2022 AAPM 64th Annual Meeting
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Session Title: New Technologies in Breast Imaging
Question 1: Which of the following dual-energy technique provides the worst spectral separation for the low and high energy images?
Reference:Schmitzberger, F. F., et al. (2011). Development of Low-Dose Photon-counting Contrast-enhanced Tomosynthesis with Spectral Imaging. Radiology: 558-564
Choice A:Two separate exposures, 28 kVp W/Al for low energy, 49 kVp W/Cu for high energy
Choice B:Photon counting detector with two energy bins, 45 kVp with W/Al
Choice C:Dual layer detector (200 micron selenium + 200 micron selenium), 45 kVp with W/Al
Question 2: Which of the following statement is true regarding flat panel detectors when 28 kVp W/Al is used as low energy (LE) and 49 kVp W/Cu used as high energy (HE) spectra
Reference:Rowlands, J. A. and J. Yorkston (2000). Flat panel detectors for digital radiography. Medical Imaging: Volume 1 Physics and Psychophysics, Psychophysics. H. K. a. R. V. M. J Beutel. Bellingham, SPIE: 223-328
Choice A:With the same 200 micron thickness, CsI indirect detector has higher quantum efficiency (QE) than direct selenium detector for LE
Choice B:With the same 200 micron thickness, CsI indirect detector has higher QE than direct selenium detector for HE
Choice C:CsI indirect detector has higher spatial resolution than direct selenium detector when pixel size is 100 microns
Question 3: Cone-beam CT systems with multi-source configurations arranged as an array of sources parallel to the rotation axis can help in alleviating effects associated to incomplete sampling, such as:
Reference:A. E. Becker, A. M. Hernandez, P. R. Schwoebel, J. M. Boone (2020). Cone beam CT multisource configurations: evaluating image quality, scatter, and dose using phantom imaging and Monte Carlo simulations. Physics in Medicine and Biology 65, 235032
Choice A:Artifacts associated to beam hardening effects
Choice B:Shading and loss of resolution at slices far from the central slice, commonly known as cone-beam effects
Choice C:Artifacts associated to sparse angular sampling
Question 4: One of the benefits of multi-source array configurations for digital breast tomosynthesis is the removal of need for mechanical motion of the x-ray source during tomosynthesis image acquisition, resulting in shorter scan times. Long scan times are associated with
Reference:N. Tirada, G. Li, D. Dreizin, L. Robinson, G. Khorjekar, S. Dromi, T. Ernst (2019). Digital Breast Tomosynthesis: Physics, Artifacts, and Quality Control Considerations. Radiographics 39(2), 413-426
Choice A:Larger radiation dose
Choice B:Increased image noise
Choice C:Image blur and artifacts from patient motion
Question 5: Distributed x-ray source technologies include approaches based on “hot cathode” designs, based on thermionic electron emission, and approaches based on “cold cathode” designs, based on field emission technology. Sources based carbon nanotube (CNT) technology are an example of:
Reference:V. B. Neculaes, P. M. Edic, M. Frontera, A. Caiafa, G. Wang, B. De Man (2014). Multisource X-Ray and CT: Lessons Learned and Future Outlook. IEEE Access, vol. 2, pp. 1568-1585, 2014, doi: 10.1109/ACCESS.2014.2363949
Choice A:Hot cathode x-ray sources
Choice B:Cold cathode x-ray sources
Question 6: What are the historically considered main concern(s) with field emission sources that have hampered their application until recently?
Reference:B. Gonzales, D. Spronk, Y. Cheng, A. W. Tucker, M. Beckman, O. Zhou, J. LU (2014). Rectangular Fixed-Gantry CT Prototype: Combining CNT X-Ray Sources and Accelerated Compressed Sensing-Based Reconstruction. IEEE Access, vol. 2, pp. 971-981, 2014, doi: 10.1109/ACCESS.2014.2351751
Choice A:High cost
Choice B:Tube lifetime and maximum power
Choice C:Capability to be arranged in array configurations
Question 7: The accuracy or suitability of mammography for screening is often limited for women:
Reference:International Agency for Research on Cancer. IARC Handbooks of Cancer Prevention, Volum 15 Breast Cancer Screening [Internet]: International Agency for Research on Cancer, 2016. Available: http://publications.iarc.fr/Book-And-Report-Series/Iarc-Handbooks-Of-Cancer-Prevention/Breast-Cancer-Screening-2016 Nelson HD, O'Meara ES, Kerlikowske K, et al. Factors associated with rates of false-positive and false-negative results from digital mammography screening: an analysis of registry data. Ann Intern Med 2016; 164:226–35.doi:10.7326/M15-0971 Alonzo-Proulx O, Mainprize JG, Harvey JA, Yaffe MJ. Investigating the feasibility of stratified breast cancer screening using a masking risk predictor. Breast Cancer Res. 2019 Aug 9;21(1):91 Yaffe MJ, Jong RA, Pritchard KI. Breast Cancer Screening: Beyond Mortality. Journal of Breast Imaging, Volume 1, Issue 3, September 2019, Pages 161–165.
Choice A:Who are at high risk due to certain mutations
Choice B:Under the age of 40
Choice C:With complex, dense patterns of fibroglandular tissue
Choice D:All of the above
Question 8: A potential advantage of “liquid biopsy” is that it
Reference:Croessmann S, Park BH. Circulating tumor DNA in early-stage breast cancer: new directions and potential clinical applications. Clin Adv Hematol Oncol. 2021 Mar;19(3):155-161. PMID: 33739964. Crosby, D. Delivering on the promise of early detection with liquid biopsies. Br J Cancer 126, 313–315 (2022). https://doi.org/10.1038/s41416-021-01646-w.
Choice A:Is a well-established method for detecting breast cancer
Choice B:Provides exquisite spatial localization
Choice C:May allow earlier detection and could identify multiple cancers at the same time
Question 9: Which of the following is true regarding screening mammograms?
Reference:Monticciolo DL, Newell MS, Hendrick RE, Helvie MA, Moy L, Monsees B, Kopans DB, Eby PR, Sickles EA. Breast Cancer Screening for Average-Risk Women: Recommendations From the ACR Commission on Breast Imaging. J Am Coll Radiol. 2017 Sep;14(9):1137-1143. doi: 10.1016/j.jacr.2017.06.001. Epub 2017 Jun 22. PMID: 28648873. Tabár L, Dean PB, Chen TH, Yen AM, Chen SL, Fann JC, Chiu SY, Ku MM, Wu WY, Hsu CY, Chen YC, Beckmann K, Smith RA, Duffy SW. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer. 2019 Feb 15;125(4):515-523. doi: 10.1002/cncr.31840. Epub 2018 Nov 8. PMID: 30411328; PMCID: PMC6588008
Choice A:Sensitivity of digital mammography is unaffected by breast density.
Choice B:Screening detected cancers have poorer prognosis than clinically detected ones
Choice C:Women who have participated in mammography screening have greater benefit from the therapy available at the time of diagnosis than do those who have not participated
Choice D:Screening mammography only benefits women over 50 years of age
Question 10: An advantage of DBT over DM in screening is
Reference:Skaane, P., et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 267, 47-56 (2013). Ciatto, S., et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 14, 583-589 (2013).
Choice A:Decreased architectural distortion detection
Choice B:Improved calcification detection
Choice C:Increased recall rates
Choice D:Increase in cancer detection
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