| Question 1: What is the ideal metric for estimating patient dose when deterministic effects are of potential concern? |
| Reference: | National Council on Radiation Protection and Measurements (NCRP) Report No. 168 – Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures. |
| Choice A: | Fluoroscopy time |
| Choice B: | Fluoroscopy time and number of images |
| Choice C: | Peak skin dose |
| Choice D: | Dose area product |
| Choice E: | Cumulative reference air kerma |
| Question 2: Which of the following should be considered when estimating patient skin dose? |
| Reference: | D.R. Bednarek et al. “A tracking system to calculate patient skin dose in real-time,” Med Phys 43 (9), 5131-5144 (2016). |
| Choice A: | Backscatter |
| Choice B: | Patient support attenuation |
| Choice C: | Field size |
| Choice D: | Beam angulation |
| Choice E: | All of the above |
| Question 3: Which approach is most effective for monitoring and managing clinical radiation dose levels? |
| Reference: | A Kuhls-Gilcrist, “Vascular Imaging for Image-Guided Interventions,” Cardiovascular and Neurovascular Imaging: Physics and Technology, CRC Press, 377-393 (2015).
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| Choice A: | Measurement of reference air kerma rates. |
| Choice B: | Review of protocol settings. |
| Choice C: | Analysis of DICOM Radiation Dose Structured Reports. |
| Choice D: | Annual radiation safety committee meetings. |
| Question 4: Which of the following sentences is NOT TRUE regarding the use of advanced software that delineates vessels feeding a tumor. |
| Reference: | a true: Cornelis, F. H., et al. 2018 Hepatic Arterial Embolization Using Cone Beam CT with Tumor Feeding Vessel Detection Software: Impact on Hepatocellular Carcinoma Response. CVIR 41(1):104-111.
b true: Yarmohammadi, H., et al. 2018 Evaluation of the Effect of Operator Experience on Outcome of Hepatic Artery Embolization of Hepatocellular Carcinoma in a Tertiary Cancer Center. Acad Radiol.
c, d true: Iwazawa J., et al. 2013. Comparison of the number of image acquisitions and procedural time required for transarterial chemoembolization of hepatocellular carcinoma with and without tumor-feeder detection software. Radiol Res Pract.
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| Choice A: | It may result in improved local tumor response after HCC embolization |
| Choice B: | It has demonstrated better sensitivity to detect tumor feeding vessels compared to standard manual analysis of DSA and reformatted CBCT images |
| Choice C: | It was proven to reduce the number of DSAs needed during liver embolization |
| Choice D: | It was proven to reduce procedure time |
| Choice E: | It was not proven to impact treatment outcome |
| Question 5: Which of the following sentences is NOT TRUE regarding multimodality fusion: |
| Reference: | Kapoor, Baljendra, and Nikunj Chauhan 2017 Advanced Intraprocedural Imaging Applications in Hepatobiliary Intervention. Digestive Disease Interventions 01(03):155-162. |
| Choice A: | It allows overlaying information from any pre-operative DICOM volume on live fluoroscopy |
| Choice B: | It allows view-only pre-operative CT/MR/PET at the time of the procedure |
| Choice C: | It allows fusing procedure CBCT to pre-procedure volumes to identify target, plan best treatment approach and/or assess treatment coverage. |
| Choice D: | It allows leveraging information provided by different modalities at one single point of care, the IR suite. |
| Choice E: | It allows patient radiation dose reduction. |
| Question 6: Which of the following best describes the comparison between CBCT – needle guidance software and CT Guidance for Percutaneous Bone Biopsies? |
| Reference: | Tselikas, L., et al. 2015 Percutaneous bone biopsies: comparison between flat-panel cone-beam CT and CT-scan guidance. Cardiovasc Intervent Radiol 38(1):167-76. |
| Choice A: | CT guidance induces lower dose than CBCT – needle guidance software. |
| Choice B: | Compared with CT-guidance, CBCT - needle guidance software increased bone biopsies accuracy, reducing patient and operator radiation doses. |
| Choice C: | Technical success was higher under CT guidance. |
| Choice D: | Puncture time was significantly lower under CT guidance. |
| Question 7: In which of the following operation modes, recursive filtering is not beneficial? |
| Reference: | Bushberg JT et al. The Essential Physics of Medical Imaging (3rd Edition). Chapter 9: Fluoroscopy. |
| Choice A: | Low dose mode. |
| Choice B: | Normal dose mode. |
| Choice C: | High-dose/Boost mode. |
| Choice D: | Digital subtraction angiography mode. |
| Question 8: Many fluoroscopes provide the ability to alert the user of elevated reference air kerma during a procedure. NCRP 168 suggests that the 1st notification alert for reference air kerma be at 3 Gy, with subsequent alerts at: |
| Reference: | National Council on Radiation Protection & Measurements, Report-168 Radiation Dose Management for Fluoroscopically Guided Interventional Medical Procedures. - Table 4.7 |
| Choice A: | Each additional 300 Gy cm2. |
| Choice B: | Each additional 2 Gy. |
| Choice C: | Each additional 1 Gy. |
| Choice D: | When you reach 15 Gy. |
| Question 9: When characterizing and evaluating a new fluoroscope - it is important to understand the 2 typical methods for selection of the spectral filters, which are: |
| Reference: | Functionality and Operation of Fluoroscopic Automatic Brightness Control/Automatic Dose Rate Control Logic in Modern Cardiovascular and Interventional Angiography Systems, TG-125, Med. Phys. 39 (5), May 2012 |
| Choice A: | Optical Sampling AGC and Video Sampling AGC methods. |
| Choice B: | Anatomical Program-Based and Seissl methods. |
| Choice C: | SID controlled and kV controlled methods. |
| Choice D: | SEER and EERD methods. |
| Question 10: A KAP meter with a correction factor of C >1 would indicate that the fluoroscope displayed Ka,r would be: |
| Reference: | Accuracy and calibration of integrated radiation output indicators in diagnostic radiology: A report of the AAPM Imaging Physics Committee Task Group 190, Med. Phys. 42 (12), December 2015. |
| Choice A: | Higher than the actual value. |
| Choice B: | Lower than the actual value. |
| Choice C: | Equivalent to the actual value. |
| Choice D: | Better obtained in the RDSR than the DICOM header. |
