| Question 1: Which of the below is correct regarding radiation dose of CEM? |
| Reference: | Phillips J, Mihai G, Hassonjee SE, Raj SD, Palmer MR, Brook A, Zhang D. Comparative Dose of Contrast-Enhanced Spectral Mammography (CESM), Digital Mammography, and Digital Breast Tomosynthesis. AJR Am J Roentgenol. 2018 Oct;211(4):839-846. doi: 10.2214/AJR.17.19036. Epub 2018 Jul 31. PMID: 30063367. |
| Choice A: | CEM is above the 3mGy FDA limit for most women |
| Choice B: | CEM dose is higher than combination 2D+ DBT |
| Choice C: | CEM dose is higher with fatty breasts |
| Choice D: | CEM dose is related to compressed thickness |
| Question 2: CEM compares to other modalities in which way? |
| Reference: | Sumkin, J.H., Berg, W.A., Carter, G.J., Bandos, A.I., Chough, D.M., Ganott, M.A., Hakim, C.M., Kelly, A.E., Zuley, M.L., Houshmand, G. and Anello, M.I., 2019. Diagnostic performance of MRI, molecular breast imaging, and contrast-enhanced mammography in women with newly diagnosed breast cancer. Radiology, 293(3), pp.531-540. |
| Choice A: | CEM has more false negatives than DBT. |
| Choice B: | CEM has fewer false positives than MRI. |
| Choice C: | CEM finds more cancers than MRI. |
| Choice D: | CEM is less accurate for cancer extent than US. |
| Question 3: Which of the below is correct for the use of ABUS for screening? |
| Reference: | Vourtsis A. Three-dimensional automated breast ultrasound: Technical aspects and first results. Diagn Interv Imaging. 2019 Oct;100(10):579-592. doi: 10.1016/j.diii.2019.03.012. Epub 2019 Apr 5. PMID: 30962169. |
| Choice A: | ABUS is associated with fewer artefacts than handheld ultrasound |
| Choice B: | ABUS increases the specificity of mammographic screening |
| Choice C: | ABUS detects about 4/1000 cancers in women after a negative screening mammogram |
| Choice D: | ABUS evaluation by artificial intelligence is equal to human interpretation |
| Question 4: Which type of imaging has the highest sensitivity for breast cancer? |
| Reference: | Mann RM, Hooley R, Barr RG, Moy L. Novel Approaches to Screening for Breast Cancer. Radiology. 2020 Nov;297(2):266-285. doi: 10.1148/radiol.2020200172. Epub 2020 Sep 8. PMID: 32897163. |
| Choice A: | Morphological imaging |
| Choice B: | Functional imaging based on tissue stiffness |
| Choice C: | Functional imaging based on tissue perfusion |
| Choice D: | Functional imaging based on metabolism |
| Question 5: In contrast-enhanced mammography (CEM), what is the purpose of the copper or titanium filter used in the high-energy acquisition? |
| Reference: | William F. Sensakovic, Molly B. Carnahan, Christopher D. Czaplicki, Samuel Fahrenholtz, Anshuman Panda, Yuxiang Zhou, William Pavlicek, and Bhavika Patel. Contrast-enhanced Mammography: How Does It Work? RadioGraphics 2021. DOI: 10.1148/rg.2021200167. |
| Choice A: | To shield the patient from high-energy X-rays, making the exam more dose efficient. |
| Choice B: | To attenuate lower-energy X-rays so that most X-rays in the spectrum have energies just above the k-edge of iodine. |
| Choice C: | To filter X-rays between the two detector layers to produce two images that have different energy weightings, allowing digital subtraction. |
| Question 6: For facilities using the ACR Digital Mammography Quality Control Manual (2018) and performing contrast-enhanced mammography (CEM), the FDA has determined: |
| Reference: | American College of Radiology. The American College of Radiology Digital Mammography QC Manual: Frequently Asked Questions, revised 3 Mar 2019. https://www.acraccreditation.org/-/media/ACRAccreditation/Documents/Resources/DMQC/DMQCFAQs.pdf |
| Choice A: | Quality control for CEM must follow the CEM section of the 2018 ACR Manual (2020 update). |
| Choice B: | The addition of CEM means that the quality control for the entire system must follow the manufacturer’s quality control manual. |
| Choice C: | The 2018 ACR manual may be used for 2D and/or tomosynthesis, and the manufacturer’s quality control procedures may be used for contrast enhancement applications. |
| Question 7: How does uniformity testing on MBI differ from that on a conventional gamma camera? |
| Reference: | Nardinger SM, Tran TD, Swanson TN, Ellingson LR, Solberg CM, O’Connor MK, Hruska CB. Guidelines for Quality Control Testing of Molecular Breast Imaging Systems. J Nucl Med Techol 2018; 46:349-354. DOI: 10.2967/jnmt.118.209221 |
| Choice A: | The passing criteria for MBI uniformity is stricter than a conventional system |
| Choice B: | MBI uniformity testing should be performed more frequently than with a conventional system |
| Choice C: | MBI uniformity maps should only be made with the collimator removed |
| Choice D: | MBI uniformity maps made with Co-57 sources are more susceptible to high-energy contaminants that create artifacts |
| Question 8: How is spatial resolution assessment on MBI systems different from that on a conventional gamma camera? |
| Reference: | Nardinger SM, Tran TD, Swanson TN, Ellingson LR, Solberg CM, O’Connor MK, Hruska CB. Guidelines for Quality Control Testing of Molecular Breast Imaging Systems. J Nucl Med Techol 2018; 46:349-354. DOI: 10.2967/jnmt.118.209221 |
| Choice A: | Spatial resolution of a pixelated MBI detector does not change over time |
| Choice B: | Spatial resolution of a pixelated MBI detector does not change with distance from the detector |
| Choice C: | Spatial resolution of a pixelated MBI detector cannot be assessed with a bar phantom |
| Choice D: | Spatial resolution of a pixelated MBI detector cannot be assessed with a line source |
| Question 9: Which of the following statements is correct regarding the use of current commercial automated breast volume scanning (ABVS) systems? |
| Reference: | van Zelst JC, Mann RM. Automated three-dimensional breast US for screening: technique, artifacts, and lesion characterization. Radiographics. 2018 May;38(3):663-83. PMID: 29624482 DOI: 10.1148/rg.2018170162 |
| Choice A: | ABVS systems use lower frequency transducers than handheld ultrasound systems. |
| Choice B: | ABVS systems are limited to only B-mode imaging. |
| Choice C: | ABVS systems can obtain a single volumetric sweep within one breath hold. |
| Choice D: | Color flow imaging on ABVS systems accurately depicts 3D vascular structure of tumors. |
| Question 10: Which of the following statements is incorrect regarding the experimental automated breast volume scanning (ABVS) systems? |
| Reference: | van Zelst JC, Mann RM. Automated three-dimensional breast US for screening: technique, artifacts, and lesion characterization. Radiographics. 2018 May;38(3):663-83. PMID: 29624482 DOI: 10.1148/rg.2018170162 |
| Choice A: | An experimental ABVS system has demonstrated scanning rates consistent with single breath-hold imaging. |
| Choice B: | An experimental ABVS system has demonstrated 3D (quasi-static) strain elastography. |
| Choice C: | An experimental ABVS system has demonstrated shear wave elastography. |
| Choice D: | No experimental ABVS system has demonstrated slow flow microvascular imaging capabilities. |
