THE TUFFEST STUFF CT REGISTRY REVIEW WORKBOOK #1

SYMPOSIA SAMPLE NOT FOR SALE THE TUFFEST STUFF CT REGISTRY REVIEW WORKBOOK #1 CT PHYSICS & RADIOLOGIC SCIENCE Crossword Puzzles Clues Answer keys Solutions Practice Quiz Items by Subject Matter Professional in scope Answer keys Answer explanations Mike Enriquez, MPA, BSRT (R)(CT) 2014

TABLE OF CONTENTS SYMPOSIA SAMPLE NOT FOR SALE A. Crossword Puzzles a. Basic CT Physics b. CT Data Management c. Quality Assurance d. Image Quality e. CT X-ray Tube f. Tough CT Terms g. Contrast Media B. Practice Tests a. Radiologic Science Physics b. CT Principles c. CT Data Acquisition d. The CT Imaging Chain e. CT Image Display f. Contrast Media g. Image Reconstruction

About the Workbook The Tuffest Stuff CT Registry Review The Workbook is composed of content specific crossword puzzles that uniquely provide a medical terminology experience linked with a vocabulary review. The manner in which the terms and definitions are arrived at promotes a learning experience that I describe as affirmation. I believe the crossword puzzle technique promotes term retention in a valuable way. Not only will correct answers be chosen but incorrect answers will more readily be rejected from selection attributable to each students improved vocabulary. The practice test items stress knowledge in CT fundamentals including the physics of image production as applied to the CT imaging chain. The practice test items are originally authored and serve as an effective review of the most science related CT topics. In the completed version shared with the seminar and online answer explanations are also included some with live lecture video I love the physics of CT!...and so will you! Assisting your understanding of what goes on with all of the functions associated with CT image production will be an amazing experience for both of us. It never gets old for me! About the Live Lecture Seminar The Tuffest Stuff CT Registry Review Everywhere I travel to present The Tuffest Stuff live lecture seminar I have the opportunity to interact with Radiologic Technologists who are seeking to improve their professional credentials. It is a moving experience and it is very much fun! My Tuffest Stuff seminar sessions are always lively and filled with interactivity. Because my CT background is much more academic than clinical I encourage the sharing of protocol details in particular. It is a talent of mine to entertainingly and meaningfully explain the linkage between the most basic of CT fundamentals with the latest scanning techniques! Always in my audiences are RT s who work with a variety of equipment and scanner generations. Commencing summer, 2013, I am pleased to announce that during the last 4 hour session of The Tuffest Stuff a live CT registry exam experience will be possible for each RT in attendance. With Wi-fi, HotSpot technology I am able to offer a live registry experience to those equipped with a tablet or notebook. Those not so computer equipped will be able to take the same exam as projected via Power Point. Everyone gets to benefit from the shared discussion of the question answers. Register today at a Tuffest Stuff CT Registry Review Seminar! www.radprof.com -MAE May 28, 2013

The Tuffest Stuff CT Registry Review CT System Principles, Operation and Components- Part 2 2012/2013 1. Which of the following statements is false? a. The elimination of superimposed structures is a distinct advantage of CT over plain film imaging. b. CT images possess superior quality. c. Contrast resolution is approximately 10x better with CT compared to plain film imaging. d. Spatial resolution is approximately 10x better with CT compared to plain film imaging. 2. Which type of beam coverage will result in the greatest production of scatter radiation? a. Fan beam b. Pencil beam c. Area beam d. Cone beam 3. Which type of beam coverage is typical of SDCT systems? a. Fan beam b. Pencil beam c. Area beam d. Cone beam 4. Which type of beam coverage is typical of MDCT systems? a. Fan beam b. Pencil beam c. Area beam d. Cone beam 5. An increase in which of the following will result in an increase in scatter radiation production? i. kvp ii. layer thickness iii. field size a. 1 only b. 2 & 3 only c. 1 & 2 only d. 1, 2 & 3

6. Which of the following describes the preliminary CT image? i. Scanogram ii. Topogram iii. Pilot iv. Scout a. 1 thru 4 b. 2,3 & 4 c. 1,2 & 3 d. 1, 2 & 4 7. Translate-Rotate is in reference to which of the following generations of CT geometries? i. First ii. Second iii. Third iv. Fourth a. 1 thru 4 b. 1 & 2 only c. 3 only d. 4 only 8. Which of the following statements is TRUE regarding the voxel? a. Voxels are what we look at on the image display monitor. b. Each voxel is assigned or designated a specific shade of density for each CT image. c. Selecting the correct voxel leads to selecting the correct slice thickness. d. Unlike a pixel a voxel possesses a Z axis. 9. Photons that pass through objects unimpeded are represented by a area on the image and a(n) CT number. a. Gray ; high b. Black ; low c. White ; low d. Black ; high 10. With regard to attenuation, the quantity of photon interaction depends on which of the following? i. Object/part thickness ii. The density of the object iii. The atomic number of the object iv. kvp a. 1 thru 3 only b. 4 only c. 3 & 4 only d. 1 thru 4

11. Which of the following structures possesses the ability to attenuate radiation the greatest? a. Air b. Muscle c. Bone d. Soft tissue 12. Which of the following structures is represented by the highest Hounsfield Unit? a. Air b. Muscle c. Bone d. Soft tissue 13. Which of the following HU values would be typical of a metallic pacemaker? a. 2000 b. 1000 c. -500 d. -2500 14. The process in CT by which different tissue attenuation values are averaged to produce one less accurate pixel reading is most likely defined as which of the following? a. Interpolation b. Extrapolation c. Volume averaging d. Beam hardening 15. Which of the following pieces of CT hardware is principally responsible for determining slice thickness when the system is SDCT? a. Pre-detector collimator b. Pre-patient collimator c. The cone beam collimator d. The fan beam collimator 16. From the choices below, please select the best way to minimize the problem associated with Partial Volume Averaging. a. Select an alternative algorithm b. Increase the slice thickness c. Decrease the slice thickness d. Increase procedure ma 17. The data collected by the detector system is most likely called which of the following? 1. scan data 2. Image data 3. Raw data a. 2 only b. 3 only c. 1 & 3 only d. 1 & 2 only

18. Segmentation and averaging of the data results in what kind of data? 1. scan data 2. Image data 3. Raw data a. 2 only b. 3 only c. 1 & 3 only d. 1 & 2 only 19. As associated with which of the following, does raw data become image data? a. The detector system b. The ADC c. The DAS d. The voxel 20. Which imaging plane divides the body into equal anterior and posterior portions? a. the MSP b. the MCP c. the Axial d. the Oblique Developed by Mike Enriquez Answer Key 1. d 2. d 3. a 4. d 5. d 6. a 7. b 8. d 9. b 10. d 11. c 12. c 13. a 14. c 15. b 16. c 17. c 18. a 19. b 20. b

1 2 3 4 Image Quality- Part A 5 6 7 8 9 10 11 12 13 14 15 16 Across: 2 - resolution in the xy direction 6 - resolution in the z direction 8 - controls beam penetration 10 - "outliers" 11 - how rapidly data are acquired 12 - undesirable fluctuation of pixel values 14 - insufficient data 16 - ability to differentiate gray shades Down: 1 - controls photon quantity 3 - data sampling for digitization 4 - from raw to image 5 - more data than noise 7 - determines quantity of raw data used for reconstruction 9 - DFOV / matrix size 10 - defines area from which raw data are acquired 13 - ability to resolve small objects 15 - ratio of image accuracy vs. object scanned DFOV, in-plane, kvp, longitudinal, low-contrast, ma, MTF, noise, Nyquist, pixel size, quantum noise, reconstruction, SFOV, SNR, spatial, standard deviation, temporal [Type text] [Type te

Solution Image Quality- Part A M I N - P L A N E R Y E Q C U S L O N G I T U D I N A L N S F R S T O T K V P R P U S T A N D A R D D E V I A T I O N C F X T E M P O R A L E I V L O S N O I S E I P Z Q U A N T U M N O I S E E T T I F A L O W - C O N T R A S T DFOV, in-plane, kvp, longitudinal, low-contrast, ma, MTF, noise, Nyquist, pixel size, quantum noise, reconstruction, SFOV, SNR, spatial, standard deviation, temporal [Type text] [Type te

Image Quality- Part A DFOV, in-plane, kvp, longitudinal, low-contrast, ma, MTF, noise, Nyquist, pixel size, quantum noise, reconstruction, SFOV, SNR, spatial, standard deviation, temporal [Type text] [Type te

Contrast Agents in CT- Part 1 1 2 3 4 5 6 7 8 9 10 11 Across: 2 - high osmolality CM 5 - normal adult: 120 ml/minute 7 - reactions that are not dose dependent 8 - same number of particles 9 - hypertonic 11 - inability of kidney to maintain homeostasis Down: 1 - excretion of CM via the kidneys 3 - number of particles in solution per unit volume liquid 4 - thickness or friction of the fluid as it flows 6 - low osmolality CM 7 - degree to which molecules separate into charged particles 10 - normal = 500 ml/minute Possible Answers: clearance, ERPF, GFR, HOCM, hyperosmolar, idiosyncratic, ionicity, isotonic, LOCM, osmolality, renal dysfunction, viscosity

Contrast Agents in CT- Part 1, Solution C L H O C M E S A M V G F R O I L A L S I D I O S Y N C R A T I C O C C L O N M E I S I T I C Y T I S O T O N I C Y T H Y P E R O S M O L A R R P R E N A L D Y S F U N C T I O N Possible Answers: clearance, ERPF, GFR, HOCM, hyperosmolar, idiosyncratic, ionicity, isotonic, LOCM, osmolality, renal dysfunction, viscosity

The Tuffest Stuff CT Registry Review Data Acquisition in Computed Tomography 2012/2013 Developed by Mike Enriquez 1. Which of the following is NOT housed in the gantry? 1. X-ray source 2. Cooling system 3. Generator 4. Slip ring system 5. Collimation system 6. Detector system a. 3 & 6 only b. 1, 3 & 6 only c. 1, 2 & 4 only d. 1 thru 6 ARE housed in the gantry 2. The process of moving the table by a specified measure is best expressed by which of the following terms? a. incrementation b. couch slip c. aperture advancement d. slip ring metric 3. Regarding weight restriction specifications, which of the following statements is TRUE? a. Accurate table referencing depends on accurately locating anatomic sites. b. CT table movement is set in mm/sec. c. Heavy patients have a greater impact on small increment table movements compared to those 5 mm or larger. d. Heavy patients have a greater impact on large increment table movements comparted to those 3 mm or larger. 4. Which of the following permits the gantry frame to rotate continuously? a. The ADC b. Slip ring technology c. The generator d. 3 rd or 4 th generation geometry 5. Which of the following produces high voltage for the creation of x-ray photons? a. The ADC b. Slip ring technology c. The generator d. 3 rd or 4 th generation geometry

6. Which of the following is the most commonly used generator type used in modern MDCT? a. Single phase, high frequency b. 3 phase, 6 pulse c. 3 phase, 12 pulse d. Single phase, 2 pulse 7. Which of the following is the most common kilowatt rating for generators used in modern MDCT? a. 75 kw b. 100 kw c. 125 kw d. 150 kw 8. In modern MDCT, heat unit production occurs in units while dissipation occurs in units. a. MHU ; khu b. MHU ; MHU c. khu ; khu d. khu ; mhu 9. Which of the following is a function of the Pb filter used in modern MDCT? 1. Minimizes beam hardening artifact 2. Reduces radiation dose 3. Shapes the x-ray beam by removing low energy photons 4. Helps to control slice thickness a. 1 thru 4 b. 2 & 3 only c. 4 only d. 1 thru 3 only 10. Which of the following is a function of the system of collimation in modern MDCT systems? 1. Restricts the beam to a specific area 2. Reduces the production of scatter radiation 3. Improves contrast resolution 4. Assists in controlling slice thickness 5. Can be used to minimize patient dose a. 1, 2, 4 & 5 only b. 1 thru 5 c. 3, 4 & 5 only d. 1, 2, 3 only

11. Which of the following is most instrumental in determining dose profile? a. The filter b. The Pre-patient collimator c. The Pre-detector collimator d. The ADC 12. Which of the following is responsible for collecting information regarding the degree to which each anatomic structure attenuates the beam? a. The ADC b. The filter c. The collimation system d. The detector system 13. Which of the following is NOT characteristic of Solid-state crystal detectors compared to Xenon gas detectors? a. Crystal detectors absorb 60-80% of the incident photons b. Crystal detectors may produce a brief afterglow c. Crystals have a higher photon absorption coefficient d. Crystals are more sensitive to temperature and moisture fluctuations 14. Which of the following is the device that transforms light energy (E) into electrical energy? a. Xenon gas detector b. Solid-state crystal photodiode detector c. both detector types operate by transforming light E to electrical E d. neither detector types operate by transforming light E to electrical E 15. For modern MDCT, which of the following is the most commonly used geometry? a. first b. second c. third d. fourth e. fifth 16. Which of the following beam types is utilized for modern MDCT? a. cone b. fan c. pencil d. area 17. Which of the following beam types is responsible for the greatest production of scatter radiation in an MDCT procedure? a. cone b. fan c. pencil d. area

18. Pencil beam scanning is a technological advancement most closely associated with which generation of CT scanner? a. first b. second c. third d. fourth e. fifth 19. Which of the following geometries is most commonly utilized in modern MDCT? a. first b. second c. third d. fourth e. fifth 20. The term used to describe the movement of the x-ray tube across the anatomy of interest is most likely which of the following? a. Translate b. Rotate c. Nutating d. Referencing 21. Rectilinear multiple pencil beam scanning, refers to which generation of CT scanner? a. first b. second c. third d. fourth e. fifth 22. Which of the following terms is consistent with the collection of attenuation data sampled one time by the computer? a. Ray b. View c. Projection d. none of the above 23. Possessing a rotating fan beam that rotates within a stationary ring of detectors most likely describes which of the following CT geometries? a. first b. second c. third d. fourth e. fifth

24. Which CT geometry was the first system to employ an advanced method of pre- & post-patient collimation? a. first b. second c. third d. fourth e. fifth 25. With which CT geometry is ring artifact most closely associated? a. first b. second c. third d. fourth e. fifth 26. With which CT geometry is nutating most closely associated? a. first b. second c. third d. fourth e. fifth 27. With which of the following is inter-scan delay a primary factor? a. volumetric scanning b. axial scanning c. helical scanning d. spiral scanning 28. Which of the following is accurately associated with the Data Acquisition System (DAS)? 1. The DAS is positioned within the gantry near the detectors 2. Within the DAS the analog signal from the detector is converted into a digital signal. 3. Within the DAS, photons that pass through the patient and strike the detector are measured. a. 3 only b. 1 & 2 only c. 2 & 3 only d. 1 thru 3 29. Which term best applies when a patient is positioned on the table, an anatomic landmark is noted and the table readout is set to zero? a. incrementation b. indexing c. referencing d. scannable range

30. The degree to which a table can move horizontally is best described by which of the following? a. incrementation b. indexing c. referencing d. scannable range ANSWER KEY 1. d 2. a 3. c 4. b 5. c 6. a 7. b 8. a 9. d 10. b 11. b 12. d 13. a 14. b 15. c 16. a 17. a 18. a 19. c 20. a 21. b 22. c 23. d 24. c 25. c 26. d 27. b 28. d 29. c 30. d

The Tuffest Stuff CT Registry Review Image Display in Computed Tomography 2012/2013 1. Which of the following determines the number of HU s represented on a specific image? a. Window level b. Window center c. Window width d. both a & b 2. Which of the following is used to select the middle CT value of the maximum number of HU s selectively available? a. Window level b. Window center c. Window width d. both a & b 3. With regard to window width, which of the following statements is TRUE? 1. The wider the width, the longer the scale 2. Values higher than the selected range will be black 3. The narrower the width, the shorter the scale 4. Values lower than the selected range will be white a. 1 thru 4 b. 1 & 3 only c. 2 & 4 only d. 1, 2 & 3 4. Which of the following is used to select the range of HU visualized? a. Window level b. Window center c. Window width d. both a & b

5. Which of the following is used to select the quantity of HU visualized? a. Window level b. Window center c. Window width d. both a & b 6. Which of the following determines which HU s are displayed as shades of gray? a. Window level b. Window center c. Window width d. both a & b 7. Calculate which HU s are displayed on the image as shades of gray if the WW is 250 and the WL is 50. a. 300 to 200 b. -175 to 75 c. -75 to 175 d. Not enough data to determine an accurate answer Use the diagram below to answer questions 8 & 9.

8. Which of the following represents the WL? a. 50 b. 200 c. 350 d. 300 9. Which of the following represents the WW? a. 50 b. 200 c. 350 d. 300 Use the image below for 10. 10. With which image is the WW wider? a. image A b. image B c. neither has a wide window d. both have a wide window

11. The ability of a CT system to portray a given number of shades of gray is expressed as which of the following? a. Dynamic range b. Spatial resolution c. Contrast resolution d. Modulation Transfer Function 12. Which of the following is a helical advantage? 1. lesion shifting is minimized or eliminated 2. exam acquisition time is minimized 3. MPR and 3D reconstruction data quality is minimized 4. shorter scan times may result in reduced IV contrast a. 1 thru 4 b. all except 3 c. all except 4 d. 2, 3 & 4 only Answer key: 1. c 2. d 3. b 4. d 5. c 6. d 7. c 8. b 9. d 10. b 11. a 12. b