| Question 1: The mechanism underlying ultrasound neuromodulation is: |
| Reference: | Tyler, WJ, Noninvasive neuromodulation with ultrasound? A continuum mechanics hypothesis. Neuroscientist, 2011; 17(1): 25-36. |
| Choice A: | Intermembrane cavitation. |
| Choice B: | Mild heating of neurons. |
| Choice C: | Oscillation of mechanosensitive receptors. |
| Choice D: | Not fully understood and potentially a combination of all of the above. |
| Question 2: Which of the following is NOT true about ultrasound focusing through the skull during neuromodulation? |
| Reference: | Connor CW, Hynynen K, Patterns of thermal deposition in the skull during transcranial focused ultrasound surgery. IEEE Trans Biomed Eng. 2004 Oct;51(10):1693-706. |
| Choice A: | The focus can be corrected using array-based transducers. |
| Choice B: | Heating is not possible in the skull. |
| Choice C: | The low frequencies used for neuromodulation transmit through bone easier. |
| Choice D: | A small ultrasound focus can be achieved through the skull. |
| Question 3: The principle behind using low-energy focused ultrasound (LOFU) exposures to stimulate the immune response is: |
| Reference: | Bandyopadhyay et al, Low-Intensity focused ultrasound induces reversal of tumor-induced T-cell tolerance and prevents immune escape, J Immunol, 196:1964-1976, 2017. |
| Choice A: | Mechanical friction leading to shear disruption of cells. |
| Choice B: | Thermal ablation of tumors leading to rapid release of cytokines into the blood stream. |
| Choice C: | Induction of a stress response in tumors leading to the expression of immunomodulatory factors. |
| Question 4: Immune priming with ultrasound is seen with what type of bioeffects? |
| Reference: | van den Bijgaart et al, Thermal and mechanical high-intensity focused ultrasound: perspectives on tumor ablation, immune effects and combination strategies. Cancer Immunol Immunother.66(2):247-258, 2017. |
| Choice A: | Thermal exposures. |
| Choice B: | Mechanical exposures. |
| Choice C: | Both A and B. |
| Question 5: Which of the following statements concerning the proton resonance frequency method is NOT true? |
| Reference: | Ishihara Y, Calderon A, Watanabe H, Okamoto K, Suzuki Y, Kuroda K, Suzuki Y, A precise and fast temperature mapping using water proton chemical shift. Magn Reson Med. 1995; 34(6):814-23. |
| Choice A: | Measures temperature change. |
| Choice B: | Is susceptible to motion. |
| Choice C: | Can accurately measure temperature in fat. |
| Choice D: | Is possible due to hydrogen bonding. |
| Question 6: The use of procedure-dedicated radiofrequency coils provide increased signal to noise ratio, which can improve: |
| Reference: | Hansen MS, Kellman P, Image reconstruction: an overview for clinicians. J Magn Reson Imaging. 2015 Mar;41(3):573-85.
|
| Choice A: | Temporal resolution. |
| Choice B: | Spatial resolution. |
| Choice C: | Improved functionality (i.e. diffusion, thermometry). |
| Choice D: | Parallel imaging capabilities. |
| Choice E: | All of the above. |
| Question 7: In MR-guided HIFU for tumor thermal ablation, the MR thermometry can be used to monitor and verify that the following thermal dose was delivered to destroy the tumor:
|
| Reference: | McDannold NJ, King RL, Jolesz FA, Hynynen KH, Usefulness of MR imaging-derived thermometry and dosimetry in determining the threshold for tissue damage induced by thermal surgery in rabbits. Radiology, 2000; 216(2):517-23.
|
| Choice A: | 40-43 C for 15 min. |
| Choice B: | 240 EM43C. |
| Choice C: | 5 EM43C. |
| Choice D: | 40-43 for 60 min. |
| Choice E: | None of the above. |
| Question 8: Shock-waves form at the focus of HIFU fields due to:
|
| Reference: | Canney MS, Khokhlova VA, Bessonova OV, Bailey MR, Crum LA. Shock-induced heating and millisecond boiling in gels and tissue due to high intensity focused ultrasound. Ultrasound Med Biol. 2010;36(2):250-67. |
| Choice A: | Ultrasound reflection and refraction by tissue structures. |
| Choice B: | Ultrasound absorption by tissue. |
| Choice C: | Nonlinear propagation of ultrasound in tissue. |
| Choice D: | Focused geometry of the ultrasound transducer. |
| Question 9: In boiling histotripsy tissue fractionation is achieved through: |
| Reference: | A. Maxwell, O. Sapozhnikov, M. Bailey, L. Crum, Z. Xu, B. Fowlkes, C. Cain, V. Khokhlova. Disintegration of tissue using high intensity focused ultrasound: Two approaches that utilize shock waves. 2012, Acoustics Today, v. 8(4), pp. 24-36. |
| Choice A: | Boiling bubble formation. |
| Choice B: | Cavitation bubble activity. |
| Choice C: | Acoustic atomization. |
| Choice D: | A combination of the above. |
| Question 10: The transition zone from fully fractionated to fully intact tissue in boiling histotripsy lesions is: |
| Reference: | Khokhlova TD, Wang YN, Simon JC, Cunitz BW, Starr F, Paun M, Crum LA, Bailey MR, Khokhlova VA. Ultrasound-guided tissue fractionation by high intensity focused ultrasound in an in vivo porcine liver model. Proc Natl Acad Sci U S A. 2014;111(22):8161-6. |
| Choice A: | 1-2 millimeters wide. |
| Choice B: | 1-2 microns wide. |
| Choice C: | 10-20 microns wide. |
| Choice D: | 100-200 microns wide. |
