| Question 1: Upon evaluation of a facility’s FFDM system, the CNR you determine is 80% of the last MEE’s CNR value. The evaluation was conducted using the ACR Digital Mammography QC Manual. Which of the following is the most in-line with due diligence and overall appropriateness for proceeding? |
| Reference: | Berns et.al. “2018 Digital Mammography Quality Control Manual” |
| Choice A: | Absolutely nothing; everything passes |
| Choice B: | Automatically contact the facility’s FSE to make adjustments to equal out the CNR |
| Choice C: | Discuss with the manager and let them decide what to do |
| Choice D: | Re-evaluate the image, methodology used, etc. This may also include looking through the DICOM Header for certain attributes and their value fields. |
| Question 2: The luminance ratios for a bank of diagnostic displays determined by you using your calibrated external photometer is 350. The Lmax measured is 700 Cd/ m2. The Lmax from the bezel with the displays is 690 Cd/ m2. Is this difference in bezel vs. external measurement significant? What is the L’min ? |
| Reference: | https://www.acr.org/-/media/ACR/Files/Practice-Parameters/elec-practice-medimag.pdf |
| Choice A: | Yes, 2.0 Cd/m2 |
| Choice B: | Yes, 1.97 Cd/ m2 |
| Choice C: | No, 2.0 Cd/ m2 |
| Choice D: | No, 1.97 Cd/ m2 |
| Question 3: An attending shows you what might be an artifact on a 3D MRI clinical image series. There are 128 images; the feature in question is on slice 10. Given that the series uses parallel imaging (acceleration factor = 2 in slice-select direction), where might you look for insight into whether the feature is a pMRI artifact? |
| Reference: | “If…there is signal in the calibration scan that doesn’t belong, such as motion or flow ghosting, the coil sensitivity in that area will be in error and image artifacts will likely result. …Inside the anatomy, this results in improper coil sensitivity maps and residual aliasing artifact” – AAPM Task Group 118 Report, 2015
Yanasak NE, Kelly MJ. MR imaging artifacts and parallel imaging techniques with calibration scanning: a new twist on old problems. Radiographics 2014; 34:532-548.
See also Figure 1 in Breuer F. Artifacts and pitfalls in parallel imaging. European Society for Magnetic Resonance in Medicine and Biology (ESMRMB) Teaching Session, Leipzig, 6 Oct 2011. |
| Choice A: | Slice 20 |
| Choice B: | Slice 74 |
| Choice C: | Slice 118 |
| Choice D: | Slice 92 |
| Question 4: You scan your ACR phantom for annual accreditation of your 1-year old 3T magnet. Your low contrast detectability test passes with a score of 37; however, the three missing “spokes” are on slice 11 (highest contrast disk). Which is the most appropriate conclusion below? |
| Reference: | “Most scanners greatly exceed the minimum passing score given in the action criteria section below. In most cases it isn’t necessary to spend time pondering difficult decisions on barely visible disks; just score the test conservatively and revisit the scoring in the unlikely event the final score is below passing.” -Large Phantom Guidance Document, ACR, 2005 |
| Choice A: | Call your service engineer immediately – the scanner is broken. |
| Choice B: | Use a different head coil. |
| Choice C: | A well-functioning 3T should pass this test easily. More scrutiny is advised. |
| Choice D: | No problem – we passed according to ACR specs (≥37). Move along. |
| Question 5: According to the 2017 ACR CT Quality Control Manual how often should the standard deviation of a uniform water phantom be evaluated to ensure stability? |
| Reference: | 2017 Computed Tomography Quality Control Manual, American College of Radiology |
| Choice A: | Daily |
| Choice B: | Weekly |
| Choice C: | Monthly |
| Choice D: | Annually |
| Question 6: According to the 2017 ACR CT Quality Control Manual, following identification of streak artifacts on a CT scanner using a uniform water phantom, who should determine if the unit may continue to be used for clinical imaging? |
| Reference: | 2017 Computed Tomography Quality Control Manual, American College of Radiology |
| Choice A: | QC Technologist |
| Choice B: | CT Manager |
| Choice C: | CT Physicist |
| Choice D: | Physician |
| Choice E: | QC Team |
| Question 7: What clinical consideration limits the fluoroscopy pulse rate and imaging frame rate settings used in video fluoroscopic feeding studies? |
| Reference: | Cohen, M.D., Can we use pulsed fluoroscopy to decrease the radiation dose during video fluoroscopic feeding studies in children? Clinical Radiology, 2009, Vol 64, Issue 1, 7073. https://doi.org/10.1016/j.crad.2008.07.011 |
| Choice A: | Patient radiation dose |
| Choice B: | Procedure duration |
| Choice C: | Temporal resolution |
| Choice D: | Visibility of low contrast structures |
| Question 8: Based on definitions from AAPM TG 116 and IEC 62494-1, what is the expected deviation index (DI) value when an acquired radiographic exposure index (EI) is equal to the Target EI? |
| Reference: | AAPM Task Group 116: “An Exposure Indicator for Digital Radiography” (2009)
AAPM Task Group 232: “Current state of practice regarding digital radiography exposure indicators and deviation indices” (2018) |
| Choice A: | -1 |
| Choice B: | 0 |
| Choice C: | 1 |
| Choice D: | 10 |
| Question 9: The input data format for an RDIM system that is the most consistent and standardized (but least flexible) is: |
| Reference: | AAPM Medical Physics Practice Guideline 6.a: Performance Characteristics of Radiation Dose Index Monitoring Systems.
www.dicomstandard.org |
| Choice A: | Radiation Dose Structured Report (RDSR) |
| Choice B: | DICOM image data file headers |
| Choice C: | Optical Character Recognition (OCR) of screen captures of dose reports |
| Choice D: | Modality Performed Procedure Step (MPPS) |
| Choice E: | Manual Entry |
| Question 10: Which RDIM output metrics are estimated values dependent on assumptions, models, and methods used and should not be applied to individuals? |
| Reference: | ICRP 103, 2007 Recommendations of the International Commission on Radiological Protection
Fisher/Fahey - Appropriate use of Effective Dose in Radiation Protection and Risk Assessment, Health Phys. 2017 |
| Choice A: | CTDIvol, Dose Length Product (DLP) |
| Choice B: | Air Kerma (AK), Dose Area Product (DAP) |
| Choice C: | Mean Glandular Dose (MGD), Entrance Skin Exposure (ESE) |
| Choice D: | Effective Dose (ED), Organ Dose, Peak Skin Dose |
