) checking of tissue for malignancy

A biopsy technique that often requires the presence of a cytological technologist is (A) open surgical biopsy (B) core biopsy (C) stereotactic breast biopsy (D) FNB

(D) FNB

“Cosmetic intervention” is 1. breast reconstruction after treatment for breast cancer 2. surgical reconstruction of the breast at the patient’s request 3. breast augmentation for personal reasons (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3

(B) 2 and 3 only

The side effects of chemotherapy are related to the effect of the drug on (A) all tissues and organs in the body (B) cancer cells only (C) the growth of cancer (D) hair follicles only

(A) all tissues and organs in the body

Any size tumor with cancer spread to chest wall and/or skin of breast and up to 10 axillary or clavicular lymph nodes is describes as stage (A) 1 (B) 2 (C) 3 (D) 4

Which of the following are contraindications for lumpectomy? 1. previous lumpectomy 2. multiple cancer sites in one breast 3. large tumors in a small breast (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3

(D) 1, 2, and 3

The staging of cancer will determine 1. if the cancer is invasive 2. the exact tumor size 3. if the cancer has spread to distant sites (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3

(D) 1, 2, and 3

In breast cancer staging, the patient was rated T1. This means that (A) the cancer has not spread beyond the breast (B) the cancer is confined to one or two lymph nodes (C) the patient has a small tumor (D) there is no evidence of metastasis

A lesion located in the upper-outer quadrant of the right breast is located in the (A) 2 o’clock position (B) 5 o’clock position (C) 7 o’clock position (D) 10 o’clock position

(D) 10 o’clock position

Morgagni tubercles are usually found (A) on the nipple (B) on the lateral border of the breast (C) in the terminal duct lobular unit (TDLU) (D) on the areola

(D) on the areola

An inverted nipple (A) always indicates breast cancer (B) sometimes indicates breast cancer (C) never indicates breast cancer (D) usually indicates breast cancer

(B) sometimes indicates breast cancer

The most mobile margins of the breast are the (A) medial and lateral aspects (B) inferior and superior aspects (C) medial and superior aspects (D) inferior and lateral aspects

(D) inferior and lateral aspects

The normal breast may have (A) 0–5 lobes (B) 15–20 lobes (C) 30–40 lobes (D) 340–350 lobes

(B) 15–20 lobes

The structure that supports the breast and contributes to breast shape is called (A) Montgomery ligament (B) Cooper ligament (C) fibroglandular tissue (D) fatty tissue

(B) Cooper ligament

The breast extends vertically from the (A) first through the ninth rib (B) second through the tenth rib (C) second through the sixth rib (D) third through the tenth rib

The thickest skin portion of the breast is at the (A) areola (B) nipple (C) tail of Spence (D) inframammary crease

Cooper ligaments attach anteriorly to the (A) deep fascia of the lobes (B) fascia of the skin (C) posterior surface of the breast (D) connective and supporting stroma

(B) fascia of the skin

Fatty tissue is generally _______ and is seen on the mammogram as areas of _______ optical density. (A) radiolucent/lower (B) radiopaque/higher (C) radiolucent/higher (D) radiopaque/lower

Typically, a patient with dense fibrous and glandular tissue throughout the entire breast on a baseline mammogram is (A) age 20 years or younger (B) between ages 50 and 60 years (C) above age 70 years (D) below age 45 years

(D) below age 45 years

Glandular tissue is usually found in the _______ of the breast. (A) medial and lower-inner quadrant (B) central and upper-outer quadrant (C) medial and lower-outer quadrant (D) central and upper-inner quadrant

(B) central and upper-outer quadrant

Immediately behind the nipple, there is a widened area of the collecting duct called the (A) lactiferous sinus (B) ampulla acinus (C) TDLU (D) segmental duct

(A) lactiferous sinus

The portion of the breast that holds the milk-producing element is the (A) ampulla (B) segmental duct (C) lobule (D) lactiferous sinus

Veins are normally located (A) in the periphery of the breast (B) in the central areas of the breast (C) in the axillary area of the breast (D) in the medial areas of the breast

(A) in the periphery of the breast

The TDLU consists of the (A) mammary ducts and the extralobular terminal ducts (ETDs) (B) intralobular terminal duct (ITD) and the segmental ducts (C) the ETDs and the lactiferous ducts (D) both the ETDs and the ITDs

(D) both the ETDs and the ITDs

A patient began taking synthetic hormones 6 months prior to her current mammography. The mammography result is most likely to (A) be unchanged from the previous year (B) show increased glandular tissue when compared with her previous result (C) show decreased glandular tissue compared with her previous result (D) show increased fatty tissue compared with her previous result

(B) show increased glandular tissue when compared with her previous result

A baseline mammogram shows that the patient’s breast consists primarily of adipose tissue. This patient is most likely to be (A) on hormone therapy (B) above age 60 years (C) below age 20 years (D) between ages 35 and 40 years

(B) above age 60 years

A patient is to undergo routine baseline mammography, but it is determined that the woman is lactating. What should be done, and why? (A) Lactating breasts are extremely sensitive to compression; mammography should be postponed. (B) Mammogram should be performed; radiation has no effect on lactation. (C) Although lactating breasts are extremely dense, mammography should not be rescheduled. (D) Lactation results in increased glandularity; mammography should be postponed.

(D) Lactation results in increased glandularity; mammography should be postponed.

The craniocaudal mammograms of a patient prior to menopause and 1 year after the onset of menopause are compared. The woman has never taken synthetic hormones. What is the most likely difference? (A) The mammogram taken prior to menopause shows signs of atrophy. (B) The mammogram taken after the onset of menopause shows signs of atrophy. (C) There will be little or no change in the glandularity of the breast. (D) The mammogram taken after menopause will show increased glandularity.

(B) The mammogram taken after the onset of menopause shows signs of atrophy.

Hormone replacement therapy could be recommended to 1. relieve insomnia symptoms 2. prevent osteoporosis 3. reduce weight gain (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

(B) 1 and 2 only

A woman is referred to as “nullipara.” This means (A) she has never given birth to a viable offspring (B) the woman has had only one child (C) the woman has given birth to more than 1 viable offspring (D) she carried a pregnancy past the point of viability regardless of the outcome

(A) she has never given birth to a viable offspring

An asymptomatic patient presents with an oval, lobulated tumor with unsharp margins. There is no evidence of a halo sign. (A) If the lesion is also radiolucent it is likely to be benign. (B) The lesion could be malignant. (C) All oval lesions are benign. (D) The absence of a halo indicates malignancy.

(B) The lesion could be malignant.

The tumor is characteristic of (A) ductal carcinoma in situ (B) a mammographically malignant tumor (C) a mammographically benign tumor (D) a low optical density tumor typical of benign lesions

(B) a mammographically malignant tumor

The calcifications seen have the typcal appearance of (A) mammographically malignant–type calcifications. (B) calcifications typical of galactoceles (C) calcifications typical of an oil cyst (D) calcified microhematomas

(A) mammographically malignant–type calcifications

Characteristics of a malignant stellate tumor include which of the following? 1. The spicules are generally bunched together. 2. A central tumor mass is present. 3. The larger the tumor, the longer are the spicules. (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1 and 3 only

29. The calcifications seen have the typical appearance of (A) an oil cyst (B) plasma cell mastitis calcification (C) a small calcified hematoma (D) a calcified sebaceous gland

(A) an oil cyst

30. Postoperative scarring 1. can sometimes be mistaken for carcinoma 2. has a solid dense central tumor 3. is usually not associated with skin thickening or dimpling over the lesion (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1 and 3 only

(D) 1 and 3 only

A mammogram shows a low optical density radiopaque tumor. The tumor is oval and lobulated, and a halo is seen along one border only. The next step should be (A) pneumocystography (B) ultrasonography (C) biopsy (D) no further testing, as the tumor is benign

(B) ultrasonography

A galactocele (A) is always radiolucent (B) is usually associated with trauma (C) is associated with nursing (D) usually has irregular borders

A lipoma (A) is generally seen as a high optical density radiopaque lesion on the mammogram (B) can be a huge encapsulated lesion occupying the entire breast (C) may have irregular borders typical of malignant lesions (D) is usually difficult to image mammographically

(B) can be a huge encapsulated lesion occupying the entire breast

A rare form of cancer that presents with swelling, warmth, or erythema and mammographically with skin thickening describes (A) inflammatory carcinoma (B) invasive ductal carcinoma (C) invasive lobular carcinoma (D) papillary carcinoma

(A) inflammatory carcinoma

Sometimes described as an oil cyst, this lesion represents an encapsulated area on the mammogram and can be caused by surgery, biopsy, trauma, or radiation therapy. (A) stellate lesion (B) galactocele (C) fat necrosis (D) lipoma

A benign, self-limiting breast tumor that is the result of new disorganized cell growth is a(n) (A) sarcoma (B) radial scar (C) invasive lobular carcinoma (D) hamartoma

(D) hamartoma

An infusaport can be used to (A) provide radiation therapy treatment (B) allow repeated access to the venous system (C) infuse radioactive tracers directly into the breast lesion (D) infuse radioactive isotopes directly into the arterial system

(B) allow repeated access to the venous system

The low optical density radiopaque lesion seen are characteristic of a (A) benign fibroadenoma (B) skin mole (C) galactocele (D) keratosis

(B) skin mole

The calcifications seen are characteristic of (A) a definite malignant (B) benign skin calcifications (C) benign calcifications but further tests are needed (D) dermal calcifications

The circular mixed radiopaque/radiolucent lesions seen are characteristic of (A) calcified microhematomas (B) galactocele, calcified (C) malignant calcification (D) epidermoid cyst

(D) epidermoid cyst

What target–filtration combination in analog imaging provides the best penetration for dense or thick breast? (A) molybdenum target with molybdenum filtration (B) rhodium target with rhodium filtration (C) tungsten target with tungsten filtration (D) molybdenum target with appropriate K-edge filtration

(B) rhodium target with rhodium filtration

The material used for the exit port of the mammography tube is necessary because (A) the intensity of the beam is less on the anode side than on the cathode side (B) regular glass would harden the emerging beam (C) the intensity of the beam is more on the anode side than on the cathode side (D) regular glass would soften the emerging beam

(B) regular glass would harden the emerging beam

The intensity of the x-ray beam from the cathode side of the tube is generally higher because (A) soft characteristic radiation emerges from the anode side (B) the cathode side is directed to the thickest part of the breast (C) the heel effect causes variation in the intensity of the x-ray beam (D) the heel effect increases the intensity of the beam at the anode side

The design of the lip of the compression paddle (both height and angle along the chest wall) affects all of the following except (A) prevents the posterior and axillary fat from overlapping the body of the breast (B) allows uniform compression of the posterior breast tissue (C) helps increase structural strength of the compression paddle (D) ensures greater compression of the anterior breast tissue

(D) ensures greater compression of the anterior breast tissue

The primary goal of compression is to (A) reduce the object-to-image receptor distance (OID) of the lesion (B) allow uniform penetration of structures within the breast (C) reduce the possibility of motion during the exposure (D) reduce the radiation dose to the breast

(B) allow uniform penetration of structures within the breast

What features of the high-transmission cellular grid allow these grids to maintain equal or less radiation dose to the patient compared with linear grids? (A) These grids use lead as the strips and wood as the interspace material. (B) They have copper as the strips and air as the interspace material. (C) They use aluminum as the strips and air as the interspace material. (D) They use wood as the strips and copper as the interspace material.

(B) They have copper as the strips and air as the interspace material.

The grid ratio can vary in modern mammography units. A common grid ratio used is (A) 8:1 (B) 6:1 (C) 4:1 (D) 2:1

The chest wall edge of the compression paddle should be aligned just beyond the chest wall edge of the detector to (A) avoid pushing the patient’s chest away and losing breast tissue (B) properly position and compress the breast (C) permit uniform exposure and reduce patient discomfort (D) avoid projecting the chest wall edge of the paddle on the mammogram

(D) avoid projecting the chest wall edge of the paddle on the mammogram

Which of the following affects focal spot size? (A) angle of the anode (B) a decrease in the source-to-image receptor distance (SID) (C) decreasing the size of the collimated beam (D) changing the relationship between the OID and the SID

(A) angle of the anode

In mammography, the commonly used focal spot size for routine work is (A) 3 mm (B) 0.3 mm (C) 1 mm (D) 0.1 mm

(B) 0.3 mm

Which of the following mammography quality control tests is performed as needed? (A) phantom images quality (B) visual checklist (C) repeat analysis (D) Mammography Equipment Evaluation (MEE)

What is the compression thickness indicator test? (A) a check of the minimum and maximum compression force on automatic compression (B) a check of the minimum and maximum compression force on manual compression (C) a check of the indicated compression thickness (D) a check of the compression on the breast

A check to ensure that the lead interpreting radiologist is aware of all quality control (QC) tests are being performed at their required frequency is (A) visual check list (B) facility QC review (C) MEE test (D) monitor QC

(B) facility QC review

A technologist test that is performed semi-annually is (A) phantom image test (B) visual check list (C) compression force test (D) repeat analysis

Repeats are (A) images taken during a breast stereo-localization (B) images used for QC (C) images that involve exposure to the patient (D) all discarded images

If the patient volume at a mammography site is 250 patients per week, the repeat/reject analysis could be performed every (A) week (B) 2 weeks (C) 2 months (D) 3 months

(D) 3 months

Mammography facilities can receive certification from 1. the ACR 2. the FDA 3. a State-as-Certifiers (SAC) state (A) 1 or 2 only (B) 2 or 3 only (C) 1 or 3 only (D) 1, 2, or 3

(B) 2 or 3 only

Aluminum filtration is likely to be matched with __________ targets. (A) molybdenum (B) rhodium (C) tungsten (D) beryllium

Which of the following visual checklist tests must be performed before clinical use? (A) Paddles/face shield must not be cracked. (B) Indicators must be working correctly. (C) C-arm motion must be smooth. (D) Collimator light must be working.

(A) Paddles/face shield must not be cracked.

Digital images are printed using (A) dry laser technology (B) computer monitor (C) photostimulable phosphor (PSP) technology (D) red-light spectrum emitting lasers

(A) dry laser technology

A single binary digit of data, such as “0” or “1,” is called a (A) pixel (B) matrix (C) bit (D) byte

In general, greater magnification will require the use of a (A) larger focal spot size (B) smaller OID (C) smaller focal spot (D) larger SID

A grid is not necessary during magnification because (A) grid use decreases spatial resolution (B) the small focal spot used will compensate for the loss of image detail (C) the large OID produces the same effect as a grid (D) magnification will magnify the normally invisible grid line

The air gap in magnification allows increase subject contrast by (A) increasing scatter (B) reducing scatter (C) reducing motion (D) increasing motion

(B) reducing scatter

If the magnification mammography is performed without using a small focal spot, the resulting image will be magnified (A) and blurred (B) and sharply outlined (C) with increased subject contrast (D) with increased detail

(A) and blurred

At higher magnification factors there is 1. higher skin dose 2. increased scatter 3. decrease source-to-object distance (SOD) (A) 1 and 2 only (B) 2 and 3 only (C) 1 and 3 only (D) 1, 2, and 3

Magnification is beneficial in all of the following situations except (A) imaging the surgical site of a patient undergoing a lumpectomy (B) imaging a specimen radiograph (C) evaluating microcalcifications in a lesion (D) imaging the entire breast in a single exposure

(D) imaging the entire breast in a single exposure

Using a small focal spot size is recommended for magnification (A) to compensate for the loss of image detail (B) because of increased patient dose (C) to compensate for the small OID (D) to compensate for motion unsharpness

(A) to compensate for the loss of image detail

The greatest disadvantage of magnification is (A) increased OID (B) increased patient dose (C) decreased subject contrast (D) increased risk of motion unsharpness

(B) increased patient dose

If the backup time stops a breast exposure, the technologist can repeat the radiograph using a (A) higher peak kilovolt (kVp) setting (B) greater density compensation (C) higher milliampere second (mAs) setting (D) different automatic exposure control (AEC) setting

(A) higher peak kilovolt (kVp) setting

The type of x-rays created from displacement of K-shell–binding electrons in the molybdenum atom are called (A) coherent scattering (B) characteristic radiation (C) Compton effect (D) Bremsstrahlung radiation

(B) characteristic radiation

The function of the filter in mammography is to remove (A) low-energy x-rays that would result in increased skin dose (B) all low-energy photons (C) low-energy x-rays needed to produce the breast image (D) photon energies above and below the range needed for breast imaging

(D) photon energies above and below the range needed for breast imaging

A recommended labeling for the mammographic image that is not required by the Mammography Quality Standard Act (MQSA) is (A) technologist identification (B) date of service (C) technical factors (D) name of patient

Lack of breast compression is most likely to cause (A) geometric unsharpness (B) plate reader artifact (C) motion unsharpness (D) printer artifact

How long should a facility maintain records of serious complaints? (A) 1 year (B) 2 years (C) 3 years (D) 4 years

Which of the following can require the use of a densitometer? (A) film printer test (B) phantom test (C) acquisition workstation monitor (AWS) test (D) compression thickness indicator

(A) film printer test

Which of the following system is likely to have a slit collimator system instead of a grid? (A) flat-panel detector tomosynthesis imaging systems (B) PSP imaging systems (C) any magnification mammography system (D) microdose photon-counting systems

(D) microdose photon-counting systems

Aluminum is used as the filtration in (A) digital breast tomosynthesis tubes with tungsten targets (B) tungsten target digital mammography tubes (C) rhodium target digital mammography tubes (D) analog mammography tubes

(A) digital breast tomosynthesis tubes with tungsten targets

40. The detector element is located in the (A) imaging plate (IP) (B) flat-panel detector (C) thin film transistor (D) AEC

41. Which of the follwing statements on detector elements is incorrect? (A) The detector element size controls the spatial resolution of the system (B) The size of the detector element can be controlled by the technologist (C) After reading the detector element, the flat-panel detector automatically erases (D) The larger the detector element in a flat-panel detector, the more the image blurs

(B) The size of the detector element can be controlled by the technologist

To allow full coverage of the detector, a tube with a 16 degree anode angle requires a tube tilt of about ____ degrees to achieve an effective anode angle of 22 degrees (A) 2 (B) 4 (C) 6 (D) 8

The monitor used to interpret the mammogram is the (A) acquisition workstation monitor (B) liquid crystal display (LCD) monitor (C) AWS monitor (D) review workstation (RWS) monitor

(D) review workstation (RWS) monitor

A system used ot store 6 to 12 months of image data that can be retrieved within a few minutes is the (A) jukebox (B) redundant array of independedn (inexpensive) disk (RAID) (C) digital linear tape (DLT) (D) compack disk (CD)

(B) redundant array of independedn (inexpensive) disk (RAID)

A computer network system that allows images to be viewed at various monitors or transmitted or stored is termed (A) picture archiving and communication systen (PACS) (B) local area network (LAN) (C) wide area network (WAN) (D) digital imaging and communication in medicine (DICOM)

(A) picture archiving and communication systen (PACS)

The remote transmission of images is (A) RAID (B) DICOM (C) PACS (D) teleradiology

(D) teleradiology

What technique is used to eliminate scatter in the photon-counting digital systems? (A) tomographic image reconstruction (B) three-dimensional imaging (C) slit scanning and doubel collimation (D) comuter -aided detection

Which if the following statements is true? (A) Compression increases image sharpness by reducing the focal spot size (B) Compression decreases subject contrast by reducing the thickness of the penetrated tissue (C) Compression increases the uniformity of the breast, making diagnosis easier (D) The compressed breast requires increased peak kilovoltage (kVp) to penetrate the thicker tissue

In assessing the degree of compression for any one patient, the technologist should take into consideration 1. the maximum to which the patients brest can actually be compressed 2. the amount of compression the patient can tolerate 3. compression that should be just suffiecient to immobilize the breast (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 2 and 3 only

(B) 1 and 2 only

Manual compression in mammography (A) has fixed upper and lower limits (B) depends solely on breast size (C) depends on breast size and the patients pain tolerance (D) generally depends on the patients pain tolerance

Some condiserations that could be given to women with painful breasts include 1. having the patient take ibuprofen prior to mammography 2. scheudlign mammography during the menstrual cycle 3. explaining, before the examination, the importance of compression (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1 and 3 only

(D) 1 and 3 only

Compression allows reduced radiation to the breast by (A) providing a uniform breast thickness (B) decreasing breast thickness (C) decreasing motion unsharpness (D) separating superimposed areas of glandular tissue

(B) decreasing breast thickness

What principle does compression use to visulaize the borders of circumscribed lesions? 1. It brings the lesion closer to the detector 2. It spreads apart overlapping tissue 3. it separates superimposed areas of glandular tisse (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1,2,3

(D) 1,2,3

Ideally, breast compression is maximized when 1. accompanied by a thorough explanation to increase patient cooperation 2. the exposure is made on arrested inspiration to reduce motion 3. the patient recognizes the advantage of compression in reducing radiation doese (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

Magnification can be used to assess the (A) margins of a lesion (B) size of a lesion (C) location of a lesion (D) tissue density of a lesion

(A) margins of a lesion

11. With calcifications, magnification an be used to assess 1. the number 2. morphology 3. tissue distribution (A) 1 only (B) 1 and 2 (C) 2 and 3 (D) 1,2,3

12. The last degree of compression should be applied (A) as gently as possible or by using manual compression (B) after the breast is realeased from compression (C) with as much force as possible to achieve maximum compression of the breast (D) with the technologists hand between the breast and the compression paddle

13. Which projection is used to determine whether a lesion is medial or lateral to the nipple? (A) craniocaudal (CC) (B) mediolateral oblique (MLO) (C) tangential (TAN) (D) mediolateral (ML)

15. The lenfth of the posterior nipple line (PNL), visualized on CC, should be within how many centimeters of the PNL and MLO? (A) 0.25 (B) 0.50 (C) 1.00 (D) 1.50

16. Which of the followign conditions must be met when imaging the breast in MLO? 1. The pectoral muscle should extend to or below the PNL 2. visualized fat should be posterior to all the fibroglandular tissues 3. the inframammary fold (IMF) should be open (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

17. In positioning fo rthe CC projection, if the C-arm of the mammography unit is raised too high, the IMF is overelevated, resulting in loss of 1. superior breast tissue 2. inferior breast tissue 3. posterior breast tissue (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

18. The single projection that will best visulize the maximum amount of breast tissue is the (A) CC (B) MLO (C) ML (D) exxagerated craniocaudal lateral (XCCL)

19. In general, whe imaging tall, thin patients the angulation is adjusted to (A) below 30 degrees (B) between 30 and 40 degrees (C) close to 60 degrees (D) over 70 degrees

20. The position used to determine whether an abnormality is superior or inferior to the nipple is the (A) CC (B) MLO (C) XCCL (D) TAN

21. The principle of mobile versus fixed tissue is used in mammography positioning to image the maximum (A) medial breast on the MLO projection (B) inferior breast on the CC projection (C) superior breast on the MLO projection (D) medial tissue on the CC projection

22. In the CC projection of the breast, the detector is positioned (A) at the level of the raised IMF (B) below the level of the raised IMF (C) at the level of the IMF (D) just below th level of IMF

23. In positioning for MLO, the tube is always angled (A) 90 degrees (B) 60 degrees (C) 50 degrees (D) none of the above

24. What position is show (A) CC (B) MLO (C) cleavage or "valley view" (CV) (D) XCCL

25. When positioning for right CC, where is the patients left arm placed? (A) brought back - this action rotates the shoulder to remove it from the imaging area (B) brought forwar - the patient an hold the handle bar of the unit (C) brought forward - the patient can hold the detector (D) remains at the patients side

26. Your patient has had reent chest surgery and has a scarred and painful area running along the sternum. With the medial aspect of the breast immobile, whcih of the followign is an alternative to right mediulateral oblique (RMLO)? (A) right lateromedial oblique (RLMO) (B) left mediolaterl oblique (LMLO) (C) left lateromedial (LLM) (D) right mediolateral (RML)

27. Which projection is used to best visualize the tail of the breast? (A) lateromedial oblique (LMO) (B) TAN (C) lateromedial (LM) (D) axillary tail (AT)

28. Calcifications seen on the mammogram are suspected ot be in the skin. The best projection necessary to prove this theory is the (A) LMO (B) TAN (C) LM (D) AT

29. The projection used to best demonstrate details of the medial breast structures of the breast is the (A) LM (B) AT (C) ML (D) TAN

30. A lesion on the lateral aspet of the breast is not seen on CC. An additional projection used to image the lesion could be the (A) CV (B) XCCL (C) FB (D) TAN

31. Which projection can be used instead of CC to image patients with severe kyphosis ? (A) ML (B) TAN (C) FB (D) CV

32. A lesion moved up on the ML projection form its original position on MLO. The location of the lesion within the breast is (A) lateral (B) medial (C) inferior (D) superior

33. Which projection can be used to prove breast calcifications are benign (A) CC (B) XCCL (C) FB (D) ML

34. Which projection can be used to give a profile image of the area in question without superimposition of breast tissue? (A) CV (B) TAN (C) LMO (D) AT

35. Idenitify the projection show (A) FB (B) XCCL (C) ML (D) AT

36. A barrel chested patient whose chest wall protrudes outward may have breast tissue extending laterally under the arm. What projection, used to image the breast with the beam direted superior to inerior, should be taken in addtion to CC? (A) AT (B) XCCL (C) CV (D) MLO

37. The FB projection can be useful in imaging 1. patients with extreme kyphosis 2. abnormalities high on the chest wall or superior aspect of breast 3. inferior lesion or lesions near the IMF (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

39. Why is MLO preferred to ML as the routine projection? (A) MLO visualizes the medial breast (B) ML does not visualize the medial breast (C) ML poorly visualizes the posterior and lateral breast (D) MLO does not distort the anterior structure of the breast

40. Which projection best shows the extreme medial aspect of the breast? (A) CC (B) MLO (C) ML (D) CV

41. In which modified projection is the superior aspect ofthe breast rolled medially? (A) rolled medial (RM) (B) rolled lateral (RL) (C) magnification (M) (D) lateromedial (LM)

42. In the LMO projection, the beam is directed from the (A) upper-inner aspet ot the lower-outer aspect of the breast (B) inner-outer aspect to the upper- outer aspect of the breast (C) lower-outer aspect to the upper-inner aspect of the breast (D) superiolateral aspect to the inferomedial aspect of the breast

45. Which projetion is especially useful when analyzing calcifications? (A) RM (B) M (C) LM (D) ML

47. All of the following statements about magnification are true except (A) with magnification, patient dose increases (B) magnificaiton can be used in ontaining specimen radiographs (C) magnification can be used to assess suspicious lesions (D) magnification images the entire breast with one exposure

48. In the rolled superior (RS) position, the surgace ____ the detector is rolled \_\_\_\_\_ (A) furthest from / inferiorly (B) closest to /superiorly (C) furthest from/ superiorly (D) closest to /inferiorly

49. Which technique accurately describes how the breast is rolled for RM ? (A) the superior surface is rolled medially and the inferior surface does not move (B) the superior surface is rolled alterally, and the inferior surface is rolled medially (C) the inferior surface is rolled medially, and the superior surface does not move (D) the inerior surface is rolled laterally, and the superior surface is rolled medially

50. A patient with pectus excavatum may present a positioning problem because the patietn has (A) extensive pectoral muscle (B) barrel chest (C) kyphosis (D) depressed sternum

51. In imaging the augmented breast in the CC position, using the implant-displaced techique the breast tissue is pulled or pushed (A) anteriorly (B) posteriorly (C) inferiorly (D) superiorly

52. A routine serires on patients with encapsulated implants oculd include an additional projection, such as the (A) TAN (B) CC (C) MLO (D) ML

53. Which of the followign is used to spread out the tissue and improve resolution on a localized area of interest (A) CV (B) AT (C) TAN (D) spot compression

54. How many projections are routinely required to image a patient with implant-augmented breasts (A) 5 (B) 6 (C) 7 (D) 8

55. Which of the followign statements is correct? (A) the breast should be imaged immediately after irradiation to rule out recurrent cancer (B) The irradiated breast should never be imaged (C) it is contraindicated to image the irradiated breast less than 6 months after irradiation treatment (D) it is contraindcated to image the irradiated breast less than 2 years after irradiation treatment

56. Which of the following projections or positions can be performed with any patient orientation, with or without magnification (A) spot compression (B) XCCL (C) AT (D) CV

57. In addition to the routine series, after a lumpectomy how many patients can also be imaged using (A) CC (B) MLO (C) ML (D) CV

58. The "implant in place" projections take on patietns with rbeast implants requires compression (A) for immobilization only (B) to separate the breast tissue (C) to provide a uniform tisse thickness (D) for improved spatial resolution

59. Magnetic resonance imaging (MRI) could be used 1. as a primary breast ancer detection tool 2. to image patients with rbeast implants to evaluate ruptures 3. to determine tumore margins and the extent of tumor spread (A) 1 only (B) 1 and 2 (C) 2 and 3 (D) 1 and 3

60. WIth its high sensitivity, MRI is ideal as (A) a routine screen tool for breast cancer (B) a replacement for mammography screening in detecting breast cancer (C) an adjunctive rool in detecting breast cancer (D) a screening toll for older women

61. MRI imgaging involves the use of (A) radiation to detect breast lesions (B) sound waves int he imaging of the breast (C) magnetic properties plus radio waves to image the breast (D) strong sound and radio waves in imaging the breast

62. Ultrasonagraphy uses (A) high-frequency sound waves to image the breast (B) low-frequency sound waves to image the breast (C) logitudinal microwaves to image the breast (D) radiofrequency waves to image the breast

63. MRI can be used to 1. map the extent of a tumor 2. image patietns with implants 3. evaluate patients with dense breasts (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

64. Ultrasonography of the breast is often used to (A) map the extent of a breast tumor (B) verify that lesion seen on the mammogram is solid or fluid filled (C) verify the presend of microcalcifications (D) perform a biopsy of a lesion seen only on MRI

65. All of the following statements, referencing the Hologic digital tomosynthesis unit, are true except (A) tomosynthesis does not use a grid (B) the highest slice number is lcosest to the detector (C) reconstruction is always in 1mm- thick slices (D) slices can be slabbed together to visualize calcifications

66. Disadvantages of the Hologic digital tomogrpahy system are that (A) it does not use a grid resultignin lower resolution images (B) greaster risks of motion as a result of the longer acquisition time (C) the technology can be used to reduce the recall rate (D) it can be used to remove overlapping tissue when imaging a dense breast

67. Motion on images with the Hologic digital breast tomosynthesis (DBT) unit are better appreciated on (A) the projection images at the radiologist workstation (B) the projection images at the technologist workstation (C) the reconstruction images at the radiologist workstation (D) the reconstruction images at the technologist workstation

68. Synthesized 2D imagingis a (A) 2D recondstruction of the 3D image (B) 3D reconstructin of the 2D image (C) 2D imaging with tomosynthesis (D) 2D tomosynthesis imaging

69. Computer aided detection (CAD) is used to (A) visually enhanced an image for viewing (B) modify the constrast of brightness of an image (C) analyze or preread the image (D) provide accurate dianostic information about the image

70. The results form one of the followign techniques is often used to reduce the amount of lymph noes removed during a chekc for breast cancer spread (A) sentinel node mapping (B) scintimammography (C) positron emission mammography (D) MRI

1. Radiation therpay is a treatment that utilizes (A) drugs to treast cancer taht may have spread (B) high-energy radiation to destroy cancer cells (C) radioactive tracers to track the path of cancer to the lymph nodes (D) potent pain medication to treat the severe pain from cancer

2. Between ages 20 and 30 years, an asymptomatic woman should be undergoing mammography every (A) year (B) 2 years (C) 3 years (D) none of the above

3. Medical hystory may include questions on hormone use because (A) treatment with synthetic hormones, such as hormone replacement therapy (HRT), will always cause breast cancer (B) the use of reproductive hromones can increase risk factors for breast cancer (C) family history of hormone use predisposes a woman to cancer (D) personal history of hormone use decreases a womans risk for breast cancer

4. In imaging implants, some of the projections taken will include an image of the implant. In these projections, compression is used (A) to allow a uniform tissue density (B) for immobilization only (C) to separate the breast tissue (D) to separate and spread out the implant

5. The glandular dose is a measure of (A) the radiation dose to the skin of the breast (B) the dose to the radiosensitive cells of the breast (C) the significant background dose recorded in the US (D) the radiation dose to the gonads

6. In digital imaging, "high detective quantum efficiency" means that (A) the system is more efficient in coverting input x-ray signals and or the system needs higher exposure factors to create an image (B) the system needs higher exposure factors to create an image and or the system has a high fill factor on the TFT array (C) the system is more efficient in coverting input x-ray signals and or the system has a high fill factor on the TFT array (D) all of the above

7. In digital imaging, a graph of the optical denisty rand to the log of relative exposure is a (A) shallow sloping curve (B) steep sloping curve (C) linear response (D) curvilinear response

8. In the new 2016 American College of Radiology (ACR) Digital Mammography Quality Control Manual, the approved accreditation phantom has a total of (A) 5 fibers, 5 speck groups and 5 masses (B) 5 fibers, 6 speck groups and 5 masses (C) 6 fibers, 5 speck groups and 5 masses (D) 6 fibers, 6 speck groups and 6 masses

9. The circular pigmented area around the nipple is called the (A) skin (B) areola (C) Montgomery gland (D) ampulla

10. Keratosis is demonstrated mammographically as a (A) sharply outlined multilobulated lesion (B) sharply outlined lesion with a halo (C) mixed radiolucent and radiopaque circular lesion with a radiolucent center (D) mixed radiolucent and radiopaque oval lesion

12. The advantages of a quality assurance program, such as the Mammography Quality Standards Act (MQSA), inlcudes all of the following except (A) increased efficiency (B) cost- effectiveness (C) permission for maniplation of the final image (D) improved patient satsfaction

13. IN magnification, what immediate role does the large object to image receptor distane (OID) play in reduing scatter radiation? (A) It allows the use of lower peak kVp values (B) There is increase source to object distance (SOD), which allows for absorption of the scattered radiation (C) Most of the scattered radiation misses the detector (D) the larger OID utilizes a smaller source to image receptor distance (SID)

14. Using a small focal spot size is recommeded for magnification (A) to reduce the resultant loss of image detail (B) because of increased patient dose (C) to compensae for the small OID (D) to compensate long exposure times

15. What is the best placemtn for the needle wire during needle localization (A) the needle wire should pass immediately below the lesion (B) the needle wire should pass immmediately above the lesion (C) the needle wire should pass through the lesion (D) the needle wire should pass immediately beside the lesion

16. Although it may mean losing some of the lateral breast tissue, in imaging for the craniocaudal (CC) projeciton, most experts agree that all efforts should be made to maximize imgaing of the medial breast tissue, why? (A) media breast is imaged best on CC (B) medial breast is imaged only on CC (C) Most cancers are found in the medial breast (D) the lateral breast is generally distorted on CC

17. Which is true when positioning for all tangential (TAN) projections? (A) The patient is always in the CC position (B) The central ray is always directed vertically (C) The central ray is always parallel to the palne of the breast (D) The central ray is always parallel to the skin surface

18. In the rolled meidal (RM) position, the inferior (lower) surface of the breast is rolled in which direction (A) lateral (B) medial (C) inferior (D) superior

19. A radiopaque implant that is used in breast reconstruction and can be adjusted for cup size after surgical placement in the breast is the (A) silicone gel implant (B) flap implant (C) silicone liquid implant (D) saline implant

20. In addition to the routine CC and mediolateral oblique (MLO) projections, a routine series after mastectomy could also inlcude (A) axiallary tail (AT) (B) mediolateral (ML) (C) TAN (D) lateromedial oblique (LMO)

21. Men with family history of breast cancer will (A) have a greater risk for breast cancer (B) Have a minor risk for breast cancer (C) have no significantly increased risk for breast cancer (D) always get breast cancer

22. The dynamic range is (A) the detectors ability to respond to different exposure levels (B) a measure of the image quality (C) an indication of how efficient the detector is at converting the remnant beam to useful data (D) the ability of the detector to record lower exposure factors

23. The abdosrbed dsoe in mammography is generally __ the entrance skin exposure (ESE) (A) significantly higher than (B) significantly lower than (C) about the same as (D) slightly higher than

24. In the compression test required by the MQSA, the maximum compression for the initial power drive should not exceed (A) 100 newtons (N) (B) 200 N (C) 400 N (D) 500 N

25. Collimation should not extend beyond any edge of the detector by more than (A) 1% of the SID (B) 2% of the SID (C) 3% of the SID (D) 4% of the SID

26. Inherent filtration will include filtration by all of the following except (A) exit port of the tube (B) compression paddle (C) molybdenum filters (D) mirror assembly

27. The MQSA was enacted (A) because mammography was overregualted (B) to address the inconsistent quality of mammography (C) to enforce continuing education for the radiologic technologist (D) to enforce continuing education for the radiologist

28. Grids are utlized in mammography (A) during normal imaging (B) during magnificaiton imaging only (C) only if requested by the radiologist (D) to reduce radiation dose to the patient

29. breast tissue can extend medially to the (A) latissimus dorsi muscle (B) mid-sternum (C) retromammary space (D) inframammary fold (IMF)

30. Which of the followign hormones has the most influence on the normal physiological changes of the breast (A) estrogen and prolactin (B) estrogen and progesterone (C) prolactin and estrogen (D) profesterone and prolactin

31. Which of the followng are considere first degre relatives (A) mother and aunt (B) first cousin and mother (C) aunt and sister (D) sister and mother

32. Image compression is often required to allow (A) teleradiography (B) digital iamging and communication in medicine (DICOM) interpretation (C) picture archiving and communication system (PACS) transmission (D) digital imaging

33. Network limited to a small geographical area is called (A) wide area network (WAN) (B) loca area network (LAN) (C) personal area network (PAN (D) PACS

34. In the lower kVp range using molybdenum target tube, what type of photon interaction predominates (A) photoelectric (B) compton (C) bremsstrahlung (D) coherent

35. In digital iamging, a reapeat analysis test is (A) unnecessary - digital imaging automatically correts exposure mistakes (B) necessary - digital imaging automatically cannot correct for overexposure (C) unneccessary - digital imaging corrects unsharpness by altering the spatial display (D) necessary - digital imaging cannot correct factors such as motion unsharpness

36. The same technologist should view the phantom images because (A) subjective judgement about iamges is always difficult (B) it is not wise to have different individuals handling the phantom (C) not all mammographers know the MQSA regualtions (D) given different images, different mammographers will calculate the optical densities differently

37. The from-below (FB) projection utlizes a beam directed (A) perpendicular to the detector (B) horizontally (C) tangentially (D) parallel to the detector

38. Changes in the breast as a result of radiation therapy include (A) erythema (B) edema (C) hardening (D) all of the above

39. Scanning the breast to locate a cancer based ont eh vast amount of glucose/sugar utilized by cancer cells is the technique used in (A) scintigraphy (B) positron emission mammography (PEM) imaging (C) magnetic resonance imaging (MRI) (D) lymphoscintigraphy

40. Which of the following projections could be used to replace MLO in patients where MLO is not possible (A) ML (B) lateromedial (LM) (C) rolled lateral (RL) (D) AT

41. Which of the following does not describe mammogrpahy filtration (A) It shapes the emerging beam by abdorbing low-energy x-rays that would only be abdorbed by the superficial tissue and contribute to patient dose (B) It will affect the half-value layer (HVL) of the emerging x-ray beam (C) filtration makes the emerging beam compatible with the characteristics of the breast (D) the filtration used in mammography is never aluminum

42. An artifact caused by dust is more common in (A) flat panel detector systems (B) computer radiography systems (C) indirect flat panel detector systems (D) scintillator based systems

43. Evaluations such as the mammography equipment evaluation (MEE) is performed by the (A) radiologic assistant (B) technologist (C) medical physicist (D) radiologist

B44. The test pattern used to ensure tha the acquistition workstation monitors are clean and free of dust, fingerprints, and other artifacts is (A) signal to noise ratio (SNR) (B) SMPTE ( Society of motion pciture and telvision engineers) (C) contrast to noise ratio (CNR) (D) moduation transfer funcion (MTF)

45. According to the 2016 American College of Radiology (ACR) Digital Quality Control Manual, which of the following test is performed monthly ? (A) phantom check (B) repeat/rejection analysis (C) compression thickness indicator check (D) compression force check

46. On a reject/repeat analysis, the rate was \<5% but one category of the reject/repeat analysis is significantly higher than others. What should be done (A) Although the rate is \<5% that one are should be targeted for improvement (B) If the other catefories are within normal limits, that are can be disregarded (C) because the rate was \>2% the entire department needs to be reassessed (D) WIth an overall rate \<5% one high riate is statistically meaningless

47. Typically, frid ratios in mammography range from (A) 7:1 to 8:1 (B) 6:1 to 7:1 (C) 4:1 to 6:1 (D) 3:1 to 5:1

48. Positron emission tomography/mammography (PET or PEM ) imaging is useful in staging tumors because (A) the postiron emitting isotopes are radioactive (B) PET or PEM imaging can display the extent and location of the tumor (C) the positron emitting isotopes will distroy the tumor bed (D) PET or PEM imaging tracks the increased blood flow from teh cancerous tumor

49. Medical history is importnat in (A) assessing risk factors for breast cancer (B) preventing breast cancer (C) evaluating treatment options (D) more than one of the above

50. Unlike general radiography x-ray tubes, some mammography tubes are tilted 6 to 24 degrees from the horizontal. The effect of this is to (A) allow the use of smaller focal spot size (B) minimize the heel effect (C) increase resolution (D) all of the above

51. The term retromammary space describes the area (A) between the breast and pectoral muscle (B) separating the skin of the breast from the deep fascia (C) sepaarating the skin from the superficial fascia (D) between the flandular tissue and the IMF

52. In which of the following are breast cysts least common (A) young women in their early 20s (B) premenopausal women (C) postmenopausal women on estrogen therapy (D) women aged 70 years

53. The CC projection shows a circumscribed oval radiolucent lesion. There is a definite halo surroudning the lesion. It is most likely to be a (A) fibroadenoma (B) galactovele (C) cyst (D) hematoma

54. The indirect effect of breast compession on Compton interaction is (A) the absolute number of compression interactions increases (B) the absolute number of compton interactions decreases (C) compression has no effect on compton interactions (D) compression affects compton interactions only about 70 kVp

55. One disadvantage of lossless compression is (A) it does not provide exact measurement for fine detail on reconstruction (B) it provides exact recontruction of the original image (C) transmission times can be too long (D) it does not support teleradiography

56. Grids with strips that are linear but slanted to match the divergence of the x-ray beam are ___ grids (A) parallel (B) crossed (C) focused (D) moving

57. Fatty tissue is generally radiolucent and will show on the mammogram as (A) glandular areas (B) high-optical density area (C) low- optical density areas (D) white or gray areas

58. The mammogram of a woman who is aged 50 years and has recently started estrogen replacement therpay is likely to show a breast that is (A) more fibroglandular than in her previous mammograms (B) more fatty than in her previous mammograms (C) less fibrous and less glandular than in her previous mammograms (D) unchanged from her previous mammograms

59. The mammogram shos an oval shaped lesion with mixed radiolucent and radiopaque content. The lesion has a central radiolucent area nd is freely movable. This lesion is most likely to be (A) fibroadenoma (B) hematoma (C) lymph node (D) galactocele

60. The method of locating the lymph nodes through which cancer is spreading from the breast is called (A) scintigraphy (B) PEM (C) MRI (D) lymphoscintigraphy

61. The change in OID could cuase loss of image detail in magnification mammography. What factors help compensate for this loss of image detail? (A) decreased OID and breast compression (B) Increased focal spot size and breast compression (C) decreased focal spot size and compression of the part (D) increased OID and coprssion of the part

62. What does the actual focal spot size measure? (A) the area on teh anode exposed to electrons (B) the are projected on the patient (C) the area projected on the detector (D) the nominal focal spot size

63. The mammography report has an assessment score of 0, accoridng to the BIRAD (breast imaging reporting and data) system. This means that (A) the mammography results is negative (B) there is a higher probability if a benign finding (C) additional imaging is needed (D) the findings are suspicious

64. Differentiate between repeat and reject images (A) Repeate is the percentage of repeats form a specific cause. Reject is the percentage of repeats from multiple causes (B) rejects are all images that are discarded. Repeats are iamges that resulted in extra radiation doses to the patietn (C) Repeats are all images that are discarded. Rejects are images that resulted in extra radiation doses to the patient (D) Rejects are images discarded after any quality control (QC\_ testing. Repeats are any images discared

65. What is epithelial hyperplasia (A) a calcified hematoma resulting from trauma (B) an oil cyst within the breast (C) an overgrowth of cells in the ducts or lobules (D) an epidermoid cyst on the skin of the breast

67. After four projection mammography, calcifications are visualized superior to the niple but only on the MLO projection. What additional projection would be used to best locate the positon of the lesion (A) exaggerated craniocaudal (XCCL) (B) cleavage (CV) (C) ML (D) AT

68. Approximately how much contrast agent is injeted into the breast during ductography? (A) approximately 1 cc (B) 15-25 cc (C) 20-40 CC (D) approximately 50 cc

69. What does the glandular dose measure? (A) the average dose to the patients skin (B) the absorbed dose to the skin (C) the absorbed dose at the tissue level (D) the same as the entrance skin dose

70. Which of the following relationshipes does not change when moving from routine to magnification mammography (A) OID (B) focal spot size (C) SID (D) SOD

71. Who performs the compression device check for mammography QC? (A) physicist (B) any staff technologist (C) radiologist (D) technologist

72. A galactocele is (A) a lesion associated with trauma to the breast (B) a benign milk filled cyst (C) assicaiated with eggshell-like calcifications (D) associated with a central radiolucent hilus

73. Instead of using a grid, what does manification mammography use to reduce scatter during normal imaging? (A) lead shielding (B) increase OID (C) a low milliampere second (D) increased SID

74. Most of the glandular tissue is arraned in the breast around the (A) medial and upper-inner quadrants (B) lateral and lower-inner quadrants (C) central and upper-out quadrants (D) medial and upper-out quadrant

75. A beryllium (Be) window on the x-ray tube enhances contrast by (A) increaseing the output of the x-ray tube (B) reducing production of scattered radiation (C) transmitting more low energy photons (D) transmitting more high-energy photons

76. Proper compression of the breast is indicated when the (A) patient is in pain (B) compression paddle stops (C) breast is taut (D) breast feels soft

77. Which factors cause increased skin dose in magnification (A) larger OID and smaller focal spot size (B) increased mAs and larger SOD (C) increased OID and decreased SOD (D) smaller OID and larger SID

78. In radiology, according to the line focus principle, the effective focal spot is (A) larger than the actual focal spot (B) smaller than the actual focal spot (C) the same as the actual focal spot (D) decreased as the target angle increases

80. WHen using the air-gap technique in magnification mammogrpahy, what additioanl step is necessary (A) grid use (B) decreased SID (C) increased OID (D) increased SID

81. Which of the following projections would best separate superimposed 12 o'clock and 6 o'clock masses? (A) MLO (B) XCCL (C) CC (D) AT

82. In positioning terminology, CV means (A) compressed position (B) cranial view (C) cleavage view (D) compression view

83. Malignant casting-type calcifications can appear on the mammogram as (A) granulated-sugar or crushed stone calcifications (B) eggshell-like calcifications (C) elongated, branching and needle-like calcifications (D) fragmented, linear branching calcification

84. The functional milk-producing units of the breast are contained within the (A) lactiferous sinuses (B) lobules (C) ampulla (D) areola

85. What is the grid ratio (A) the height of the lead strips divided by the distance between each strip (B) the height of the lead strips multiplied by the distance between each strip (C) twice the height of each lead strip (D) the distance between each strip divided by the height

86. The AT projection best demonstrates the (A) subareolar area (B) medial aspect of the breast (C) axillary aspect of the breast (D) lower-inner quadrant of the breast

88. The patient had trauma to the breast 1 month ago and has developed a lump. Such an injury may show mammographically as a (A) galactocele (B) hematoma (C) lymph node (D) fibroadenoma

89. A device used to convert light to a digtital signal is a (A) film digitizer (B) DICOM (C) analog to digital converter (ADC) (D) digital to anlog converter (DAC

90. If too much of the upper axilla and shoulder are under the compression paddle when imaging for MLO, the effect is to (A) inhibit proper comprssion of the upper breast (B) inhibit proper copression of the lower breast (C) ensure equal compression of the upper and lower breast (D) ensure proper compression of the lower breast

91. Which of the following types of breast imaging methods will fall under the category of nuclear imaging. (A) PEM (B) MIR (C) ultrasonography (D) digital tomosynthesis

93. A rolled projection cam be performed to (A) separate superimposed tissues (B) identify microcalcifications (C) localize a skin lesion (D) determine the location of a finding seen only on one of the standard projections

94. Ideally, in an open surgical biopsy, when shoudl a breast tissue specimen be imaged? (A) immediately after surgery (B) within 24 hours of the surgery (C) just prior to the surgery (D) after the lesion is removed but before the surgical site is closed

95. Which projection gives a mirror image of MLO (A) ML (B) LM (C) LMO (D) AT

96. The nominal focal spot size of the mammography unit is 0.3. This means that the (A) actual focal spot size is 0.3 (B) effective focal spot size is 0.3 (C) both effective and actual focal spot sizes are 0.3 (D) actual focal spot is smaller than 0.3

97. After lumpectomy, patients could have magnified images of the tumor bed taken to (A) confirm the removal of the cancer (B) check calcium deposits that may result from radiation and surgical changes (C) all of the above (D) none of the above

99. Where is the grid placed (A) above the breast (B) between the breast and the image plate or detector (C) below the image plate (D) between the breast and the x-ray tube

100. Which of the following statements is true of both the photstimulable phosphor (PSP) and the flat-panel mammography systems? (A) The iamging plates (IPs) used can be damaged or dropped during transport (B) The system has a wide latitude and dynamic range (C) PSP is very sensitive to radiation (D) The iamging system is susceptible to scratches

101. The puporse of the mammography certification and accreditation process is to (A) provide legal mammography services (B) enforce minimum national quality standards for mammography (C) ensure that all women have access to a certifeid mammography facility (D) authorize certain states to certify mammography facilities and conduct inspections

102. A facility has a sign posted advising patiensts to contact a designated person within the organization with comments. This facility is meeting the US Food and Drug Administartion (FDA) (A) medical outcome audit program (B) record keeping program (C) patient communication of results program (D) customer cmplaint program

103. A hamartoma is (A) a malignant tumor of the breast (B) a benign tumor of the breast (C) associated with trauma of the breast (D) associated with nursing

104. During lactation, the contraction of which cells help eject milk from the alveoli (A) epithelial cells (B) myoepithelial cells (C) basement cells (D) superficial cells

105. A finding of BIRAD 2 on the mammogram means that (A) it cannot aid in accurate evaluation of the breast (B) the findings are benign (C) the findings are suspicious (D) it is suggestive for malignancy

106. Erythema of the brest is an indication (A) of inflammatory breast cancer (B) a breast abscess (C) of a breast infection (D) that further testing of the breast is necessary

107. Which of the followign is used as a treatment for estrogen-dependent tumors in postmenopausal and premenopausal women? (A) Radiation therapy (B) chemotherapy (C) tamoxifen (D) antibody therapy

108. In flat-panel detector systems, the spatial resolution of the system is controlled by the (A) pixel number (B) detector element (DEL) size (C) matrix size (D) thin film transistor (TFT) number

109. A thin supportive layer located netweem the basal surface of the epithelium and the connective tissue layer of the lobule is called (A) chief cells (B) myoepithelial (C) basement membrane (D) superfical A cells

110. The appearanc of a "camel's nose" breast contour in the MLO projection can be prevented by (A) including all of the breast under the compression paddle (B) angling the detector parallel to the pectoralis muscle (C) properly supporting the anterior breast during compression (D) ensuring that the nipple remains in profile during compression

111. The superioinferior oblique (SIO) projection will best demonstrate the (A) outer-upper quadrant and the lower outer quadrant of the breast (B) lower inner quadrant and the upper inner quadrant of the breast (C) upper inner quadrant and lower outer quadrant of the breast (D) lower inner quadrant and the outer upper quadrant of the breast

112. The basic premise of a medical audit is that 1. all positive mammograms should be followed up 2. the pathology results of all biopsy procedures performed should be collected 3. all pathology results should be correlated with the radiologists findings (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

113. Under the MQSA, how long are facilities required to maintain the records of a patient who died shortly after her first mammography (A) 5 years (B) 10 years (C) 20 year (D) permanently

114. Under which of the following circumstances would eb the triangulation technique be necessary (A) to locate an abnormality visualized on one projection only (B) during routine mammography screening (C) when performing spot magnification (D) to locate a palpable lesion

115. A dimpled skin condition seen in cases of lumphatic edema of the breast is called (A) inflammatory carcinoma (B) ductal ectasia (C) plasma cel mastitis (D) peau d' orange

1. Clinical breast examination (CBE) and breast self examination (BSE) are similar in that both (A) involve looking and feeling for changes in the breast (B) are performed by a trained medical professional (C) are performed montly (D) are performed yearly

2. The most common cause of under compression is (A) a faulty compression paddle (B) inadequate compression by technologist (C) the patients pain tolerance level (D) a broken autmatic compression device

(B) inadequate compression by technologist

3. The Health Insurance Portabilit and Acountability Act (HIPAA) of 1996 has an influence on the radiology department and other hospital departmenents because of its focus on (A) patient record confidentiality (B) facility reimbursement (C) quality management (D) risk management

(A) patient record confidentiality

4. Ductal papilloma is (A) a benign proliferation of tissue in the male breast (B) a malignant tumor involving ducts (C) a collection of blood in the breast occurring after surger (D) benign growths involving the milk ducts

(D) benign growths involving the milk ducts

5. The right craniocaudal (CC) projection in a routine imaging series showed a small irregular shaped lesion at the posterior margin of the image plus scattered calcifications, including calcification clusters. Typucally the radiologist will recommened ___ as the immediate next step (A) ultrasonography to assess the content of the lesion and provide an analysis of the calcifications (B) spot compression, includign magnification, to assess calcifications and the margins of the lesion (C) magnetic resonance imaging to assess for malignancy and to assess any calcifications (D) a breast biopsy to check for malignancy

(B) spot compression, includign magnification, to assess calcifications and the margins of the lesion

6. A bunch of eight bits equals one (A) pixel (B) byte (C) matrix (D) bit depth

(B) byte

7. Which of the followign could be used when imaging extrmely small breasts in the CC position (A) spatula (B) mediolateral (ML) projection (C) cleavage view (CV) projection (D) exaggerated craniocaudal (XCCL) projection

(A) spatula

8. In the tangential (TAN) projection, any tube angulation will depend on (A) the size of the patients breast (B) the location of the abnormality (C) the position of the mid axillary line in relation to the detector (D) whether the abnomality is palpable or non palpable

(B) the location of the abnormality

9. A small but growing cancer may not be obvious to the individual because it often presents as (A) skin irritation (B) inverted nipples (C) a painless mass (D) a painful mass

10. Mammography is more accurate in (A) premenopausal women (B) postmenopausal women (C) women with fibrocystic breast (D) women with dense breast tissue

(B) postmenopausal women

11. In taking medical history, hormone use (both natural and artificial) is taken into account because (A) hormones cause breast cancer (B) early menarche can increase breast cancer risks (C) late menarche can increase breast cancer risks (D) contraceptive use lowers the risk for breast cancer

(B) early menarche can increase breast cancer risks

12. One major difference between collimation in mammography and collimation in general radiography is that (A) in mammography, the entire detector area is exposed (B) decreasing collimation increases exposure in mammography (C) mammography uses a variety of beam limiting device (D) in radiogrpahy, the entire detector area is always exposed

(A) in mammography, the entire detector area is exposed

13. Line pair per millimeter is the unit of (A) matrix size (B) spatial resolution (C) field of view (FOV) (D) bit depth

(B) spatial resolution

14. Image brightness is adjusted by changing the (A) milliampere second (mAs) (B) peak kilovoltage (kVp) (C) window level (D) window width

15. The retromammary space is filled with (A) supportive and connecting tissues (B) adipose tissue (C) fibroglandular tissue (D) blood vessels

(B) adipose tissue

16. The fatty versus fibroglandular nature of the breast itssue is affected by which of the following (A) age (B) hormone use (C) number of pregnancies (D) all of the above

(D) all of the above

17. In positioning for the exaggerated craniocaudal (XCCL) projection, if the shoulder of the affected side is in the way of the compression device (A) push the shoulder down (B) use 5-degree lateral tube angulation (C) use 5-degree medial tube angulation to avoid superposing the shoudler on breast tissue (D) reduce the patients lateral rotation

(B) use 5-degree lateral tube angulation

18. In the CC position, the pectoral muscle is seen (A) all the time (B) rarely if ever (C) about 30 to 40% of the time (D) about 50% of the time

19. Between ages 20 and 39 years, the American Cancer Society (ACS) recommends CBE every (A) year (B) 2 years (C) 3 years (D) 4 years

21. Regardless of the reason, if the proper amount of compression cannot be applied, which of the followign must apply (A) the patient must be infomred (B) the patients doctor must be informed (C) the radiologist must be informed (D) it must be noted on the patients history form

(D) it must be noted on the patients history form

22. On the CC image, the posterior nipple line (PNL) should extend to the (A) level of the nipple (B) posterior breast or edge of the image (C) level of the inframammary fole (IMF) (D) most anterior breast

(B) posterior breast or edge of the image

23. The interspace material of the mammography linear grid is generally made of (A) carbon or wood (B) aluminum (C) any highly radiopaque material (D) lead

(A) carbon or wood

24. Which section of the breast is poorly visualized on the CC projection (A) medial (B) axial (C) lateral (D) superior

26. Adjusting the image contrast is achieved by (A) changing the window level (B) decreasing the pixel size (C) changing the window width (D) increasing the pixel size

27. Which projection could be used to demonstrate a deep medial lesion not seen on CC (A) axillary tail (AT) (B) XCCL (C) CV (D) MLO

28. After a routine four projection mammographic series, the nipple is not seen in profile on any of the images. Additional projections are done if 1. the nipple is indistinguishable from a mass 2. a subareolar abnormality is suspected 3. the nipple is not marked iwth a BB (lead shot ) (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

(D) 1,2,3

30. Your patients sister was diagnosed iwth rbeast cancer at age 35 years. Your patient is considered to have (A) a greater risk of breast cancer (B) a lower risk for breast cancer (C) no significantly increased risk for breast cancer (D) a personal history of breast cancer

(A) a greater risk of breast cancer

31. The MQSA mandates tha the average flandular dose received per projection/position during routine mammogrpahy screening not exceed (A) 1 mGy (100 mrad) (B) 2 mGy (200 mrad) (C) 3 mGy (300 mrad) (D) 4 mGy (400 mrad)

32. The device used to vonvert the films in an analog imaging system to a digital image is called (A) a film digitizer (B) DICOM (C) an analogn to digital converter (ADC) (D) a digital to analog converter (DAC)

(A) a film digitizer

33. The computer netweork that allows images to be viewed at various monitors or transmitted or stored is termed (A) local area network (LAN) (B) picture archivign and communications system (PACS) (C) DICOM (D) wide area network (WAN)

(B) picture archivign and communications system (PACS)

34. Which of the following statements about health care records is false (A) health records must inlcude all signed informed consent forms (B) patients have a right to amend their health care records (C) patietns can access their health records (D) health care records cannot be used in a court of law

(D) health care records cannot be used in a court of law

35. Montgomery glands are specialized (A) sweat glands (B) sebaceous glands (C) Cooper ligaments (D) hair follicles

(B) sebaceous glands

36. A woman takign hormone replacement therpay may notice changes in the breast, such as (A) breast enlargement (B) increase in fibroadenomas (C) increase in breast cysts (D) all of the above

(D) all of the above

37. Pagets disease of the breast is a (A) infiltrating carcinoma generally limited to the breast (B) form a carcinoma associated with changes in the nipple (C) benign breast conidtion that is relatively common (D) malignant form of breast carcinoma involving lobules

(B) form a carcinoma associated with changes in the nipple

38. in a digital image, what determines the matrix size (A) the number of bits in each pixel (B) the number of pixels in the rows and columns (C) the pciture elements in the matrix (D) the number of gray shaes that a pixel can produce

(B) the number of pixels in the rows and columns

39. A set of computer software standards that permits a wide range of digital imaging programs to understand each other is called (A) DIGCOM (B) PACS (C) DICOM (D) PCAS

40. A PACS network typically would include (A) digital images from multiple modalities (B) images from a single modality (C) all records of patients (D) surgical and radiography patient records

(A) digital images from multiple modalities

41. Women who were exposed to diethylstilbestrol (DES) in utero may have (A) a lower risk for breast cancer (B) a higher risk for breast cancer if they are also receiving hormone replacement therapy (C) a lower risk for breast cancer if theya re also receiving HRT (D) breast tissue that is extra sensitive to radiation

(B) a higher risk for breast cancer if they are also receiving hormone replacement therapy

42. In which of the followign modified proejctions is the superior surface of the rbeast rolled medially (A) rolled medial (RM) (B) roller lateral (RL) (C) medial (M) (D) lateromeidal (LM)

(A) rolled medial (RM)

43. factors that lower breast cancer risks include 1. having the first child after age 30 years 2. breastfeeding 3. late menarch (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

(B) 2 and 3

44. PACS stands for (A) picture access to communication system (B) picture archiving and computer system (C) picture archiving and communication system (D) pixel access and computer system

45. The computer processing or photostimulable phosphor (PSP) reader function to (A) focus a beam of infrared light on the PSP (B) trap excited electrons at a higher energy level (C) scan, read, and erase the exposed PSP (D) provide enrgy to rapped electrons

46. Gynecomastia is the term for (A) a localized abscess (B) increased breast tissue in the male breast (C) decreased breast tissue in the female breast (D) a risk of carcinoma in the male patient

(B) increased breast tissue in the male breast

47. Photostimulable luminescence (PSL) is (A) emission of bluish-purple light from electrons as they transition from higher energy to a lower enegery state (B) conversion of light energy to an electrical signal by the phtomultiplier tube (PMT) (C) conversion of the analog signal to a digital signal by the ADC (D) conversion of light into an analog signal by the charge coupled device (CCD)

(A) emission of bluish-purple light from electrons as they transition from higher energy to a lower enegery state

48. According to MQSA regulations, which of the following is not required on the final mammographic image? (A) date of the examination (B) tehcnical factors used (C) technologist identification (D) projection identification

(B) tehcnical factors used

49. The IMF is located at approxiametely the level of the (A) 2nd to 3rd rib (B) 3rd to 4th rib (C) 4th and 5th rib (D) 6th to 7th rib

(D) 6th to 7th rib

52. Scatted radiation is reduced during magnification mammography by (A) using a small focal spot size (B) using a grid (C) using the air gap technique (D) increasing the source to image receptor distance (SID)

53. Ductography can be used to determine (A) the location of lesions in ducts (B) whether a lesion is benign or malignant (C) change or abnormalities associated with ducts (D) more than one of the above

(D) more than one of the above

54. When imaging smal breasta, a ueful option is (A) replacing CC with XCCL (B) using Ml instead of MLO (C) using a spatula to avoid compressing the fingers (D) reducing angulation to avoid to much comression of the pectoral muscle

55. During magnification, positioning the breast away from the detector utilizes which law/principle in scatter reduction (A) inverse square law (B) reciprocity law (C) heel effect (D) line focus principle

(A) inverse square law

56. A nulliparous woman has a lower risk for breast cancer compared with a woman with a history of (A) late menopause (B) late menarche (C) breast cancer (D) early menarche

57. In routine mammography, the primary purpose of the frid is to (A) improve image sharpness (B) reduce the productionof scatter (C) reduce patient dose (D) increase the subject contrast

(D) increase the subject contrast

58. The implant displaced (ID) projection is possible on all of the following cases except (A) implants placed posterior to the pectoral muscle (B) implants placed anterior to the pectoral muscle (C) soft implants (D) encapsulated implants

(D) encapsulated implants

59. A palpable mass that is not seen on a diagnostic mammogram generally means that (A) breast cancer is ruled out; the mass is probably benign (B) other diagnostic testing must be considered (C) the mass is likely breast cancer (D) the mass is likely caused by fluctuating hormones

(B) other diagnostic testing must be considered

60. Which of the following patients has the greatest risk for breast cancer (A) a nulliparous woman age 40 years (B) a never married woman (C) a woman age 70 years (D) a owman age 30 years

61. A technologist using a 0.1mm focal spot size is most likely performing (A) routine mammography work (B) magnification imaging (C) spot compression imaging (D) stereotactic work

(B) magnification imaging

62. Which of the following patients cannot give consent (A) a minor who is married (B) a minor serving in the military (C) a competent adult (D) a mentally challenged adult

(D) a mentally challenged adult

63. In the PSP computer reader (CR) the phtomultiplier tube (A) collects the blue/purple light given off by trapped electrons (B) scans the PSP with a red laser light (C) provides energy to the trapped electrons in teh phosphor layer (D) erases the PSP by releasing electrons

(A) collects the blue/purple light given off by trapped electrons

64. Which of the following statmetns is true about imaging the breast (A) fold and or wringkels should be eliminated by pusing the posteriorly (B) skin folds and wrikles may be impossible to avoid in older adults (C) when imaging older adults, the study will be compromised by folds and wrinkles (D) fold and wrinkles can be eliminated by pulling them anteriorly

(B) skin folds and wrikles may be impossible to avoid in older adults

65. The term base of the breast refers to the (A) the nipple are of the areola (B) areas adjacent to the chest wall (C) axilla area of the breast (D) lower outer quadrant of the breast

(B) areas adjacent to the chest wall

66. Fibrous tissues are presented radiographically as (A) black or radiolucent areas (B) gray and less dense areas (C) white or denser areas (D) black and less dense areas

67. The calcifications seen are characteristic of \*\* ADD PIC\*\* (A) invasive ductal carcinoma (B) malignant calcifications (C) calcifications caused by plasma cell mastitits (D) numerous oil cysts

(B) malignant calcifications

68. The MLO projection demostrates a large encapsulated lesion occupying almost the entire breast. The contour is sharp, and the lesion is radiolucent. This lesion is most likely to be (A) oil cyst (B) hematoma (C) fibroadenoma (D) lipoma

(D) lipoma

69. The latent image on the PSP can last several hours but will lose (A) 50% of its energy in 4 hours (B) 50% of its energy in 8 hours (C) 25% of its energy in 4 hours (D) 25% of its energy in 8 hours

(D) 25% of its energy in 8 hours

70. Disadvantages of the PSP or computed mammography (CM) technology includes (A) reduced repeats (B) wide latitude and dynamic range of the system (C) PSPs sensitivity to radiation (D) speed of the imaging system

71. In the nonscintillator direct-based flat-panel digital mammography (DM) system, the x-ray beam strikes a (A) scintillator (B) photoconductor (C) thin film transistor (D) photomultiplier

(B) photoconductor

72. Spot compression 1. applies more compression to a localized area 2. can be perfored with magnification 3. employs a coned collimated field to limit the area of interest (A) 1 (B) 1 and 2 (C) 2 and 3 (D) 1,2,3

(B) 1 and 2

74. To reduce the possibility of projecting the abdomen on the MLO image, the technologist could (A) have the patient stand just at the detector and bend backward (B) have the patient stand away fromt eh detector and bend forward (C) have the patient turn medially to image the lateral breast on CC (D) image the breasat in the lateral position instead

(B) have the patient stand away fromt eh detector and bend forward

75. A four-projection mammography series shows a solitary tumor, with the halo sign, in the upper outer quadrant of the left breast. The lesion is partially obscured. The recommended next step is (A) biopsy (B) ultrasonography (C) stereotactic localization (D) aspiration

(B) ultrasonography

76. Why is the specimen magnified (A) to ensure that the lesion has been completely removed (B) to visualize the cacifications within the specimen (C) to compare the magnified and nonmagnified images (D) to check the number and placement of calcifications

(B) to visualize the cacifications within the specimen

77. In digital mammography, a grossly underexposed image (A) appears excessively noisy (B) is too light (C) is too dark (D) appears correctly exposed

(A) appears excessively noisy

78. Which of the following patients is likely to be diagnosed with pathological gynecomastia (A) lactating woman (B) older man (C) premonopausal woman (D) young man

(B) older man

79. Montgomery glands are located on the breasts (A) skin (B) nipple (C) areola (D) muscle

80. Aluminum can be used as the filtration material in (A) digital units, when imaging dense breasts (B) digital tomosynthesis units (C) digital units, when imaging fatty breasts (D) digital units, when using molybdenum targets

(B) digital tomosynthesis units

81. Digital mammography units often use ___ as the target material (A) molybdenum (B) rhodium (C) aluminum (D) tungsten

(D) tungsten

82. The ACS has recommended that women over age 40 years undergo CBE every (A) year (B) 2 years (C) 3 years (D) 4 years

(A) year

83. When imaging the breast usign the CC projection, if the detector is too high or too low, the IMF will be overelevated or underelevated. Overelevation of the IMF will result in (A) loss of posterior and superior breast tissue in the image (B) loss of anterior and posterior breast tissue in the image (C) loss of superior and posterior breast tissue in the image (D) loss of inferior and posterior breast tissue in the image

(D) loss of inferior and posterior breast tissue in the image

84. Capture leemtns in the flat panel detector system can include all of the following except (A) phtomultiplier (B) cesium iodide (C) gadolinium oxysulfide (D) amorphous selenium

(A) phtomultiplier

85. Which of the following involves the use of a small guage needle to remove cell samples from a suspected cancerous lesion int eh breast for cytoogical analysis (A) core biopsy (B) excisional biopsy (C) needle localization (D) fine needle biops (FNB)

(D) fine needle biops (FNB)

86. A lesion is superimposed by breast tissue in the CC projection. A projection/position used to demonstrate the lesion int he same orientation but free of superimposition is the (A) MLO (B) ID (C) XCCL (D) RM

(D) RM

87. In imaging the breast in the MLO projection, compression to the lower, anterior portion of the breast is compromised if (A) the detector is too high (B) the pectoral muscle extends to the nipple line (C) too much axilla and shoulder are under compression (D) the IMF is not horizontal

88. The term involuation of the breast describes a process by which (A) milk is removed from the breast by suckling (B) breast epithelium proliferates during menstruation (C) the glandular tissue in the breast is replaced by fat (D) estrogen use causes an overall decrease in tissue density in the breast

89. In imaging the breast for the CC projection, what technique is used to minimize skin folds in the lateral aspect of the breast (A) lifting the posterior lateral aspect of the breast onto the detector (B) drapign the contralateral breast over the corners of the detector (C) having the patient turn the head to face the lateral breast (D) the patients arm hanging relaxed on the side being imaged, with the humerus externally rotated

(D) the patients arm hanging relaxed on the side being imaged, with the humerus externally rotated

90. Phosphor crystals in the flat panel detector system are classified as ___ phosphores when they are scattered through the phosphor level (A) needle (B) turbid (C) amorphous (D) selenium

(B) turbid

91. Grid use in magnification mammography is contraindicated because (A) the use of a grid will increase subject contrast (B) scatter is already minimized (C) grid use increases with scatter (D) the use of grids would result in decreased subject contrast

(B) scatter is already minimized

94. Which statement best describes a parallel or linear grid? (A) lead strips are aligned adjacent to one another and placed lengthwise in the same direction within the structure of the grid (B) lead strips are aligned at right angles to each other (C) lead strips are designed to take advantage of the divergence of the x-ray beam as it leave the x-ray tube (D) lead strips are designed to move during the exposure

(A) lead strips are aligned adjacent to one another and placed lengthwise in the same direction within the structure of the grid

95. The main difference between the technlogist monitor and the radiologists monitor is (A) display size (B) resolution (C) illuminance (D) luminance

(B) resolution

96. Scintillators are used to convert (A) xrays to light (B) xrays to electrons (C) light to electrons (D) electrons to light

(A) xrays to light

97. The photoconductor in the direct digital radiography system is used to convert (A) xray to light (B) xrays to electrons (C) light to electron (D) electrons to light

(B) xrays to electrons

98. The repeat rate should be analyzed if the rate changes from the previous measure rate by more than (A) +/- 2% points (B) +/- 3% points (C) +/- 4% points (D) +/- 5% points

(A) =/- 2% points

99. A magnification image of a breast shows severa oval shaped radiolucent lesions with eggshell-like calcifications. These are most likely to be (A) ductal papilloma (B) fibroadenomas (C) oil cysts (D) hematomas

100. The thin-film transistor (TFT) in the flat panel detector systems collects (A) light (B) pixels (C) electrons (D) xrays

101. In general, the ID series are taken using the (A) AT and MLO projection (B) CC and ML projections (C) CC and MLO projections (D) CC and LM projections

102. Currently, all technologists or radiographers performing mammography independently must have (A) satisfied the final requirements of the US Food and Drug Administration (FDA) (B) completed at least 20 hours of documented training in mammography (C) performed at least 75 examinations under direct supervision of a qualifed technologist (D) none of the above

(D) none of the above

103. The criteria for a properly positioned MLO projection includes 1. concave pectoral muscle on the anterior border 2. fat visualized posterior to the fibroglandular tissues 3. an open IMF (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3,

(B) 2 and 3

104. A benign inflammatory conidtion of the lactiferous ducts leading to nipple discharge, nipple inversion or periareolar sepsis is called (A) ductal ectasia (B) Paget's disease of the breast (C) peau d'orange (D) ductal papilloma

(A) ductal ectasia

105. The cells lining the alvoli in lobules are called (A) epithelial cells (B) myoepithelial cells (C) basement cells (D) superficial cells

(A) epithelial cells

106. Informed consent imploes that the patient 1. has already signed the authorization for treatment 2. was informed on the procedure or operation, its risks, possible consequence , and any alternative options 3. the patient was given information about the procedure in his or her language (A) 1 and 2 (B) 2 and 3 (C) 1 and 3 (D) 1,2,3

(B) 2 and 3

107. The technique for reshaping of the breast is called (A) reduction mammoplasty (B) mammoplasty (C) breast augmentation (D) breast biopsy

(B) mammoplasty

The detector elements (DELs) are located within the (A) scintillator (B) TFT (C) CCD (D) complementary metal oxide silicon (CMOS)

(B) TFT

111. The CC projection in males will present the same difficulty as imaging small, firm breasted females. An added problem may be that (A) male patients have more problems with compression (B) the amle breast is smaller than the smallest female breast (C) males have more muscular breast tissue (D) hair on the chest of males makes compression difficult

(D) hair on the chest of males makes compression difficult

113. Which of the following are considered agencies granting accreditation under FDA regulation (A) state of california (B) ACR (C) New York State Department of Health (D) State of Florida

(B) ACR

114. Which alternative projection could be used, in addition to CC, in imaging a patient with a pacemaker (A) ML (B) lateromedial oblique (LMO) (C) XCCL (D) MLO

(B) lateromedial oblique (LMO)

116. In addition to the patietns name, all mammographic reports should have the (A) final assessment of findings (B) hospital number or additional patient identifier (C) name of the radiologist (D) all of the above

(D) all of the above

Breast cancer is the number one killer in the ____ and the second in the \_\_\_\_

world united states

What hormone increases cancer

estrogen

What type of exame is done when the patient is having no issues and its been at least 1 year since her last screening exam and she is 40 or older.

screening mammogram

\_\_\_\_\_ ____ screenins may be done on patiets as young as 30 but not younger than 25

high risk

What type of exam are done when the patient is complaining of an issue with her breast or her physician feels somethign in the breast

diagnostic exam

Anyone under 25 years old will get what type of exam

ultrasound

Acording to the ACS Women ages 40-44 consult with their physician so they can obtain _____ \_\_\_\_\_

informed consent

According to the ACS women 45-54 should undergo ____ \_\_\_\_ mammography

anual screening

According the the ACS women ages ___ and older can transition to every other year or continue anual screening

According the ACS women should continue screening mammography as long as their overall health is good and they have a life expectancy of ___ years or longer

True or False The ACS recommends self breast exams and clinical breast exams

false

According to the ACR screening mammograms should starte at age ____ for average risk

According to the ACR women at higher risk should begin by age ___ but no sooner than \_\_\_

30 25

What percent of palpable lumps are not visualized on a mammogram

15%

\_\_\_\_\_ % of the time nipples arent in profile on both views

10%

You mark up to how many moles on one breast

scar tissues can grow and cahnge for up to __ years after surgery

2 years

The second most common spot for cancer to grow is where?

behind the nipple

What are the 3 distinct patterns for BSE

wedge spiral up and down

What part of your hand should be used for a BSE

2,3,4th pads of the fingers with light and deep touch

What are the 9 signs and symptoms

pain lump thickening nipple discharge skin changes nipple and areolar changes edema erythema dimpling

True or False pain is not typically associated with breast cancer

true

When does pain in the breast become a concer

when the pain is focal (less than a quadrant of the tissue) and is severe

True of False Lumpiness that occurs in both breast is normal for many women

true

Where does most of the glandular tissue reside

upper outer quadrant

True or False A firm lump or area of thickening that suddenly presents in one breast is a concern

true

What are 3 reasons that a clear milky discharge may be present

nursing breast stimulation hormones

When is nipple discharge a concern

When it is bloody or milky and occurs without stimulation

What is the difference between and inverted nipple and a retracted nipple.

a retracted nipple will not come back out when stimulated

Aging, duct ectasia and breast cancer are all causes of

nipple retraction

What is the largest organ of the body

skin

What is the function of the skin

to protect the body

Where is the thickest skin of the breast

at the base (closest to the chest) (2mm)

Where is the thinnest skin of the breast

around the nipple (0.5 mm)

What are the 3 layers of the skin

epidermis dermis hypodermis

What is the outer layer of the breast called

epidermis

What is the iddle layer of the breast that consists of blood vessels, elastin fibers, lymphatic channels, oil/sweat glands

dermis

The circular colored skin around the nipple

areola

Lives in teh center of the areola

nipple

The areola contains what three things

nipple montogmery glands hair follicles

The areola contain between __ - __ opening of milk ducts

5-15

the small bumps on the ksin of the areola that enlarge durigng pregnancy

montgomery glands

The montgomery glands are a tyepe of ____ \_\_\_\_ gland that surrounds the nipple

modified sebaceous

The name for the opening of the montgomery gland

morgagni tubercles

what do the montgomery gland secrete? why?

bacteriostatic lubrictation to keep the areola and nipple lubricated and protected from infection during lactation

What glands secrete a bacteriostatic lubrication to keep the areola and nipple lubricated and protected from infection during lactation

montgomery glands

What is the angle of deflection where the breast tisse meets the chest wall below the breast

inframammary fold

What is the superior border of the breast

clavicle

Where does the superior border of the breast attach

2nd or 3rd rib

What is the inferior border of the breast

inframammary crease

Where does the inferior border of the breast attach

6th or 7th rib

What is the medial border of the breast

sternum

What is the lateral border of the breast

mid axillary line

What is the portion of the breast that is nearest the nipple

What is the breast nearest the chest wall

posterior

what is the middle portion of the breast called

central

The breast lies on top of what muscle

pectoralis major

How many facscial layers are there in the breast

The facial layers are made up of what?

connective tissue

What is the purpose of the fascial layers

sepearates the breast from the skin and separates the breast from the muscle

what are the two fascial layers

superficial fascia deep fascia

what fascial layer separates the rbeast from the skin

superficial fascia

what fascial layer separates the breast from the muscle

deep fascia

in between the deep fascia and the rbeast tissue is an area call the

retro-mammary fat space

Beneath the skin is what type of fat

subcutaneous

The breast is firmyl attached to the deep fascia via suspensory ligaments called

coopers ligament

what is the order of the breast layers moving from the nipple back

skin subcutaneous fat superficial fascia breast tissue retromammary fat space deep facia pectoralis major

what is the extension of the breast tissue that extends into the axilla

axillary tail or tail of spence

Where is the largers portion of glandular tissue found

in the central and upper outer quadrant, extending into the tail of spence

Where is the largest number of cancers found

central and upper outer quadrant

What is the name of the ligaments that run under the skin of the breast through and aroudn the breast tissue and connect to the deep facia in from of the pec muscle

coopers ligaments

What are responsible for maintaining the shape and configuration of the breast

coopers ligaments

What plays a major role in preventing breast ptosis

coopers ligament

Appears on mammograms as liens from skin projecting to the chest wall

coopers ligament

Coopers ligaments are easiest to see on what views

lateral MLO

Coopers ligament are easier to see on ____ breast

dense

The milk line extends from teh ___ to the \_\_\_

axilla groin

Definition of polythelia

extra nipple

What is the term for an extra nipple and where do they usually develop

polythelia milk line

What is the most common breast anomaly

polythelia (extra nipple)

Polythelia occurs in what percent of the population

10%

what are two other terms used for an extra nipple

accessory nipple supernumerary

Extra nipples generally occur along the milk line but they can develop anywhere along the ___ \_\_\_

embryonic ridge

The glandular tissue holds ____ \_\_\_ cells

milk producing

Mammary glands are considered modified ____ \_\_\_\_

subaceous (sweat) glands

Fills the space between fibrous and glandular tissue, giving the breast its size

fatty tissue

What tissue gives breasts its size

fatty tissue

Holds the reast tissue in place

fibrous tissue

\_\_\_\_\_ ______ tissue and fat are surrounded by connective tissue and held up between the skin and pec muscle by coopers ligaments

fibro-glandular

Many breast lumps turn out to be caused by what

fibrosis tissue changes and cysts

Each mammary gland consists of a series of ___ that produce milk

lobes

Within the lobes of the breast are many ____ which conect to smal ducts that connect to bigger lactiferous ducts

lobules

The ___ \_\_\_ are repsonsible for delivering the milk to the nipple

lactiferous ducts

Each breast consists of how many lobes

15-20

Each lobe consists of many \_\_\_

lobules

What do lobules look like

grapes

Lobules vary in size during life due to

hormone changes

The extra lobular terminal duct is also known as

segmental duct

What is the duct that is outside of the lobule called

extra- lobular terminal duct or segmental duct

What is another name for the intra-lobular terminal duct

sub-segmental duct

What is the ducts called that is inside the lobules

intra-lobular terminal duct or sub-segmental duct

Together the lobule and extralobular terminal duct makes up what

TDLU (terminal ductal lobular unit)

Where specifically does cancer begin?

TDLU (terminal ductal lobular unit)

What takes the milk to the nipple

lactiferous duct

The lactiferous duct is connected to the

extra lobular terminal duct

\_\_\_\_\_ ____ is directly inside the nipple

lactiferous sinus

What happens to the lactiferous sinus when nursing

it dialates and acts as a milk reservoir

What is used to classify how big the cancer is

staging

what is used to classify how fast the cancer is growing

grade

Refers to cancer inside the milk ducts

ductal carcinoma

What is the most common form of breast cancer

ductal carcinoma

Refers to cancer in the lobules

lobular carcinoma

Subgroup of cancer that remains in the area it originated

in situ

Subgroup of breast cancer that have spread to neighborign regions from where it began

invasive

What is the smallest functional unit of the breast

acini

what small units are found in the TDLU and help produce milk

acini

What are the three layers of the cells in a duct

luminal epithelium myoepithelium (Muscle) Basement or basel membrane

The inner layer of a cell that actually secrets cells of the TDLU

luminal epithelium

What layer of the cell do cancers begin on a cellular level

luminal epithelium

What is the middle layer of the cell that acts as a barrier to keep everything inside the duct

myoepithelium

What is the outer layer of the cell that holds it all together and responds to hormonal fluctuation

basement or basel membrane

The ____ brest receives 60% of the blood supply via the \_\_\_

medial internal thoracic (mammary) artery

The medial breast receives ___ % of the blood supply fromt he internal thoracic mammary artery

The internal thoracic mammary arter is a branch of the

subclavian artery

The ___ breast receives 40% of the blood supply from four cessels coming off the \_\_\_\_

lateral axiallary artery and the intercostal artery

The lateral breast receives ___ % of the blood supply from four vessels coming off the axillary artery and the intercostal artery

What are the 4 vessels that supply the lateral breast

lateral thoracic branches thoracoacromial branches lateral mammary branches mammary branch

What two branches of the axillary artery help supply the lateral breast with blood

lateral thoracic branches thoracoacromial branches

What two branches of the intercostal artery help supply the lateral breast with blood

lateral mammary branches mammary branch

What vein drains the medial breast

internal thoracic mamary vein

the internal thoracic mammary vein drains the ___ breast

medial

The axillary vein drains what portion of the breast

lateral

What drains the skin over the breast of lymp

superficial lymphatics

The superficial lymphatics drain what?

the skin over the breast

The __ \_\_\_\_ drain the parecnchyma glands of the breast, the nipple and areola

deep lymphatics

The deep lymphatics drain what?

the parenchyma gland of the breast, the nipple and areola

\_\_\_\_ ____ receive 75-90% if lymph drainage

axiallary nodes

Axillary nodes receive what percent of lymph drainage

75-90%

\_\_\_ ___ receive 10-25% of lymph drainage

parasternal nodes

Parasternal nodes receive what percentage of lymph drainage

10-25%

what 4 areas are lymphnodes found in the breast

clavicular axillary intramammary parasternal

Why is the lymphatic drainage of the breast of great clincal importance

it helps in the spread (metastasis ) of breast cancer

the more glandular tissue you have the more ___ your breast are

dense

BIRADS A

fatty

BIRADS B

scattered 25-50%

BIRADS C

heterogeneous

BIRADS D

Dense

Central ray enters superiorly and exits inferiorly, what view?

CC | (craniocaudal)

what view can you see the breast medial/lateral top to bottom

what view do you see the breast inferior/ superior and anterior/posterior

MLO

Cental ray enters medialy and exits laterally and the patient is obliqued with an angle on the machine

MLO

What are the fixed anatomical borders

medial superior

What are the mobile anatomical borders

lateral inferior

What are the two benefits of using the mobility principles

1. minimal tissue is displaced during compression 2. maximizes the amount of tissue visualized

What view best demonstrates the medial tissue

What is a projection limitation of the CC view

You might miss the tail of spence in the lateral tissue

Other than the medial tissue, what tissue will you see on the CC view

central, retroareolar and some lateral

What is the criteria in determining if you have an optimal CC view

- all posterior tissue visualized - poertior nipple line (PNL) measures withing 1 cm of MLO - nipple in profile and ventered

How do you know if you have all the posterior tissue visualized in the CC view

the retromammary spcae is seen

Pectoral muscle is seen in teh CC view on what percent of patients

30-40%

True or False If the patien has an active infection in the IMF she will need to reschedule her mammogram

True

Where does the technologist stand for the CC view

medial side of the breast she is imaging

Which way should the patients head be turned for CC view

toward the medial side of the breast being imaged

When brigning the patient in for the CC view, you want to elevate the breast until what point

the PNL is perpendicular to the chest wall

In the CC view you want to elevate the IR to what level

The elevated inframammary crease

What type of pulling in method do you want to use when doing a CC

bi-manual pull-lift (lift up and over the IR)

During a CC view, after you have pulled and lifted you want to slide your ____ hand out toward the nipple and your ___ hand anchores the breast down

bottom top

In the CC view the nipple will always point towards what?

missing tissue

In the CC view you should have a ____ light field across the posterior portion of the breast

straight

What can a dark black line on a CC view indicate

that you have air gap

How can you avoid airgap in a CC view

push the abdomen back and down

In the CC view, an arm around the back will encourage what 3 things

1. straight shoudlers 2. softened shoulders 3. posterior tissue inclusion

In the CC view lifting up on the skin under the clavicle will help what

lighten the tugging sensation on the chest wall

To help with lateral fold in the CC view what can be done

palce hand on the side of the IR

what view best demonstrates the lateral tissue

MLO

the MLO view best demonstrates what tissue

lateral

The CC view best demonstrates what tissue

medial

In the MLO you see tissue from the ___ to the \_\_\_

axilla IMF

What criteria helps determine if you have an optimal MLO view

- all posterior tissue is visualized from the axilla to IMF - convex pectoral muscle to level of the nipple (PNL) - breast lifted up and out - IMF visualized and open

In the MLO you want to angle the IR so that it is

parallel to the pec muscle

In the MLO when the correct angle is used optimal ____ is achieved

compression

The ACR recommened what angle for shorter, heavier people

30-40

The ACR recommened what angle for average height and weight

40-50

The ACR recommened what angle for tall and slender people

50-60

In the MLO view you want the IR to line up with the

mid axillary line

In the MLO the corner of the IR is between the ____ \_\_\_ and the ___ \_\_\_

latissimus dorsi pectoral muscle

What will squeezing the handrails in a MLO view do ?

make the muscle concave

In the MLO, when sweeping behind the lateral breast to the ___ \_\_\_\_ ____ , lift the breast tissue away from the IR using a ___ hand

mid axillary line flat

Airgap in the MLO view will cause what

folds

In the MLO view allow the abdomen to be ___ \_\_\_ of the IR

in front

In the MLO view the paddle should fall just below the ____ and on the edge of the \_\_\_

clavicle sternum

In the MLO view you want to ___ the belly down but do not push it off

elongate

In the MLO, improper stance can cause what

droopy or camels nose

Optimal compression is reached when

the breast feels taught or slightly less than painful, whichever comes first

Adequate compression is determeied by the patients __ \_\_\_ and its ___ \_\_\_

tissue type maximum compressibility

which portion of the breast will compress more rapidly

posterior

Where should tautness of the breast be checked

anteriorly

when the IR is up too high on the CC what tissue will you lose

posterior /inferior

When the IR is down too low in the CC view what tissue is lost

superior

Other than superior tissue loss, what other issue is created when the IR is down to low on a CC view

air gap

When the IR is up too high on an MLO what tissue is lost

inferior

When the IR is too low on an MLO what tissue is lost

superior

In the MLO view, if the pectoral muscle is vertical what is wrong

IR too high

In the MLO view, if the pectoral muscle is concave what is wrong

grippling or angle

In the MLO view, if you have inadequate muscle what is wrong

not stepped forward enough

What are the 3 main reasons for quality control

- reduce exposure to the patients and personnel - ensure adequate and consistent patient image quality - detet and correct for potential problem

what is the goal for screening mammography

find breast cancer in asymptomatic women early enough to optimize a womans chance of a full recovery

Find breast cancer in asymptomatic women early enough to optimize a womans chance of a full recovery - what is this done with

screening mammograms

To assure very lin in the mammogrpahy imaging chain is workign optimally in order to ensure images of diagnostic and final interpretive quality at the lowest possible radiation dose is ____ \_\_\_\_

quality control

what are 3 things that quality control is not

- detailed technical evaluation of the unit - detailed measure of limits of a unit - not the optimization of the unit

- detailed technical evaluation of the unit - detailed measure of limits of a unit - the optimization of the unit These are all asses on what?

The annual medical physicist survey

According to MQSA, full field digital mammogrpahy machines QC must use the quality control manual from

the manufacturer

FFDM Quality Controls is ___ for every manufacturer

different

What are the 8 QC tests done by mammographers

- phantom image - compression thickness - viusal checklist - acquisition and radiologist workstation monitors - repeat analysis - viewing conditions - compression fprce - manufacturer detector calibration

what two things does the phatom image QC test check for

quality artifact

what two things does the acquisition and radiologist workstation monitors QC test look for

- monitor cleanliness - monitor calibration and test pattern

What QC test ensures that he image acquisition chain is consistenly producing adequate image quality and that artifacts are not clinically significant

Phantom image

What is the performance criteria for the phantom evaluation

2 fibers, 3 speck groups, 2 masses no artifacts that interfer with image quality

How often is the phantom evaluation QC test performed

weekly

what equipment is needed for the phantom image evaluation QC test

2016 ACR DM phantom ACR DM phantom image quality form

The ACR DM phantom used for the phantom image QC test simulates what

a 4.2 cm compressed breast iwth 50/50% fat/glandular tissue

What is the corrective action for a failed phantom evaluaiton

before clinical use

For the phantom image QC test what IR and paddle size do you want to use

the largest available that is used for imaging

How many lbs of pressure is used for the phantom image QC test

approximately 12 lbs or 5 daN

In the phatom image QC test you are evaluating for both ____ \_\_\_\_ ____ and ___ \_\_\_

broad area artifacts detailed artifacts

non-uniformities, blotches and streaks that are usually best seen while observing the phantom image as a whle and not in peices

broad area artifacts

black and white pixels, clusters of pixels, lines or dust particles that are suaully best seen while observing the phantom image at full spatial resolution, where one pixel on the display matches one pixel in the image or with magnificaiton, using a zoom factor greater than 1.0

detailed area artifacts

Banding its a type of what kind of artifact

broad area artifact

ghosting is a type of what kind of artifact

broad area artifact

Dead pixels are a type of what kind of artifact

detailed area artifact

Artifact evaluations are assigned as a ____ if the artifacts are present that impeded clinical interpretation

fail

Artifact evaluation fail if

the artifacts impede clinical interpretation

Artifact evaluations ___ if the image is free of artifacts or artifacts are clinically insignificant

pass

Artifact evaluations pass if

if the image is free of artifacts or artifacts are clinically insignificant

3 reasons an artifact evaluation would fail is if

- artifacts are as promiment as the visible test object - artifact obscure test objets in the phantom - artifacts could affect clinical interpretation

In the phantom image QC test he artifact should eb identified and isolated to dertmine it it orginiated from what 3 areas

- monitor - detector - xray system

Test that ensures compression thickness is within tolerance

compression thickness

How often should the compresion thickness be performed

monthly

What equipment is needed for the compression thickness test

an object aht is \< 10 cm wide and long and 4-6 cm thick

What is the criteria for performance of the compression thickness test

accurate to +/- 5cm

If the compression thickness test fails when should it be corrected

within 30 days

When counting fibers what counts as a full length fiber for a full point

\> or = 8 mm

When couting fibers what counts as half of a point

at least half of the length (\> or = 5 mm and \<8 mm)

When couting speck groups how man specks need to be visible to count as a full point

4-6 points

When counting speck groups, how many specks need to be visible to count as a half point

2-3 specks

When counting masses what counts as a full point

- density difference is visible - continuous border (\> or = 3/4) - circular

when counting masses what counts as a half point

- density difference is visible - border not continuous ( \> or = 1/2)

When counting fibers, if there is a break in the fiber if its less than ____ it still is counted

the width of the fiber

When scoring fibers, specks and masses you count until reaching

0 or 0.5 then stop

When scoring the phantom evaluation how many fibers, specks and masses must be present

2 fibers 3 specks 2 masses

When doing the compression thickness test, the phantom should be flush with the ___ \_\_\_\_ and centered \_\_\_\_

edge wall laterally

What compression paddle is used for the compression thickness indicator

spot compression paddle

When performing the compression thickness QC test, if a spot compression paddle is not available what paddle should be used

the smallest non-flex compression paddle available

True or False The flex function is on during the compression thickness indicator test

false

How much force should be applied during the compression thickness indicator test

10-15lbs

The compression thickness indicated must be accurate to ____ from the actual thickness of the phantom

+/- 0.5cm

What QC test ensures that digital mammography x-ray system indicator lights, displays, mechanical locks and detents are working properly and that the mechanical rigidity and stability of the equipment is optimum

visual checklist

How often should the visual checklist be performed

monthly

What equipment do you need for the visual checklist

visual checklist form

What is needed for the visual checklist to pass

checkmarks in all the boxes indicating that everything is working properly

What things in the visual checklist are considered critical and need to be repaired or replaced before clinical use

- cleaning solution must be available - all locks must work properly - paddles/faceshields must not be cracked - the breast support must not be cracked - the DBT assembly must move as designed (through range of motion)

The following are considered _____ on the visual checklist and must be repaired \_\_\_\_\_\_\_ - cleaning solution must be available - all locks must work properly - paddles/faceshields must not be cracked - the breast support must not be cracked - the DBT assembly must move as designed (through range of motion)

critical before clinical use

What things in the visual check list are considered less critical and need to be rapaired within 30 days

- magnfication stands and paddles must be dust free - indicators must be working - the collimator light must be working - cables must be safely positioned - The c arm motion must be smooth - the compression paddle motion must be smooth - Items missing from the room should be replaced

The following are considered ____ \_\_\_\_ on the visual checklist and need to be repaired \_\_\_ - magnfication stands and paddles must be dust free - indicators must be working - the collimator light must be working - cables must be safely positioned - The c arm motion must be smooth - the compression paddle motion must be smooth - Items missing from the room should be replaced

less critical within 30 days

What is the purpose of the technologist acquisition (AW ) and Radiologist Review (RW) workstation monitor QC test

to ensure that: - monitors are clean - monitros are calibrated (brightness/contrast appropriate) - monitros meet manufacturere specifications

How often do the AW and RW workstation monitor QC need to be done

monthly

What equipment is needed for the AW and RW workstation monitor QC tests

- dry soft lint free cloth - AAPM TG18-QC pattern or SMPTE test pattern - for RW an ACR digital mammogrpahy (DM) phantom image

For the AW/RW testing what pattern do we use in our facility

SMPTE

During the AW and RW monitor testing, what three things need to be evaluated on the test pattern image

- are the 0-5% contrast boxes visble (grey in white box) - are the 95%-100% contrast boxes available (grey in black box) - are the line pair imags at the cnter and four corners visible and clearly distinguishable

If the test image quality and monitor manufacturer automated test fails when does it need to be corrected

within 30 days

What QC test ensures that the mammogrpahy system can provide adequate compression in both manual fine adjustment and hands free, intial power drive moes, that the quipment does not allow too much compression to be applied when used in initial power drive mode and that adequate copresion can be maintained throughout image acquisition

compression force

How often is the compression force test done

every 6 months (semi-annually)

What equipment is needed for the compression force test

- calibrated, flat analog bathroom scale - towels

What amount of force do you use during the compression force test

between 25-40lbs or 111-200 newtons or 11.1 - 20 daN

If the compression force does not pass when does it need to be repaired

before clinical use

What two modes do you need to test the compression force

inital power drive and manual fine adjustment mode

What QC test is used to determine the number and cause of repeated mammograms

repeat analysis

What does the analysis of the repeat analysis provide

Identify ways to improve efficiency and reduce patient exposure

How often should a repeat analysis be performed

as needed

How many patients should a repeat analysis be done on

at least 250 patients

What is the criteria for a passing repeat analysis

The overal repeat rate should be 2% or less, but a rate of 5% is adequate if the radiologist and physicitst agree this is a reasonable amount based on body habitus of patients seen

What 3 things are not considered in a repeat analysis

1. wire or other localiztion images 2. additional views needed to image the entire breast for larger breasted women 3. quality control images

Poor positioning, patient motion, patient caused artifacts, incorrect patient ID are all forms of what type of repeat

patient related repeats

Exposure too low (excessive noise), exposure too high (image saturation), equipment caused artifacts, x-ray equipment failure, software failure, aborted automated exposure control exposure are what types of repeats

technical repeats

Blank images, good image ( no apparent reason), other-miscellaneous

miscellaneous repeats

Wire localizations, 1-125 seed localization, additional views to image the entire breast, quality control are considered what kind of repeats

They do not count as repeat

What is the repeat analysis performance criteria

The overall repeat rate should be below 2% or less but a rate of 5% is adequate

What does too low or a no repeat rate indicate during a repeat analysis

that poor image quality is being tolerated

What does a reason for repeat that is significantly higher indicate

that there is an area for potential improvement

If the repeat rate exceeds the selected acceptance level of either 2% or 5% or if it changes by 2% from the previous measured rate what should happen

it should be investigated and corrective action shuld be taken

Any corrective action should be recorded on the ____ \_\_\_ \_\_\_\_

corrective action log

The effectiveness of the corrective actions should be assessed by another repeat analysis how soon after

the next quarterly repeat analysis

How soon should corrective action on a repeat analysis be done

within 30 days

What QC test ensures optimal viewing condition in teh radiologist reading room

viewing conditions

How often does the viewing condition QC need to be done

daily

What equipment is needed for viewing condition

viewing conditions check and setting form which is posted in teh reading room during the most recent meidcal physicist evaluation

What performance criteria must be met for viewing conditions

viewing conditions must meet medical physicist requirements

If the viewing conditions dont meet the performance criteria how soon must corrective action be taken

before diagnostic reading of images

When viewing diagnostic images ___ contast and ___ resoluation is optimal

high high

When viewing diagnostic images high ____ and high ____ is optimal

contrast resolution

\_\_\_ is the maount of light coming out of the monitor

luminance

\_\_\_\_ is the amount of ambient room light shining down on the review workstation (you want this as close to zero as possible)

illuminance

In reading rooms the illuminance shoud be

under 20 lux

\_\_\_ ___ or high ____ decreases contrast

ambient light illuminance

Ambient light or high illuminance decreases \_\_\_\_

contrast

ACR DM phantom image evaluation is done how often

weekly

How often should the compression thickness indicator be done

monthly

How often should the visual checklist be done

monthly

How often should the acquisition workstation monitor QC be done

monthly

How often should the review workstation monitor QC be done

monthly

How often should the compression force QC test be done

semi-annually

How often should the repeat analysis be done

as needed

How often should the manufacturer calibration QC be done

manufacturers recommendations

How quickly should corrective action be taken with a failure in the ACR DM phantom image evaluation QC test

immediate

How quickly should corrective action be taken with a failure in the acquisition workstation monitor QC test

immediate

How quickly should corrective action be taken with a failure in the review workstation monitor QC test

immediate

How quickly should corrective action be taken with a failure in the compression force QC test

immediate

How quickly should corrective action be taken with a failure in the visual checklist critical tests

immediate

How quickly should corrective action be taken with a failure in the Visual checklist less critical tests

30 days

How quickly should corrective action be taken with a failure in the compression thickness indicator

30 days

How quickly should corrective action be taken with a failure in the repeat analysis

as needed

How quickly should corrective action be taken with a failure in the manufacturer calibration

manufacturers recommendation

What does BIRADS stand for

Breast Imaging reporting and data system

What is a BIRAD

a quality assurance tool published and trademarked by the ACR

BIRADS satared our for use in mammography and later adapted to what two other modalities

ultrasound MRI

What are the assessment categories for BIRADS

0-6

What is the BIRAD category for someone that needs addiational imaging evlauation and or prior mammograms for comparison

Category 0

What is the likelihood of cancer with someone with a BIRAD of 0

n/a

What is the BIRAD for a negative exam

category 1

What is the managment of someone with a category 1 BIRAD

routine mammography screening

What is the likelihood of cancer with someone with a BIRAD 1

essentially 0% chance of malignancy

What is the BIRAD of a probably benign exam

category 3

What is the management if somone with a category 1 BIRAD

routine mammography screening

What is the management of someone with a category 3 BIRAD

shrot interval (6 month) followup or continued survelliance mammography

What is the likelihood of cancer with someone with a BIRAD 2

essentially 0% likelihood of malignancy

What is the likelihood of cancer with someone with a BIRAD 3

\>0% but = 2% likelihood of malignancy

What is the BIRAD for a suspicious mass

category 4

What are the 3 subcategories of a BIRAD 4

4A 4B 4C

A BIRAD 4 of low suspicion for malignancy is subcategorized as

A BIRAD 4 of moderate suspicion for malignancy is subcategorized as

A BIRAD 4 of high suspicion for malignancy is subcategorized as

What is the management for a BIRAD 4

tissue diagnosis

What is the likelihood of malignancy for a BIRAD 4

\> 2% but \<95%

What is the likelihood of malignancy for a BIRAD 4A

\>2% but = 10%

What is the likelihood of malignancy for a BIRAD 4B

\>10% to =50%

What is the likelihood of malignancy for a BIRAD 4C

\>50% to \<95%

What BIRAD is highly suggestive of malignancy

category 5

What is the management of a BIRAD 5

tissue diagnosis

What is the likelihood of malignancy for a BIRAD 5

\>/= 95%

What is the BIRAD for a known biopsy proven malignancy

category 6

What is the management for a BIRAD 6

surgical exision when clinically appropriate

BIRAD 0

need addiation imaging evaluation and or prior mammograms for comparison

BIRAD 1

Negative

BIRAD 2

Benign

BIRAD 3

probably benign

BIRAD 4

suspicious

BIRAD 5

highly suggestive of malignancy

BIRAD 6

known biopsy proven malignancy

What are the mammographic appearance in order of severity

asymmetry focal asymmetry mass calcifications architectural distortion

An area of fibro-glandular tissue seen on only one projection is known as

asymmetry

an area of fibro-glandular tisse seen on only one projection

asymmetry is mostly caused by what

superimposition of normal breast tissue

focal asymmetry

an area of fibro-glandular tissue seen on two projections but only on one side

focal asymmetry

What QC test corrects for non uniformities in the detector matrix

detector calibration

Detector calibration should be done how often

per manufacturer

What corrective action should be taken if a detector calibration fails

per manufacturer

What is the performance criteria for the detector calibration QC test

per manufacturer

When should corrective action be taken if the detector calibration fails

per manufacturer

mass

something a little more substantial and has volume and occupies space

mass

Masses can be many things including \_\_\_\_, \_\_\_\_, \_\_\_\_\_

cyst noncancerous tumors or a sign of cancer

When is a mass suspicious

when its denser in teh middle than towards the edges

A mass found during a mammgraphy will be described according to its ___ , ___ and \_\_\_

shape density margins

\_\_\_\_ of a mass refers to the amount of fatty elements present

density

Density of a mass refers to what

the amount of fatty elements present

When the density of a mass is high (little evidence of fatty tissue), what does that indicate

highly suspicous of cancer

If there is very little fatty tissue in a mass this indicated that the mass has a ___ \_\_\_\_

high density

Breast cancers are never ___ \_\_\_

fat containing

It is rare but not impossible for breast cancer to be ____ \_\_\_\_\_

lower density

What 5 shapes can a mass be decribed as

round oval irregular architectural distortion lobulated

What are the 5 margins that a mass can be described as

circumscribed indistinct spiculated obscured mico-lobulated

Describe the mass shape

round

Describe the mass shape

oval

Describe the mass shape

lobulated

Describe the mass shape

irregular

Describe the mass shape

architectural distortion

Describe the margin shape

circumscribed

Describe the margin

obscure

Describe the margin

microlobulated

Describe the margin

indistinct ill defined

Describe the margin

spiculated

What does circumscribed mean

smooth and well rounded

Malignant or benign hard painless lumps

malignant

Malignant or benign masses with irregular edges

malignant

Malignant or benign lumps that are fixed to skin or the chest wall

malignant

Malignant or benign skin changes such as dimpling

malignant

Malignant or benign Nipple discharge that is bloody

malignant

Malignant or benign nipple retraction

malignant

Malignant or benign smooth and rubbery painful lumps

benign

Malignant or benign masses with well defined edges

benign

Malignant or benign lumps that move under skin or in tissue

benign

Malignant or benign no skin changes

benign

Malignant or benign nipple discharge is more more likely to be colored

benign

Malignant or benign no nipple retraction

benign

What mass shapes are considered to be benign

round oval lobulated

What mass shapes are considered malignant

lobulated irregular architectural distortion

what mass margins are considered benign

circumscribed obscured micro-lobulated

what mass margins are considered malignant

micro lobulated indistinct /ill defined spiculated

Calcification are present in what percent of mammograms

85%

Calcifications increase with what

age

What percent of calcifications are associated with breast cancer

50%

Calcifications are described according to what 4 things

location distribution morphology (shape) udnerlying etiology (cause of)

What 5 things do radiologist look for in calcifications

density distribution change over time number size

What is the term used for the palcement of calcifications in the breast

distribution

Distribution of calcifications randomly through the breast is called

diffuse

Distribuation of calcifications occupying a large portion of the breast is called

regional

Distribution of calcifications with few calcifications occupying a small portion of the breast is called

grouped

Distribution of calcifications arranged in a line is called

linear

Distribution of calcifications that are deposits in a duct or ducts and their branches

segmental

What is the standard imaging for calcifications

mag views

Calcifications can vary in size from ___ to \_\_\_

mm to cm

What are the three different mag views that are used to image calcifications

spot mag regular mag tangetial mag

When is the tangential mag used

for skin calcifications

Calcifications that are poorly defined, clustered, variable densities, varialble shapes, and in only one breast are considered

suspicious for malignancy

calcificaitons that are well defined, scattered, same density, ring like, round and in both breasts are considered

benign

Dystriohic, skin calcificaitons, vascular calcifications, milk of calcium, rod like and popcorn calcifications are considered

benign

What 6 types of calcifications are considered benign

dystrophic skin calcificaitons vascular calcifications milk of calcium rod like popcorn

\_\_\_ ___ \_\_\_ layers in the lateral view like a teacup

milk of calcium

Term used for calcifications that are so small and/or hazy in appearance that a more specific shape cannot be determined

amorphous or indistinct

Calcifications that are termed amorphous or indistinct are what

so small and or/hazy in appearance that a more specific shape cannot be determined

What percent of biopsied amourphous/indistinct calcifications are malignant

20 %

Calcifications that are irregular, clearly visible and are between 0.5mm and 1mm are termed

coarse heterogeneous

What type of calcifications are irregular, clearly visible and are between 0.5mm and 1mm

Coarse heterogeneous calcifications

What percent of biopsied coarse heterogeneous calcifications are malignant

15%

Calcifications that are defiend as discrete calcifications with irregular margins, vary in size and shape, and usually smaller than 0.5mm are termed

fine heterogenous

Fine heterogenous calcifications are defined as

discrete calcifications with irregular margins, vary in size and shape and are usually smaller than 0.5mm

Calcifications that are usually more clearly visble than amorphous forms and are seen to have individual, separate and distinct shapes, without fine linear and linear branchign forms and are usually \<0.5mm are called

fine pleomorphic

What percent of biopsied fine heterogenous are malignant

30%

What percent of biopsied fine pleomorphic calcifications are malignant

25-40%

Calcifications that are thin, linear irregular and may be discontinuous with occasionally branching forms that can be seen and are usually \<0.5 mm are termed

fine linear or fine linear branching

A sac-like picket of tissue that contains fluid, air or other substances

cyst

What type of cyst has smooth thin walls that are filled with fluid. Ultrasound waves pass through them indicating there are no solid areas

simple cysts

What type of cycts are always benign

simple cysts

What type of cyst contains somethign besides clear fluid.

complex or complicated cyst

What type of cyst usually needs close follow up and somtimes a biopsy

complex (complicated) cysts

A milk filled cyst common in young pregnant or breast feeding women

galactocele

What is a galactocele

a milk filled cyst common in young pregnant or breast feeding women

When do galactoceles most commonly occur

when breast feeding has stopped

What causes a galactocele

when milk become stagnant within the breast ducts

True or False Galactoceles are always benign and does not increase your of breast cancer

true

Benign tumors composed of stromal and epithelia elements

fibroadenoma

True or False Multiple or complex fibroadenomas may indicate a slightly increased risk for breast cancer

true

The relative risk is approximately ____ of a patient of similar age without firoadenoma

twice

A pocket of fat that is encapsualted by a thin fibrous capsuel

lipoma

A slow growing tumor that most commonly occur in post-menopausal women

lipoma

True or False Lipomas are extremely rare and only occur in the breast

false - they are very common and can occur in many areas of the body

What results from a benign proliferation of fibrous glandular and fatty tissue

hamartoma (fibroadenolipoma)

What is another term used for a hamartoma

fibroadenolipoma

Hamartomas are surrounded by a thing capsule of

connective tissue

Hamartomas are thought of as a ____ within a \_\_\_\_

breast breast

What term describes when the lactiferous duct widens, the duct wlals thicken and the duct fills with fluid

ductal ectasia

During ducatal ectatia, the lactiferous duct ____ and duct walls _____ and the ducts fill with \_\_\_\_

widens thicken fluid

Ductal ectasia can cause ____ nipple discharge

green

Ductal ectasia occurs in ___ or ____ menopausal women

peri or post

True or False Ductal ectasia does not increase breast cancer

True

Ductal ectasia causes the milk duct to become \_\_\_\_

blocked

A blood filled swelling caused by trauma to the breast

hematoma

\_\_\_\_ are common after breast bopsies

hematoma

Hematomas can also cause \_\_\_\_\_, ____ and ____ \_\_\_\_

inflammation fever skin discoloration

Hematomas may leave behind ____ tissue that can mimic what

scar the shape of a breast tumor

a bacterial infection that causes th breast to become red and inflammed

mastitis

Most breast abscesses occur due to complications of \_\_\_\_

mastitis

Mastitis most commonly affect _____ women

breastfeeding

Women who ____ habe an increased risk of developing non-breastfeeding mastitis

smoke

True or False Mastitis will affect both breastfeeding and non-breastfeeding women, with breastfeeding women being affected more often

true

Damaged or dead tissue

fat necrosis

\_\_\_ ____ can occur following a needle biopsy, and breast surgery (including recondrutction or radiotherapy)

fat necrosis

What does fat necrosis feel like

firm round lump that is generally painless

What is another term used for fat necrosis

oil cyst

Does fat necrosis (oil cyst) go away on their own

yes, but sometimes need surgery to remove them

Small clumps of immune cells that act as filters for the lymphatic system

lymph nodes

The lymphatic system rusn throughotu the body like the _____ system and carries ____ and \_\_\_

circulatory fluid and cells

The ____ lymph nodes are the first-place breast cancer is likely to spread

axillary

A common disorder of the endocrine system in whcih there is a noncancerous increase in the size of male breast tissue

gynecomastia

True or False Gynecomastia can be unilateral or bilateral

true

\_\_\_\_ use can be a cause gynecomastia

marijuana

An are of hardening of the breast tissue that can occur as the breast ages

radical star

A radial scar can mimic \_\_\_\_

malignancy

What is another term for a radial scar

complex sclerosing lesion

Having a radial scar causes and ___ - ___ % higher risk of breast cancer

8-30%

How is a radial scar removed

surgically

It is not unusual for a radial scar to contain a small amount of

malignant cells

Benign or Malignant Cyst

benign

Benign or Malignant galactocele

benign

Benign or Malignant Fibroadenoma

benign

Benign or Malignant Lipoma

benign

Benign or Malignant Hamartoma ( fibroadenolipoma )

benign

Benign or Malignant ductal ectasia

benign

Benign or Malignant Hematoma

benign

Benign or Malignant Breast absecess

benign

Benign or Malignant Fat necrosis (oil cyst)

benign

Benign or Malignant Gynecomastia

benign

Benign or Malignant Radial scar

benign

Benign or Malignant Papilloma

benign but high risk

A tumor growing in the ducts inside the nipple with finger like frond

papilloma

What does a papilloma feel like, and what can it cause

small lump near the nipple nipple discharge and bleeding

How are papillomas diagnosed

with ultrasound or ductogram

Papillomas can be with \_\_\_\_

atypia

How is a papilloma removed and what will happen

surgically and it will be tested for atypical cell growth

Benign or Malignant Lobular carcinoma

malignant

LCIS

lobular carcinoma

Cells that look like cancer cells are growing in the lobules but they dont grow through the wall of the lobules

lobular carcinoma

LCIS is not considered to be \_\_\_\_

cancer

Having lobular carcinoma ____ your risk of breast cancer

increases

True or False LCIS (lobular carcinoma) does not cause a lump that can be felt or changes that can be seen on a mammogram

true

How are most lobular carcinomas found

when doing a biopsy for another breast issue

Benign or Malignant Atypical ductal hyperplasia Atypical lobular hyperplasia

benign

Increased cellular activity in the ducts or lobes and surrounding tissue

atypical ductal hyperplasia atypical lobular hyperplasia

How to the cells appear in atypical ductal hyperplasia and atypical lobular hyperplasia

irregular non-standard structure

Atypical ductal hyperplasia and atypical lobular hyperplasia is not a form of ___ \_\_\_ but ____ your risk

breast cancer increases

Benign or Malignant Ductal carcinoma in situ (DCIS)

malignant

Benign or Malignant Invasive/Infiltrating ductal carcinoma

malignant

DCIS

ductal carcinoma in situ

The presence of abnormal cells inside a milk duct

ductal carcinoma in situ (DCIS)

What is considered the earliest form of breast cancer

Ductal carcinoma in situ (DCIS)

DCIS that has not spread out of the milk duct to invade other parts of the breast

non-invasive

Cancer that began growing in the duct and breaks the wall of the duct and grows into the fatty tissue of the breast

Invasive /Infiltrating ductal carcinoma

IDC

Invasive/ infiltrating ductal carcinoma

What is the most common form of breast cancer

invasive / infiltrating ductal carcinoma

Invasive/ infiltrating ductal carcinoma represents \_\_\_% of all breast cancers

80%

Benign or malignant Invasive lobular carcinoma

malignant

What breast cancer begins in the lobules of the breast

invasive lobular carcinoma

What type of malignancy doesnt typically form a lump

invasice lobular carcinoma

What breast changes occur in the breast with invasive lobular carcinoma

thickening or fullness in one part of the breast that is different from the surrounding tissue

A raare and very aggressive disease in which cancer cells block lymph vessels in the skin of the rbeast

inflammatory carcinoma

Most inflammatory breast cancers are what kind of cancer

invasive ductal carcinoma

What type of cancer usually starts with reddenign and swelling of the breast instead of a distinct lump

inflammatory carcinoma

Orange peel skin is an indication of

inflammatory carcinoma

Malignant cells extend from the lactiferous ducts to the nipple

Pagets disease

A patients with pagets disease will present with

nipple and areolar thickening with and without a palpable lump

What is rare and accounts for only 1% of all breast cancers

pagets disease

Pagets disease can be either in-situ or \_\_\_

invasive

Pagets disease accounts for \_\_% of all the breast cancers

True or False Pagets diesase of the breast isnt related to pagets disease of the bone

true

Breast ___ refers to a relative group of rare breast tumors

sarcoma

What are 5 types of sarcomas

angiosarcoma pleomorphic sarcoma fibrosarcoma myxofibrosarcoma leiomyosarcoma primary osteosarcoma

Breast sarcomas begin where

in the connective tissue that supports the ducts and lobules

Sarcomas can be _____ or _____ tumors

primary or secondary

What term is used to describe a tumor that occurs from previous radiation to the chest

secondary tumor

Sarcomas tend to be ____ than other types of breast tumors and can show up int ____ women

larger younger

Benign or Malignant Pagets disease

malignant

Benign or malignant sarcoma

malignant

Sarcomas present how

as large non-spiculated dense masses

A neoplasm which originate in lymph tissue

lymphoma

What is the the most common symptoms of lymphoma and where is it generally located

painless breast mass located in the outer quadrants

Lymphoma can cause enlarged lymph nodes in the ___ and \_\_\_-

neck armpit

Is lymphoma considered to be cancer?

no, but its difficult to distinguish in the early stages

All components of our equipment are based on what principle

low dose, high contrast

The primary radiation that goes int the patient, get partially absorbed as it travels through the patient and hits the IR

attenuation

The ___ \_\_\_ produced by an object depends on its attentuation of the x-ray beam

image contrast

Breast masses often has the same ___ as the surrounding tissue making them difficult to see

attenuation

What 3 materials are the targets (anodes) made out of in mammography

molybdenum (Mo) Rhodium (Rh) Tungsten (W)

The system will choose the target thats best for the _____ \_\_\_\_ and \_\_\_

tissue type and thickness

What are filters generally used for? and what does mammography use them for

to reduce scatter enhance contrast

What are the 4 types of filters used in mammography

Molybdenum (Mo) Rhodium (Rh) Aluminum (Al) Silver (Ag)

In general what two type of filtration does mammography have

inherent added

What type of filtration includes parts of the x-ray tube and tube housing

inherent

The exit window of the tube housing is made of

Beryllium

What 4 things (parts of the tube) are included in the inherent filtration

exit window oil in the tube mirror assembly compression plate

What type of filtration has thin sheets of metal inserted in the x-ray beam

added filtration

Rhodium, silver, molybdenum, and aluminum are what type of filtration

added

What are the two roles of added filrations

1. removes soft photons which add dose 2. removes higher energy photons which reduce contrast

What are the 6 target/filter combinations that can occur

Molybdenum/Molybdenum Molybdenum/Rhoidum Rhodium/Rhodium Tungsten/Silver Tungsten/Rhodium TUngsten/Aluminum

What is the best target/filter combination for average breasts

Molybdenum/Molybdenum

A grid is used to ____ \_\_\_\_and _____ \_\_\_\_\_\_

absorb scatter improve contrast

Grids absorb what percentage of scatter

75-85%

What is the downfall to using a grid

increase patient dose

Why does the grid move during the exposure

to blur and reduce the visibility of grid lines

The working ability of the grid is described by the ___ \_\_\_\_

grid ratio

The ratio of height of the lead strips to the distance between the lead strips (the interspace)

grid ratio

The higher the grid ratio the better the ____ \_\_\_\_ but at a cost of ____ \_\_\_\_ \_\_\_

image contrast increased patient dose

What grid ratios are used in mammography

3:1 to 5:1

What grid frequency is used in mammography

30-50 lines per cm

What are the two types of grids that are used in mammography

linear/focused honeycomb/ HTC

What is another name for a linear grid

focused

What is another name for a honeycomb grid

HTC

True or False Grids are always used in routine mammography imaging

true

What views NEVER use a grid

magnification views

HTC

high transmission cellular

What type of grid reduces scatter in two directions

HTC

HTC grids reduce scatter in how many directions

two

what type of grid results in less radiation to the patient

HTC

What is the interspace material in HTC grids

air

What type of grid reduces scatter from only one direction

linear

Linear-focused grids reduce scatter in how many directions

one

What grid results in higher radiation to a patient

linear-focused grid

What is the interspacing material of a linear-focused grid

carbon

What is one of the essentials of effective mammography

compression

The compression paddle shall ot extend beyond the chest wall edge of the image recptor by more that what percent when compressing an average breast

How far should the breast be compressed

unitl its taut or slightly less than painful (whichever comes first)

What are the 6 benefits from compression

- more uniform breast thickness - better visualization of chest wall tissue - better exposure - reduced blurring from patient motion - reduced scatter radiation dose - improved contrast

What are used to accomodate a breast that wont compress flat

flex and curved paddles

True or False The shadow of the vertical edge of the compression paddle shall not be visible on the image

true

In mammography the exposure field is chosed by what

the size paddle you have attached

What is the biggest field of view that is used in mammography

24cm x 30 cm

True or False collimation is used in mammography

false- paddle size determines the light field

The light field will come all the way to the ____ \_\_\_\_ and not exceed the edge by more than \_\_\_%

chest wall 2%

The light field brightness should provide an average illumination of not less than ___ \_\_\_ (\_\_\_\_ ___ ) at ____ \_\_\_\_ or the maximum SID whichever is less

160 lux (15foot candles) at 100 cm

The light field is checked how often and by who

annually physicist

The radiation shield in front of the operator station must have an equivalent attenuation of at least ____ mm of lead at __ kVp to limit operators exposure to below __ mSv per week

0.08 35 1

The area of the anode (target) bombarded by electrons

actual focal spot

What focal spot doesnt change

actual focal spot

The downward projection of the actual focal spot is called the

effective focal spot

The effective focal spot is dependent upon what

the steepness of the anode angle

The steeper the angle the ___ the effective focal spot

smaller

The steeper the angle the better the \_\_\_\_

detail

The smaller the effective focal spot the better the \_\_\_

detail

To produce a sharp image, focal spots need to

be small but able to withstand heat without melting the anode

A large focal spot is used when a ___ \_\_\_ ___ is priority

short exposure time

Mammography tubes have how many focal spots

A mammography tubes large focal spot measures ____ and is used for ___ \_\_\_

0.3mm standard imaging

Mammographys small focal spot measures _____ and is used for ______ \_\_\_\_\_ only

0.1mm magnification imaging

Mammography focal spots are generally ___ than other modality focal spots

smaller

Why are mammogaphy focal spots smaller than other modality focal spots

because of the requirements for minimal blurring and good visibility of detail

Who will run tests for estimating the size of your effective focal spot

physicist

When a physicist tests the size of the focal spot what do they base it off of

what the manufacturer states the sizes are

The steep (Verticle) target creates a ___ xray field where the CR is not in the \_\_\_\_\_

narrow center

When we tilt the mammography tube (with a less steep angle) we get a ____ xray field

wider

When the x-ray tube is tilted and the field is wider the CR is in the \_\_\_

middle

When tilting the anode and creating a wider field of view the beam is not all uniform, what is this called

anode heel effect

The intesnsity of the x-ray beam which is ot all uniform in all portions of the beam

anode heel effect

The anode acts as a filter, which we refer to as ___ \_\_\_

self filtration

The rays towards th cathode end of the tube have ___ \_\_

more intensity

Why does the cathode side rays have more intesity

because they have less of the anode to travel through

Which side of the tube has more dose

cathode

The rays towards the anode side are ___ \_\_\_

less intense

Why are the rays on the anode side less intense

beacuse they have more anode to travel through and are more absorbed

What side of the xray tube has less doese

anode

How do we use the anode heel effect in mammography? The stronger part of the beam is aimed towards what part

the thickest part (chest wall)

The focal spot measures the ____ on ___ side nearest the \_\_\_\_\_

smallest anode nipple

Whereever the focal spot measurese the smallest will proivide the _____ \_\_\_\_

highest resolution

If the CR is in the center of the body what tissue is missed

posterior

In half field geometry, if the tube is moved closer to the patient it prevents the beam from getting into the ___ \_\_\_\_

lung field

What controls the wavelength of the x-ray beam

kVp

kVp is the ___ \_\_\_ of the beam

penetrating power

kVp influences ____ and ___ \_\_\_\_

contrast exposure latitude

Determinng proper kVp depends on what 3 things

breast composition thickness target/filter

A unit of radiographic exposure equal to the product of milliamperage (mA) and the exposure time in second (S)

mAs

What controls the xray beam intensity

mAs

mAs conrols the xray beam

intensity

The mA is used to control the image

blackening

mA stations are \_\_\_\_

fixed

Why are mA stations fixed?

Because the focal spots are so small that the anode could get burnt out if the mA was too high

What is the typical mA selection is

20-100 mA

What are typical times that are used in mammography exposures

0.4 to over 1 second

If calibration is not maintained what can happen to the mA

could drift out of acceptable tolerances

Back up timers are needed to avoid what

gross overexposure

What is the maximum back up time for grid and non-grid work

600 mAS (grid) 300 mAs

How can you avoid the back up timer

using higher kVp

The back up timer will kick in if we try to photo time what an

implant dense fluid/filled breast

The functionality of the AEC depends on

manufacturer

The emerging x-ray beam is determined by 3 factors

kV anode material filter material

kV is the kilovoltage the generator supplies to the what

cathode

What does the kV supplied to the cathode do

causes it to heat up and send electrons toward the anode

What are the varying energies of xrays called

keVs (kiloelectron volts)

The higher the kV the ___ the keV

higher

The kV applied to the generator is chosen by the \_\_\_\_

operator

What two types of radiation are produced by the emerging xray beam

bremsstrahling characateristic

What type of radiation is produced in the form of multiple energies (keV)

bremmstrahling

What is the most common type of radiation produced

bremsstrahling

The maximum energy (keV) is determiend by the selected \_\_\_

What type of radiation is confed to 2 energy spikes that are determined by the anode material

characteristic radiation

What radiation is most important for determining x-ray beam penetration and giving us optimal contrast

characteristic

Why have molybdenum anodes traditionally been used in mammography

because Mo produces the characteristic radiation that is optimal to penetrate an average breast resuling in optimal contrast

Which target material produces the most optimal contrast

molybdenum

Molybdenum anodes produce characteristic radiation spikes of ____ and \_\_\_\_

17. 6 keV 19. 7 keV

Rhodium andoes are used for what type of breasts

larger and denser breasts

Rhodium produces characterisitc radiation of ____ and \_\_\_

20. keV 22. 7 keV

Tungsten produces characteristic radiation of ___ and \_\_\_

59 68

\_\_\_\_ targets have super high energies

tungesten

What is the downfall with using a tungsten target

its high energies obliterate contrast

What target material couldnt be used with film but is used with digital

tungsten

When using a tungsten target, the contrast can be brought back by ___ and ____ and dose can be ____ with a higher penetrating beam

window and level lowered

What is insereted into the x-ray beam to block the higher energies of the bremsstrahlung radiation that would cause a decrease in constrast

filter

The filters ____ is how the filter is able to achieve its filtration of the beam

k-edge

The boundary between photon energies that are not attenuated and the photon energies that will be attenuated is the \_\_\_

k-edge

The k-edge is determined by the ___ \_\_\_ of the filter material

atomic number

Molybdenums k-edge is \_\_\_

Molybdenums k-edge is 20 keV which means what

it filters xprays with energies above 20 keV

MO filter supresses energies lower than __ keV which would only add \_\_\_

15 dose

When the Mo filters otu energies above 20 keV, it acts to ___ \_\_\_

decrease contrast

Rhodium filters have a k-edge of _____ which means it filters x-rays with energies ___ \_\_\_\_

23.22 above 23.22

The rhodium filter is used with what kinds of breasts and why

larger breasts that need higher penetration

Rh filters supresses engeries lower than ___ keV which would only add \_\_\_

15 dose

Achieving the correct x-ray specturm is critical to optimizing ___ and \_\_\_

contrast dose

what 3 steps are there to achieving optimal x-ray spectrum

1. choose appropriate anode 2. choose appropraite filter materia 3. choose appropriate kV

The MQSA law state the maximum permissible dose for one view of an average breast is ____ or \_\_\_\_

300 mRad 3mgy

The distance between the xray source and the imaging receptor

SID

What is the average SID in mammography

65-66 cm

What constitutes as an average breast

50% dense 50% fatty compressed to 4.2 cm

SID is determined by what 3 things

- geometry of the tube - tube angle - machine design

The distance from the breast to the imaging receptor

OID (object to image distance)

An increase in OID will result in\_\_\_\_ of an area of breast tissue

magnification

Magnificatoni increases the possibility of ____ , how do we compensate for this

unsharpness use a small focal spot to gain detail

With magnification our techniqed has a reduced ____ and increased ____ to not burn out the tube

mA time

What is the typical time for Mag views

2-4 seconds

Most units have Mag factors of what

1.5 and 2.0

The larger the magnification factor the ____ the image, but what decreases ______ \_\_\_\_\_

larger image resolution

Why are grids never utlized with magnification views

the air gap reduces scatter so the grid isnt needed

What imaging views never use a grid

magnification

True or false dose is abotu the same as regular mammogram images

true

Who performs the mammgraphy equipment evaluation (MEE)

physicists

What test is to ensure that mammography equipment meets section 900.12(b) of FDAs final rule for mammography and complies with MEE- only required tests

mammography equipment evaluation (MEE)

What is the frequency of the mammography equipment evaluation test (3)

new units after relevant service after component replacement

What tests purpose is to ensure that the xray field aligns with the light field, ensure tha thte collimartor allows for full coverage of the image receptor (while not allowing significant radiation beyond its edges) and to ensure tha tthe chest wall edge of the compression paddle aligns acceptable with the chest wall edge of the image receptor

collimattion assessment

Who performs the collimation assessment

physicist

What is the frequency in with the collimation assessment should be done

For 2D: - as part of MEE for new units - after relavent service - after component replacement For DBT - as part of MEE - after relaveant service - annually

Who performs the spatial resolution (line pair) test

physicist

What test is used to measure the limitng spatial resolution as an indicator of detector performance

System resolution and spatial resolution (line pair) test

How often should the system resolution and spatial resolution test be done

- MEE of a new unit - after a relavant service - annually

Who performs the room illuminance (ambient light) test

physicist

What test is used to evaluate the reading room environment where the RW resides for appropariate ambient light levels for mammography interpretation

room illuminance (ambient light)

\_\_\_ is extremely important in mammography image and is degraded by extraneous \_\_\_

constrast ligher

How often should the room illuminance (ambient light) be tested (4)

- RWS QC - MEE of new equipment - after relavant service - annually

Who performs the evaluation of technolgists QC program

physicist

What test ensures that technologists QC is being perfoemd correctly, to compare the QC technologists and the medical physicists ACR digital mammogrpahy phantom scores and to identify areas where image quality and QC testing can be improved. To enable the medical physicist to provide an external assessment of quality and possibly compare image quality and WC practives with those of other mammography tests and to present an opportunity for the medical physicist to provide or recommend further eduction to the QC tech

evaluation of technologist QC program

How often should the evalutation of technologist QC program be done

annually

What test ensures tht mammography equipment meets section 900.12 (b0b of FDAs final rule for mammography and complies with MEE -only required tests

application of compression

Who does the applications of compression testing

physicist

How often should the application of compression test be done (3)

- MEE of new units - after relavant service - after component replacement

What test ensures that adequate compression is applied uniformly over the breast for paddles tha tare designed to be flat and parallel to the breast support

compression paddle deflection

Who does the copression paddle deflection test

physicist

How often should the compression paddle deflection test be done (4)

MEE of new units after relevant service after component replacement annually

What test states the following the compression paddle shall be flat and parallel to the breast support table and shall not defelct form parallel by more than 1 cm at any point on the surface of the compression paddle when compression is applied

compression paddle alignment according to MQSA

Paddles that are designed to not be flat and parallel to the breast, shall mee what requirements

manufacturers design specifications and maintenance requirements

The chest wall edge of the compression paddle shall be ___ and _____ to the edge of the image receptor

straight parallel

The chest wall edge may be bent upward for patient _____ but shall not appear on the image

comfort

What test is done to ensure that AW monitors are clean and free from dust, fingerprints other marks that may interfere with clinical information. To ensure that monitors are calibrated correctly and brightness and contrast settings are set correctly and that mintors meet manufacturer specifications via the conduct of monitor manufacturer automated testes

AWS QC

Who performs th AWS QC

physicist

How often should the AWS QC be done

MEE of new equipment after relevant service annually

What test is the same as the RWS

interpretation RWS QC

How often should the interprestation RWS QC be done (3)

- MEE of new equipmemt - after relvant service - annually

IRSD

image receptor support device (ie. IR, detector)

What type of view may be needed to include normal anatomy and may be obtained at the time of screeing without radiologist approval

supplemental views

What is the most common supplemental view

XCCL

What type of exam views are used for detailed imaging evaluation of a specified area, trying to locate or triangulate a specific lesion and are radiologist directed

diagnostic view

what is the most common diagnostic view

90 degree lateral

What is the labeling code for a mediolateral (90 degree)

What way does the CR travel for a mediolateral

medial to lateral

What view best demonstrates the lateral lesions

ML (mediolateral )

What are the 4 purposes of a mediolateral view

- orthoganal view used in triangulation of a lesion - demonstrates benign milk of calcium - resolves superimposition of glandular tissue - demonstrates lateral lesions

In a mediolateral view what side of the breast is closest to the IR

lateral

What is the labeling code for a lateromedial (90 degree)

What direction is the central way traveling for a lateromedial view

lateral to medial

What are the 4 purposes of a lateromedial view

- orthognal view used to triangulated lesion location - demonstrates benign milk of calcium - resolve superimposition of glandular structures - demonstrates medial lesions

what view demonstrates medial lesions the best

lateromedial view

When doign 90 degree laterals how much time should you wait to allow for fluid to settle

2 minutes

What portion of the breast is closest to the IR in a lateromedial projection

medial

Benign sedimented calcifications in macro or micro cysts

milk of calcium

In milk of calcium, a typical feature is apparent chane in ___ on different projections

shape

When a lesion is seen on MLO but not on a CC, what projection should be done to help determine location on a CC using triangulation principles

90 degree lateral

What is the order of images in triangulation to determine lesion location

CC, MLO, ML

If the lesion moves down in the ML compared to the MLO where is the lesion located

on the lasteral aspect

If the lesion moves up on the ML compared to the MLO then the lesion is located where

on the medial side of the CC breast

Using triangulation if the position of the lesion does not shift significantly on the ML when compared to the MLO what is the location of the lesion

it is located central on the CC breast

When a lesion is seen on the CC and not seen on the MLO , what views can be done

15 degree obliques 90 degree lateral

When a lesion is seen on a CC and not the MLO, instead of doing 15 degree obliques some radiologists may decided to do what other imaging

tomogram ultrasound

What is the labeling code for an exaggerated craniocaudal lateral

XCCL

What direction does the CR travel for a exaggerated craniocaudal alteral

superior to inferior

During an XCCL you may angle the IR toward the lateral side __ - ___ degrees

0-10

During a XCCL the nipple points toward the

opposite corner of teh IRSD

During a XCCL the compression paddle should fit tightly against the _____ \_\_\_\_\_ just anterior to the _____ \_\_\_\_\_\_\_\_

chest wall humeral head

During the XCCL if the humerial head is in the way how can you compensate

use angle

What are the two purposes of a exaggerated craniocaudal laterl (XCCL)

- demonstrates anatomy that may extend to the outer aspect of the breast not visualized by a standard CC - ideal for patietns with prminent tail of spence and glandular extensions

What view demonstrate the following - orthognal view used to triangulated lesion location - demonstrates benign milk of calcium - resolve superimposition of glandular structures - demonstrates medial lesions/lateral lesions

LM (lateromedial)/ML (mediolateral)

XCCLs are needed on what percent of screenings

10%

Most patiets have some ___ \_\_\_ in the tail of spence, some more _____ and some more \_\_\_\_

glandular tissue lateral posterior

What is the labeling code for exaggerated craniocaudal medial

XCCM

What direction does the CR travel for a exaggerated craniocaudal medial

superior to inferior

In an XCCM you want to exaggerate the patients body so the ___ portion of the breast is centered

medial

IN a XCCM, the nipple points toward the

lateral corner of the IR

What view is ideal for visualizing extreme medial anatomy and pathlogy

exaggerated craniocaudal medial (XCCM)

What is the purpose of the XCCM

ideal for visualizing extreme medial anatomy and pathology

What is the labeling code for the cleavage view

What direction does the central ray travel for the cleavage view

superior to inferior

What views purpose is to visualize anatomy and pathology in the deep posterior and medial aspects of both breasts

cleavage view

The cleavage views purpose is to visualize anatomy and pathology in the ___ \_\_\_ and ___ aspects of both breasts

deep posterior medial

What two things do you want to make sure to do when performing a cleavage view

- ensure ther eis no tissue overlapping before applying compression - separate the breasts slightly

In the CV (cleavage view) you may use a ____ \_\_\_\_ paddle if ROI is included

spot compression

What is the labeling code for the axillary tail

What direction is the CR traveling in the axillary tail view

medial to lateral

The axillary tail view is used as a supplemental view for greater tissue inclusion for patients with _____ \_\_\_\_ but shouldnt be used as a supplemental view for a \_\_\_\_\_\_\_\_\_\_\_\_\_\_

special circumstance poorly positioned MLO

What is the labeling code for a rolled medial

What is the labeling code for a rolled lateral

what direction is the CR traveling in a rolled medial view

superior to inferior

what direction is the CR traveling in a rolled lateral view

superior to inferior,

What are the 3 purposes of rolled medial and rolled lateral view

- separate superimposed breast tissue - confirm the presence of an abnormality - determine the location of fiding seen on only one view (CC)

What view demonstrates the following - separate superimposed breast tissue - confirm the presence of an abnormality - determine the location of fiding seen on only one view (CC)

rolled medial and rolled lateral

What does the rolled medial and rolled lateral view help determine

if the lesion is superior or inferior

In a rolled medial view, what tissue is rolled medially

superior

In a rolled lateral view, what tissues is rolled laterally

superior

In a rolled medial view what direction is the inferior tissue rolled

lateral

In a rolled lateral view what direction is the inferior tissue rolled

medially

In a rolled CC view (RM/RL) if the lesion rolls in the same direction as the superior hand what portion of the breast is the lesion in

superior

In a rolled CC view (RM/RL) if the mass rolls in the opposite direction of the superior hand where is the lesion

in the inferior tissue

What is the labeling code for a rolled superior view

What is the labelling code for a rolled inferior

What direction is the CR traveling for a rolled superior view

medial to lateral

What direction is the CR traveling for a rolled inferior view

medial to lateral

What view is used to - separate superimposed breast tissue - confirm the presence of a lesion - determine the leacion of finding seen on only 1 view (MLO)

RI RS

The rolled inferior and rolled superior views are used to determine if a lesion is

in the medial or lateral tissue

In a rolled MLO view, the lesion is in what area if the lesion rolls in the same direction as the top hand

medial

In a rolled MLO view, the lesion is in what area if the lesion rolls in the opposite direction as the top hand

lateral

In a rolled superior view, the top hand is rolled ____ and the bottom hand is rolled \_\_\_\_

superior inferior

In a rolled inferior view, the top hand is rolled ____ and the bottom hand is rolled \_\_\_\_

inferior superior

When is the anterior compression used

on a MLO when the portion of the breast is not compressed until it is taut

According the ____ at least ___ view on each side must have the nipple in profile

ACR one

The term used when it is only seen on one view (CC or MLO)

asymmetry

The term used when it is seen on both view (CC and MLO)

focal asymmetry

What is the purpose of a spot compression

- greater reduction in thickness reduces OID - displaces tissues overlying ROI - improves definition for more dtailed evaluation of asymmetry, architectural distortion of density

What view does the following - greater reduction in thickness reduces OID - displaces tissues overlying ROI - improves definition for more dtailed evaluation of asymmetry, architectural distortion of density

spot compression

ROI

region of interest

What are the 3 measurements needed to determine a lesion location for a spot compression

1. depth relative to a line drawn directly poseriot from the nipple 2. distance from line one to the lesion in the superior/inferior (ML)/LAT) OR medial lateral direction (CC) 3. distance from the lesion to the skin

Additional focal compression is ___ uncomfortable

What is the labeling code for magnification

What paddles are used during magnification

spot compression smaller MAG paddle

What are the different sizes of mag stands (3) and what are they influenced by

1. 5 1. 8 2. 0 IP preference

True magnification is determined by two things

breast thickenss lesion location

Mag ML views are best done with how much of a delay

2 minute

What is the purpose of magnification views

- evaluation of characteristics of calcification - used to characterize masses, asymmetries or architectural distortion - may reveal unexpected findings not evident on standard views

What view determines the following - evaluation of characteristics of calcification - used to characterize masses, asymmetries or architectural distortion - may reveal unexpected findings not evident on standard views

magnification

During the magnification view, the exposure time is ____ and the focal spot is \_\_\_

longer .1mm

How do you determine the lesion location for the mag view

with the 3 measurement technique

What pathology can a tangential be used for

when there is a palpable lump or skin calcifications

What is the labeling code for a tangential

TAN

What is the purpose of a tangential for a palpable lump

- for palpable lesions that are not visualized or are obscured by breast tissue

What view is done for palpable lesions that are not visualized or are obscured by breast tissue

tangential

During a tangential the CR travels in what direction

perpendicular to the BB-nipple line

What is the process for a tangential view

- place a BB directly over the lump - Rotate the IR approximately parallel to line from BB to nipple

In a tangential view how far do you rotate the IR

until it is parallel to the BB to nipple line

The tangential maneuver places the palpable lump directly over the ____ \_\_\_\_ which allows \_\_\_\_

subcutaneous fat visualization

What is the purpose of a tangential for calcification

To verify whether mammographic calcifications are located in the skin

What view is done to verify whether mammographic calcifications are located in the skin

tangential for calcification

During a tangential for calcification what type of compression paddle needs to be used

open grid compression

During a tangential for calcification you should position the skin with the calcifications closets to what

the grid window of the compression paddle

During a tangential for calcifications the IRSD is rotated to what position

parallel to the BB to nipple line

During a tengential for calcifications the breast is rotated until

the BB is tangent to the beam

Labeling code ML

90 degree mediolateral

Short purpose of an ML

localize define

lateromedial

Short purpose of LM

localize define

XCCL

exaggerated craniocaudal lateral

short purpose of the XCCL

localize supplement

XCCM

exaggerated craniocaudal medial

short purpose of XCCM

localize supplement

cleavage

short purpose of CV

localize

axillary tail

short purpose of AT

localize define supplement

Women with ___ glandular tissue have a higher risk of breast cancer

dense

women who used ____ (medication) during pregnancy have a higher risk of breast caner

diethylstilbestrol (DES)

What are the 4 major factors affecting dose

- xray beam energy - imgaing chain - compression - patients breast tissue type

Enterance skin exposure from a single exposure should be what dose

800-1200 mrad (812 mGy)

\_\_\_ mammography is administered to detect breast cancer in wmen who have osymptoms

diagnostic

\_\_\_ mammgraphy is typically administered when a woman has no known symptoms of breast cancer

screening

The microscopic examination of cell samples

cytological analysis

The part of the breast that makes the milk

glandular tissue

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