Term
What is the artifact present in this image?
[image]
a) The image illustrates motion on the scan
b) This patient has a current fracture
c) The forearm is not straight and should be repositioned
d) There is a metal foreign object, such as a bracelet |
|
Definition
a) The image illustrates motion on the scan
This image illustrates classic motion on the forearm scan. The forearm scan is the most sensitive to motion and the tech must make every effort to keep the patient from moving during scan acquisition. |
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Term
What should a tech do in the scenario where the scan shows surgical hardware as seen in the image?
[image]
a) Scan other hip for DXA study
b) Scan the forearm if both hips have hardware
c) Delete scan because it is not clinically useful
d) All of the above |
|
Definition
d) All of the above
All of the above. A hip with surgical hardware cannot be used in a bone density study. |
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Term
Serial scanning is part of clinical management of patients with osteoporosis. How does the technologist insure adequate results?
a) Follow up scans must be done on the same scanner
b) Follow up scans must be performed with same scan speed and positioning devices
c) The technologist must understand the relationship between LSC and precision on scanner
d) All the above |
|
Definition
d) All the above
Each point presented in this question is relevant to serial scanning. Serial scans are the best way to determine how effective drug therapy is for the patient. However, in order for serial scans to be clinically useful, the precision assessment must be preformed and the LSC must be determined. |
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Term
True or False
When performing a follow up (serial) scan, the technologist should use the compare or copy feature in the scanner's software. |
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Definition
True
This is true. The software is designed to provide a comparison against previous scans. The radiologist will have the current and previous BMD at hand when interpreting the study. |
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Term
If a patient states there is a possibility of pregnancy, what is the appropriate response?
a) Postpone DXA exam until pregnancy is ruled out.
b) Perform exam with pelvic shielding
c) Perform exam as normal, no action is required
d) Call patient's ordering physician to get direction |
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Definition
a) Postpone DXA exam until pregnancy is ruled out.
Postpone the exam until pregnancy is ruled out. Bone density studies are not "stat" exams so there is no good reason to risk radiation exposure if pregnancy is possible. |
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Term
True or False
A technologist can make the decision to decide if an ordered exam is necessary or not. |
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Definition
False
It is not in the scope of practice to determine if an ordered exam is necessary or not. The technologist must contact the ordering physician with any concerns. |
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Term
What action must be taken to correct this scan?
[image]
a) Adjust the vertebral markers.
b) Select proper site for scan and rescan.
c) Adjust the bone edges and rescan.
d) Internally rotate the femur 5 inches more. |
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Definition
b) Select proper site for scan and rescan.
The only way to correct the scan is to select proper scan for site and rescan. The software cannot change the site once the scan is complete. |
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Term
What is an example of a removable storage device?
a) External hard drive
b) CD
c) DVD
d) All the above |
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Definition
d) All the above
Each of the these choices are examples of external storage media. Even with network archiving, the files should copied onto removable storage. |
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Term
For a bone density study, how should the femur be oriented?
a) In natural position where femur curves in
b) Knees up on the positioning block
c) Femur shaft should be straight and parallel to the table edge
d) In a lateral position |
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Definition
c) Femur shaft should be straight and parallel to the table edge
The femur should be straight and parallel to the table edge. This can be achieved by gently pulling the thigh outward and away from centered position. |
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Term
True or False
HIPAA mandated that protected patient information remain protected co not apply to bone density studies. |
|
Definition
False
This answer is false. HIPAA mandates all patient information remains protected. There are no exceptions based on the type of medical care. |
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Term
True or False
DXA scans are invasive procedures. |
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Definition
False
DXA scans are not invasive procedures which helps set a patient ease. It also makes the scan quick and painless. |
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Term
The T-Score is a standard score. Why is this significant?
a) There is no significance. It is just a simplified method of expressing risk.
b) Standard scores are expressed as standard deviations.
c) Standard scores signify how many standard deviations, above or below the mean, a specific value lies.
d) All the above
e) B and C only |
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Definition
e) B and C only
T-Scores and Z-Scores are expressed as standard scores and signify how many standard deviations a specific value (a patient's BMD) lies from the mean (reference database) |
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Term
All serial scans must be consistent with the baseline scan. What extra step must be taken to insure an accurate follow up hip scan?
a) Follow up scan should always be performed on fast scan mode.
b) It is not necessary to use the copy or compare function when doing serial hip scans
c) The femur rotation, shaft and centering must match the baseline scan as closely as possible
d) The neck box is not used in subsequent scans |
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Definition
c) The femur rotation, shaft and centering must match the baseline scan as closely as possible
Special care must be taken to match the femur rotation, shaft and centering to the baseline scan. The neck box should also match in size and shape. |
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Term
What are the most common sites for BMD measurement using DXA technology?
a) Heel and forearm
b) Spine and proximal femur
c) Forearm and proximal femur
d) Spine and heel
The most common sites for BMD measurement is the spine and proximal femur. |
|
Definition
b) Spine and proximal femur
The most common sites for BMD measurement is the spine and proximal femur. |
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Term
True or False
A bone density technologist is considered a covered entity and are allowed access to PHI in order to provide the proper level of patient care. |
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Definition
True
This statement is true. Under HIPAA rules, covered entities are allowed access to PHI. |
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Term
Adequate calcium and vitamin D is important in preventing or managing osteoporosis. What is the recommended daily inake?
a) 800 mg calcium and 1600 IU vitamin D per day
b) Only what can be eaten in a normal diet each day
c) 400-800 IU vitamin D and 1200-1500 mg calcium per day
d) 2500 mg calcium and 2500 IU vitamin D per day |
|
Definition
c) 400-800 IU vitamin D and 1200-1500 mg calcium per day
1200-1500 mg of calcium and 400-800 IU vitamin D is the recommended amount each day. While meeting these requirements through daily diet is optimal, it is often not achievable. Supplements can help insure adequate intake. |
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Term
True or False
When performing a Whole Body Composition scan, the technologist does not have to remove external artifacts, such as jewelry or underwire bras. |
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Definition
False
This statement is false. The external artifacts should be removed and any internal artifacts should be noted on history sheet. |
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Term
True or False
Fan-beam or array scanners have a broader, fan shaped beam. Scanning occurs line by line and scan times are shorter. |
|
Definition
True
This statement is true. The beam is wider, scan times are usually under 1 minute and image resolution is higher. |
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Term
What is the primary concern with scans that yield falsely elevated BMD?
a) There may be underlying pathologies that need attention
b) False BMD elevations can mask osteoporosis
c) False BMD readings are not possible
d) False BMD readings indicate a technical problem with the scanner |
|
Definition
b) False BMD elevations can mask osteoporosis
The primary concern with scans that have falsely elevated BMD readings is the possibility that osteoporosis will be overlooked. |
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Term
What is the synchronized order of the bone remodeling cycle?
a) Activation, resorption and formation
b) Formation, activation and resorption
c) Activation, destruction, reconstruction
d) Resorption, restoration, activation |
|
Definition
a) Activation, resorption and formation
The synchronized cycle of bone remodeling is activation, resorption and formation. |
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Term
What are the advantages of including a VFA in a DXA study?
a) Lower radiation dose than regular X-rays
b) Fractures and deformities are best seen in the lateral view
c) In fan array DXA spine image, the C-arm travels along the spine allowing the beam to remain perpendicular to produce an image with clear visualization of the vertebral end plates without distortion
d) All the above |
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Definition
d) All the above
Each answer choice is a valid advantage of including VFA in a study when indicated. Patients who suffer from height loss or have a history of fracture over the age 50 are candidates for VFA. |
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Term
True or False
The computer that is used with DXA scanner must be dedicated for use only with that scanner. |
|
Definition
True
The computer that runs the software for the DXA scanner must be dedicated to that specific scanner and not be used for other applications. |
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Term
What does ALARA stand for?
a) As Low as Reasonably Achievable
b) Apply Little as Radiographically Applicable
c) Acronym to check exposure factors
d) As long as reasonably accepted |
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Definition
a) As Low as Reasonably Achievable
ALARA stands for "As Low as Reasonably Achievable" and is a radiation protection acronym. ALARA is based on the principle that unnecessary radiation exposure is not acceptable, even in osteoporosis. |
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Term
Name the concepts of radiation protection for the technologist.
a) Time, distance and shielding
b) Monitoring occupational dose (maximum is 50 mSv per year for radiation worker)
c) Wear a personal dosimeter (technologist)
d) All the above |
|
Definition
d) All the above
Time, distance and shielding are the biggest factors for technologists performing DXA scans. Choosing the shortest scan time that is appropriate for the patient and staying a distance of 1 meter away from DXA table are generally acceptable. Shielding is seldom necessary. |
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Term
A patient history questionnaire is an important tool for both the technologist and reading physician. What questions should be asked?
a) Patient demographics, fracture history, risk factors
b) Patient blood type, blood pressure reading, date of last menstrual period
c) Date of last physical exam, accurate listing of all medications the patient is taking
d) Gastrointestinal health history, dairy allergies the patient may have |
|
Definition
a) Patient demographics, fracture history, risk factors
Patient demographics, fracture history, risk factors are among the questions that should be on the history sheet. Current and past medications that are relevant to bone health or known to cause bone loss and lifestyle factors should also be included. |
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Term
True or False
The technologist should analyze the study first to ensure images are ready for the reading physician before sending the scan for interpretation. |
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Definition
True
The technologist should analyze the study first to ensure images are ready for the reading physician before sending the scan for interpretation. |
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Term
The NHANES III database only references the proximal femur. Where does the reference data for other sites come from?
a) The World Health Organization
b) The CDC
c) Provided by manufacturer
d) A database comprised of patients from specific facility that houses the DXA scanner |
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Definition
c) Provided by manufacturer
Each manufacturer supplies reference databases for sites other than proximal femur. Most reference databases are created with Caucasian,uniform and non race adjusted but are gender specific. |
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Term
When should a precision assessment be performed?
a) Following the installation of a new DXA system
b) With newly hired technologists
c) After a new technologist has learned basic scanning skill and completed 100 scans
d) All the above |
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Definition
d) All the above
Precision assessment should be preformed following all the above events. |
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Term
What role does a network play in bone density exams?
a) Allows scan images to be pushed to PACS
b) Keeps facilities connected, streamlined and allows for the expedited transfer of images between work stations and reading stations
c) Allows the reading physicians to review and report studies efficiently
d) All the above |
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Definition
d) All the above
Networks play a valuable role in bone density and workflow. The images can be sent to the physician for efficient interpretation, the facilities can stay connected and PACS can be accessed. |
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Term
Why should the block be the same height on serial PA spine scans as was used for baseline scan?
a) To insure all variables are as closely matched to the original scan as possible
b) It is not to necessary to use a positioning block that is the same height as baseline scan
c) The patient's health insurance may not cover the scan if different equipment is used.
d) The positioning block is not an important part of the PA spine scan and is optional |
|
Definition
a) To insure all variables are as closely matched to the original scan as possible
Serial scans must be performed with variables that are as closely matched to the original variables as possible. If there are too many changes, it will be difficult to determine if changes in the BMD are true or not. |
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Term
Baseline lumbar spine analysis must include:
a) Verified patient biographical information
b) Manual adjustment of gray-scale, brightness or contrast if needed
c) L1-L4 vertebrae must be clearly separated at the disc spaces and labeled correctly
d) All the above |
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Definition
d) All the above
It is very important that the technologist insures the baseline scan is accurate, complete and correct. Therefore all the above points must be included. |
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Term
Why is the principle of attenuation important in DXA scanning?
a) Attenuation is largely influenced by the tissue the X-Ray beam passes through.
b) Tissues with higher density contain more electrons so the intensity of the beam is affected as it passes though (ex. bone)
c) Absorptiometry is then a method for measuring BMD using attenuation of a gamma or x radiation beam.
d) All the above |
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Definition
d) All the above
Attenuation is responsible for the behavior of photons as they pass through the body. High density tissues, such as bone, will absorb more photons. Simple put, the number of photons that reach the detector influence the BMD. |
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Term
True or False
The questionnaire should not be sent to the radiologist. |
|
Definition
False
This statement is false. The questionnaire should always be sent to the reading doctor. |
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Term
True or False
A correctly positioned spine scan must have equal amounts of soft tissue on either side of the spine. |
|
Definition
True
This statement is true. It is important to be sure there are equal amounts of soft tissue on either side of the spine to get an accurate BMD. |
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Term
What is the purpose of the Bone Mass Measurement Act that was passed by Congress in 1997?
a) To legalize the use of dual-energy X-ray absorptiometry for bone density studies
b) The Act outlined the 5 circumstances in which Medicare would pay for bone densitometry
c) The Act is another aspect of HIPAA
d) The Act outlines protocols for drug companies who manufacture treatment medicines |
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Definition
b) The Act outlined the 5 circumstances in which Medicare would pay for bone densitometry
The Bone Mass Measurement Act outlined the 5 circumstances in which Medicare would pay for bone density studies. |
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Term
How many numbers should follow the decimal place (to the right) when expressing BMD in a numerical value?
a) One
b) Three
c) Two
d) Four |
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Definition
b) Three
The correct answer is three. BMD would be expressed numerically as 1.026 g/cm2. The T-score would have only one number following the decimal space. |
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Term
True or False
Typically, Medicare will cover a bone density measurement once every 23 months. |
|
Definition
True
This statement is true. Medicare will cover bone density studies every 23 months. There are two exceptions, long term glucocorticoid therapy and those with initial exams done with a technique that won't be used for monitoring. A second BMD study may be done quickly to establish a baseline before pharmacological treatment begins. |
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Term
Why is the manufacturer's positioning device used to position for the hip scan?
a) Insures the femur is straight
b) To keep toes pointing upright
c) To create optimal femur rotation of 15-25 degrees from the hip and helps patient maintain the rotation during scan
d) Prevent patient from straightening leg. |
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Definition
c) To create optimal femur rotation of 15-25 degrees from the hip and helps patient maintain the rotation during scan
The positioning device is used to insure optimal internal rotation of the femur. It also helps the patient maintain the position. |
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Term
The bones of the skeleton are differentiated in four ways. Which of the four is unique to densitometry?
a) Weight bearing or non weight bearing
b) Axial or appendicular
c) Central or peripheral
d) Cortical or trabecular |
|
Definition
c) Central or peripheral
Differentiating central from peripheral skeletal sites is unique to densitometry because central DXA units scan different sites than peripheral scanners. Central DXAs can scan the spine and proximal femur, giving better insight to the health of a patient's bones. |
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Term
The NHANES III is a result of a random sampling of the population, with _____________ or ________________ being the only exclusion.
a) People under age 30 and men over age 50
b) Prior vertebral fractures and premenopausal women
c) Individuals on steroid therapy and pregnancy
d) Prior hip fractures and pregnancy |
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Definition
d) Prior hip fractures and pregnancy
The NHANES III was built with the data of 7,116 men and women in the age range of 20-29, with the only exclusions being prior hip fracture and pregnancy. |
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Term
In addition to proper positioning, what else should the technologist look for when reviewing image?
a) No motion
b) No artifacts
c) Proper image contrast
d) All the above |
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Definition
d) All the above
In addition to proper positioning, there should be no motion, artifacts and the image should have proper contrast. |
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Term
What corrections must be taken to improve this scan?
[image]
a) Adjust the neck box position
b) Reanalyze the scan
c) Straighten femur and rotate internally
d) Roll patient 20 deg onto left hip |
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Definition
c) Straighten femur and rotate internally
To correct the positioning on the scan, the tech must straighten the femur so it is parallel to the table edge and rotate the femur internally to tuck the lesser trochanter behind the shaft. |
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Term
True or False
Some studies suggest 1 out of 4 men will suffer from broken bones related to osteoporosis. |
|
Definition
True
Osteoporosis affects men as well as women and 1 out of 4 men may suffer from fractures caused by osteoporosis. |
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Term
The technologist is responsible for patient safety during the DXA exam. How should the special needs patient be handled?
a) Always assist patient as needed according to disability
b) Special needs patients must be treated like any patient
c) A second person must be present during the entire exam
d) All the above |
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Definition
d) All the above
The technologist should always assist the patient as needed, according to disability. The tech should also note and remove (if possible) external medical devices and assess mental acuity. |
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Term
True or False
It is appropriate to use FRAX to monitor treatment response. |
|
Definition
False
It is not appropriate to use FRAX to monitor treatment response. The technologist should turn off the FRAX function if it is preset in the software. |
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Term
What is rare earth K-edge filtering?
a) An isotope used in SPA
b) A K-edge filter is employed is employed in some DXA scanners to split the beam into high and low energies
c) Material the detector is made of
d) The calibration phantom |
|
Definition
b) A K-edge filter is employed is employed in some DXA scanners to split the beam into high and low energies
Rare earth K-edge filters are used in DXA scanners that have a constant potential generator to split the beam into dual energies. |
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Term
What should a bone density technologist understand about HIPAA?
a) Originally passed in 1996 to require the standardization of electronic health transactions
b) Technologists preforming bone density studies are considered "covered entities" and are allowed to access patient information that is pertinent to the current exam
c) HIPAA required prudent steps should be taken to protect PHI (protected health information) from loss or unauthorized access
d) All the above |
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Definition
d) All the above
The bone density technologist should understand all the statements above in regards to HIPAA. PHI must be protected, confidential and a disaster recovery plan must be in place. HIPAA is a complex law that can carry penalties when not followed. |
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Term
Why should the patient questionnaire have space for technologist's comments?
a) To convey any needed information to reading doctor
b) To document any anomalies the patient has
c) To notate any non removable aritfacts
d) All the above |
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Definition
d) All the above
Each of the answers listed in this question are valid reasons for a section on the questionnaire for technologist's comments. Often information must be documented or conveyed to reading physician. |
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Term
What is Quality Assurance?
a) The daily phantom test
b) The technologist precision test
c) The comprehensive quality program ensuring proper scanner functions and minimizing operator error
d) Daily logs of testing |
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Definition
c) The comprehensive quality program ensuring proper scanner functions and minimizing operator error
QA is the comprehensive quality program. It includes daily QC with the phantom and technologist precision tests. |
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Term
What is the third site commonly used in bone density scanning?
a) Ankle
b) Heel
c) Ribs
d) Forearm |
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Definition
d) Forearm
The third site commonly scanned is the forearm. |
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Term
This images illustrates proper positioning for a hip scan. What are the positioning elements the tech should look for?
[image]
a) Proper internal rotation which rolls the lesser trochanter behind the femoral shaft
b) Elongated femoral neck
c) Femoral shaft is straight, parallel to table edge
d) All of the above |
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Definition
d) All of the above
The answer is all of the above. Each of the above is required for correct positioning of the hip scan. |
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Term
What organization issued guidelines regarding the scoring of DXA studies, specifically the recommendation of standard scores should be written as T-scores and Z-scores?
a) WHO
b) ISCD
c) CDC
d) NOF |
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Definition
b) ISCD
In 2004, the International Society for Clinical Densitometry issued recommendations that standard scores should be written as T-scores and Z-scores. |
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Term
True or False
Dual-photon absorptiometry operates on the same basic principle as SPA with either a single isotope capable of emitting energy at two peaks or two isotopes that have different peak energies. |
|
Definition
True
DPA can operate with a single isotope or two isotopes. Dual energies allowed the system to measure the BMD of bones without a water bath, including spine or proximal femur. However, the cost to maintain the unit, coupled with the loss of precision and accuracy as the isotope(s)decayed rendered DPA obsolete. |
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Term
Why is the whole body composition analysis software useful?
a) It offers a comprehensive look at body composition, with accurate BMD, lean tissue and fat
b) It can give T-scores of most bone simultaneously
c) It is only useful for premenopausal women
d) It is not useful in clinical practice |
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Definition
a) It offers a comprehensive look at body composition, with accurate BMD, lean tissue and fat
Whole body composition is useful in research and managing patients with metabolic disorder syndromes. An accurate account of lean muscle and fat distributions can aid in treatment for patients. |
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Term
What artifacts can cause elevated BMD?
a) Pathology such as scoliosis or fracture
b) Sclerosis
c) External artifacts
d) All the above |
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Definition
d) All the above
Each of these listed can cause elevated BMD. Prior fractures, cancer, osteoarthritis are other examples of artifacts that can impact BMD. |
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Term
Why is it prudent for a technologist to understand radiation safety and awareness?
a) The radiation dose to a patient during a DXA scan is equivalent to a pelvis CT scan.
b) There is no reason to understand radiation safety in DXA
c) Because ionizing radiation can be hazardous to living beings and cause damage to living cells
d) DXA scans can be dangerous for a technologist to perform due to radiation exposure |
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Definition
c) Because ionizing radiation can be hazardous to living beings and cause damage to living cells
Ionizing radiation can cause harm to living cells. |
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Term
True or False
Once the scan is complete, the technologist can allow the automated analysis feature to perform scan analysis, with no need to review the scan. |
|
Definition
False
This statement is false. The technologist must always review the scan to be sure no manual adjustments need to be made. Always refer to manufacturer's guidelines for analysis instructions. |
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Term
True or False
Every facility that offers DXA scans also offer VFA. |
|
Definition
False
Not all facilities practice practice VFA and not every scanner will have VFA software installed. |
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Term
Bone is a living biomaterial and can:
a) Adapt to meet functional demands
b) Repair itself
c) Neither of the above
d) A and B only |
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Definition
d) A and B only
Bone is a living biomaterial that adapts to meet functional needs and can repair itself. |
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Term
This serial scan of a PA spine illustrates an evolving fracture of L1. What action must the tech take to do a comparison on this patient?
[image]
a) Keep the original scan as is and exclude L1 on the new scan
b) Serial scans of the PA spine are no longer useful for clinical treatment
c) Exclude L1 when analyzing current scan and reanalyze the previous scan also excluding L1
d) Compare the scans without excluding any vertebrae |
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Definition
c) Exclude L1 when analyzing current scan and reanalyze the previous scan also excluding L1
In order to compare the scans and have useful clinical information both scans must have L1 excluded. The fracture will alter the BMD and it will be impossible to to know for certain if treatment is making an impact for this patient. |
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Term
True or False
The forearm is a common site for serial scans. |
|
Definition
False
This statement is false. The forearm is generally not used for serial scan because the rate of change typically is to slow to be useful. |
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Term
When should a technologist change the scan speed?
a) When the patient's body habitus dictates a slower scan speed.
b) According to the department protocols
c) In a serial scan on a patient when the baseline scan was done in a different scan mode
d) All the above |
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Definition
d) All the above
Typically, the scan speed will be a constant in most departments. There would be no reason to change the scan speed unless necessary. In particular, serial scans would be subject to speed changes if the baseline scan was performed using a different speed. |
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Term
What are the most common charts used in DXA QC?
a) CUSUM charts
b) Shewhart charts
c) Bar charts
d) Scatter charts |
|
Definition
b) Shewhart charts
The Shewhart chart is the most commonly used chart in QC programs to provide graph visuals for plotting results. |
|
|
Term
True or False
Quantitative Ultrasound (QUS) can be used to measure spine and hip sites. |
|
Definition
|
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Term
What is attenuation?
a) Focusing radio waves to broadcast a specified radio station
b) The reduction of the energy or number of X-Ray photons in a beam
c) The means to harness electromagnetic waves
d) An increase of the number of X-Ray photons |
|
Definition
b) The reduction of the energy or number of X-Ray photons in a beam
Attenuation is the reduction of the energy or number of X=Ray photons (intensity) of a beam. |
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Term
What steps must be taken to correct this image?
[image]
a) This is image is correct as is.
b) Reposition the patient and label the vertebrae correctly.
c) Adjust the bone edges.
d) Change the labels on the vertebrae and exclude L1. |
|
Definition
b) Reposition the patient and label the vertebrae correctly.
In order to correct this image, the patient must be rescanned to include all of L1 and then the vertebrae must be labeled correctly. |
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Term
True or False
Functional dominance must be considered when choosing which forearm to scan. |
|
Definition
True
Functional dominance will affect BMD of the forearm. For this reason, the non-dominant forearm should be scanned. |
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|
Term
Lordosis of the spine means:
a) The spine curves away from the mid-line of the body
b) The upper or thoracic spine has an extreme curve outward causing a hump in the upper back
c) The spine is completely straight with no natural curves
d) The lower or lumbar spine has an exaggerated inward curve causing the buttocks to appear more predominate |
|
Definition
d) The lower or lumbar spine has an exaggerated inward curve causing the buttocks to appear more predominate
The lumbar spine has a natural inward curve but when that curve is very exaggerated is becomes an abnormality. |
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|
Term
True or False
Disease prevention includes proper nutrition, adequate calcium and vitamin D intake, weight bearing exercise and healthy lifestyle choices. |
|
Definition
|
|
Term
Stochastic effects are:
a) Randomly occurring adverse effects
b) Delayed
c) A function of dose, however, the risk is small and there is no specific threshold dose.
d) All the above |
|
Definition
d) All the above
Stochastic effects are delayed, randomly occurring adverse effects. Evidence suggest these effects are a function of dose, however, the risk is small and there is no specific threshold dose. |
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Term
Why is data management relevant to Bone Densitometry?
a) The technologist must understand basic computer programming in order to update reference data
b) The technologist is responsible for implementing software updates
c) The technologist must possess basic computer skills in order to operate the manufacturer's software, archive and back up data and manage patient information
d) The technologist must possess basic computer skills in order to correctly diagnose osteoporosis when present. |
|
Definition
c) The technologist must possess basic computer skills in order to operate the manufacturer's software, archive and back up data and manage patient information
Data management is part of the technologist's responsibilities in bone density programs. It is important that patient information is entered correctly, that scans are protected from loss and the software used properly. |
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|
Term
What are the indications for VFA?
a) Post menopausal women, women who have had hysterectomies before the age of 40.
b) Documented height loss, history of fracture over age 50, long term glucocorticoid therapy
c) Prior fractures as a child, being over age 65
d) None of the above |
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Definition
b) Documented height loss, history of fracture over age 50, long term glucocorticoid therapy
Not every patient needs VFA imaging. However, those patients with history of fracture over the age 50, documented height loss or have been on long term steroid therapy are candidates for VFA. |
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Term
True or False
It is acceptable for the technologist to give the patient the results of the bone density scan once the scan is complete. |
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Definition
False
It is not in the scope of practice for the technologist to give results to patients. The technologist may offer the WHO criteria of T-score ranges and their meaning for educational purposes. |
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Term
FRAX is an absolute fracture risk prediction tool that uses clinical risk factors to predict the absolute 10-year risk of fracture. Which of the following statements is true?
a) FRAX can be used to predict hip fracture or a major osteoporosis fracture at any site.
b) FRAX can function as a stand alone site but is incorporated into DXA software.
c) FRAX can be used with femoral neck BMD or T-Score.
d) All the above. |
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Definition
d) All the above.
FRAX can predict fracture as a stand alone website but is built into the software of most DXAs. It can only be used with the BMD or T-Score of the femoral neck. |
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Term
True or False
The definition of osteoporosis states that a fracture must be present before a diagnosis can be made. |
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Definition
False
The correct answer is false. After the 1991 and 1993 conferences held by the NOF and other global organizations the stipulation of fracture was dropped from the definition. |
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Term
Who is responsible for performing the daily phantom scanning and documenting the QC results?
a) The tech assistant
b) The radiologist
c) The technologist
d) Practice manager |
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Definition
c) The technologist
The technologist is responsible for following the Quality Assurance and Quality Control protocols. This is an integral part of the bone density program and insures all equipment is operating correctly. |
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Term
What region of the forearm has the most cortical bone?
a) 10% UD
b) The entire forearm
c) 33%, approximately mid-forearm
d) The forearm is composed of trabecular bone |
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Definition
c) 33%, approximately mid-forearm
The 33% or 1/3 region of forearm (approximately mid-forearm), is mostly cortical bone. |
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Term
Type 2 primary osteoporosis occurs:
a) Due to estrogen decrease with menopause
b) Late in life, generally after age 70 and is also known as senile osteoporosis
c) as a side effect of certain medicines
d) in premenopausal women |
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Definition
b) Late in life, generally after age 70 and is also known as senile osteoporosis
Type 2 (senile) primary osteoporosis occurs late in life and is age related. Usually onsets after age 70. |
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Term
True or False
DXA software contains gray-scale, contrast and brightness tools for image manipulation. |
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Definition
True
This statement is true. The software allows the technologist to manipulate the image for scan analysis. |
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Term
Why is it important to place a positioning block under the patient's knees for the spine scan?
a) It is for the patient's comfort
b) The positioning block is used to flatten out the small of the back and open disk spaces
c) Upright knees help patient remain still during scan
d) When the knees are drawn up, the spine naturally falls into a straight line. |
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Definition
b) The positioning block is used to flatten out the small of the back and open disk spaces
The positioning block is used to flatten out the small of the back and open disk spaces. |
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Term
What advantages does QCT or Quantitative CT offer in bone density testing?
a) Volumetric measurement
b) Separates trabecular and cortical bone
c) Vertebral size does not cause error in reading
d) All the above |
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Definition
d) All the above
QCT separates trabecular from cortical bone, which is useful because certain bone disorders are found in trabecular bone. Volumetric measurement considers the entire vertebrae verse the aerial measurements of a DXA unit. |
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Term
True or False
Erythema can be caused by DXA studies. |
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Definition
False
Skin reddening or erythema cannot occur as a result of a central DXA exam because the scanner cannot deliver a high enough radiation dose. |
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Term
What type of patient education is acceptable within the scope of the technologist's practice?
a) Offering pamphlets or literature on osteoporosis
b) Offer some suggestions to for fall prevention in the home
c) Explain how calcium rich foods and weight bearing exercise can help prevent osteoporosis
d) All the above |
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Definition
d) All the above
All the answer choices are acceptable for the technologist to discuss with a patient. Patient results or opinions regarding treatment drugs should not be discussed between technologist and patients. |
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Term
True or False
According the the World Health Organization, a patient with a T-score of -0.7 has BMD that is considered normal. |
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Definition
True
According to the WHO criteria, the normal bone density range is -1.0 or higher. |
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Term
What does patient preparation include?
a) Check for potential scan obstacles or artifacts
b) Note previous fracture sites
c) Have patient remove external artifacts such as metal snaps, zippers or buttons
d) All the above |
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Definition
d) All the above
All the choices are part of patient preparation before the scan is started. |
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Term
The human skeleton is comprised of 206 bones. What other function does the skeleton have?
a) Protection for internal organs
b) Anchorage for skeletal muscles
c) Metabolic
d) All the above |
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Definition
d) All the above
The function of the skeleton is protection, anchorage, metabolic and provides a mineral reservoir. |
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Term
When analyzing a hip scan, when should the technologist manipulate the bone edges and neck box?
a) The bone edges and neck box should be manually manipulated every scan
b) Only the bone edges should be manipulated after each scan
c) Only when necessary and always according to the manufacturer's specifications
d) Absolutely never |
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Definition
c) Only when necessary and always according to the manufacturer's specifications
The bone edges and neck box should only be manually manipulated when necessary, and always according to the manufacturer's specifications. This is especially true with the neck box as each manufacturer has strict guidelines about placement. |
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Term
What does the Z-Score represent?
a) A comparison of the BMD of a specific person to the average value of same age adults.
b) A comparison of the BMD of a specific person to the average peak value of young adults.
c) Only used on patients over the age of 80.
d) None of the above. |
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Definition
a) A comparison of the BMD of a specific person to the average value of same age adults.
The Z-Score compares the BMD of a specific person to the average value of same age adults. |
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Term
Why is it important for the technologist to be aware of the weight limit of the scanner?
a) If the patient exceeds the table weight limit the table may break and it is very costly to repair
b) There is no weight limit on the table because the scanner is not enclosed like a CT or MRI
c) Exceeding the weight limit will invalidate the manufacturer's warranty
d) Exceeding the weight limit will cause poor scan images |
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Definition
c) Exceeding the weight limit will invalidate the manufacturer's warranty
The technologist must be aware of the weight limit of the table because exceeding it will invalidate the manufacturer's warranty. |
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Term
True or False
The technologist should palpate the top of both crests to see if they are level and observe patient from the head of the table. |
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Definition
True
This statement is true. This will allow the tech to position patient before starting the scan. |
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Term
How is the BMD established on the phantom?
a) The manufacturer provides it
b) It is preset on the phantom
c) By scanning the phantom 5 times and finding the average
d) By scanning the phantom 10 times without repositioning and calculating the average or mean of the readings |
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Definition
d) By scanning the phantom 10 times without repositioning and calculating the average or mean of the readings
The BMD is established by scanning the phantom 10 times without repositioning. Calculate the mean and set the 1.5% limits. |
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Term
True or False
This image is an example of a patient with scoliosis.
[image] |
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Definition
False
False. This is not an example of a patient with scoliosis. The patient is not straight on the table and should be rescanned. The tech should reposition the patient before repeating the scan. |
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Term
What is the difference between archiving and backup?
a) Nothing, they are interchangeable terms
b) Backup refers to maintaining the computer settings and directories; archive applies to saving scan images to another media or file
c) Archiving is protecting the computer settings and directories while backup refers to saving the scan images
d) Backup refers to sending the images to PACS |
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Definition
b) Backup refers to maintaining the computer settings and directories; archive applies to saving scan images to another media or file
Archive refers to saving scan images to another media while backup maintains the computer settings and directories. |
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Term
True or False
X-Rays can travel in a straight line in any direction. |
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Definition
True
X-Rays can only travel in a straight line in any direction. |
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Term
What are two major types of bones?
a) Short and long
b) Skeletal and peripheral
c) Cartilage and connective
d) Cortical and trabecular |
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Definition
d) Cortical and trabecular
Cortical and trabecular are the two types of bone. Cortical is the hard outer shell and trabecular is the spongy inner bone. |
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Term
What does KVP control in medical X-Rays?
a) The direction of the X-Ray beam
b) The quantity of the X-Ray beam (number of photons produced)
c) The quality of the beam and the contrast or gray scale of the image
d) The density of resulting image |
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Definition
c) The quality of the beam and the contrast or gray scale of the image
KVP controls the quality of the beam. KVP also has the biggest influence of image contrast. |
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Term
Explain why the spine scan is referred to PA position when patient is laying in a supine position.
a) The X-ray beam enters the patient from the top making position PA
b) The X-ray beam comes from below the patient, entering the back of patient and exiting the front
c) The X-ray beam is generated from the lateral position on the patient, so the PA label is inaccurate
d) There is no positional relationship between the X-ray beam direction and patient orientation |
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Definition
b) The X-ray beam comes from below the patient, entering the back of patient and exiting the front
Because the beam enters the back of the patient and exits the from, the positional direction of PA is correct. The X-ray beam is orientated beneath the patient on the table. |
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Term
In the images shown, which is correct for forearm positioning?
[image]
a) The image with the positioning device
b) The image without the positioning device
c) Both are correct.
d) Neither image shows correct positioning for the forearm. |
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Definition
c) Both are correct.
Both are correct. GE requires a positioning device for the forearm scan while Hologic does not require a device to be used. |
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Term
True or False
This is an example of a properly positioned spine.
[image] |
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Definition
True
This is an example of a well positioned PA spine. All the landmarks are well visualized, the spine is straight and the crests are visible. |
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Term
True or False
The technologist should offer assistance on and off the DXA table to all patients. |
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Definition
True
The technologist should always offer assistance to patients. |
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Term
T-Score (% young adult) compares the patient's BMD to what?
a) The average value of same age adults
b) The calculated value of the patient's peak bone density.
c) The average peak value of young adults.
d) The database of the manufacturer's choosing. |
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Definition
c) The average peak value of young adults.
The T-Score compares the BMD of a specific patient to a database made up of young healthy adults. |
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Term
Why is the least significant change (LSC) vital to bone density testing?
a) In order to be sure that the patient's BMD in subsequent scans can be considered true biological changes, the LSC must be a known variable.
b) As with any medical testing, the likelihood of numeric values being reproduced identically in serial testing is almost non-existent.
c) The technologist's precision error rate is used to determine the LSC
d) All the above |
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Definition
d) All the above
LSC is vital to bone density testing when patients are being monitored during treatment because the reading doctor must determine if the changes seen in serial exams are true changes in the BMD or due to technical factors. If the changes exceed the LSC, it can be assumed that the changes are clinically significant. |
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Term
When should a forearm scan be included in the study?
a) Patients suffering from hyperparathyroidism
b) Patients with surgical hardware, pathology or other contraindication in the spine or hip
c) Ordering doctor's discretion
d) All the above |
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Definition
d) All the above
The correct answer is all the above. Each of the reasons listed are valid grounds to do a forearm scan as part of a comprehensive study. |
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Term
VFA clearly illustrates ____________________ that may not be visible on the PA spine scan.
[image]
a) Fractures
b) Scoliosis
c) Kyphosis
d) Calcified aorta |
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Definition
a) Fractures
VFA will clearly illustrate fractures that a PA spine scan may not demonstrate. Calcifications of the aorta can be seen on many VFA images and also may be seen on the PA spine scan. |
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Term
True or False
The internal hard drive on the DXA computer is the only place to store patient data and scans. |
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Definition
False
This statement is false. It is critical to have data archived on a regular basis to protect the patients' information and medical record. If the data is not archived and an event occurs that causes the hard drive in the computer to be compromised, there is a good chance the medical records may be lost. |
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Term
True or False
Osteoporosis is termed "the silent disease" because symptoms seldom present prior to fracture, height loss or stooped posture. |
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Definition
True
There are typically no early symptoms for osteoporosis. |
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Term
Why is Whole Body Composition scanning with DXA preferable over BMI calculations?
a) BMI calculations are limited
b) BMI uses only two variables, height and weight, to reach the percentage of body fat
c) There is no accounting for BMD, percentage of lean body mass or true percentages of body fat
d) All the above |
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Definition
d) All the above
Whole Body Composition scans can offer much more useful information than BMI calculations. DXA is a much more comprehensive look at all the different tissue compositions. |
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Term
What region of the hip is the T-score calculated from?
a) Ward's area
b) Shaft
c) Trochanter
d) Total |
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Definition
d) Total
The T-score is calculated at the total region of interest because all the individual regions are included. The total regions is a combination of trabecular and cortical bone. |
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Term
What are the risk factors for osteoporosis?
a) Aging for both men and women
b) Estrogen of testosterone deficiency
c) malabsorption
d) All the above |
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Definition
d) All the above
The correct answer is all the above. All three choices are risk factors for osteoporosis, along with Cushing's disease, lifestyle choices such as smoking, hyperthyroidism, anticonvulsants, lithium and long term use of steroids. |
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Term
True or False
Denistometry is principally a quantitative measurement technique. |
|
Definition
True
In this scope, the quantity being measured is bone mass or density. This concept is present in many areas of clinical medicine, such as blood glucose and sphygmomanometry. |
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Term
True or False
Many times vertebral fractures are non-symptomatic and can go undiagnosed. |
|
Definition
True
This statement is true. For this reason, VFA is a valuable asset to help visualize vertebral fractures and provides clinical information to aid in treatment. |
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Term
What should the technologist explain to the patient regarding the procedure?
a) DXA studies are non-invasive, with no injections or enclosures
b) Quick and painless
c) Low radiation
d) All the above |
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Definition
d) All the above
The technologist should explain the procedure for a DXA scan as quick and painless, non-invasive with no injections or enclosures and a low radiation dose. |
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Term
Using the four skeletal classes, describe the lumbar spine.
a) Peripheral, axial, non-weigh bearing , cortical
b) Axial, central, weigh bearing, cortical
c) Appendicular, peripheral, weight bearing, predominantly trabecular
d) Central, weight bearing, axial, predominantly trabecular |
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Definition
d) Central, weight bearing, axial, predominantly trabecular
According to the four classes, the spine falls in the central, weight bearing, axial locations and is comprised of predominantly trabecular bone. |
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Term
What are the regions of interest the proximal femur is divided into?
a) Shaft, tibia, neck
b) Femoral joint, lesser trochanter, shaft, femoral head
c) Neck and shaft
d) Femoral neck, trochanter, Ward's area, shaft |
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Definition
d) Femoral neck, trochanter, Ward's area, shaft
The proximal femur is divided into regions of interest; femoral neck, trochanter, Ward's area and shaft. |
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Term
What would optimal positioning display for a PA spine scan?
a) L1-L4 are regions of interest and must clearly visible
b) The iliac crests should be level and ribs visible at T12
c) Spine should be straight with clear separations between the vertebrae
d) All the above |
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Definition
d) All the above
Each of these are points are necessary for a well positioned PA spine scan. L1-L4 must be visualized, the spine should e straight with clear separations between vertebrae and iliac crests should be level. |
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Term
What is mutagenesis?
a) Latent effects that cause most types of cancers
b) The exposure of parents following massive radiation doses that increases the probability of sever genetic effects for future generations
c) In utero exposure that can cause miscarriage and congenital abnormalities of the fetus
d) A condition unrelated to radiation exposure |
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Definition
b) The exposure of parents following massive radiation doses that increases the probability of sever genetic effects for future generations
Mutagenesis is the exposure of parents. Severe genetic effects in future generations can result. |
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Term
Osteoporosis is a public health concern because ………… Americans are affected by it.
a) 26 Million
b) 19 Million
c) 1 Billion
d) 54 Million |
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Definition
d) 54 Million
The correct answer is D, 54 million Americans are affected by osteoporosis. |
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Term
______________ bone provides most of the metabolic function and is the primary site for bone remodeling.
a) Calcium
b) Trabecular
c) Cortical
d) Lamellar |
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Definition
b) Trabecular
Trabecular bone provides most of the metabolic function. Cortical bone provides protection and mechanical function. |
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Term
True or False
The NHANES III database includes both PA spine and proximal femur sites. |
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Definition
False
This statement is false. The NHANES III only contains proximal femur skeletal site. The data gathered in this database is used as a reference population in the DXA computer software. |
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Term
Who are radiation protection programs designed to protect?
a) The public
b) The patient
c) The technologist and other medical staff involved
d) All the above |
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Definition
d) All the above
Radiation protection programs are designed to protect everyone. This includes patients, the public and healthcare workers. |
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Term
What skills are necessary for a technologist to possess in order to produce quality DXA studies?
a) Scan acquisition
b) Excellent people skills
c) Detail orientated
d) All the above |
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Definition
d) All the above
A good technologist will possess all the above skills. Scan acquisition is of course a very important skill but the ability to talk to patients, put them at ease, explain the procedure and effectively communicate with the physicians are just as vital. |
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Term
What technical errors can lead to a scan that is clinically useless?
a) Motion
b) Mislabeling vertebra
c) Poor positioning
d) All the above |
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Definition
d) All the above
Any of these choices can yield a scan that is clinically useless. Motion can impact the image and lead to inaccurate BMD while poor positioning may lead to poor visualization of anatomy. |
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Term
What action should the technologist take if a patient presents for a DXA scan with a belly button piercing?
a) The technologist should ask the patient to remove the piercing prior to scanning
b) The technologist should perform a forearm scan in place of a the PA spine
c) The technologist should scan patient like normal without removing the piercing
d) None of the above |
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Definition
a) The technologist should ask the patient to remove the piercing prior to scanning
The technologist should ask the patient to remove the artifact and proceed with scan. |
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Term
True or False
Improper rotation of the baseline hip scan will affect precision and reproducibility. |
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Definition
True
This statement is true. Improperly rotating the femur on the baseline hip scan will affect precision and reproducibility. This is especially true if the baseline scan is going to be used to track a patient undergoing drug therapy. |
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Term
Primary osteoporosis is
a) Common and age related
b) Divided into two types
c) Due to Endocrine disorders
d) All of the above
e) A and B only |
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Definition
e) A and B only
Endocrine disorders contribute to secondary osteoporosis, not primary osteoporosis. |
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