| Question 1: Injected contrast is more difficult to see on mammography than on CT or MRI |
| Reference: | Lewin JM, Isaacs PK, Vance V, et al. Dual-energy contrast-enhanced digital subtraction mammography: feasibility. Radiology. 2003;229(1):261-268.
Lewin JM, Niklason L. Advanced applications of digital mammography: tomosynthesis and contrast-enhanced digital mammography. Semin Roentgenol. 2007 Oct;42(4):243-52. |
| Choice A: | The contrast resolution of projection radiography techniques such as mammography is much lower than for cross-sectional techniques |
| Choice B: | The energies used in contrast-enhanced mammography are farther away from the k-edge of iodine than those used in CT |
| Choice C: | Breast compression used for mammography increases blood flow and therefore the uptake of contrast |
| Choice D: | Atom for atom, iodine used with x-ray is a better contrast agent than gadolinium used with MRI |
| Question 2: An advantage of using dual-energy subtraction, as opposed to temporal subtraction, for CEDM is: |
| Reference: | Lewin JM, Isaacs PK, Vance V, et al. Dual-energy contrast-enhanced digital subtraction mammography: feasibility. Radiology. 2003;229(1):261-268.
Lewin JM, Niklason L. Advanced applications of digital mammography: tomosynthesis and contrast-enhanced digital mammography. Semin Roentgenol. 2007 Oct;42(4):243-52. |
| Choice A: | The breast does not need to be compressed during contrast administration so contrast uptake is not hindered by decreased blood flow. |
| Choice B: | Multiple projections can be obtained from a single injection. |
| Choice C: | The two images are obtained within a few seconds so misregistration due to patient motion is minimized. |
| Choice D: | all of the above |
| Question 3: Which of the following statements is TRUE regarding dual-energy subtraction in CEDM? |
| Reference: | Lewin JM, Isaacs PK, Vance V, et al. Dual-energy contrast-enhanced digital subtraction mammography: feasibility. Radiology. 2003;229(1):261-268.
Lewin JM, Niklason L. Advanced applications of digital mammography: tomosynthesis and contrast-enhanced digital mammography. Semin Roentgenol. 2007 Oct;42(4):243-52. |
| Choice A: | Images are acquired at two x-ray energies, one before and one after contrast injection. |
| Choice B: | Iodine absorbs the high-energy beam better than the low-energy beam. |
| Choice C: | Breast tissue absorbs the high-energy beam better than does the low-energy beam. |
| Choice D: | The breast is in full compression for the precontrast image and in light compression for the postcontrast image. |
| Question 4: The low energy image of a CEDM study: |
| Reference: | Francescone MA, et al. Low energy mammogram obtained in contrast-enhanced digital mammography is comparable to routine full-field digital mammography. Eur J Radiol 2014 |
| Choice A: | is diagnostically equivalent to a standard (non-contrast) mammogram |
| Choice B: | shows cancers as dark regions |
| Choice C: | is obtained prior to contrast administration |
| Choice D: | must be obtained prior to the high energy image |
| Question 5: A dual energy CEDM view has a dose that is about _________ that of a standard mammogram: |
| Reference: | Jeukens CR, Lalji UC, Meijer E, et al. Radiation exposure of contrast-enhanced spectral mammography compared with full-field digital mammography. Invest Radiol. 2014;49(10):659-665. |
| Choice A: | the same |
| Choice B: | 1.5 times |
| Choice C: | 2.0 times |
| Choice D: | 2.5 times |
| Question 6: Results of the 2013 Jochelson et al. study revealed that _________. |
| Reference: | Jochelson MS, Dershaw DD, Sung JS, et al. Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology. 2013;266(3):743-751. |
| Choice A: | CEDM had about the same sensitivity as breast MRI |
| Choice B: | MRI was slightly better than CEDM for detecting additional foci |
| Choice C: | CEDM had fewer false positives than MRI |
| Choice D: | all of the above |
| Question 7: Which of the following of these is not a limitation of tomosynthesis for quantification: |
| Reference: | Michielsen K, Rodriguez-Ruiz A, Reiser I, Nagy J, Sechopoulos I. Iodine Quantification in Limited Angle Tomography. 5th International Conference on Image Formation in X-Ray Computed Tomography. Salt Lake City, Utah; 2018. |
| Choice A: | X-ray scatter |
| Choice B: | Monochromatic reconstructions |
| Choice C: | Limited angular sampling |
| Choice D: | Spatial resolution |
| Choice E: | Unknown breast shape |
| Question 8: Which is one benefit of contrast enhanced breast tomosynthesis that may allow for quantification: |
| Reference: | Michielsen K, Rodriguez-Ruiz A, Reiser I, Nagy J, Sechopoulos I. Iodine Quantification in Limited Angle Tomography. 5th International Conference on Image Formation in X-Ray Computed Tomography. Salt Lake City, Utah; 2018. |
| Choice A: | Sparsity |
| Choice B: | Spatial resolution |
| Choice C: | Low noise |
| Choice D: | Wide angular sampling |
| Question 9: Compared to the radiation dose from a mammogram, an 8 mCi injection of Tc-99m sestamibi for an MBI examination results in __________ breast dose and ___________ effective dose. |
| Reference: | • Hendrick RE, Pisano ED, Averbukh A, et al. Comparison of acquisition parameters and breast dose in digital mammography and screen-film mammography in the American College of Radiology Imaging Network digital mammographic imaging screening trial. AJR Am J Roentgenol 2010; 194:362-369.
• Leng S, Hruska CB, McCollough CH. Use of ionizing radiation in screening examinations for coronary artery calcium and cancers of the lung, colon, and breast. Semin Roentgenol. 2015; 50:148-60.
• Andersson M. Erratum to: Effective dose to adult patients from 338 radiopharmaceuticals estimated using ICRP biokinetic data, ICRP/ICRU computational reference phantoms and ICRP 2007 tissue weighting factors. EJNMMI Phys. 2015;2:1-22. |
| Choice A: | lower, lower |
| Choice B: | higher, higher |
| Choice C: | lower, higher |
| Choice D: | higher, lower |
| Question 10: What are the 4 categories used to subjectively classify background parenchymal uptake on MBI as shown in this figure? |
| Reference: | • Conners AL, Maxwell RW, Tortorelli CL, et al. Gamma camera breast imaging lexicon. AJR Am J Roentgenol. 2012; 199:W767-74 |
| Choice A: | Minimal, mild, moderate, marked |
| Choice B: | Photopenic, uniform, moderate, marked |
| Choice C: | Uniform, minimal to mild, moderate, marked |
| Choice D: | Photopenic, minimal to mild, moderate, marked |
