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Msb study Mode Imaging Procedures
exam review
416
Medical
Undergraduate 3
06/21/2021
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Term
Which of the following is a typical protocol for a CT study of the brain for a patient with a history of dizziness?
A. 10-mm × 10-mm sections from the skull base to the vertex
B. 7-mm × 7-mm sections from the skull base to the posterior fossa
C. 2.5-mm × 2.5-mm sections through the posterior fossa, 5 mm × 5 mm to vertex
D. 1.5-mm × 1.5-mm sections from skull base to vertex
 Definition
C. Patients with histories of headaches and/or dizziness should be evaluated for abnormalities of the inner ear. Thin sections (1 to 3 mm) are required through the posterior fossa in order to best demonstrate the small anatomic structures and improve image quality.
Term
Which of the following describes the scout (localizer) projection used to prescribe an axial CT acquisition of the brain?
A. Anteroposterior
B. Submentovertical
C. Lateral
D. Posteroanterior
 Definition
C. A lateral projection of the head, including from below the skull base through the vertex, is used as a scout image (scanogram) for a CT scan of the brain. CT systems utilizing automatic tube current modulation (ATCM) software may also require the acquisition of an anteroposterior (AP) scout or localizer projection.
Term
Glioma is a general term used to describe a group of primary tumors. Consisting of malignant glial cells, gliomas occur in the:
A. oral cavity.
B. kidney.
C. brain.
D. liver.
 Definition
C The term glioma refers to the group of glial tumors that occur in the brain. Glial cells are connective neural cells that play a supportive role in the brain. There are several common types of gliomas, including astrocytomas and glioblastomas.
Term
MSB 1 Number 3 corresponds to which of the following?

A. Nasopharynx
B. Sphenoid sinus
C. Ethmoid sinus
D. Trachea
 Definition
Number 3 corresponds to the nasopharynx.
Term
MSB 1 Which of the following numbers corresponds to the right lateral pterygoid plate?
 Definition
Number 4 corresponds to the right lateral pterygoid plate.
Term
MSB 1 Which of the following clinical findings best describes the abnormal anatomic condition labeled as number 6?

A. Mucosal thickening
B. Deviated septum
C. Sinusitis
D. Retropharyngeal hematoma
 Definition
B The nasal septum is a cartilaginous process that vertically separates the nasal cavities. The nasal septum in the figure deviates, or abnormally curves, toward the left.
Term
MSB 2 Which of the following patient positions may have been used to produce this scout image of the head?

A. Supine
B. Lateral
C. Prone
D. Both A and C
 Definition
D A coronal scout or pilot projection of the head may be obtained with the patient in either the supine or the prone position. In the supine position, the patient is instructed to hyperextend the neck by dropping the head back so that it rests on its vertex on a positioning support device. In the prone position, the patient is instructed to extend the neck with the head resting on the chin. Coronal CT images may be produced in either case with the imaging plane positioned parallel to the coronal plane of the patient’s head
Term
MSB 2 Number 1 corresponds to which of the following?

A. Lateral pterygoid plate
B. Styloid process
C. Rostrum
D. Posterior clinoid process
 Definition
Number 1 corresponds to the posterior clinoid process.
Term
MSB 2 Number 3 corresponds to which of the following?

A. External auditory meatus
B. Foramen rotundum
C. Foramen ovale
D. Mastoid air cells
 Definition
Number 3 corresponds to the external auditory meatus.
Term
MSB 3 Number 4 corresponds to which of the following?

A. Cochlea
B. Semicircular canal
C. Malleus
D. Incus
 Definition
Number 4 corresponds to the semicircular canal.
Term
MSB 3 Number 5 corresponds to which of the following?

A. Dorsum sella
B. Anterior clinoid process
C. Petrous bone
D. Posterior clinoid process
 Definition
Number 5 corresponds to the petrous bone.
Term
MSB 3 Which of the following window level and width settings were used to display this image?

A. Level= −700, width= 2000
B. Level= +50, width= 400
C. Level= +150, width= 1000
D. Level= +250, width= 4000
 Definition
D lEVEL+250, WIDTH=4000
An extremely wide window should be used to display images containing tissues with varying density ranges. A width such as 4000 is sufficient to display the dense bone of the mastoid tip and internal auditory canals. The level is set at the approximate average value of the tissues displayed. A level of +250 is the approximate average of all tissues within this anatomic region.
Term
MSB 3 Number 1 corresponds to which of the following?

A. Dorsum sella
B. Sphenoid sinus
C. Ethmoid sinus
D. Pituitary fossa
 Definition
Number 1 corresponds to the sphenoid sinus.
Term
MSB 3 Which of the following is the best choice for scan field of view (SFOV) for the acquisition of the image in this figure?

A. Small (25 cm)
B. Head (25 cm)
C. Medium (35 cm)
D. Large (48 cm)
 Definition
B. HEAD(25CM) The scan field of view (SFOV) chosen for any CT study must be larger than the anatomic part of interest. Specific scan field of view choices such as the head incorporate special correction factors for their respective anatomic areas and should be used when applicable.
Term
Which of the following areas of the head commonly becomes calcified?
1. Thalamus
2. Pineal gland
3. Choroid plexus
A. 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
C. 2 and 3 only
The choroid plexus and pineal gland are common areas of calcification in the brain. These areas of increased attenuation and density are easily identified on the CT image.
Term
Following the injection of intravenous contrast media during a CT examination of the brain, which of the following anatomic areas does not enhance?
A. Anterior communicating artery

B. Choroid plexus

C. Posterior horn of lateral ventricle

D. Dura mater
 Definition
C. Posterior horn of lateral ventricle
The posterior horn of the lateral ventricle contains cerebrospinal fluid and does not enhance following the intravenous administration of contrast material. Areas with a good blood supply, such as the cranial blood vessels, choroid plexus, and dura mater, do enhance during a contrast study of the brain.
Term
Which of the following conditions or indications would not require the injection of iodinated contrast material for proper visualization during a CT examination of the brain?
A. S/P MVA 3 days ago; R/O subdural hematoma
B. Headaches; R/O meningioma
C. Loss of vision; R/O astrocytoma
D. Lung cancer; R/O metastases
 Definition
A. S/P MVA 3 days ago; R/O subdural hematoma
Subdural hematomas caused by relatively recent trauma appear as hyperdense areas on CT images of the brain. Intravenous iodinated contrast media is not necessary for their visualization and may act to conceal them. Contrast media are extremely valuable for visualization of intracranial tumors.
Term
Which of the following statements regarding the pituitary gland is false?
A. It is sometimes referred to as the hypophysis cerebri.
B. It is seated within the sella turcica.
C. The infundibulum attaches it to the hypothalamus.
D. It is responsible for the production of epinephrine.
 Definition
D. It is responsible for the production of epinephrine.
The pituitary gland is responsible for the production of several hormones, including somatotropin and prolactin. It is the adrenal glands that play a role in the production and secretion of epinephrine (adrenaline).
Term
Which of the following correctly describes the patient position relative to the gantry for a CT study of the brain?
A. Supine, feet first
B. Prone, feet first
C. Supine, head first
D. Prone, head first
 Definition
C. Supine, head first
The patient is usually placed in the supine position so as to move head first into the gantry for a CT examination of the brain.
Term
Cerebrospinal fluid (CSF) is produced in the:
A. tentorium cerebelli.
B. pineal gland.
C. corpus callosum.
D. choroid plexuses.
 Definition
D. The cerebrospinal fluid is secreted by the choroid plexuses that are located in each of the four ventricles of the brain.
Term
A stereotactic unit would be used for which of the following specialized CT examinations?
A. CT-guided fine-needle aspiration of an abdominal abscess

B. 3-D CT angiogram

C. CT-guided biopsy of the brain

D. Dual window scanning
 Definition
C. CT-guided biopsy of the brain Stereotactic biopsy units are specialized units designed specifically for CT-guided biopsies. They are most commonly used for intracranial lesions, for which precision and accuracy are extremely important.
Term
MSB 4 Which number corresponds to the lateral rectus muscle?

A. 5
B. 2
C. 6
D. 4
 Definition
Number 2 corresponds to the lateral rectus muscle.
Term
MSB 4 Number 4 corresponds to which of the following?

A. Frontal sinus
B. Maxillary sinus
C. Sphenoid sinus
D. Ethmoid sinus
 Definition
Number 4 corresponds to the ethmoid sinus.
Term
MSB 4 The image is part of a series that could be used to evaluate which of the following?

1. Posterior fossa
2. Orbits
3. Paranasal sinuses

A. 1 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
C. 2 and 3 only
The image includes the anatomic areas of the paranasal sinuses and the orbits.
Term
MSB 4 Number 5 corresponds to which of the following?

A. Superior rectus muscle
B. Levator palpebrae superioris muscle
C. Optic nerve
D. Inferior rectus muscle
 Definition
Number 5 corresponds to the optic nerve.
Term
MSB 4 Number 1 corresponds to which of the following?

A. Vomer
B. Nasal bone
C. Lacrimal bone
D. Clivus
 Definition
Number 1 corresponds to the nasal bone.
Term
MSB 5 Which of the following most accurately describes the proper position of the patient for a CT examination of the brain?

A. Prone with head extended
B. Supine with head extended
C. Prone with chin down
D. Supine with chin down
 Definition
D. Supine with chin down
CT images of the brain should be acquired parallel to the skull base. Placing the patient in the supine position with the chin down facilitates the axial acquisition at an angle 15 degrees above the infraorbitomeatal line (IOML).
Term
MSB 5 Number 4 corresponds to which of the following?

A. Fourth ventricle
B. Vein of Galen
C. Third ventricle
D. Thalamostriate vein
 Definition
Number 4 corresponds to the third ventricle.
Term
MSB 5 Number 3 corresponds to which of the following?

A. Cerebrum
B. Vermis of cerebellum
C. Tentorium cerebelli
D. Occipital lobe
 Definition
Number 3 corresponds to the vermis of the cerebellum.
Term
MSB 5 Number 5 corresponds to which of the following?

A. Caudate nucleus
B. Putamen
C. Thalamus
D. Globus pallidus
 Definition
Number 5 corresponds to the putamen.
Term
MSB 5 Number 2 corresponds to which of the following?

A. Caudate nucleus
B. Putamen
C. Thalamus
D. Globus pallidus
 Definition
Number 2 corresponds to the thalamus.
Term
MSB 5 Which of the following corresponds to the genu of the corpus callosum?

A. 6
B. 5
C. 2
D. 1
 Definition
Number 6 corresponds to the genu of the corpus callosum.
Term
In which of the following cranial nerves would an acoustic neuroma be found?
A. Third

B. Eighth

C. Tenth

D. Twelfth
 Definition
B. Eighth An acoustic neuroma (schwannoma) arises from Schwann cells of the eighth cranial nerve, or the vestibulocochlear nerve. This type of cranial mass may be imaged with CT examinations of the internal auditory canals.
Term
Which of the following types of pathologic conditions cannot be easily diagnosed from a CT scan of the brain?
A. Astrocytoma

B. Traumatic hemorrhage

C. Cerebral infarct

D. Alzheimer’s disease
 Definition
Alzheimer’s disease is not easily diagnosed from a CT scan of the brain. Alzheimer’s disease may present with enlargement of the temporal horns but this is typically not specific on CT examinations.
Term
MSB 6 This type of image is referred to as a(n)

A. three-dimensional (3-D) image.
B. retrospective image.
C. stereotactic image.
D. MPR image.
 Definition
Multiplanar reformation (MPR) describes the process of displaying CT images in a different orientation from the one used in the original reconstruction process. MPR images may be constructed in the coronal, sagittal, or any other two-dimensional plane. MPR images are typically formed from a vertical stack of contiguous, helically acquired axial CT images.
Term
MSB 6 Number 2 corresponds to which of the following?

A. Dental implants
B. Mandibular fractures
C. Surgical staples
D. Roots of teeth
 Definition
Number 2 corresponds to the roots of teeth.
Term
MSB 6 Number 3 indicates that this image was generated from a series of __________ CT images.

A. sagittal
B. axial
C. coronal
D. panoramic
 Definition
B. Axial The reference image labeled as number 3 is an axial image of the mandible.
Term
In an effort to reduce radiation exposure to the orbits during a CT examination of the brain, the gantry may be angled:
A. perpendicular to the hard palate.

B. parallel to the hard palate.

C. 15 degrees superior to the infraorbital-meatal line (IOML).

D. 15 degrees inferior to the infraorbital-meatal line (IOML).
 Definition
C. 15 degrees superior to the infraorbital-meatal line (IOML).

Acquisition for a brain CT may be performed at an angle 15 degrees above the IOML, parallel to the skull base, to reduce orbital radiation dose and minimize beam-hardening artifact.
Term
The abnormal accumulation of cerebrospinal fluid on the ventricles of the brain is called:

A. schwannoma.

B. cranial abscess.

C. arteriovenous malformation (AVM).

D. hydrocephalus.
 Definition
D. hydrocephalus.
Hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) within the cerebral ventricular system. It is typically a congenital disorder but may also be caused by cranial lesions, hemorrhage, and so on.
Term
Unless the use of iodinated contrast media is contraindicated, which of the following pathologic conditions require(s) the administration of such media for optimal visualization on CT examination?
1. Suspected neoplasm
2. Arteriovenous malformation (AVM)
3. Acute hemorrhage
A. 1 only

B. 1 and 2 only

C. 2 and 3 only

D. 1, 2, and 3
 Definition
B. 1 and 2 only
Noncontrast CT examinations of the brain are routinely indicated to diagnose intracranial hemorrhage or hematoma, because contrast enhancement may mask subtle signs of hemorrhage.
Term
High-resolution CT examinations of the temporal bones and internal auditory canal should include which of the following technical parameters?
1. 5- to 7-mm section width
2. Small (less than 10 cm) targeted DFOV
3. Soft-tissue kernel
A. 1 only

B. 2 only

C. 1 and 3 only

D. 1, 2, and 3
 Definition
B. 2 only
CT studies of the temporal bones and internal auditory canal require a high-resolution imaging technique. The tenets of high-resolution CT include thin sections (1 to 2 mm), a small targeted DFOV, and the use of a high-resolution algorithm (kernel) for reconstruction.
Term
Which of the following technical parameters is NOT a necessary component of a high-resolution CT examination of the internal auditory canals (IAC)?
A. 1-mm section width

B. Targeted 10-cm DFOV

C. Sagittal MIP images

D. Bone algorithm
 Definition
C. Sagittal MIP images
CT studies of the temporal bones and internal auditory canal require a high-resolution imaging technique. The tenets of high-resolution CT include thin sections (1 to 2 mm), a small targeted DFOV, and the use of a high-resolution algorithm (kernel) for reconstruction.
Term
MSB 7 Number 1 corresponds to which of the following?

A. Coronoids
B. Coracoids
C. Mastoids
D. Adenoids
 Definition
Number 1 corresponds to the mastoids (air cells).
Term
MSB 7 Number 5 corresponds to which of the following?

A. Internal auditory canal
B. External auditory canal
C. Middle auditory canal
D. Vestibule
 Definition
Number 5 corresponds to the internal auditory canal.
Term
MSB 7 Which number corresponds to the vestibule?

A. 2
B. 3
C. 4
D. 5
 Definition
Number 4 corresponds to the vestibule.
Term
MSB 7 This image is displayed in which of the following anatomic planes?

A. Axial
B. Oblique axial
C. Coronal
D. Sagittal
 Definition
A. The image is displayed in the axial plane.
Term
MSB 8 Number 2 corresponds to which of the following?

A. Incus
B. Cochlea
C. Semicircular canal
D. Vestibule
 Definition
Number 2 corresponds to the semicircular canal.
Term
MSB 8 This image is displayed in which of the following anatomic planes?

A. Axial
B. Oblique axial
C. Coronal
D. Sagittal
 Definition
The image is displayed in the coronal plane.
Term
MSB 8 Number 4 corresponds to which of the following?

A. Internal auditory canal
B. Middle auditory canal
C. External auditory canal
D. Vestibule
 Definition
Number 4 corresponds to the internal auditory canal (IAC).
Term
MSB 9 Number 3 corresponds to which of the following?

A. Right parietal lobe
B. Left parietal lobe
C. Right temporal lobe
D. Left temporal lobe
 Definition
Number 3 corresponds to the left parietal lobe.
Term
MSB 9 The areas indicated by number 2 correspond to which of the following?

A. Corpus callosum
B. Thalamus
C. Pons
D. Internal capsule
 Definition
Number 2 indicates the corpus callosum.
Term
MSB 9 The areas indicated by number 4 correspond to which of the following?

A. Subarachnoid hemorrhage
B. Calcified pineal gland
C. Contrast-enhanced meningioma
D. Calcified choroid plexus
 Definition
Number 4 indicates the partially calcified choroid plexuses of the posterior horns of the lateral ventricles.
Term
MSB 9 Number 1 corresponds to which of the following?

A. Corpus callosum
B. Internal capsule
C. Septum pellucidum
D. Putamen
 Definition
Number 1 corresponds to the septum pellucidum.
Term
MSB 10 Number 2 corresponds to which of the following?

A. Anterior cerebral artery
B. Third ventricle
C. Fourth ventricle
D. Optic tract
 Definition
Number 2 corresponds to the third ventricle.
Term
MSB 10 Number 4 corresponds to which of the following?

A. Temporal lobe
B. Medulla oblongata
C. Pons
D. Cerebellum
 Definition
Number 4 corresponds to the cerebellum.
Term
MSB 10 Number 1 corresponds to which of the following?

A. Third ventricle
B. Fourth ventricle
C. Ambient cistern
D. Sagittal sinus
 Definition
Number 1 corresponds to the ambient, or quadrigeminal, cistern.
Term
MSB 10 Number 3 corresponds to which of the following?

A. Anterior horn of the lateral ventricle
B. Cingulate sulcus
C. Posterior horn of the lateral ventricle
D. Superior temporal sulcus
 Definition
Number 3 corresponds to the anterior horn of the left lateral ventricle.
Term
Multiplanar reformation (MPR) images along the long axis of the optic nerve would be best described by which of the following anatomic planes?
A. Sagittal

B. Coronal

C. Oblique sagittal

D. Oblique coronal
Submit
 Definition
C. Oblique sagittal
The optic nerve runs along a lateral-to-medial path from the orbit anteriorly and to the optic chiasma posteriorly. Oblique sagittal MPR images will demonstrate the optic nerve in a profile parallel to its long axis.
Term
Which of the following may be used to reduce metal streak artifact on coronal-plane CT images of the orbits?
1. Retrospective reconstruction of targeted images with reduced display field of view (DFOV)
2. Metallic artifact reduction (MAR) software to improve image quality
3. Construction of coronal multiplanar reformation (MPR) images from the acquired axial-plane images
A. 1 only
B. 3 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
c. 2 and 3 only.
Volumetric MDCT axial acquisition through the orbits, sinuses, and so on allows for high-quality coronal MPR images without metal streaking artifact. CT manufacturers may offer metallic artifact reduction (MAR) software in an effort to reduce streaking artifact from metal substances. Targeted reconstructions would eliminate only the streak artifact at the periphery of the field and would not remove unwanted streak artifact appearing through the area(s) of interest.
Term
MSB 11 Number 3 corresponds to which of the following?

A. Superior oblique muscle
B. Optic nerve
C. Medial rectus muscle
D. Medial ophthalmic vein
 Definition
Number 3 corresponds to the medial rectus muscle.
Term
MSB 11 Number 8 corresponds to which of the following?

A. Sphenoid sinus
B. Ethmoid sinus
C. Maxillary sinus
D. Frontal sinus
 Definition
Number 8 corresponds to the ethmoid sinus.
Term
MSB 11 This image is displayed in which of the following anatomic planes?

A. Axial
B. Oblique axial
C. Coronal
D. Sagittal
 Definition
The image is displayed in the coronal plane.
Term
MSB 11 Number 1 corresponds to which of the following?

A. Optic nerve
B. Medial rectus muscle
C. Superior rectus muscle
D. Ophthalmic artery
 Definition
Number 1 corresponds to the optic nerve.
Term
Coronal imaging through the paranasal sinuses is typically performed with the plane of imaging:
A. parallel to the infraorbital-meatal line.

B. perpendicular to the glabellomeatal line.

C. parallel to Reid’s baseline.

D. perpendicular to the hard palate.
 Definition
D. perpendicular to the hard palate.
The imaging plane should be positioned perpendicular to the hard palate for coronal evaluation of the paranasal sinuses. This may be achieved by positioning the patient in either the supine, head extended-back position, or with the patient in the prone position. In either case, appropriate angulation of the gantry can help achieve an acquisition angle that is perpendicular to the hard palate. Alternatively, multiplanar reformation (MPR) images may be produced at an angle perpendicular to the axial acquisition, also resulting in coronal images through the paranasal sinuses.
Term
Which of the following statements accurately describes the effects of administering an iodinated IV contrast agent during Imaging Procedures of the brain?
1. The contrast agent increases the attenuation values for normal gray matter.
2. The contrast agent improves the differentiation of subtle hemorrhage.
3. The contrast agent enhances neoplasms that have disrupted the blood–brain barrier.
A. 1 only

B. 1 and 2 only

C. 1 and 3 only

D. 1, 2, and 3
 Definition
C. 1 and 3 only
During CT imaging for suspected intracranial bleeding, contrast administration is initially contraindicated because the associated enhancement may mask subtle signs of hemorrhage.
Term
Which of the following is NOT a component of the blood supply to the brain commonly referred to as the circle of Willis?
A. Right middle cerebral artery

B. Left posterior communicating artery

C. Anterior communicating artery

D. Left posterior cerebral artery
 Definition
The circle of Willis is composed of the anterior cerebral, anterior communicating, internal carotid, posterior cerebral, and posterior communicating arteries. The basilar artery and middle cerebral arteries are important vessels supplying blood to the brain, but they do not form a part of the circle of Willis.

A. Right middle cerebral artery
Term
Which of the following methods may be used to determine the appropriate injection delay for optimal vessel enhancement during a CTA examination of the brain?
1. Measuring the patient’s pulse rate
2. Performing a bolus-timing sequence
3. Utilizing bolus-tracking software
A. 1 only

B. 1 and 3 only

C. 2 and 3 only

D. 1, 2, and 3
 Definition
Although pulse rate may provide an indication of the patient’s overall cardiac function, it is not utilized to determine injection delays for angiographic Imaging Procedures. Empiric delays, bolus-timing sequences, and bolus-tracking software may all be used to accurately acquire CTA studies during peak vasculature enhancement.
C. 2 and 3 only
Term
During a CTA of the brain’s circle of Willis, if an iodinated contrast agent is injected at a rate of 3 to 4 mL/sec, an adequate delay for optimal vessel opacification would be in the range of:
A. 4 to 10 seconds.

B. 12 to 20 seconds.

C. 45 to 60 seconds.

D. 60 to 90 seconds.
 Definition
An empiric delay of 12 to 20 seconds would be adequate to ensure good vessel opacification of the circle of Willis.
B. 12 to 20 seconds
Term
Evaluation of the venous vascular structures of the brain is known as:
A. CT angiography.

B. CT perfusion.

C. CT runoff.

D. CT venography.
 Definition
CT venography (CTV) of the brain is a variation of the CTA technique whereby the timing of data acquisition is optimized for the period of peak venous opacification.
D. CT venography.
Term
The primary indication for CT perfusion of the brain is:
A. status-post trauma.

B. acute stroke.

C. mass lesion.

D. hydrocephalus.
 Definition
CT perfusion (CTP) evaluates cerebral perfusion by monitoring the initial passing of iodinated contrast media through the vasculature of the brain. The primary indication for CTP is in the evaluation of acute stroke.

B. acute stroke
Term
During CT perfusion studies, the quantity of blood (in mL) contained within 100 g of brain tissue is termed the:
A. mean transit time (MTT).

B. cerebral blood flow (CBF).

C. cerebral blood volume (CBV).

D. percent-washout value (PWV).
 Definition
Cerebral blood volume (CBV) describes the quantity of blood (in mL) contained within a 100-g volume of brain tissue. Normal range is 4 to 5 mL/100 g.
C. cerebral blood volume (CBV).
Term
During CT perfusion studies, the measured time (in seconds) required for blood to pass through an area of brain tissue is termed the:
A. cerebral blood flow (CBF).

B. ejection fraction (EF).

C. mean transit time (MTT).

D. cerebral blood volume (CBV).
 Definition
Mean transit time (MTT) describes the average time, in seconds, for blood to pass through a given region of brain tissue. MTT varies with the distance traveled between arterial inflow and venous outflow for a particular area.

C. mean transit time (MTT)
Term
Which of the following correctly illustrates the central volume principle of cerebral perfusion?
A. CBF = CBV/MTT

B. CBF = CBV × MTT

C. MTT = CBV × CBF

D. CBF = MTT/CBV
 Definition
CBF = CBV/MTT
The central volume principle is described by the formula CBF = CBV/MTT. It illustrates the relationship of cerebral blood flow as a factor of the volume of blood within a given area of brain tissue and the time it takes for that blood to pass through the area. Reduced CBF may indicate ischemia resulting from stroke or other brain abnormalities.
Term
The normal range of cerebral blood flow (CBF) through 100 g of the brain’s gray matter is:
A. 2 to 4 mL/100 g/min.

B. 15 to 25 mL/100 g/min.

C. 50 to 60 mL/100 g/min.

D. 110 to 135 mL/100 g/min.
 Definition
C. 50 to 60 mL/100 g/min
The normal range of CBF in gray matter is 50 to 60 mL/100 g/min.
Term
The normal range of cerebral blood volume (CBV) contained within 100 g of brain tissue is:
A. 0.6 to 1.0 mL/100 g.

B. 4 to 5 mL/100 g.

C. 15 to 19 mL/100 g.

D. 30 to 40 mL/100 g.
 Definition
The normal range of CBV in brain tissue is 4 to 5 mL/100 g.
Term
Ischemic brain tissue is identified as an infarct core when cerebral blood volume (CBV) falls below:
A. 2.5 mL/100 g.

B. 5.0 mL/100 g.

C. 10.0 mL/100 g.

D. 50.0 mL/100 g.
 Definition
A. 2.5 mL/100 g
Brain parenchyma with a CBV less than 2.5 mL/100 g is identified as the infarct core.
Term
An injury to the brain at a location opposite to the site of traumatic impact is referred to as:
A. coup.

B. contrecoup.

C. subdural.

D. epidural.
 Definition
B. contrecoup
The contrecoup type of acute brain injury occurs at a location on the opposite side of the head from the point of impact. As the moving skull rapidly decelerates prior to impact, the portion of brain opposite to the impact site temporarily pulls away from the skull before forcibly recoiling back into its original position, resulting in traumatic injury. In comparison, coup injuries to the brain occur at the actual site of traumatic impact.
Term
The type of hemorrhage that occurs between the skull and outer layer of the dura in traumatic brain injury is referred to as a(n):
A. subdural hematoma.

B. epidural hematoma.

C. subarachnoid hematoma.

D. subcutaneous hematoma.
 Definition
B. epidural hematoma
An epidural hematoma occurs between the skull and the outermost meningeal covering of the brain called the dura mater. Subdural hematomas occur between the dura mater and the next inner layer of the meninges, known as the arachnoid. The innermost layer of the meninges is called the pia mater.
Term
MSB 12 Which number corresponds to the common carotid artery?

A. 4
B. 3
C. 1
D. 5
 Definition
Number 3 corresponds to the common carotid artery.
Term
MSB 12 Number 4 corresponds to which of the following?

A. Internal jugular vein
B. External carotid artery
C. Internal carotid artery
D. Retromandibular vein
 Definition
Number 4 corresponds to the internal jugular vein.
Term
MSB 12 Number 2 corresponds to which of the following?

A. Trapezius muscle
B. Levator scapulae muscle
C. Sternocleidomastoid muscle
D. Parotid gland
 Definition
Number 2 corresponds to the sternocleidomastoid muscle.
Term
Which of the following is the best scout or localizer projection for a CT scan of the neck?
A. AP

B. Oblique

C. PA

D. Lateral
 Definition
D. Lateral

Axial images of the neck are easily prescribed from a lateral projection scanogram or scout.
Term
MSB 13 Number 2 corresponds to which of the following?

A. Azygous vein
B. Esophagus
C. Internal jugular vein
D. Descending aorta
 Definition
Number 2 corresponds to the esophagus.
Term
MSB 13 Number 4 corresponds to which of the following?

A. First rib
B. Second rib
C. Clavicle
D. Acromion
 Definition
Number 4 corresponds to the clavicle.
Term
MSB 13 Number 1 corresponds to which of the following?

A. Thyroid cartilage
B. Hyoid bone
C. Adam’s apple
D. Thyroid gland
 Definition
Number 1 corresponds to the thyroid gland.
Term
MSB 13 Which of the following pathologic processes best describes the abnormal finding in the figure?

A. Primary lung cancer
B. Esophageal tumor
C. Enlarged thyroid
D. Tonsillitis
 Definition
C. Enlarged thyroid
The thyroid gland is abnormally enlarged. This may be because of several processes, including thyroid carcinoma and various endocrine disorders.
Term
MSB 14 Which number corresponds to the retromandibular vein?

A. 3
B. 5
C. 4
D. 2
 Definition
Number 3 corresponds to the left retromandibular vein.
Term
MSB 14 Number 6 corresponds to which of the following?

A. Nasopharynx
B. Oropharynx
C. Esophagus
D. Larynx
 Definition
Number 6 corresponds to the oropharynx.
Term
MSB 14 Number 2 corresponds to which of the following?

A. Adenoids
B. Epiglottis
C. Pharyngeal constrictor muscle
D. Parotid gland
 Definition
Number 2 corresponds to the pharyngeal constrictor muscle.
Term
MSB 15 Number 2 corresponds to which of the following?

A. Cricoid cartilage
B. Thyroid cartilage
C. Hyoid bone
D. Arytenoid cartilage
 Definition
Number 2 corresponds to the hyoid bone.
Term
MSB 15 Number 4 corresponds to which of the following? See Fig.
A. Parotid gland

B. Sternocleidomastoid muscle

C. Submandibular gland

D. Trapezius muscle
 Definition
Number 4 corresponds to the sternocleidomastoid muscle.
Term
MSB 15 Number 1 corresponds to which of the following?

A. Right internal jugular vein
B. Right external carotid artery
C. Right internal carotid artery
D. Right external jugular vein
 Definition
Number 1 corresponds to the right external carotid artery.
Term
MSB 15 Number 3 corresponds to which of the following?

A. Vertebral artery
B. Cervical ganglion
C. Vagus nerve
D. Posterior spinal artery
 Definition
Number 3 corresponds to the vertebral artery.
Term
MSB 16
Number 2 corresponds to which of the following?

A. Azygous vein
B. Lymph node
C. Cricothyroid ligament
D. Esophagus
 Definition
Number 2 corresponds to the esophagus.
Term
MSB 16
Number 4 corresponds to which of the following?

A. Left internal jugular vein
B. Left common carotid artery
C. Left vertebral artery
D. Left anterior jugular vein
 Definition
Number 4 corresponds to the left common carotid artery.
Term
MSB 16 Which of the following pathologic conditions could be exhibited by the structure labeled as number 3?

A. Carotid artery disease (CAD)
B. Jugular vein distention
C. Vocal cord paralysis
D. Hypothyroidism
 Definition
D. Hypothyroidism
Number 3 is the thyroid gland. Hypothyroidism, or underactive thyroid, is a condition in which the thyroid does not produce a sufficient amount of thyroid hormone.
Term
MSB 16 Number 1 corresponds to which of the following?

A. Right internal jugular vein
B. Right external carotid artery
C. Right internal carotid artery
D. Right external jugular vein
 Definition
Number 1 corresponds to the right internal jugular vein.
Term
The tortuous S-shaped portion of the internal carotid artery as it enters the bony skull may be referred to as the carotid:
A. lordosis.

B. kyphosis.

C. siphon.

D. sinus.
 Definition
C. siphon
Carotid siphon refers to the portion of the internal carotid artery as it enters the bony skull and bifurcates into the anterior cerebral and middle cerebral arteries.
Term
Which of the following patient positions is best suited for CT evaluation of the chest?
A. Prone

B. Left lateral decubitus

C. Right lateral decubitus

D. Supine
 Definition
D. Supine
CT examinations of the chest usually require that the patient be placed in the supine position. Patients may also be scanned in the prone position, to increase aeration of the posterior lung base, or in a lateral decubitus position, to help differentiate certain types of pathology.
Term
MSB 17 Number 5 corresponds to which of the following?

A. Left atrium
B. Right ventricle
C. Ascending aorta
D. Descending aorta
 Definition
Number 5 corresponds to the right ventricle.
Term
MSB 17 Which number corresponds to the left atrium?

A. 1
B. 2
C. 3
D. 4
 Definition
Number 2 corresponds to the left atrium.
Term
MSB 17 Number 4 corresponds to which of the following?

A. Azygous vein
B. Superior vena cava
C. Left ventricle
D. Right atrium
 Definition
Number 4 corresponds to the azygous vein.
Term
MSB 18 Which of the following algorithms was used in the reconstruction of this image?

A. Bone
B. Edge
C. Soft tissue
D. Detail
 Definition
C. Soft tissue
The soft tissue or standard algorithm is selected for imaging of soft tissue structures such as those found in the mediastinum.
Term
MSB 18 Number 2 corresponds to which of the following?

A. Left primary bronchus
B. Descending aorta
C. Superior vena cava
D. Left pulmonary artery
 Definition
Number 2 corresponds to the left pulmonary artery.
Term
MSB 18 Which number corresponds to the right primary bronchus?

A. 6
B. 3
C. 5
D. 1
 Definition
Number 5 corresponds to the right primary bronchus.
Term
MSB 18 Number 3 corresponds to which of the following?

A. Descending aorta
B. Inferior vena cava
C. Left pulmonary artery
D. Esophagus
 Definition
Number 3 corresponds to the descending aorta.
Term
Which of the following types of CT scanners is best suited for the evaluation of coronary artery disease?
A. PET-CT

B. Fourth-generation

C. Electron beam CT (EBCT)

D. Second-generation
 Definition
C. Electron beam CT (EBCT)
Electron beam CT (EBCT) scanners are designed to acquire information at an extremely rapid rate. With the use of electron beam technology, these ultrafast CT systems can greatly reduce cardiac and pulmonary motion, allowing detailed evaluation of anatomic areas such as the coronary arteries.
Term
High-resolution computed tomography (HRCT) of the chest incorporates which of the following protocols?

A. 10-mm sections, standard algorithm
B. 10-mm sections, bone algorithm
C. 3-mm sections, standard algorithm
D. 1-mm sections, bone algorithm
 Definition
D. 1-mm sections, bone algorithm
High-resolution computed tomography (HRCT) of the chest is used to examine diffuse pulmonary disease. This technique offers excellent visualization of the lungs, airways, and pulmonary hilum. HRCT involves the use of narrow sections (1 to 3 mm) and a high-resolution algorithm.
Term
A solitary pulmonary nodule can be assumed benign when its average density is within which of the following ranges?

A. 10 to 30 HU
B. 45 to 80 HU
C. 100 to 140 HU
D. 165 to 200 HU
 Definition
D. 165 to 200 HU
Pulmonary nodules appearing on CT examinations of the lungs may be determined as benign if their average density is more than +164 Hounsfield units. Although there have been conflicting studies in this area, researchers tend to agree that density values approaching +200 HU make the benign diagnosis more certain.
Term
Which of the following contrast media may be used during a CT examination of the chest?
1. Diatrizoate meglumine
2. Barium sulfate
3. Iopamidol

A. 1 only
B. 1 and 2 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
D. 1, 2, and 3
Diatrizoate meglumine is an ionic intravenous contrast material, and iopamidol is a nonionic one. Both may be used for soft-tissue enhancement during CT of the chest. A barium sulfate contrast agent, usually in the form of a paste, may also be used to outline the esophagus, when necessary.
Term
MSB 19 This localizer (scout) image was performed for a general CT survey of the chest. What technical error(s) was/were made with this image?

1. Image proceeds too far superiorly and inferiorly.
2. Incorrect azimuth is used.
3. Patient’s hands were not positioned overhead.

A. 1 only
B. 1 and 2 only
C. 1 and 3 only
D. 1, 2, and 3
 Definition
C. 1 and 3 only
A scout image or scanogram for a CT examination of the chest should be a frontal projection including from above the apices to just below the costophrenic angles. The patient’s arms should be positioned overhead whenever possible to avoid streaking artifacts on the axial images.
Term
MSB 19 Number 1 corresponds to which of the following?

A. Acromion
B. Coronoid
C. Coracoid
D. Olecranon
 Definition
Number 1 corresponds to the acromion
Term
MSB 19 Number 4 corresponds to which of the following?

A. Esophagus
B. Middle hemi-diaphragm
C. Carina
D. Thymus gland
 Definition
Number 4 corresponds to the carina.
Term
MSB 19 Number 3 corresponds to which of the following?

A. Cardiophrenic angle
B. Costophrenic angle
C. Caudal margin of pleura
D. Lingula
 Definition
Number 3 corresponds to the costophrenic angle.
Term
The __________ gland is located in the anterosuperior portion of the mediastinum and is often identified with CT during scanning of younger patients.
A. thyroid

B. Luschka

C. thymus

D. parathyroid
 Definition
C. thymus
The thymus gland may be found in the anterosuperior portion of the mediastinum. It is most easily visible prior to puberty. After puberty it becomes increasingly infiltrated with fat, so it is more difficult to image with computed tomography.
Term
MSB 20 Number 6 corresponds to which of the following? See Fig.
A. Right brachiocephalic vein

B. Left subclavian artery

C. Brachiocephalic artery

D. Left common carotid artery
 Definition
Number 6 corresponds to the right brachiocephalic vein.
Term
MSB 20 Number 2 corresponds to which of the following?

A. Right brachiocephalic vein
B. Left subclavian artery
C. Brachiocephalic artery
D. Left common carotid artery
 Definition
Number 2 corresponds to the left common carotid artery.
Term
MSB 20 Number 7 corresponds to which of the following?

A. Right brachiocephalic vein
B. Left subclavian artery
C. Brachiocephalic artery
D. Left common carotid artery
 Definition
Number 7 corresponds to the brachiocephalic artery.
Term
MSB 20 Which number corresponds to the left brachiocephalic vein?

A. 2
B. 4
C. 5
D. 1
 Definition
Number 1 corresponds to the left brachiocephalic vein.
Term
MSB 20 Which of the following does not branch off from the aortic arch?

A. 6
B. 3
C. 7
D. 2
 Definition
A. 6
The subclavian (3), brachiocephalic (7), and common carotid (2) arteries all branch off the superior portion of the aortic arch. The left (1) and right (6) brachiocephalic veins originate from the superior vena cava.
Term
MSB 21 Number 2 corresponds to which of the following?

A. Right ventricle
B. Right atrium
C. Left ventricle
D. Left atrium
 Definition
Number 2 corresponds to the left ventricle.
Term
MSB 21 Which of the following algorithm type, matrix size, and section thickness parameters were used for the image?

A. Soft tissue, 320, 5.0 mm
B. Bone, 512, 10.0 mm
C. Standard, 512, 5.0 mm
D. Standard, 512, 10.0 mm
 Definition
D. Standard, 512, 10.0 mm
The matrix size, algorithm type, and section thickness can all be found on the peripheral portion of the image. Each of these factors is variable and greatly affects the image quality.
Term
MSB 21 Number 4 corresponds to which of the following?

A. Descending aorta
B. Esophagus
C. Azygous vein
D. Trachea
 Definition
Number 4 corresponds to the azygous vein.
Term
MSB 21 Which of the following technical changes would serve to improve the quality of the image?

A. Change matrix size to 256.
B. Decrease DFOV size.
C. Change matrix size to 320.
D. Increase DFOV size.
 Definition
The image was reconstructed in a DFOV larger than necessary. The image appears minified because of this error. The DFOV chosen for an image should be slightly larger than the diameter of the area of interest. The B. Decrease DFOV size
DFOV used here was 48 cm. This image would appear significantly larger with a DFOV of 36 to 40 cm.
Term
MSB 21 Which number corresponds to the right atrium?

A. 2
B. 5
C. 1
D. 3
 Definition
Number 5 corresponds to the right atrium.
Term
Which of the following improvements in CT chest imaging is a direct result of the advent of multidetector CT (MDCT)?
1. Reduction in misregistration artifacts
2. Increased examination speed
3. Reduction in patient dose

A. 1 only
B. 1 and 2 only
C. 1 and 3 only
D. 1, 2, and 3
 Definition
B. 1 and 2 only
Speed is one of the key attributes of helical MDCT. The ability to volumetrically acquire images of the entire chest in a single breath-hold has greatly reduced the occurrence of misregistration artifacts. For many applications, MDCT may result in greater patient radiation dose than single-slice CT (SSCT).
Term
Which of the following is NOT an improvement in CT chest imaging because of the development of multidetector technology?

A. An overall reduction in patient radiation dose
B. Reduction in partial volume artifact
C. Elimination of misregistration artifacts
D. Improved contrast enhancement
 Definition
A. An overall reduction in patient radiation dose
The speed of MDCT systems allow for images of the entire chest to be volumetrically acquired in just a few seconds. Fast, single-breath-hold acquisitions greatly reduce artifacts from breathing motion and allow for more efficient utilization of iodinated contrast agents. The ability to retrospectively reconstruct thin-section images can effectively eliminate the partial volume artifact on small areas of pathology. The drawback to MDCT is the potential for an increase in overall patient radiation dose. However, careful protocol optimization and continued technologic advancements work to limit any increases in patient radiation dose from MDCT examinations.
Term
For general contrast-enhanced MDCT of the chest, sufficient opacification of vascular structures can be typically obtained with injection rates of:

A. 0.5 to 1.2 mL/sec.
B. 2.5 to 4.0 mL/sec.
C. 5.0 to 7.5 mL/sec.
D. more than 8.0 mL/sec.
 Definition
B. 2.5 to 4.0 mL/sec
Administration of 50 to 150 mL of iodinated contrast agent at a rate between 2.5 and 4.0 mL/sec provides adequate opacification of the mediastinum and other vascular structures for most CT examinations of the chest.
Term
MSB 22 Number 3 corresponds to which of the following muscles? See Fig.
A. Pectoralis major

B. Pectoralis minor

C. Intercostals

D. Serratus posterior superior
 Definition
Number 3 corresponds to the pectoralis major muscle.
Term
MSB 22 The administration of which of the following contrast agents is evident on this image?

1. IV iodinated contrast agent
2. Oral water-soluble contrast agent
3. Oral barium paste

A. 1 only
B. 2 only
C. 1 and 3 only
D. 1, 2, and 3
 Definition
A. 1 only
The superior vena cava (1), aortic arch (2), and azygos vein (6) are clearly opacified with an IV iodinated contrast agent. The esophagus (5) does not contain barium paste, and the remaining GI tract is not visualized on this section.
Term
MSB 22 Number 2 corresponds to which of the following?

A. Left pulmonary artery
B. Thymus
C. Left brachiocephalic vein
D. Aortic arch
 Definition
Number 2 corresponds to the aortic arch.
Term
During HRCT of the lungs, image acquisition upon full expiration may be performed to improve demonstration of:

A. pulmonary nodules.
B. metastatic lesions.
C. air trapping from COPD.
D. dilated pulmonary arteries.
 Definition
C. air trapping from COPD.
Suspension of breathing at the end of forced expiration (static expiratory HRCT) may be utilized to demonstrate air trapping in patients with suspected small airway disease, such as chronic obstructive pulmonary disease (COPD), and emphysema.
Term
The blocking of a pulmonary artery by a thrombus that has migrated from a distal vein is referred to as:

A. carotid artery disease.
B. coronary artery disease.
C. pulmonary embolism.
D. peripheral artery disease.
 Definition
C. pulmonary embolism
A pulmonary embolism occurs when a thrombus (blood clot) breaks free from elsewhere in the venous system (usually the lower extremities) and migrates into a pulmonary artery.
Term
Primary technical considerations for a CTA of the chest to rule out pulmonary embolism include:
1. Short acquisition in a single breath-hold from diaphragm to lung apex
2. Bolus injection of iodinated contrast agent at 4 to 5 mL/sec
3. Portal-phase acquisition at 60 to 70 seconds

A. 1 only.
B. 1 and 2 only.
C. 2 and 3 only.
D. 1, 2, and 3.
 Definition
B. 1 and 2 only
CTA acquisition for pulmonary embolism must occur during peak contrast enhancement of the pulmonary arteries. Test bolus and automated bolus tracking methods are available to ensure appropriate scan delay for acquisition during the arterial phase of vessel opacification. Additional technical parameters include thin-section (0.5 to 1.25), caudocephalad acquisition with the use of a saline flush immediately following the administration of 80 to 150 mL of low-osmolar or iso-osmolar contrast media.
Term
Why is it recommended that data acquisition for a CTA of the pulmonary arteries be performed in the caudocephalad direction?
A. To reduce overall patient radiation dose
B. To reduce required contrast volume
C. Pulmonary emboli are more prevalent superiorly
D. Less streaking artifact from dense contrast in the superior vena cava
 Definition
D. Less streaking artifact from dense contrast in the superior vena cava
Scanning is best performed in the caudocephalad direction because there is reduced streaking artifact from dense contrast in the superior vena cava as the scan progresses. Also, if the patient is unable to hold the breath for the entire scan, motion artifacts are reduced higher in the chest.
Term
Following a CTA of the chest for pulmonary embolism, an additional acquisition may be performed through the lower extremities to evaluate for:

A. swelling.
B. contrast retention.
C. deep vein thrombosis (DVT).
D. femoral aneurysm.
 Definition
C. deep vein thrombosis (DVT)
During a CT pulmonary angiogram (CTPA) study, CT venography (CTV) of the lower extremities for the identification of deep vein thrombosis (DVT) may also be performed. DVT, the formation of blood clots within distal blood vessels, is common in the popliteal and femoral veins of the lower extremities. Pulmonary emboli occur when clots formed in the distal extremities dislodge and travel into the pulmonary arteries.
Term
For a given CTA examination of the pulmonary arteries, 100 mL of a low-osmolar iodinated contrast agent is administered at a rate of 4 mL/sec. Peak pulmonary artery opacification should occur at approximately:

A. 5 to 10 seconds.
B. 20 to 25 seconds.
C. 50 to 60 seconds.
D. 80 to 90 seconds.
 Definition
B. 20 to 25 seconds
Empiric scan delays for CTA of the pulmonary arteries vary between 20 and 25 seconds. Peak contrast opacification of the pulmonary arteries depends heavily on the rate of injection and the cardiac output of the patient. Performing a test bolus sequence and utilizing bolus-tracking software are valuable methods of ensuring that acquisition occurs during the period of maximum vessel opacification.
Term
The primary indication for a noncontrast cardiac MDCT examination is:

A. coronary artery stenosis.
B. aortic aneurysm.
C. coronary artery calcium quantification.
D. pulmonary embolism.
 Definition
C. coronary artery calcium quantification.The primary clinical indication for noncontrast cardiac MDCT is coronary artery calcium (CAC) quantification for the assessment of atherosclerotic disease.
Term
Prospectively gated cardiac CT data acquisition occurs only during the portion of the ECG termed the:
A. P wave.

B. QRS complex.

C. ST segment.

D. T wave.
 Definition
D. T wave.
With prospective electrocardiography (ECG) monitoring, scanning only occurs during diastole, when the heart demonstrates the least motion. A user-defined percentage of the R-R interval is set as the trigger for data acquisition to occur during the T wave of the ECG.
Term
For MDCT, identified areas of calcium must demonstrate relative attenuation values greater than:
A. +20 HU.

B. +130 HU.

C. +450 HU.

D. +1000 HU.
 Definition
B. +130 HU
On MDCT cardiac examinations for coronary artery calcification (CAC) quantification, areas of calcium are identified as those greater than 1 mm2 in area with Hounsfield values above 130.
Term
An Agatston score of 250 on an MDCT cardiac examination for coronary artery calcification is rated as:
A. minimal.

B. mild.

C. moderate.

D. extensive.
 Definition
C. moderate
The Agatston scoring system quantifies coronary artery calcium as minimal (1 to 10), mild (11 to 100), moderate (101 to 400), and extensive (>400).
Term
An Agatston score of 5 on an MDCT cardiac examination for coronary artery calcification is rated as:
A. minimal.

B. mild.

C. moderate.

D. extensive.
 Definition
The Agatston scoring system quantifies the volume and density of calcium within the coronary arteries. A score of 1-10 is minimal. A score between 11-A. minimal
100 is mild. A score between 101-400 is moderate. A score greater than 400 is extensive.
Term
The major controlling factor of examination quality for coronary CTA is the:
A. contrast injection rate.

B. patient heart rate.

C. signal-to-noise ratio (SNR).

D. pitch.
 Definition
B. patient heart rate
The major controlling factor of coronary CTA is the patient’s heart rate. Stable, steady heart rates below 65 to 70 beats per minute (bpm) yield the best results.
Term
In patients who are right dominant, the posterior descending artery branches from the:

A. ramus intermedius.
B. conus artery.
C. right coronary artery.
D. right ventricular branch.
 Definition
C. right coronary artery.
85% of the population is said to be right dominant, meaning that the posterior descending artery (PDA) branches from the right coronary artery (RCA).
Term
In patients who are left dominant, the posterior descending artery branches from the:

A. left circumflex artery.
B. left ventricular branch.
C. conus artery.
D. sinus node artery.
 Definition
A. left circumflex artery
8% of the population is said to be left dominant, meaning that the posterior descending artery (PDA) branches from the left circumflex artery (LCX).
Term
Patients whose posterior descending artery branches from the right coronary artery and whose left posterior ventricular branches arise from the left circumflex artery, are said to be:

A. right dominant.
B. left dominant.
C. codominant.
D. posteriorly dominant.
 Definition
C. codominant
7% of the population is said to be codominant, meaning that the posterior descending artery (PDA) is supplied by the right coronary artery (RCA), and the left posterior ventricular branches arise from the left circumflex artery (LCX).
Term
Which of the following conditions absolutely prohibits a patient from undergoing a coronary CTA?

A. Cardiac arrhythmia
B. Contraindication to iodinated contrast agents
C. Tachycardia
D. Contraindication to β-blockers
 Definition
B. Contraindication to iodinated contrast agents
Contraindication to iodinated contrast agents is the only absolute contraindication to coronary CT, because all such studies must be performed after administration of an iodinated contrast agent.
Term
The branches of the left coronary artery include the:
1. Sinus node artery
2. Left anterior descending artery
3. Left circumflex artery

A. 2 only.
B. 1 and 2 only.
C. 2 and 3 only.
D. 1, 2, and 3.
 Definition
C. 2 and 3 only
Term
During a coronary artery CTA, single-segment reconstruction of a 400-msec rotation scan results in a temporal resolution of:

A. 100 msec
B. 200 msec.
C. 400 msec.
D. 800 msec.
 Definition
B. 200 msec
During single-segment, or half-scan reconstruction, data from only half a gantry rotation is used, resulting in a temporal resolution equal to one half the gantry rotation time.
Term
The ability of an MDCT system to freeze heart motion during a cardiac CT is described by its:

A. detector resolution.
B. spatial resolution.
C. temporal resolution.
D. contrast resolution.
 Definition
C. temporal resolution
The temporal resolution of an MDCT system describes its ability to freeze the motion of the heart as well as the arterial motion velocity within the coronary vasculature.
Term
Which of the following technical attributes enables MDCT systems to acquire motion-free images of the heart and surrounding vasculature?

A. Excellent contrast resolution
B. Superior temporal resolution
C. Consistent linearity
D. High SNR
 Definition
B. Superior temporal resolution
The temporal resolution of an MDCT system describes its ability to freeze the motion of the heart as well as the arterial motion velocity within the coronary vasculature.
Term
The primary advantage of prospective ECG gating for cardiac CT over retrospective ECG gating is:
A. the ability to scan patients with severe arrhythmia.
B. the ability to evaluate cardiac function.
C. a reduction in required contrast dose.
D. a reduction in patient radiation dose.
 Definition
D. a reduction in patient radiation dose
The main benefit of prospective ECG gating is the potential for up to a 70% reduction in patient radiation dose. Prospective ECG gating requires a steady heartbeat to limit motion artifact, and the evaluation of cardiac function is not possible because data is acquired only during diastole.
Term
The Stanford type B dissecting aneurysm affects which portion of the aorta?

A. Ascending thoracic
B. Descending thoracic
C. Abdominal
D. Bifurcation
 Definition
B. Descending thoracic
Stanford type B dissecting aneurysms affect the descending aorta. Stanford type A dissecting aneurysms affect the ascending aorta.
Term
During prospectively ECG-gated cardiac CTA studies, the scanning acquisition mode may be best described as:

A. axial "step-and-shoot."
B. helical volumetric.
C. axial cine.
D. multiplanar reconstruction.
 Definition
A. axial "step-and-shoot."
During prospective ECG-gated cardiac CTA, data are acquired in an axial "step-and-shoot" mode. The x-ray and data acquisition systems are activated only during the diastolic portion of the R-R interval. Retrospective ECG gating involves a volumetric helical acquisition with only the diastolic portion of the data used for image reconstruction. Cine CT involves a series of acquisitions of a limited area over time. Routinely used in perfusion CT studies, cine acquisitions may have certain cardiac applications, such as the evaluation of valves, specific vessels, and cardiac perfusion.
Term
The quantity of blood pumped out of a ventricle every heartbeat is termed the:

A. end-diastolic volume.
B. ejection fraction.
C. end-systolic volume.
D. injection fraction.
 Definition
B. ejection fraction.
Ejection fraction describes the percentage of blood pumped out of a cardiac ventricle during each contraction. It is a measure of cardiac function and can be accurately determined during a cardiac CT examination. With system software, the ejection fraction can be calculated from a comparison between the volume of blood within a ventricle at the end of filling (end-diastolic volume) and the volume at end of contraction (end-systolic volume).
Term
On axial CT images of the chest, the region between the ascending aorta and descending aorta just below the aortic arch is commonly referred to as the:

A. carina.
B. costophrenic angle.
C. retrocrural space.
D. aortic-pulmonary (AP) window.
 Definition
D. aortic-pulmonary (AP) window.
The aortic-pulmonary (AP) window is located between the ascending and descending aorta on axial CT cross section, just below the aortic arch. Containing mostly fat, the AP window is a common location for the visualization of abnormally enlarged lymph nodes (lymphadenopathy).
Term
By CT criteria, a solitary pulmonary nodule may be defined as a focal area of increased density in the lung that is smaller than:

A. 1 cm.
B. 3 cm.
C. 5 cm.
D. 10 cm.
 Definition
B. 3 cm
Solitary pulmonary nodules are typically ovoid focal areas of increased density that are less than 3 cm in diameter. Any lesion larger than 3 cm is referred to as a focal mass, with an increased propensity for malignancy.
Term
The exaggeration of displayed calcification within the coronary arteries during a cardiac MDCT study is referred to as:

A. aliasing.
B. blooming.
C. star artifact.
D. penumbra.
 Definition
B. blooming
Blooming refers to the potential overestimation of vessel calcification because of partial volume artifact. During cardiac MDCT studies, blooming may be somewhat mitigated by improving the spatial resolution of a given acquisition or choosing an appropriately wide window setting (1500 HU) to reduce the appearance of the artifact.
Term
MSB 23 Number 5 corresponds to which of the following?

A. Gallbladder
B. Inferior vena cava
C. Descending aorta
D. Right adrenal gland
 Definition
Number 5 corresponds to the inferior vena cava.
Term
MSB 23 Number 3 corresponds to which of the following?

A. Spleen
B. Small bowel
C. Descending colon
D. Left kidney
 Definition
Number 3 corresponds to the spleen.
Term
The portion of the nephron responsible for filtration of unwanted materials from the blood plasma is called the:

A. afferent arteriole.
B. proximal tubule.
C. efferent arteriole.
D. glomerulus.
 Definition
D. glomerulus
The glomerulus is the portion of the nephron responsible for filtering unwanted substances from blood plasma. The blood enters into the glomerulus through the afferent arteriole and exits through the efferent arteriole. The waste fluid leaves the glomerulus through the proximal tubule.
Term
The muscular contraction responsible for transporting material through the digestive tract is called:

A. mastication.
B. phagocytosis.
C. peristalsis.
D. deglutition.
 Definition
C. peristalsis
Peristalsis is the rhythmic contraction of smooth muscle that transports material through the gastrointestinal tract. It is also commonly found in the bile duct and ureters.
Term
Differentiation between the duodenum and head of the pancreas is best accomplished with:
1. An oral contrast agent administered 30-45 min. B4 scanning
2. Pre- and post-contrast images of the abdomen
3. Placement of the patient in the RT lat. dequb. position prior to scanning
A. 1 only.
B. 1 and 3 only.
C. 2 and 3 only.
D. 1, 2, and 3.
 Definition
B. 1 and 3 only
The duodenum and pancreatic head are often difficult to distinguish. This is one important reason why the small bowel must be properly opacified. To accomplish adequate opacification, an oral contrast agent should be administered at least 30 minutes prior to scanning. Positioning the patient in a right lateral decubitus position is also helpful in ensuring opacification of the duodenum, which surrounds the pancreatic head.
Term
__________ is a term that refers to an excessive amount of nitrogenous materials in the blood and is a symptom of renal failure.

A. Hydronephrosis
B. Azotemia
C. Oliguria
D. Diuresis
 Definition
B. Azotemia
Azotemia describes the condition of excessive nitrogenous materials in the blood. This condition is also commonly called uremia. Azotemia is a symptom of renal insufficiency and may occur during chronic renal failure.
Term
CT images of the abdomen should be acquired with the patient:

A. at full inspiration.
B. breathing quietly.
C. at full expiration.
D. breathing normally.
 Definition
C. at full expiration
Suspended respiration at the end of full expiration is the most reproducible point in the respiratory cycle. It results in less misregistration artifact during CT examinations of the abdomen.
Term
Which would be most suited for a scout (localizer) image of the abdomen?
A. From below the diaphragm to the bottom of the kidneys
B. From the top of the kidneys to the level of the mid-sacrum
C. From the top of the kidneys to the umbilicus
D. From above the diaphragm to the iliac crest
 Definition
D. From above the diaphragm to the iliac crest
The localizer or scout image for a CT study of the abdomen should include from above the diaphragm to the level of the iliac crest. Routine studies of the abdomen require axial sections including the liver in its entirety to the beginning of the pelvis at the iliac crest.
Term
Following the intravenous administration of iodinated contrast media, a hepatic hemangioma may become __________ and may no longer appear on the CT image.

A. hypodense
B. radiolucent
C. isodense
D. hyperdense
 Definition
C. isodense
The diagnosis of hemangioma is confirmed on CT by evaluation of its pattern of enhancement. Hemangiomas enhance from the periphery inward, until they become isodense with the surrounding hepatic tissue. Once isodense, the hemangioma attenuates the beam in the same way as the hepatic tissue. The CT numbers of the hemangioma and hepatic tissue become equal and the structures may become impossible to differentiate.
Term
Which of the following would most likely require the intravenous injection of an iodinated contrast agent for accurate differentiation during a CT study of the abdomen?

A. Angiomyolipoma
B. Renal stone
C. Diverticulitis
D. Renal cyst
 Definition
D. Renal cyst
The diagnosis of simple cyst is accurately made with proper CT examination. Pre- and post-contrast images must be obtained to measure enhancement. The attenuation values for the cystic area should be at or near zero. The diagnoses of angiomyolipoma, renal stone, and diverticulitis can be made without the intravenous injection of contrast material.
Term
MSB 24 Number 2 corresponds to which of the following?

A. Splenic vein
B. Left renal artery
C. Pancreas
D. Duodenum
 Definition
Number 2 corresponds to the pancreas.
Term
MSB 24 Which of the following methods of oral contrast agent administration would be suitable for the CT scan of the abdomen depicted in this figure?

A. 1500 mL 90 to 120 minutes prior to scanning
B. 1200-mL enema immediately prior to scanning
C. 100 mL 3 hours prior to scanning with an additional 50 mL given just before the study
D. 450 mL 30 minutes prior to scanning with an additional 250 mL given just before the study
Submit
 Definition
D. 450 mL 30 minutes prior to scanning with an additional 250 mL given just before the study
For a CT examination of the abdomen, an oral contrast agent should be administered in a volume of approximately 450 mL 15 to 30 minutes prior to the examination. An additional 250 mL should be given just prior to the study. This method of administration should provide adequate opacification of the stomach and small bowel.
Term
MSB 24 Number 3 corresponds to which of the following?

A. Inferior mesenteric artery
B. Adrenal gland
C. Tail of pancreas
D. Renal vein
 Definition
Number 3 corresponds to the adrenal gland.
Term
MSB 24 Which number corresponds to the left lobe of the liver?

A. 5
B. 1
C. 4
D. 6
 Definition
Number 1 corresponds to the left lobe of the liver.
Term
The presence of outpocketings in the wall of the colon is referred to as:

A. intussusception.
B. diverticulitis.
C. polyps.
D. diverticulosis.
 Definition
D. diverticulosis.

Diverticulosis is the presence of small pouch-like openings in the wall of the colon. Diverticulitis is used when the diverticula become inflamed.
Term
Often seen in pediatric patients, a specific type of renal mass arising from immature kidney cells is referred to as:

A. Krukenberg tumor.
B. Wilms tumor.
C. von Hippel-Lindau syndrome.
D. Ewing sarcoma.
 Definition
B. Wilms tumor
Wilms tumor is a specific type of renal mass that develops from immature renal parenchyma. It may also be referred to as nephroblastoma and occurs in pediatric patients, usually between ages 1 and 5 years.
Term
During a CT examination of the abdomen including intravenous administration of an iodinated contrast agent, which of the following abnormal findings could appear hyperdense in comparison with surrounding tissue?

A. Angiomyolipoma of the kidney
B. Simple hepatic cyst
C. Dilated common bile duct
D. Gallstone
 Definition
D. Gallstone
Owing to their relatively high CT numbers, gallstones usually appear hyperdense in comparison with the bile-filled gallbladder. Some gallstones having lower attenuation values can appear isodense on a CT scan of the abdomen.
Term
CT-guided needle biopsies are most commonly performed on which of the following anatomic areas?

A. Brain
B. Pancreas
C. Cervix
D. Stomach
 Definition
B. Pancreas
The pancreas is a common area for CT-guided needle biopsy. The location of a pathologic process and the type of tissue involved govern the use of percutaneous biopsy under CT guidance.
Term
Which of the following sets of reconstructed section widths and intervals would be best suited for a general survey CT study of the abdomen and pelvis in a patient with a history of lymphoma?

A. 0.625 mm × 0.625 mm
B. 1.25 mm × 2.5 mm
C. 5.0 mm × 5.0 mm
D. 10 mm × 15 mm
 Definition
C. 5.0 mm × 5.0 mm
General survey CT studies for lymphoma are typically performed contiguously with section widths ranging from 3.0 to 5.0 mm for routine review. Data acquisition with an MDCT system may involve the use of a thinner detector configuration, such as 0.625 mm. Thicker section widths are reconstructed for review, with thinner images used for multiplanar reformation (MPR) or for areas of specific concern.
Term
The water-soluble oral contrast agents used for CT scans of the abdomen and pelvis should contain approximately __________ iodine.

A. 2% to 5%
B. 8% to 12%
C. 15% to 20%
D. 25% to 40%
 Definition
A. 2% to 5%
A solution of 2% to 5% iodinated water-soluble contrast agent and water provides sufficient bowel opacification for CT studies of the abdomen and pelvis. Some institutions may use a flavored contrast agent or add a flavoring agent to the solution for ease of consumption. Common water-soluble contrast media include Gastrografin and Hypaque.
Term
MSB 25 What procedure is being performed in this figure?

A. Quantitative CT
B. Percutaneous abscess drainage
C. Percutaneous needle biopsy
D. Radiation therapy planning
 Definition
C. Percutaneous needle biopsy
The high-density object leading from the skin surface into the pancreatic head indicates that this image is part of a CT-guided percutaneous needle biopsy.
Term
MSB 25 Number 4 corresponds to which of the following?

A. Streaking artifact
B. Hernia
C. Gunshot
D. Biopsy needle
 Definition
Number 4 corresponds to a biopsy needle.
Term
MSB 25 Number 3 corresponds to which of the following?

A. Abscess
B. Hepatic tumor
C. Ascending colon
D. Gallbladder
 Definition
Number 3 corresponds to the gallbladder.
Term
MSB 25 Number 1 corresponds to which of the following?

A. Transverse colon
B. Splenic flexure
C. Stomach
D. Diverticular abscess
 Definition
Number 1 corresponds to the stomach.
Term
MSB 26 Number 2 corresponds to which of the following?

A. Erector spinae muscle
B. Gluteus medius muscle
C. Psoas major muscle
D. Sacrospinalis muscle
 Definition
Number 2 corresponds to the psoas major muscle.
Term
MSB 26 The circle labeled as number 1 is used here for what purpose?

A. To outline an area of pathology
B. To make an ROI (region of interest) measurement
C. To target an area for needle biopsy
D. To change the display field of view
 Definition
B. To make an ROI (region of interest) measurement
Region of interest (ROI) or attenuation measurements may be made on the CT image through numerous software applications. The image in this figure has a circular cursor positioned over an area of the kidney. The computer is capable of calculating the average attenuation value (CT number) for the pixels included within the circle. This information is valuable in identifying the type of tissue present and can aid in the determination of a diagnosis for selected pathologies.
Term
MSB 26 The measured density of the area labeled as number 4 is approximately +5 HU. This area most likely represents:

A. kidney stone.
B. angiomyolipoma.
C. renal tumor.
D. renal cyst.
 Definition
D. renal cyst.

The diagnosis of renal cyst from a CT scan depends on several factors. The area must be of relatively homogeneous density with explicit demarcations from the surrounding renal tissue. It must also present no remarkable enhancement after intravenous contrast agent administration, maintaining an average Hounsfield value of zero (±20 HU).
Term
MSB 26 Which of the following statements is true concerning CT scans of the abdomen for the differentiation of renal cysts?

1. Acquisitions through the kidneys should be performed before and after administration of an IV contrast agent.
2. ROI measurements of the cyst should be made to help determine its composition.
3. The patient should refrain from urination for 2 hours prior to the examination.

A. 1 only
B. 1 and 2 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
B. 1 and 2 only
CT examinations for the evaluation of renal cysts should be performed pre- and post-contrast agent administration to determine whether the area in question enhances. A renal cyst should also have an average density near or equal to that of water: −20 to +20 HU.
Term
MSB 26 Number 3 corresponds to which of the following?

A. Adrenal gland
B. Spleen
C. Liver
D. Duodenum
 Definition
Number 3 corresponds to the liver.
Term
Which of the following abnormal findings will reduce the density of the liver?

A. Hyperdense cyst
B. Contrast-enhancing tumor
C. Fatty infiltrate
D. Calcified granuloma
 Definition
C. Fatty infiltrate
The density of the liver decreases with the presence of fatty infiltrates. The minimal attenuation of fat and its low CT number cause an overall decrease in the attenuation and CT number of the hepatic parenchyma.
Term
CT scanning of the liver for tumor evaluation should NOT be performed during which of the following phases of contrast enhancement?

A. Arterial phase
B. Equilibrium phase
C. Portal venous phase
D. Bolus phase
 Definition
B. Equilibrium phase
Contrast enhancement is at its lowest point during the equilibrium phase. This phase is apparent when the aorta and inferior vena cava differ by less than 10 HU. It is during this phase that hepatic lesions may become isodense with the surrounding hepatic parenchyma. Noncontrast scanning of the liver is actually preferred to scanning during the equilibrium phase.
Term
The kidneys are usually located anatomically between which vertebrae?

A. T6 and L2
B. T12 and L3
C. L2 and L4
D. L3 and S1
 Definition
B. T12 and L3
The CT technologist is often called upon to localize the exact area of the kidneys. Although there may be some fluctuation from patient to patient, the kidneys can usually be found between the 12th thoracic vertebrae and 3rd lumbar vertebrae.
Term
The majority of pancreatic tumors occur in the pancreatic:

A. head.
B. body.
C. tail.
D. uncinate process.
 Definition
A. head
The majority of pancreatic tumors occur in the head of the pancreas. The majority of these masses are adenocarcinomas.
Term
Which of the following organs is/are characterized as retroperitoneal in location?

1. Pancreas
2. Liver
3. Kidneys

A. 1 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
B. 1 and 3 only
Retroperitoneal structures are those contained within the retroperitoneum. The retroperitoneum is the space located between the peritoneum and the posterior abdominal wall. It includes the duodenum, pancreas, adrenal glands, kidneys, ureters, and bladder.
Term
Normal unenhanced hepatic parenchyma exhibits CT densities within the range of:

A. −20 to 0 HU.
B. +15 to +30 HU.
C. +45 to +65 HU.
D. +80 to +105 HU.
 Definition
C. +45 to +65 HU
Normal unenhanced hepatic parenchyma is homogenous in appearance with CT densities between +45 and +65 Hounsfield units (HU). The CT density of the unenhanced liver is normally slightly greater than the densities of blood vessels and the splenic parenchyma.
Term
Which of the following is an example of a hypovascular hepatic mass?

A. Hemangioma
B. Hepatic cyst
C. Hepatocellular carcinoma (HCC)
D. Focal nodular hyperplasia (FNH)
 Definition
B. Hepatic cyst
The hallmark CT finding for a cyst is lack of enhancement with IV contrast agent administration. Cysts are therefore characterized as hypovascular. Hemangiomas, hepatocellular carcinomas (HCC), focal nodular hyperplasia (FNH), and certain metastatic lesions are all examples of hypervascular tumors of the liver.
Term
Malignant neoplasms of the liver include which of the following?
1. Focal nodular hyperplasia (FNH)
2. Cavernous hemangioma
3. Hepatocellular carcinoma (HCC)

A. 3 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
A. 3 only
Hepatocellular carcinoma (HCC) and metastases are the most common malignant neoplasms of the liver. Hemangiomas and focal nodular hyperplasia (FNH) are both examples of benign hepatic tumor.
Term
The liver has a dual blood supply and receives 25% of its blood from the:

A. hepatic artery.
B. superior mesenteric artery.
C. portal vein.
D. superior mesenteric vein.
 Definition
A. hepatic artery
The liver has a dual blood supply, receiving 75% of its supply from the portal vein, and the remaining 25% of blood from the hepatic artery.
Term
Contrast enhancement phases of the liver include which of the following?

1. Corticomedullary
2. Arterial
3. Portal venous

A. 2 only
B. 1 and 2 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
C. 2 and 3 only
The primary hepatic phases of contrast enhancement are the arterial, portal venous, and equilibrium phases. The early arterial and delayed phases of hepatic enhancement are also noted.
Term
After initiation of rapid bolus administration of an iodinated contrast agent, the hepatic venous phase of contrast enhancement occurs at approximately:

A. 15 to 20 seconds.
B. 25 to 35 seconds.
C. 60 to 70 seconds.
D. 120 to 180 seconds.
 Definition
C. 60 to 70 seconds
The hepatic (or portal) venous phase is the period of peak hepatic parenchymal enhancement during which contrast material redistributes from the blood into the extravascular spaces. It occurs at approximately 60 to 70 seconds after the initiation of rapid bolus administration of a contrast agent.
Term
After initiation of rapid bolus administration of an iodinated contrast agent, the equilibrium phase of hepatic contrast enhancement occurs at approximately:

A. 15 to 20 seconds.
B. 25 to 35 seconds.
C. 60 to 70 seconds.
D. 120 to 180 seconds.
 Definition
D. 120 to 180 seconds.
The equilibrium phase of hepatic contrast enhancement usually occurs 2 to 3 minutes after the initiation of contrast agent administration. During this phase, hepatic parenchymal enhancement dissipates and there is minimal difference in contrast enhancement between the intravascular and extravascular spaces.
Term
After initiation of rapid bolus administration of an iodinated contrast agent, the early arterial phase of hepatic contrast enhancement occurs at approximately:

A. 15 to 20 seconds.
B. 25 to 35 seconds.
C. 60 to 70 seconds.
D. 120 to 180 seconds.
 Definition
A. 15 to 20 seconds
Occurring at 15 to 20 seconds after the initiation of contrast administration, the early arterial phase of contrast enhancement is the optimal phase for angiographic applications of liver CT. During this phase, the hepatic arterial supply is well opacified with little or no parenchymal enhancement.
Term
The period of peak hepatic parenchymal enhancement following rapid bolus injection of iodinated contrast is termed the:
A. equilibrium phase.

B. portal venous phase.

C. arterial phase.

D. nephrographic phase.
 Definition
B. portal venous phase.
The portal (or hepatic) venous phase is the period of peak hepatic parenchymal enhancement during which contrast material redistributes from the blood into the extravascular spaces. It occurs at approximately 60 to 70 seconds after the initiation of rapid bolus contrast administration.
Term
The presence of stones within the gallbladder is termed:
A. nephrolithiasis.

B. cholelithiasis.

C. choledocholithiasis.

D. sialolithiasis.
 Definition
B. cholelithiasis
The condition of stones within the gallbladder is referred to as cholelithiasis. Choledocholithiasis is the presence of gallstones within the bile ducts. Nephrolithiasis refers to renal stones. Sialolithiasis refers to the presence of stones in the salivary glands.
Term
The hallmark CT finding for focal nodular hyperplasia (FNH) of the liver is:
A. lack of enhancement with IV contrast agent administration.

B. CT density approximately 10 HU less than that of the spleen.

C. peripheral globular enhancement during initial contrast agent administration.

D. central scar that remains hypodense after initial contrast agent administration.
 Definition
D. central scar that remains hypodense after initial contrast agent administration
Focal nodular hyperplasia (FNH) is a common vascular lesion often identified along the surface of the liver. It is characterized by intense homogeneous enhancement with contrast agent administration. There is usually a central scar that remains hypodense until delayed imaging, when it may also enhance.
Term
Portal venous phase imaging of the liver is used to optimally demonstrate which of the following?

A. Hepatocellular carcinoma (HCC)
B. Hypovascular hepatic metastases
C. Hepatic artery aneurysm
D. Focal nodular hyperplasia (FNH)
 Definition
B. Hypovascular hepatic metastases
Portal venous phase imaging is the phase during which hypovascular lesions are most conspicuous because of their density difference in comparison with the enhancing hepatic parenchyma. Hepatocellular carcinoma (HCC), hepatic artery aneurysm, and focal nodular hyperplasia are all hypervascular in nature and would be best demonstrated on arterial phase imaging.
Term
During post-contrast CT imaging of the abdomen, the degree of hepatic parenchymal enhancement depends on:
1. The iodine concentration of the contrast agent
2. The rate if contrast agent injection
3. The osmolality of the contrast medium

A. 1 only.
B. 1 and 2 only.
C. 2 and 3 only.
D. 1, 2, and 3.
 Definition
B. 1 and 2 only
The extent of hepatic parenchymal enhancement depends on the overall dose of iodine delivered. The iodine dose may be increased directly by utilizing a contrast agent with a higher concentration, or indirectly by increasing the injection rate.
Term
The approximate CT density of the unenhanced spleen is:
A. less than 0 HU.

B. between +40 and +60 HU.

C. between +75 and +90 HU.

D. greater than +100 HU.
 Definition
B. between +40 and +60 HU
The CT density of the unenhanced spleen is between +40 and +60 HU. The unenhanced spleen CT density is approximately 10 HU less than that of the unenhanced liver.
Term
Which of the following phases of contrast enhancement optimally demonstrates the relationship between pancreatic neoplasm and the surrounding vasculature?

A. Pre-contrast
B. Arterial phase
C. Pancreatic phase
D. Portal venous phase
 Definition
B. Arterial phase
During arterial phase acquisition through the pancreas, there is maximum opacification of the surrounding vasculature, including the aorta and superior mesenteric artery. An important goal of pancreatic CT is to evaluate the involvement of surrounding vessels by pancreatic neoplasm.
Term
Which of the following technical considerations is necessary to differentiate hydronephrosis from parapelvic cysts on CT examination?

A. Administration of an iodinated IV contrast agent
B. Prone acquisition
C. Administration of an oral contrast agent
D. Valsalva maneuver
 Definition
A. Administration of an iodinated IV contrast agent
Parapelvic cysts are simple cysts arising within the renal pelvis. They are similar in appearance to the distention of the pelvis and calyces known as hydronephrosis. Delayed imaging after IV contrast agent administration opacifies the renal pelvis, clearly differentiating hydronephrosis from parapelvic cysts.
Term
After initiation of rapid bolus administration of an iodinated contrast agent, the corticomedullary phase of renal contrast enhancement occurs at approximately:

A. 20 to 25 seconds.
B. 30 to 40 seconds.
C. 70 to 90 seconds.
D. 3 to 5 minutes.
 Definition
B. 30 to 40 seconds
The corticomedullary phase is a late arterial phase beginning 30 to 40 seconds after the initiation of contrast agent administration. Optimal enhancement of the renal cortex and renal veins occurs during this period.
Term
After initiation of rapid bolus administration of an iodinated contrast agent, the excretory phase of renal contrast enhancement occurs at approximately:

A. 20 to 25 seconds.
B. 30 to 40 seconds.
C. 70 to 90 seconds.
D. 3 to 5 minutes.
 Definition
D. 3 to 5 minutes
The excretory phase is a delayed-imaging phase that begins approximately 3 minutes after the initiation of contrast agent administration. During this phase, contrast material has been excreted into the renal calyces, opacifying the renal pelvis and the remainder of the urinary collecting system (ureters, bladder). The excretory phase best demonstrates the filling defects and potential lesions involving the urothelium, such as those from transitional cell carcinoma (TCC).
Term
The period of peak enhancement of the renal cortex following rapid bolus injection of an iodinated contrast agent is termed the:

A. early arterial phase.
B. portal venous phase.
C. corticomedullary phase.
D. nephrographic phase.
 Definition
C. corticomedullary phase
The corticomedullary phase is a late arterial phase beginning 30 to 40 seconds after the initiation of contrast agent administration. Optimal enhancement of the renal cortex and renal veins occurs during this period.
Term
Which of the following phases of renal contrast enhancement provides maximum sensitivity for parenchymal lesions?

A. Early arterial
B. Corticomedullary
C. Nephrographic
D. Excretory
 Definition
C. Nephrographic
During the nephrographic phase, enhancement between renal cortex and medulla reaches equilibrium, providing optimal sensitivity for parenchymal lesions. The nephrographic phase occurs between 70 and 90 seconds after the start of injection.
Term
An abnormal connection between the intestine and an adjacent anatomic structure is called a(n):

A. perforation.
B. abscess.
C. sinus tract.
D. fistula.
 Definition
D. fistula
A fistula is an abnormal connection between the intestine and an adjacent structure. Fistulas are commonly associated with inflammatory bowel disease.
Term
Which of the following phases of IV contrast agent administration provides the best gastric and intestinal wall enhancement?

A. Early arterial
B. Corticomedullary
C. Portal venous
D. Excretory
 Definition
C. Portal venous
For indications involving the GI tract, acquisition is typically obtained during the portal venous phase for optimal gastric and intestinal wall enhancement.
Term
The duodenum is suspended from the diaphragm by the:

A. ligamentum teres.
B. diaphragmatic crus.
C. falciform ligament.
D. ligament of Treitz.
 Definition
D. ligament of Treitz
The suspensory ligament of the diaphragm is commonly referred to as the ligament of Treitz.
Term
Which of the following oral contrast agents offers the best visualization of the enhancing GI wall on post-IV contrast CT examination?

A. Low-osmolar water-soluble iodinated solution
B. High-osmolar water-soluble iodinated solution
C. Water
D. Barium sulfate suspension
 Definition
C. Water
Water as a negative oral contrast agent improves visualization of the enhancing enteral wall when an IV contrast agent is administered. Other agents, such as VoLumen and milk, may also be effective as agents capable of distending the bowel while allowing for wall visualization.
Term
The condition whereby a portion of the small intestine collapses or telescopes into itself is termed:

A. ileus
B. diverticulosis.
C. adhesion.
D. intussusception.
 Definition
D. intussusception.
Intussusception describes the condition whereby a portion of the small intestine collapses or telescopes into itself. It is a rare occurrence that may result in obstruction.
Term
The term appendicolith is applied to which of the following pathologic conditions of the appendix?
A. Perforation

B. Inflammation

C. Calcification

D. Fistula
 Definition
C. Calcification
An appendicolith is a calcification or stone within the appendix and is often associated with appendicitis.
Term
MSB 27 Number 1 corresponds to which of the following?

A. Ligament of Treitz
B. Portal vein
C. Ligamentum teres
D. Gallbladder
 Definition
Number 1 corresponds to the gallbladder.
Term
MSB 27 This image of the abdomen was most likely acquired in which of the following renal enhancement phases?

A. Pre-contrast
B. Corticomedullary
C. Nephrographic
D. Excretory
 Definition
B. Corticomedullary
Beginning 30 to 40 seconds after the initiation of contrast agent administration, the corticomedullary phase demonstrates optimal enhancement of the renal cortex with maximum differentiation from the renal medulla.
Term
MSB 27 Number 5 corresponds to which of the following?

A. Portal vein
B. Superior mesenteric vein
C. Left renal vein
D. Left ureter
 Definition
Number 5 corresponds to the left renal vein.
Term
MSB 27 Number 8 corresponds to which of the following?

A. Inferior vena cava
B. Common bile duct
C. Portal vein
D. Superior mesenteric vein
 Definition
Number 8 corresponds to the inferior vena cava.
Term
MSB 28 Number 4 corresponds to which of the following?

A. Large colon
B. Jejunum
C. Spleen
D. Pancreas
 Definition
Number 4 corresponds to the spleen.
Term
MSB 28 Number 7 corresponds to which of the following?

A. Renal pyramid
B. Renal pelvis
C. Renal cortex
D. Renal calyx
 Definition
Number 7 corresponds to the renal pelvis.
Term
MSB 28 Which of the following reformation techniques best describes the image?

A. Volume-rendered (VR) 3-D
B. Multiplanar reformation (MPR)
C. Maximum intensity projection (MIP)
D. Minimum intensity projection (minIP)
 Definition
B. Multiplanar reformation (MPR)
This coronal representation is a standard multiplanar reformation (MPR) image. It demonstrates the same density and contrast as a conventional helically acquired axial image. Multiplanar reformation (MPR) describes the process of displaying CT images in a different orientation from the one used in the original reconstruction process. The reformatted image is one voxel thick, with the pixels facing the viewer and each representing the average attenuation occurring within the represented voxels.
Term
MSB 28 Which of the following corresponds to the high-attenuation area indicated by number 1?

A. Renal cortex
B. Renal pelvis
C. Renal calyx
D. Renal pyramid
 Definition
Number 1 corresponds to the renal cortex.
Term
MSB 28 Number 2 corresponds to which of the following?

A. Renal cortex
B. Renal pelvis
C. Renal calyx
D. Renal pyramid
 Definition
Number 2 corresponds to the renal pelvis.
Term
MSB 29 The areas indicated by number 3 most likely correspond to which of the following?

A. Appendicolithiasis
B. Urolithiasis
C. Phleboliths
D. Cholelithiasis
 Definition
Phleboliths are calcifications within pelvic veins. On this post-contrast CT urogram, the calcifications are demonstrated outside of the urinary tract.
Term
MSB 29 Number 4 corresponds to which of the following?

A. Ureteropelvic junction
B. Ureterovesical junction
C. Ureterocalyceal junction
D. Ureteropyramidal junction
 Definition
Number 4 corresponds to the ureterovesical junction (UVJ).
Term
MSB 30 Number 5 corresponds to which of the following?

A. Duodenum
B. Descending colon
C. Jejunum
D. Ascending colon
 Definition
Number 5 corresponds to the descending colon.
Term
MSB 30 This image of the abdomen was most likely acquired in which of the following renal enhancement phases?

A. Pre-contrast
B. Corticomedullary
C. Nephrographic
D. Excretory
 Definition
C. Nephrographic
The nephrographic phase occurs between 70 and 90 seconds after the start of injection. Enhancement between renal cortex and medulla reaches equilibrium, providing optimal sensitivity for parenchymal lesions.
Term
MSB 30 Number 1 corresponds to which of the following?

A. Transverse colon
B. Duodenum
C. Jejunum
D. Cecum
 Definition
Number 1 corresponds to the duodenum.
Term
MSB 30 Number 6 corresponds to which of the following?

A. Erector spinae muscle
B. Psoas muscle
C. Gluteus minimus muscle
D. External oblique muscle
 Definition
Number 6 corresponds to the erector spinae muscle.
Term
MSB 31 Number 8 corresponds to which of the following?

A. Internal iliac vein
B. Common iliac artery
C. Femoral artery
D. Femoral vein
 Definition
Number 8 corresponds to the common iliac artery.
Term
MSB 31 Number 2 corresponds to which of the following?

A. Splenic flexure
B. Transverse colon
C. Stomach
D. Duodenum
 Definition
Number 2 corresponds to the stomach.
Term
MSB 31 Number 1 corresponds to which of the following?

A. Portal vein
B. Hepatic artery
C. Inferior vena cava
D. Common bile duct
 Definition
Number 1 corresponds to the portal vein.
Term
MSB 32 Number 4 corresponds to which of the following?

A. Ischium
B. Ilium
C. Pubis
D. Obturator
 Definition
Number 4 corresponds to the ilium.
Term
MSB 32 Number 5 corresponds to which of the following?

A. Ileum
B. Cecum
C. Appendix
D. Jejunum
 Definition
Number 5 corresponds to the appendix.
Term
MSB 32 Number 2 corresponds to which of the following?

A. Jejunum
B. Ileum
C. Descending colon
D. Sigmoid colon
 Definition
Number 2 corresponds to the jejunum.
Term
MSB 32 Number 3 corresponds to which of the following?

A. L4
B. L5
C. Sacrum
D. Coccyx
 Definition
Number 3 corresponds to the sacrum.
Term
MSB 32 Number 1 corresponds to which of the following?

A. Ileum
B. Cecum
C. Jejunum
D. Duodenum
 Definition
Number 1 corresponds to the cecum.
Term
The abdominal aorta divides into the left and right common iliac arteries at approximately the level of:

A. L2.
B. L4.
C. sacrum.
D. pubic symphysis.
 Definition
B. L4.
The abdominal aorta divides into the right and left common iliac arteries at approximately the level of L4.
Term
MSB 33 Number 1 corresponds to which of the following?

A. Renal artery
B. Hepatic vein
C. Superior mesenteric artery
D. Celiac trunk
 Definition
Number 1 corresponds to the superior mesenteric artery (SMA).
Term
MSB 33 Which of the following would best describe the position of the patient during data acquisition?

A. Supine
B. Prone
C. Right lateral decubitus
D. Left lateral decubitus
 Definition
A. Supine
The obvious air-fluid level in the transverse colon (5) indicates that the patient was imaged in the supine position.
Term
MSB 33 Number 3 corresponds to which of the following?

A. Renal artery
B. Hepatic vein
C. Superior mesenteric artery
D. Celiac trunk
 Definition
Number 3 corresponds to the celiac trunk.
Term
MSB 33 Number 2 corresponds to which of the following?

A. Spleen
B. Liver
C. Kidney
D. Pancreas
 Definition
Number 2 corresponds to the liver.
Term
Assuming a bolus injection of iodinated contrast agent at a rate of at least 4 mL/sec, an appropriate scan delay for a CTA examination of the mesenteric vasculature would be in the range of:

A. 5 to 8 seconds.
B. 20 to 30 seconds.
C. 45 to 60 seconds.
D. 70 to 90 seconds.
 Definition
B. 20 to 30 seconds
Dual-phase imaging including the arterial phase (20 to 30 seconds) and portal venous phase (60 to 70 seconds) is typically performed for complete evaluation of the mesenteric vasculature. The use of bolus-tracking software or test bolus technique is recommended to ensure appropriate scan timing.
Term
An IV contrast enhanced specialized CT evaluation of the small bowel after the oral administration of a low-density (0.1%) barium sulfate solution is termed:

A. CT enteroclysis.
B. CT colonography.
C. CT enterography.
D. CT colonoscopy.
 Definition
C. CT enterography
CT enterography does not involve contrast agent administration through a nasogastric tube and is therefore less invasive than CT enteroclysis.
Term
During CT colonography examinations, tagged fecal matter appears __________ on the image.

A. black
B. gray
C. white
D. noisy
 Definition
C. white
Dual-agent tagging involves the oral administration of both barium and water-soluble iodinated contrast agent. The barium tags residual stool and coats the surface of polyps. The iodine contrast tags residual fluid. Tagged fluid and fecal matter exhibit high CT density and appear white on the CTC image. Tagging allows for differentiation of polyp from fecal matter and improves the visualization of polyps that may be surrounded by residual fluid.
Term
The oral administration of barium and iodinated contrast media prior to CT colonography serves the primary purpose of:

A. lesion enhancement.
B. insufflation.
C. catharsis.
D. polyp tagging.
 Definition
D. polyp tagging.
Dual-agent tagging involves the oral administration of both barium and water-soluble iodinated contrast. The barium tags residual stool and coats the surface of polyps. The iodine contrast tags residual fluid. Tagged fluid and fecal matter exhibit high CT density and appear "white" on the CTC image. Tagging allows for differentiation of polyp from fecal matter and improves the visualization of polyps that may be surrounded by residual fluid.
Term
Which of the following contrast agents may be used for the purpose of colon insufflation during a CT colonography examination?

1. Room air
2. CO2
3. Normal (0.9%) saline

A. 1 only
B. 1 and 2 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
B. 1 and 2 only
Colon insufflation involves the introduction of room air or carbon dioxide into the colon for the purpose of bowel wall distention.
Term
Which of the following is an advantage of automatic CO2 insufflation for CT colonography?

1. Cheaper cost
2. Lower risk of anaphylaxis
3. Lower risk of perforation

A. 1 only
B. 3 only
C. 1 and 2 only
D. 2 and 3 only
 Definition
B. 3 only
Advantages of automatic CO2 insufflation include better overall distention and lower risk of perforation. Also, owing to the faster absorption rate of CO2, there is a reduction in post-procedural discomfort in the patient.
Term
Advantages of automatic CO2 insufflation for CT colonography include:

1. Better distention
2. Lower risk of perforation
3. Improved patient comfort

A. 1 only
B. 1 and 2 only
C. 1 and 3 only
D. 1, 2, and 3
 Definition
D. 1, 2, and 3
Advantages of automatic CO2 insufflation include better overall distention and lower risk of perforation. Also, owing to the faster absorption rate of CO2, there is a reduction in post-procedural discomfort in the patient.
Term
During CT colonography, acquisitions are performed with the patient in at least two positions for the purpose of:

A. reducing gonadal dose.
B. differentiating polyps fromfeces/fluid.
C. allowing digital subtraction techniques.
D. measuring lesion dimensions.
Submit
 Definition
B. differentiating polyps from feces/fluid.
During CT colonography, two positions are a necessity to ensure maximal distention of the various segments of the colon and to differentiate between fixed polyps and mobile feces and fluid.
Term
Which of the following window settings would optimally display CT colonography images?

A. Level= −400, width= 1600
B. Level= +50, width= 400
C. Level= +150, width= 1000
D. Level= +250, width= 4000
 Definition
A. Level= −400, width= 1600
CT colonography images are best displayed in a wide "lung-type" window setting.
Term
The act of the CT patient straining the abdominal muscles or "bearing down" to improve demonstration of an abdominal wall hernia is referred to as:

A. Valsalva maneuver.
B. catharsis.
C. insufflation.
D. Spurling maneuver.
 Definition
A. Valsalva maneuver
Valsalva maneuver refers to the physical act of straining the abdominal muscles or "bearing down." A CT acquisition while the patient performs this maneuver may be utilized to improve visualization of abdominal wall hernias.
Term
The portion of the male reproductive system responsible for storage of the majority of mature sperm is the:

A. seminal vesicles.
B. vas deferens.
C. testes.
D. prostate gland.
 Definition
B. vas deferens
The majority of mature sperm is stored in the vas deferens. Sperm is produced in the seminiferous tubules and passes through the epididymis, where a small amount may be stored.
Term
Which of the following scan parameters is commonly used during a radiation therapy planning CT study of the prostate gland?

1. Patient placed on a flat tabletop
2. Small DFOV used to include only the prostate gland
3. CT scan performed with patient in exact position used for radiation treatment

A. 1 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
B. 1 and 3 only
CT scans are commonly performed for radiation therapy planning. The purpose of the examination is to precisely locate the area of interest for therapeutic treatment with irradiation. It is important that the patient position during the CT examination is exactly the same as that used during radiation therapy. This includes using a flat tabletop, via a board or foam insert. Equally important is the DVOV chosen by the technologist. It must be large enough to include the entire surface of the anatomic part.
Term
MSB 34 The region of interest measurement in the figure has an average Hounsfield value of +10. Given its position in this female pelvis, this density most likely represents a(n):

A. fibroid uterus.
B. ovarian cyst.
C. diverticular abscess.
D. endometrial tumor.
 Definition
B. ovarian cyst
Because of its location and attenuation value, this structure is most likely an ovarian cyst. The cyst is present on the right kidney and has an attenuation value of +10. Cysts of the ovary, as well as those occurring elsewhere in the body, have attenuation values close to that of water or near zero.
Term
MSB 34 Number 5 corresponds to which of the following?

A. Right ovary
B. Bladder
C. Uterus
D. Prostate gland
 Definition
Number 5 corresponds to the uterus.
Term
MSB 34 Number 1 corresponds to which of the following?
A. Iliacus muscle
B. Gluteus minimus muscle
C. Superior gluteal artery
D. Psoas major muscle
 Definition
Number 1 corresponds to the psoas major muscle.
Term
MSB 34 Which number corresponds to the ilium?

A. 3
B. 6
C. 4
D. 2
 Definition
Number 6 corresponds to the ilium.
Term
Which of the following types of contrast material may be used during CT evaluation of the pelvis?

1. An intravenous iodinated contrast agent
2. Low dense barium sulfate solutions
3. Oil-soluble contrast material

A. 1 only
B. 2 only
C. 1 and 2 only
D. 1, 2, and 3
 Definition
C. 1 and 2 only
During CT examination of the pelvis, both intravenous and oral contrast agents are commonly administered. An intravenous contrast agent is important in differentiating pelvic blood vessels from lymph nodes. An oral contrast agent serves to opacify the small and large colon and greatly improves their visualization. Oil-based contrast media are not commonly used for CT Imaging Procedures.
Term
A common, nonmalignant enlargement of the prostate gland is typically referred to as:

A. prostatic carcinoma.
B. prostatic abscess.
C. prostatic hypertrophy.
D. extraprostatic extension.
 Definition
C. prostatic hypertrophy
Benign prostatic hypertrophy (BPH) is a nonmalignant enlargement of the prostate commonly seen in men over the age of 50.
Term
MSB 35 Which of the following type(s) of contrast material was/were administered to this patient?

1. Oral
2. IV
3. Rectal

A. 1 only
B. 2 only
C. 1 and 2 only
D. 1, 2, and 3
 Definition
B. 2 only
The air–fluid level present in the bladder indicates that the patient was administered an IV contrast agent. The rectum is not opacified, thus giving no indication of oral or enema administration of contrast material.
Term
MSB 35 Number 3 corresponds to which of the following?

A. Seminal vesicles
B. Rectal tendon
C. Anus
D. Ureters
 Definition
Number 3 corresponds to seminal vesicles.
Term
MSB 35 Number 2 corresponds to which of the following?

A. Iliac artery
B. Femoral vein
C. Iliac vein
D. Femoral artery
 Definition
Number 2 corresponds to the femoral artery.
Term
MSB 35 Number 1 corresponds to which of the following?

A. Iliopsoas muscle
B. Sartorius muscle
C. Gluteus minimus muscle
D. Rectus femoris muscle
 Definition
Number 1 corresponds to the sartorius muscle.
Term
MSB 36 Number 4 corresponds to which of the following?

A. Iliac crest
B. Anterior superior iliac spine
C. Anterior inferior iliac spine
D. Posterior inferior iliac spine
 Definition
Number 4 corresponds to the anterior superior iliac spine.
Term
MSB 36 Which of the following best describes the position of the patient?

A. Prone with hands behind the back
B. Ventral recumbent with hands over the head
C. Dorsal recumbent with hands above the head
D. Supine with hands crossed over the chest
 Definition
C. Dorsal recumbent with hands above the head
The patient was positioned in the dorsal recumbent (supine) position with the arms placed over the head. This is the standard position for production of localizer projections during CT studies of the chest, abdomen, and pelvis.
Term
MSB 36 Number 1 corresponds to which of the following?
A. Ascending colon

B. Hepatic flexure

C. Splenic flexure

D. Transverse colon
 Definition
Number 1 corresponds to the splenic flexure.
Term
MSB 36 The localizer (scanogram) image could be used to program which of the following CT examinations?

1. Abdomen only
2. Chest and abdomen
3. Abdomen and pelvis

A. 1 only
B. 1 and 2 only
C. 1 and 3 only
D. 1, 2, and 3
 Definition
C. 1 and 3 only
The localizer (scout) image includes the areas of the abdomen and pelvis. The chest is not included in its entirety, and therefore this scout image should not be used to prescribe a CT study of the chest. Ideally, CT studies of just the abdomen should be prescribed from a scout image including the area from above the diaphragm to the level of the iliac crests, so as to limit unnecessary exposure to the pelvis.
Term
MSB 36 Number 3 corresponds to which of the following?

A. Pelvic outlet
B. Pubic arch
C. Greater sciatic notch
D. Obturator foramen
 Definition
Number 3 corresponds to the obturator foramen.
Term
Which of the following techniques assists in visualizing the vagina during a CT study of the pelvis?

A. Tampon insertion
B. Pre- and post-contrast scanning
C. Oral administration of a contrast agent
D. Administration of a contrast by enema
 Definition
A. Tampon insertion
Insertion of a tampon during the CT examination of the pelvis dilates the vagina and fills it with negative contrast (air). This makes for easier visualization of the vagina and its relationship with surrounding structures.
Term
Which of the following are reasons why intravenous contrast is administered during CT evaluation of the pelvis?

1. Distention and contrast enhancement of the bladder
2. Visualization of the rectosigmoid junction
3. Differentiation of blood vessels and pelvic lymph nodes
A. 1 only
B. 1 and 2 only
C. 1 and 3 only
D. 1, 2, and 3
 Definition
C. 1 and 3 only
Intravenous contrast agent administration during a CT examination of the pelvis is valuable for several reasons. The bladder is easily visualized when filled with contrast material, and differentiation between blood vessels and enlarged pelvic lymph nodes is improved. The rectosigmoid junction may be better visualized once opacification has been attained through the use of oral or enema administration of a contrast agent.
Term
Which of the following algorithm types would provide the greatest soft tissue detail during a CT study of the pelvis?

A. High spatial frequency
B. Detail
C. Edge
D. Low spatial frequency
 Definition
D. Low spatial frequency
Low spatial frequency algorithms are usually referred to as standard or soft tissue algorithms. They filter out high spatial frequency information, such as that pertaining to bone, and provide maximum details of soft tissue structures.
Term
Which of the following correctly describes the position of the seminal vesicles in the male pelvis?

A. Posterior to the bladder and anterior to the rectum
B. Superior to the rectum and inferior to the prostate
C. Anterior to the bladder and superior to the prostate
D. Inferior to the bladder and posterior to the rectum
 Definition
A. Posterior to the bladder and anterior to the rectum
The seminal vesicles are located posterior to the bladder and anterior to the rectum on a cross section of the male pelvis.
Term
MSB 37 Which number corresponds to the gluteus medius muscle?

A. 5
B. 7
C. 2
D. 3
 Definition
Number 7 corresponds to the gluteus medius muscle.
Term
MSB 37 Number 1 corresponds to which of the following?

A. Iliac vein
B. Femoral vein
C. Iliac artery
D. Femoral artery
 Definition
Number 1 corresponds to the femoral artery.
Term
MSB 37 Number 5 corresponds to which of the following?

A. Iliopsoas muscle
B. Sartorius muscle
C. Obturator internus muscle
D. Gluteus minimus muscle
 Definition
Number 5 corresponds to the obturator internus muscle.
Term
MSB 37 Number 8 corresponds to which of the following?

A. Iliac vein
B. Femoral vein
C. Iliac artery
D. Femoral artery
 Definition
Number 8 corresponds to the femoral vein.
Term
An abnormal accumulation of fluid around a testicle is termed as:

A. hernia.
B. hypergonad.
C. hydrocele.
D. hypogonad.
 Definition
A hydrocele of the testes is an abnormal accumulation of fluid around a testicle.
Term
Components of the uterine wall include which of the following?

1. Perimetrium
2. Myometrium
3. Endometrium

A. 3 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
D. 1, 2, and 3
The perimetrium is the outer layer of the uterine wall. The myometrium is the middle layer, and the endometrium the innermost layer.
Term
Which layer of the uterine wall brightly enhances after IV administration of an iodinated contrast agent?

A. Mesometrium
B. Perimetrium
C. Myometrium
D. Endometrium
 Definition
C. Myometrium
The myometrium enhances brightly after IV contrast agent administration owing to its highly vascular composition.
Term
A dermoid tumor of the ovary may also be referred to as a:

A. leiomyoma.
B. cystic teratoma.
C. germ cell tumor.
D. hemorrhagic cyst.
 Definition
B. cystic teratoma
A dermoid cyst is a mature cystic teratoma that is characterized on CT imaging by areas of widely varying densities including fat, fluid, and calcifications.
Term
MSB 38 Number 7 corresponds to which of the following?

A. Bladder
B. Uterus
C. Cervix
D. Vagina
 Definition
Number 7 corresponds to the uterus.
Term
MSB 38 Number 2 corresponds to which of the following?

A. Ileum
B. Jejunum
C. Sigmoid colon
D. Cecum
 Definition
Number 2 corresponds to the sigmoid colon.
Term
MSB 38 On the basis of the appearance of the image, by which of the following routes was a positive contrast agent administered?

1. Rectal
2. Oral
3. IV

A. 2 only
B. 1 and 2 only
C. 1 and 3 only
D. 2 and 3 only
 Definition
D. 2 and 3 only
D. 2 and 3 only
Opacified small bowel and ureters are indicative of the IV and oral administration of contrast material. Lack of contrast in the sigmoid colon is evidence that contrast material was not administered rectally to this patient.
Term
MSB 38 Number 8 corresponds to which of the following?

A. Ureter
B. Appendicolith
C. Iliac vein
D. Common iliac artery
 Definition
Number 8 corresponds to the ureter.
Term
MSB 38 Number 1 corresponds to which of the following?

A. Ilium
B. Jejunum
C. Ileum
D. Sigmoid colon
 Definition
Number 1 corresponds to the ileum.
Term
MSB 38 Number 3 corresponds to which of the following?

A. Piriformis muscle
B. Gluteus minimus muscle
C. Gluteus medius muscle
D. Gluteus maximus muscle
 Definition
Number 3 corresponds to the gluteus minimus muscle.
Term
MSB 38 Number 10 corresponds to which of the following?

A. Ilium
B. Ischium
C. Ileum
D. Obturator
 Definition
Number 10 corresponds to the ilium.
Term
MSB 38 This image of the pelvis was most likely acquired in which of the following IV contrast enhancement phases?

A. Pre-contrast
B. Corticomedullary
C. Nephrographic
D. Excretory
 Definition
D. Excretory
The well-opacified ureters indicate that the acquisition of this image occurred during the excretory phase of IV contrast enhancement.
Term
MSB 38 Number 5 corresponds to which of the following?

A. Piriformis muscle
B. Gluteus minimus muscle
C. Gluteus medius muscle
D. Gluteus maximus muscle
 Definition
Number 5 corresponds to the piriformis muscle.
Term
MSB 38 Number 9 corresponds to which of the following?

A. Piriformis muscle
B. Gluteus minimus muscle
C. Gluteus medius muscle
D. Gluteus maximus muscle
 Definition
Number 9 corresponds to the gluteus maximus muscle.
Term
MSB 39 Number 3 corresponds to which of the following?

A. External iliac artery
B. Femoral artery
C. External iliac vein
D. Femoral vein
 Definition
Number 3 corresponds to the external iliac artery.
Term
MSB 39 Number 6 corresponds to which of the following?

A. Cervix
B. Vagina
C. Cecum
D. Rectum
 Definition
Number 6 corresponds to the rectum.
Term
MSB 39 On the basis of the appearance of the image, by which of the following routes was a positive contrast agent administered?

1. Rectal
2. Oral
3. IV

A. 1 only
B. 3 only
C. 2 and 3 only
D. 1, 2, and 3 only
 Definition
B. 3 only
The uterus, bladder wall, and pelvic vasculature show evidence of iodinated IV contrast agent administration. There is no evidence of opacified bowel by either the oral or rectal administration route.
Term
MSB 39 Number 2 corresponds to which of the following?

A. Uterus
B. Prostate gland
C. Seminal vesicles
D. Cervix
 Definition
Number 2 corresponds to the uterus.
Term
MSB 41 Number 7 corresponds to which of the following?

A. Ovary
B. Bladder
C. Uterus
D. Cul-de-sac
 Definition
Number 7 corresponds to the bladder.
Term
MSB 41 Number 1 corresponds to which of the following?

A. External iliac artery
B. Femoral artery
C. External iliac vein
D. Femoral vein
 Definition
Number 1 corresponds to the external iliac vein.
Term
MSB 41 Number 4 corresponds to which of the following?

A. Ilium
B. Ischium
C. Pubis
D. Obturator
 Definition
Number 4 corresponds to the ischium.
Term
MSB 40 Number 2 corresponds to which of the following?

A. Inferior vena cava
B. Superior mesenteric vein
C. Aorta
D. Superior mesenteric artery
 Definition
Number 2 corresponds to the aorta.
Term
MSB 40 Which of the following anatomic planes best describes the image?

A. Coronal
B. Sagittal
C. Oblique axial
D. Para-axial
 Definition
The image was obtained in the sagittal plane.
Term
MSB 40 Number 4 corresponds to which of the following?

A. Prostate gland
B. Ovary
C. Vagina
D. Uterus
 Definition
Number 4 corresponds to the uterus.
Term
MSB 40 Number 1 corresponds to which of the following?

A. Inferior vena cava
B. Superior mesenteric vein
C. Aorta
D. Superior mesenteric artery
 Definition
Number 1 corresponds to the superior mesenteric artery (SMA).
Term
Axial CT sections of the lumbar spine for intervertebral disk evaluation should be reconstructed with the plane of imaging:

A. perpendicular to the transverse plane of the patient.
B. parallel to the plane of the intervertebral disk spaces.
C. parallel to the transverse plane of the patient.
D. perpendicular to the coronal plane of the patient.
 Definition
B. parallel to the plane of the intervertebral disk spaces.
For best demonstration of lumbar vertebral disk spaces, the plane of imaging should be parallel to the plane of the disk spaces. This may be accomplished with individual axial acquisitions through each disk space with the gantry angled parallel to the plane of the intervertebral disk. With the volumetric acquisition capabilities of MDCT, multiplanar reformation (MPR) images may be reconstructed from a single complete data set acquired with a perpendicular gantry position.
Term
Which of the following sets of section widths and intervals is best suited for a CT examination of the cervical spine to rule out intervertebral disk herniation?

A. 5 mm × 5 mm
B. 1.25 mm × 1.25 mm
C. 5 mm × 7 mm
D. 10 mm × 10 mm
 Definition
B. 1.25 mm × 1.25 mm
Contiguous acquisition with narrow slice thickness is preferred during CT examination of the cervical spine. Section widths of 1.25 mm or less should be used with no gap or even an overlap, thus ensuring thorough evaluation of the relatively small intervertebral disk spaces.
Term
Quantitative computed tomography (QCT) is a specialized technique used most often for the diagnosis of:

A. lymphoma
B. osteoporosis.
C. renal cyst.
D. hemangioma.
 Definition
B. osteoporosis
Quantitative computed tomography (QCT) is used to measure the mineral content of bone. Density measurements of the patient’s bone are compared with density measurements of a reference phantom. The bone mineral density (BMD) values are compared with normal values to assess osteoporosis.
Term
Which of the following would be a suitable range for contrast agent volume for an intrathecal injection during a postmyelogram CT examination of the lumbar spine in an adult patient?

A. 1 to 3 mL
B. 5 to 9 mL
C. 12 to 14 mL
D. 18 to 22 mL
 Definition
C. 12 to 14 mL
A common range of contrast agent volume for an intrathecal injection during post-myelographic CT is 12 to 14 mL in an adult patient. The total volume should not exceed approximately 17 mL, so as to keep the iodine dose below 3 g.
Term
MSB 41 Number 4 corresponds to which of the following?

A. Lateral condyle
B. Medial condyle
C. Lateral epicondyle
D. Medial epicondyle
 Definition
Number 4 corresponds to the lateral condyle.
Term
MSB 41 Number 3 corresponds to which of the following?

A. Retropatellar space
B. Medial meniscus
C. Tibial collateral ligament
D. Intercondylar fossa
 Definition
Number 3 corresponds to the intercondylar fossa.
Term
MSB 41 During this CT examination of the knee, the patient was most likely in the __________ position.

A. ventral recumbent
B. right lateral
C. supine
D. left lateral
 Definition
C. supine
CT examinations of the knee are commonly performed with the patient in the supine position. In this figure the patella is positioned superiorly, indicating the supine position. If the patient had been in the prone position, the image would have to be rotated on the screen 180 degrees to be placed in the proper orientation.
Term
MSB 42 Number 4 corresponds to which of the following?

A. Pedicle
B. Spinous process
C. Lamina
D. Transverse process
 Definition
Number 4 corresponds to the lamina.
Term
MSB 42 Number 6 corresponds to which of the following?

A. Anterior process
B. Lamina
C. Body
D. Superior articulating process
 Definition
Number 6 corresponds to the body.
Term
MSB 42 Which number corresponds to the foramen transversarium?

A. 1
B. 2
C. 3
D. 5
 Definition
Number 1 corresponds to the foramen transversarium.
Term
Which of the following display fields of view (DFOV) should be chosen for a CT examination of the thoracic spine on a patient whose thorax measures 40 cm?

A. 15 cm
B. 25 cm
C. 32 cm
D. 42 cm
 Definition
A. 15 cm
During a CT examination of the spine, the display field of view should be one that displays the spine enlarged on the monitor. Commonly referred to as targeting, this technique provides the viewer with an enlarged image of the spine without the loss of detail that accompanies magnification of the CT image. Although in this example the patient measures 40 cm, the DFOV of 15 cm will be sufficient to target the spine and enlarge its image on the viewing monitor.
Term
MSB 43 Number 6 corresponds to which of the following?

A. Transverse process
B. Pedicle
C. Lamina
D. Spinous process
 Definition
Number 6 corresponds to the pedicle.
Term
MSB 43 The image was formed using a large scan field of view (48 cm). Which of the following display field of view sizes was used to display the image?

A. 12 cm
B. 24 cm
C. 36 cm
D. 48 cm
 Definition
A. 12 cm
CT images of the spine are commonly reconstructed with the use of small display field of view sizes within the range of 12 to 15 cm. DFOV values within this range reconstruct the spine in an enlarged fashion while maintaining good detail.
Term
MSB 43 Number 2 corresponds to which of the following?

A. Costotransverse articulation
B. Intervertebral articulation
C. Intervertebral foramen
D. Costovertebral articulation
 Definition
Number 2 corresponds to the costovertebral articulation.
Term
MSB 43 Number 1 corresponds to which of the following?

A. Azygous vein
B. Inferior vena cava
C. Descending aorta
D. Esophagus
 Definition
Number 1 corresponds to the descending aorta.
Term
MSB 44 The image is displayed in which of the following anatomic planes?

A. Coronal
B. Axial
C. Sagittal
D. Oblique
 Definition
B. Axial
The axial plane divides the body into inferior and superior portions. This section bisects the foot perpendicular to its long axis and is said to be an axial image in reference to the standard anatomic position.
Term
MSB 44 Number 1 corresponds to which of the following?

A. First metatarsal
B. Second metatarsal
C. Third metatarsal
D. Fourth metatarsal
 Definition
Number 1 corresponds to the first metatarsal.
Term
MSB 44 Number 2 corresponds to which of the following?

A. Proximal phalanges
B. Lateral and medial cuneiforms
C. Sesamoid bones
D. Bone spurs
 Definition
Number 2 corresponds to the sesamoid bones.
Term
MSB 45 Which of the following is/are accurate method(s) that could be used to center this patient’s hip within the gantry?

1. Palpate approximately 6 inches below iliac crest.
2. Have the patient rotate the leg and palpate the greater trochanter.
3. Palpate the pubic bone.

A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
C. 2 and 3 only
The hip joint is located at the same level as the greater trochanter of the femur and the pubic bone. Palpation of either of these areas should be used to accurately center the hip within the gantry.
Term
MSB 45 Number 3 corresponds to which of the following?

A. Pubis
B. Ilium
C. Ischium
D. Lesser trochanter
 Definition
Number 3 corresponds to the ischium.
Term
MSB 45 Which number corresponds to the acetabulum?

A. 5
B. 3
C. 1
D. 2
 Definition
Number 2 corresponds to the acetabulum.
Term
MSB 45 Number 1 corresponds to which of the following?

A. Pubis
B. Ischium
C. Tuberosity of ischium
D. Ilium
 Definition
Number 1 corresponds to the pubis.
Term
MSB 46 Number 4 corresponds to which of the following?

A. Greater trochanter
B. Sciatic tubercle
C. Lesser trochanter
D. Coracoid
 Definition
Number 4 corresponds to the greater trochanter.
Term
MSB 46 Which of the following scan parameters should be used for a 3-D disarticulation study of the hip, such as the model shown?

1. 1- to 2-mm section width
2. Small scan field of view (SFOV)
3. Overlapping sections

A. 1 only
B. 1 and 2 only
C. 1 and 3 only
D. 1, 2, and 3
 Definition
C. 1 and 3 only
The image quality of 3-D reconstructed images is greatly improved with the use of narrow, overlapping sections. This approach increases the total volume of information used to construct the 3-D model. The use of a small scan field of view in the area of the hip would cause an out-of-field artifact.
Term
MSB 46 Number 1 corresponds to which of the following?

A. Ischium
B. Pubis
C. Ilium
D. Acetabulum
 Definition
Number 1 corresponds to the ilium.
Term
Number 5 corresponds to which of the following?

A. Sciatic notch
B. Humeral neck
C. Gluteal tuberosity
D. Femoral neck
 Definition
Number 5 corresponds to the femoral neck.
Term
MSB 46 Which number corresponds to the ischium?

A. 1
B. 4
C. 2
D. 3
 Definition
Number 3 corresponds to the ischium.
Term
MSB 47 Which of the following statements regarding the image is correct?

A. Oral iodinated contrast was administered 2 hours prior to scanning.
B. A small scan field of view (SFOV) was used.
C. The width of the window used to display the image is approximately 2000 HU.
D. The level of the window used to display the image is approximately −150 HU.
 Definition
C. The width of the window used to display the image is approximately 2000 HU.
The window width used to provide maximum detail of bony structures is approximately 1200 to 2000. This relatively large width allows for complete visualization of the variable densities present in bony anatomic areas.
Term
MSB 47 Number 3 corresponds to which of the following?

A. Vertebral foramen
B. Pedicle
C. Sacral canal
D. Sacral foramen
 Definition
Number 3 corresponds to the sacral foramen.
Term
MSB 47 Which of the following best describes the pathologic abnormality present?

A. Metastatic disease of the sacrum
B. Sacral cyst
C. Fracture of sacrum
D. Dislocated sacroiliac joint
 Definition
C. Fracture of sacrum
The pathology present in the figure is a fractured sacrum. Notice the interruption in the smooth delineation of the right anterior sacrum.
Term
Of the bones of the foot, which are tarsals?

1. Third proximal phalanx
2. Lateral cuneiform
3. First metatarsal

A. 1 only
B. 2 only
C. 2 and 3 only
D. 1, 2, and 3
 Definition
B. 2 only
The tarsals include the calcaneus, talus, navicular, and cuboid and the medial, intermediate, and lateral cuneiforms.
Term
The articulation between the inferior articular processes of one vertebra with the superior articular processes of the next is called a:

A. spondylolisthesis joint.
B. spondylolysis joint.
C. pars interarticularis joint.
D. zygapophyseal joint.
 Definition
D. zygapophyseal joint.

A zygapophyseal joint is the articulation between the inferior articular processes of one vertebra with the superior articular processes of the next. Zygapophyseal joints may also be referred to as facet joints.
Term
The soft center of each intervertebral disk is called the:

A. nucleus pulposus.
B. nucleus prepositus.
C. annulus fibrosus.
D. annulus stapedius.
 Definition
A. nucleus pulposus
The nucleus pulposus is the soft center of an intervertebral disk.
Term
At its distal end, the spinal cord tapers into the:

A. bulbus cordis.
B. caudate nucleus.
C. conus elasticus.
D. conus medullaris.
 Definition
The distal spinal cord tapers into the conus medullaris.
Term
A portion of a herniated intervertebral disk that has migrated from its normal position is called a(n):
A. bulging disk.

B. sequestered disk.

C. osteophyte.

D. protrusion.
 Definition
B. sequestered disk
Sequestered disk or free fragment is used when a portion of the disk nucleus completely breaks free and migrates from its normal position.
Term
Compression of the spinal cord or nerve roots from a herniated intervertebral disk may result in the referred limb pain commonly referred to as:
A. ischemia.

B. sciatica.

C. spondylolisthesis.

D. spondylolysis.
 Definition
B. sciatica
Compression of the spinal cord and/or nerve roots may result in the referred limb pain commonly referred to as sciatica. Additional causes include disk herniation, tumor, and the formation of osteophytes (abnormal bone growths).
Term
The degenerative pathologic process of the spine known as spondylolysis involves a defect in the:

A. spinous process.
B. transverse process.
C. pars interarticularis.
D. intervertebral disk.
 Definition
C. pars interarticularis
Spondylolysis involves a defect in the pars interarticularis commonly caused by osteophyte formation. The pars interarticularis is the area of the vertebrae between the inferior and superior articular processes (neck of the "scotty dog").
Term
Which of the following imaging planes best demonstrates spondylolisthesis of the spine?

A. Axial
B. Coronal
C. Sagittal
D. Oblique axial
 Definition
C. Sagittal
Spondylolisthesis refers to the forward "slipping" of an upper vertebral body over the lower because of degenerative changes of the facet joints. It is best demonstrated on sagittal MPR images of the spine.
Term
Which of the following is a malignant tumor of the skeletal system?

A. Chondroblastoma
B. Osteochondroma
C. Enchondroma
D. Osteosarcoma
 Definition
D. Osteosarcoma
Malignant tumors of the skeletal system include osteosarcoma, chondrosarcoma, and multiple myeloma.
Term
Which of the following bones is found within the hindfoot?

A. Talus
B. Metatarsals
C. Navicular
D. Cuboid
 Definition
A. Talus
The talus and calcaneus constitute the hindfoot. The navicular, cuboid, and cuneiforms make up the midfoot, and the forefoot consists of the metatarsals and phalanges.
Term
The CT imaging plane that is parallel to the metatarsals, approximately 20 to 30 degrees caudal from the direct axial plane, is called the:

A. mortise plane.
B. oblique axial plane.
C. sagittal plane.
D. coronal plane.
 Definition
B. oblique axial plane.
The oblique axial plane is located parallel to the metatarsals, approximately 20 to 30 degrees caudal from the direct axial plane. MPR images along this plane are used to assess the tarsal–metatarsal joint.
Term
The articulation between the distal tibia and fibula is called the:
A. synarthrosis.
B. amphiarthrosis.
C. synostoses.
D. syndesmosis.
 Definition
D. syndesmosis.
The syndesmosis is the articulation between the distal tibia and fibula.
Term
MSB 48 Number 3 corresponds to which of the following?

A. Navicular
B. Cuboid
C. Calcaneus
D. Talus
 Definition
Number 3 corresponds to the talus.
Term
MSB 48 Number 1 corresponds to which of the following?

A. Fibula
B. Tibia
C. Cuboid
D. Cuneiform
 Definition
Number 1 corresponds to the fibula
Term
MSB 48 Number 5 corresponds to which of the following?

A. Navicular
B. Cuboid
C. Calcaneus
D. Talus
 Definition
Number 5 corresponds to the calcaneus.
Term
MSB 49 Number 2 corresponds to which of the following?

A. Erector spinae muscle
B. Psoas major muscle
C. Latissimus dorsi muscle
D. Internal abdominal oblique muscle
 Definition
Number 2 corresponds to the psoas major muscle.
Term
MSB 49 In this image at the level of the L4-L5 disk space, number 6 corresponds to which of the following?

A. Spinal cord
B. Conus medullaris
C. Cauda equina
D. Denticulate ligament
 Definition
C. Cauda equina
The spinal cord extends inferiorly from the brain’s medulla and terminates at approximately the level of T12-L1. At its distal end, the spinal cord tapers into the conus medullaris. The cauda equina is the nerve bundle extending inferiorly from the spinal cord.
Term
MSB 49 Number 1 corresponds to which of the following?

A. Inferior vena cava
B. Superior mesenteric artery
C. Iliac vein
D. Aorta
 Definition
Number 1 corresponds to the inferior vena cava.
Term
MSB 49 Number 5 corresponds to which of the following?

A. Lamina
B. Inferior articular process
C. Pedicle
D. Superior articular process
 Definition
Number 5 corresponds to the superior articular process.
Term
MSB 50 Number 5 corresponds to which of the following?

A. First metatarsal
B. First metacarpal
C. Fifth metatarsal
D. Fifth metacarpal
 Definition
Number 5 corresponds to the first metatarsal.
Term
MSB 50 Number 2 corresponds to which of the following?

A. Navicular
B. Cuboid
C. Calcaneus
D. Talus
 Definition
Number 2 corresponds to the talus.
Term
MSB 50 The anatomic plane of the image can be best described as the:

A. coronal plane.
B. sagittal plane.
C. axial plane.
D. oblique axial plane.
 Definition
D. oblique axial plane
The oblique axial plane is parallel to the metatarsals, approximately 20 to 30 degrees caudal to the direct axial plane. MPR images such as these are used to assess the tarsal–metatarsal joint.
Term
MSB 50 Number 4 corresponds to which of the following?

A. Medial cuneiform
B. Intermediate cuneiform
C. Lateral cuneiform
D. Cuboid
 Definition
Number 4 corresponds to the lateral cuneiform.
Term
MSB 51 Number 4 corresponds to which of the following?

A. Clavicle
B. First rib
C. Scapula
D. Acromion
 Definition
Number 4 corresponds to the scapula.
Term
MSB 51 What scan field of view (SFOV) value was most likely used for the acquisition of this CT image?
A. 9.6 cm

B. 15.0 cm

C. 25.0 cm

D. 50.0 cm
 Definition
D. 50.0 cm
The acquisition was most likely made with use of a large scan field of view (SFOV), 48 to 50 cm. Any smaller SFOV would result in out-of-field artifact, because portions of the upper shoulder area would lie beyond the range of the detector array. A smaller display field of view (DFOV) value was used for image reconstruction, targeting the side of interest.
Term
MSB 51 Number 1 corresponds to which of the following?

A. Acromion
B. Glenoid process
C. Coracoid process
D. Coronoid process
 Definition
Number 1 corresponds to the coracoid process.
Term
MSB 51 Number 2 corresponds to which of the following?

A. Clavicle
B. First rib
C. Scapula
D. Acromion
 Definition
Number 2 corresponds to the clavicle.
Term
MSB 52 Number 2 corresponds to which of the following?

A. Ischium
B. Superior pubic ramus
C. Inferior pubic ramus
D. Ischial tuberosity
 Definition
Number 2 corresponds to the superior pubic ramus.
Term
MSB 52 Number 4 corresponds to which of the following?

A. Inferior pubic ramus
B. Ischial tuberosity
C. Sacrum
D. Coccyx
 Definition
Number 4 corresponds to the coccyx.
Term
MSB 52 Which of the following statements regarding the image is accurate?

A. The patient is lying in the prone position.
B. The image is displayed in a soft tissue window.
C. The image is reconstructed with a high-spatial-frequency algorithm.
D. Iodinated IV contrast has been administered.
 Definition
C. The image is reconstructed with a high-spatial-frequency algorithm.
The level of bony detail displayed indicates that the image was reconstructed using a high-spatial-frequency algorithm and is displayed in a bone window.
Term
MSB 52 Number 3 corresponds to which of the following?

A. Ischium
B. Superior pubic ramus
C. Inferior pubic ramus
D. Ischial tuberosity
 Definition
Number 3 corresponds to the ischium.
Term
MSB 52 Number 5 corresponds to which of the following?

A. Greater trochanter
B. Gluteal tuberosity
C. Lesser trochanter
D. Linea aspera
 Definition
Number 5 corresponds to the greater trochanter.
Term
MSB 53 Number 1 corresponds to which of the following?

A. Acetabular fossa
B. Fovea capitis
C. Zona orbicularis
D. Obturator foramen
 Definition
Number 1 corresponds to the fovea capitis.
Term
MSB 53 Number 5 corresponds to which of the following?

A. Lesser trochanter
B. Gluteal tuberosity
C. Greater trochanter
D. Linea aspera
 Definition
Number 5 corresponds to the lesser trochanter.
Term
MSB 53 For trauma indications, CT examinations of the pelvis and hips such as the one illustrated in the figure may include which of the following advanced applications?

1. CT enteroclysis
2. CT angiography
3. CT cystography

A. 2 only
B. 3 only
C. 1 and 2 only
D. 2 and 3 only
 Definition
D. 2 and 3 only
Contrast-enhanced MDCT acquisitions of the post-traumatic pelvis may include CTA evaluation for vascular injury as well as assessment of the bladder via CT cystography.
Term
MSB 53 Number 4 corresponds to which of the following?

A. Ischium
B. Pubic ramus
C. Posterior column
D. Ischial tuberosity
 Definition
Number 4 corresponds to the pubic ramus.
Term
MSB 53 Number 2 corresponds to which of the following?

A. Radial head
B. Coronoid process
C. Trochlea
D. Capitulum
 Definition
Number 2 corresponds to the trochlea of the humerus.
Term
MSB 54 Number 5 corresponds to which of the following?

A. Humerus
B. Ulna
C. Radius
D. Olecranon
 Definition
Number 5 corresponds to the ulna.
Term
MSB 54 Which of the following best describes the anatomic plane of the image?

A. Axial
B. Coronal
C. Oblique axial
D. Sagittal
 Definition
D. Sagittal
Demonstration of the olecranon (1) in profile indicates that this is a sagittal image of the elbow.
Term
MSB 54 Number 4 corresponds to which of the following?

A. Radial head
B. Coronoid process
C. Trochlea
D. Capitulum
 Definition
Number 4 corresponds to the coronoid process of ulna.
Term
Each iliac artery bifurcates into the internal and external iliac arteries at about the level of:

A. L4.
B. L5-S1.
C. the pubic symphysis.
D. the patella.
 Definition
The iliac artery bifurcates into internal and external branches at L5-S1.
Term
During IV contrast agent administration for peripheral CTA examinations, the bolus duration should be equal to the scan time minus:

A. 0 seconds.
B. 5 seconds.
C. 15 seconds.
D. 30 seconds.
 Definition
B. 5 seconds
The duration of scan acquisition for peripheral CTA will be based on the anatomic length of the study and the capabilities of the particular CT system in use. Faster scanners run the risk of "outrunning" the bolus by completing the acquisition before the entire contrast volume has been administered. Bolus duration, or the time required to inject a specific volume of contrast, may be calculated as the product of injection flow rate and total contrast agent volume. The subtraction of 5 seconds allows the scanner to maintain pace with the contrast agent as it moves down the aorta and results in the cessation of contrast agent administration just prior (5 seconds) to the end of data acquisition.
Term
The most common indication for CT-guided radiofrequency ablation (RFA) is in treatment of neoplasms involving the:

A. internal auditory canal (IAC)
B. uterus.
C. lungs.
D. liver.
 Definition
D. liver
The most common indication for CT-guided RFA is in treatment of hepatic neoplasm.
Term
The detectors of a PET system absorb and measure what type of radiation?

A. x-ray photons
B. Annihilation photons
C. Light photons
D. Ultraviolet photons
 Definition
B. Annihilation photons
Annihilation photons are emitted from the radionuclide F-18-fluorodeoxyglucose (FDG) that has been taken up by the tumor cells. PET detectors absorb the emitted photons, measuring the activity of a given area of potential malignancy.
Term
The role of computed tomography during combined PET-CT includes:
1. Anatomic location of tumor activity
2. Attenuation correction of emitted photons
3. Reduction of overall patient dose

A. 1 only.
B. 1 and 2 only.
C. 2 and 3 only.
D. 1, 2, and 3.
 Definition
B. 1 and 2 only
The process of attenuation correction utilizes the transmission data acquired in the corresponding CT analysis to account for the change in energy that occurs as annihilation photons emitted from decaying radionuclide travel through the patient. The CT image data is utilized for tumor localization and results in an increase in patient dose.
Term
What is the maximum allowable blood glucose measurement for patients scheduled to undergo PET-CT examination?

A. 25 mg/dL.
B. 75 mg/dL.
C. 150 mg/dL.
D. 500 mg/dL.
 Definition
C. 150 mg/dL
The patient’s blood glucose may be measured prior to the injection of F-18-fluorodeoxyglucose (FDG). It should be below 150 mg/dL to prevent FDG uptake inhibition by glucose circulating in the bloodstream.
Term
The typical dose of the radiopharmaceutical F-18-fluorodeoxyglucose (FDG) for combined PET-CT examination is within the range of:

A. 0.3 to 0.8 millicuries (mCi).
B. 1.5 to 3.0 mCi.
C. 5.0 to 7.0 mCi.
D. 10.0 to 15.0 mCi.
 Definition
D. 10.0 to 15.0 mCi.
Typical dose consists of 10 to 15 millicuries (mCi) of FDG administered intravenously.
Term
During combined PET-CT imaging, abnormal physiologic uptake of radiopharmaceutical can occur in patient muscle because of:

A. low blood glucose.
B. pre-examination fasting.
C. strenuous activity.
D. high blood pressure.
 Definition
C. strenuous activity
Strenuous physical activity can cause abnormal physiologic uptake of FDG in muscle. Therefore, the patient is instructed to avoid such activity prior to the injection and during the delay for imaging. In addition, all patient activity and speech are limited for up to 60 minutes after the injection of FDG.
Term
The purpose of intravenous contrast agent administration during a CT study is to:
1. Increase the contrast between adjacent structures
2. Increase the overall image density
3. Increase beam attenuation of enhanced structures

A. 1 only.
B. 1 and 3 only.
C. 2 and 3 only.
D. 3 only.
 Definition
B. 1 and 3 only
Iodinated intravenous contrast agents alter the CT image by increasing the density of enhanced structures. Organs, blood vessels, and so on containing iodine attenuate a greater portion of the primary beam, thereby increasing their attenuation value. This permits greater differentiation of anatomic structures and pathologic processes. Any "enhanced" structure has an increased attenuation value (and subsequent image density) than its normal, unenhanced state.
Term
The excretion half-time of intravenous iodinated contrast media in a patient with normal renal function is between:

A. 1 and 2 hours.
B. 18 and 24 hours.
C. 1 and 2 days.
D. 5 and 7 days.
 Definition
A. 1 and 2 hours.
Excretion half-time is a value describing the amount of time necessary for 50% of the contrast agent administered to be filtered by the renal system. In patients with normal renal function, the half-time is usually between 1 and 2 hours.
Term
The plane that passes vertically through the midline of the body, dividing it into equal anterior and posterior portions, is referred to as the:

A. orthogonal.
B. axial.
C. midsagittal.
D. midcoronal.
 Definition
D. midcoronal
The midcoronal plane passes through the body vertically, dividing it into equal anterior and posterior portions. The midsagittal plane divides the body into equal right and left portions. Any axial (transverse, horizontal) plane is one occurring at right angles to the coronal and sagittal planes and divides the body into superior and inferior portions.
Term
A common formula used to calculate dosage of intravenous iodinated contrast material in the pediatric patient is:

A. 3 mg per kg body weight.
B. 5 mL per lb body weight.
C. 1 mL per lb body weight.
D. 100 mL over 10 lb.
 Definition
C. 1 mL per lb body weight.
Dosage calculations for intravenous contrast agent administration in the pediatric patient are usually made following the general rule of 1 mL per pound of body weight.
Term
Which of the following may be considered as advantages of spiral/helical CT over conventional CT scanning?

1. Reduced scan time
2. Reduction of misregistration artifacts
3. Decreased patient radiation dose

A. 1 only
B. 1 and 2 only
C. 1 and 3 only
D. 1, 2, and 3
 Definition
B. 1 and 2 only
Spiral/helical CT offers many advantages over conventional computed tomography. Complete anatomic areas are scanned in very short times owing to continuous acquisition and no interscan delay (ISD). Because no delays are needed, entire volumes of information may be obtained, often during only one breath-hold. This reduces misregistration artifacts associated with inconsistent patient breathing. There is no reduction in patient radiation dose with the use of spiral CT.
Term
The plane that passes vertically through the body, dividing it into left and right portions, is referred to as the:

A. orthogonal plane.
B. axial plane.
C. sagittal plane.
D. coronal plane.
 Definition
C. sagittal plane.
The sagittal plane divides the body into right and left portions. The coronal plane divides the body into anterior and posterior portions. The axial (transverse, horizontal) plane occurs at right angles to the sagittal and coronal planes and divides the body into superior and inferior portions.
Term
During a CT-guided needle biopsy, the insertion site is usually anesthetized with:

A. diazepam.
B. lidocaine.
C. lithium.
D. Percodan.
 Definition
B. lidocaine
Lidocaine is a local anesthetic commonly used for preparation of the needle insertion site during a percutaneous biopsy.
Term
An axial CT image of the trunk should be viewed in which of the following orientations?

A. From the feet toward the head with the patient’s left on the viewer’s left
B. From the feet toward the head with the patient’s left on the viewer’s right
C. From the head toward the feet with the patient’s right on the viewer’s right
D. From the head toward the feet with the patient’s right on the viewer’s left
 Definition
B. From the feet toward the head with the patient’s left on the viewer’s right
When one is viewing transverse cross-sectional anatomy, the image should be oriented with the left side of the patient on one’s right side with a perspective up from the feet toward the head.
Term
Which of the following technical factor(s) play(s) a role in the production of an isotropic data set?

1. Section width
2. Scan field of view (SFOV)
3. Display field of view (DFOV)

A. 1 only
B. 1 and 2 only
C. 1 and 3 only
D. 2 and 3 only
 Definition
C. 1 and 3 only
Isotropic resolution is approached by choosing the thinnest detector collimation available to produce the thinnest slices available and by reconstructing the acquired data with the smallest DFOV allowed according to the part of interest. Minimizing these two factors results in voxels approaching equal lengths in all directions.
Term
The retroperitoneum contains which of the following anatomic structures?

A. Spleen
B. Ovaries
C. Kidneys
D. Stomach
 Definition
C. Kidneys
The retroperitoneum is the space located between the peritoneum and the posterior abdominal wall. It contains the duodenum, pancreas, adrenal glands, kidneys, ureters, and bladder.
Term
CTA of the renal arteries should be performed using a section width of:

A. 1.25 mm or less.
B. 2 to 3 mm.
C. 3 to 5 mm.
D. 5 to 7 mm.
 Definition
A. 1.25 mm or less
The renal arteries are small structures that are optimally visualized with MDCT section widths of 1.25 mm or less.
Term
The most common indication for CT-guided percutaneous biopsy is the:

A. identification of foreign bodies.
B. quantification of bone mineral density.
C. confirmation of a malignancy.
D. measurement of tissue perfusion.
 Definition
C. confirmation of a malignancy
The most common indication for CT-guided percutaneous biopsy is to confirm the malignancy of a mass.
Term
Axial CT images of the knee may be acquired in four separate series with gantry angulations of 0, 30, 45, and 60 degrees in order to demonstrate the:

A. tibial plateau.
B. patellofemoral joint.
C. medial and lateral menisci.
D. anterior cruciate ligament.
Submit
 Definition
B. patellofemoral joint
This technique allows for visualization of the relationship between the patella and the femur as the knee is increasingly flexed. The patellofemoral congruence, or the position of the patella within the patellar surface of the femur, may be measured at each point of flexion. Any medial or lateral displacement of the patella may indicate an abnormality of the patellofemoral joint.
Term
Which of the following paranasal sinuses is usually the last to fully develop?

A. Frontal
B. Ethmoidal
C. Sphenoidal
D. Maxillary
 Definition
A. Frontal
The frontal sinuses are absent at birth and do not usually fully develop until after puberty. The ethmoidal, maxillary, and sphenoidal sinuses begin to develop during gestation.
Term
Which of the following pelvic bones combine(s) to form the acetabulum?

1. Ilium
2. Ischium
3. Pubis

A. 2 only
B. 1 and 2 only
C. 2 and 3 only
D. 1, 2 and 3
 Definition
D. 1, 2 and 3
The acetabulum is a cup-shaped cavity that holds the head of the femur, forming the hip joint. It is composed of portions of the ilium, ischium, and pubis.
Term
A CT angiogram of the neck is performed primarily for the evaluation of the:

A. carotid veins.
B. jugular veins.
C. carotid arteries.
D. coronary arteries.
 Definition
C. carotid arteries.
CTA of the neck is used primarily to evaluate the carotid arteries.
Term
On an ECG of the complete cardiac cycle, at which portion of the R-R interval is the heart muscle in diastole?

A. 10% to 20%
B. 35% to 50%
C. 55% to 75%
D. 85% to 95%
 Definition
C. 55% to 75%
The least heart motion occurs at approximately 55% to 75% of the R-R interval, typically corresponding to the point of mid-diastole.
Term
During a spiral or helical CT examination, the scanner acquires data:

1. Continuously as the patient travels through the gantry
2. One section at a time
3. In the form of a complete volumetric data set

A. 1 only.
B. 2 only.
C. 1 and 3 only.
D. 2 and 3 only.
 Definition
C. 1 and 3 only
Spiral/helical CT examinations are obtained with the scanner continuously acquiring data as the patient travels through the gantry. The data acquired are volumetric, containing all of the attenuation information for a given area of anatomy.
Term
Prior to a CT colonography, the patient may undergo a process of bowel cleansing termed:

A. purgation.
B. hydration.
C. catharsis.
D. fasting.
 Definition
C. catharsis
Catharsis describes the process of bowel cleansing that is required to improve the examination quality of CT colonography. A combination of restricted diet and bowel cleansing with polyethylene glycol (PEG) or magnesium citrate is used to achieve catharsis.
Term
Which of the following protocols would provide the best image quality for a 3-D disarticulation study of the hip?

A. Noncontiguous 10-mm-thick sections, standard algorithm
B. Contiguous 10-mm-thick sections, bone algorithm
C. Overlapping 1.5-mm-thick sections, bone algorithm
D. Noncontiguous 5-mm-thick sections, standard algorithm
 Definition
C. Overlapping 1.5-mm-thick sections, bone algorithm
Three-dimensional studies are best performed with the use of narrow sections acquired with no spacing (contiguous) or, preferably, with a reconstruction an overlap (e.g., 1.5-mm-thick section reconstructed every 1.0 mm). A detail (bone) algorithm is used for optimal demonstration of bony structures.
Term
Which of the following sets of section width and spacing would be most suitable for a general survey CT of the neck?

A. 0.75-mm-thick every 0.75 mm
B. 3-mm-thick every 5 mm
C. 3-mm-thick every 3 mm
D. 10-mm-thick every 10 mm
 Definition
C. 3-mm-thick every 3 mm
A contiguous study with section widths ranging from 3 to 6 mm is sufficient for a general survey CT study of the neck.
Term
Which of the following technical maneuvers may be used to remove unwanted pulsation artifacts from cardiac motion during a CTA of the chest for pulmonary embolism?

A. Automated bolus tracking
B. Automatic tube current modulation
C. Retrospective ECG gating
D. Saline flush
 Definition
C. Retrospective ECG gating
Electrocardiographic (ECG) gating can be utilized to eliminate pulsation artifacts because of cardiac motion during the study. Retrospective gating involves scanning throughout the entire cardiac cycle. Only data from specific user-determined portions of the ECG waveform are reconstructed into images.
Term
The ideal scan field of view (SFOV) for a CT examination of the cervical spine would be:

A. 9.6 cm.
B. 15.0 cm.
C. 25.0 cm.
D. 50.0 cm.
 Definition
D. 50.0 cm
Acquisition of the cervical spine is performed with a large SFOV, 48 to 50 cm. Targeted reconstructions are made using a display field of view (DFOV) between 10 and 15 cm. Larger DFOV reconstructions may be used to retrospectively display a greater anatomic area as clinical indication dictates. Utilizing a SFOV that is too small for the lower cervical spine region (shoulder girdle) would result in an out-of-field artifact.
Term
Which of the following is used as the IV-administered radiopharmaceutical during a PET-CT hybrid examination?

A. Technetium Tc 99m
B. Iodine I 131
C. Fludeoxyglucose F 18 (FDG)
D. Strontium chloride Sr 89
 Definition
C. Fludeoxyglucose F 18 (FDG)
Positron emission tomography (PET) is a functional nuclear medicine study utilizing fluorodeoxyglucose F 18 (FDG) as a radiopharmaceutical. During a PET-CT hybrid study, CT technology is used for morphologic (anatomic) visualization of structures, while PET technology provides physiologic information related to radiopharmaceutical uptake.
Term
Vascular components of the brain’s blood supply known as the circle of Willis include the:

1. Internal carotid arteries
2. Basilar artery
3. Anterior communicating artery

A. 2 only.
B. 1 and 2 only.
C. 1 and 3 only.
D. 1, 2, and 3.
 Definition
C. 1 and 3 only
The circle of Willis is composed of the anterior cerebral, anterior communicating, internal carotid, posterior cerebral, and posterior communicating arteries. The basilar artery is an important vessel supplying blood to the brain, but it is not part of the circle of Willis.
Term
Retrospective ECG gating utilizes which of the following portions of the cardiac cycle for image reconstruction?

1. Atrial systole
2. Ventricular systole
3. Cardiac diastole

A. 2 only
B. 3 only
C. 1 and 2 only
D. 2 and 3 only
 Definition
B. 3 only
Complete cardiac diastole is the period of relaxation after heart contraction. Diastole is the portion of the cardiac cycle when coronary artery motion is the slowest and cardiac motion is at its lowest. For evaluation of the coronary arteries, the MDCT system utilizes only the diastolic portion of the acquisition in the reconstruction process.
Term
An enema is indicated prior to a CT examination of the pelvis to administer positive contrast material into the large bowel. Which of the following dosages would be sufficient to opacify the rectosigmoid region?

A. 150 to 250 mL
B. 300 to 500 mL
C. 500 to 750 mL
D. 900 to 1100 mL
 Definition
A. 150 to 250 mL
Positive contrast material can be administered into the large bowel via enema to achieve thorough opacification. A dosage of 150 to 250 mL should be sufficient to opacify the rectosigmoid region. Doses of 300 to 500 mL may be necessary to opacify the large bowel in its entirety.
Term
A CT examination of the lumbar spine reveals a herniated disk at the level of L2-L3. Which of the following reformation planes would best demonstrate posterior compression of the disk material onto the spinal cord?

A. Coronal
B. Sagittal
C. Axial
D. Oblique
 Definition
B. Sagittal
An image reformatted in the sagittal plane would demonstrate the relationship of the disk material as it protrudes posteriorly into the spinal cord.
Term
The Stanford type A dissecting aneurysm affects which portion of the aorta?

A. Ascending thoracic
B. Descending thoracic
C. Abdominal
D. Bifurcation
 Definition
A. Ascending thoracic
Stanford type A dissecting aneurysms affect the ascending aorta. Stanford type B dissecting aneurysms affect the descending aorta.
Term
Which of the following refers to the surgical resection of the pancreas and duodenum for treatment of pancreatic carcinoma?

A. Endoscopic retrograde cholangiopancreatography (ERCP)
B. Cholecystectomy
C. Roux-en-Y anastomosis
D. Whipple procedure
 Definition
D. Whipple procedure
Whipple procedure is the surgical resection of the pancreas and duodenum (pancreaticoduodenectomy) for the treatment of pancreatic carcinoma.
Term
Often evaluated during body CTA examinations, the branches of the celiac axis are the:

1. Left gastric artery
2. Common hepatic artery
3. Splenic artery

A. 1 only.
B. 3 only.
C. 2 and 3 only.
D. 1, 2, and 3.
 Definition
D. 1, 2, and 3
The branches of the celiac axis are the left gastric artery, common hepatic artery, and splenic artery.
Term
Vital components of a CT urogram (CT-IVP) protocol include:
1. Administration of 1200 to 1500 mL of a positive oral contrast agent 90 minutes prior to examination
2. Thin-section excretory phase imaging of the entire urinary tract
3. Volume-rendered 3-D and maximum intensity projection (MIP) imaging of the urinary tract

A. 2 only.
B. 1 and 2 only.
C. 2 and 3 only.
D. 1, 2, and 3.
 Definition
C. 2 and 3 only.
Water is the preferred oral contrast material for CT urograms, because its use avoids the interference seen with denser materials when one is producing volume-rendered and MIP images. Additional protocol considerations include pre-contrast acquisition of the urinary tract and post-contrast nephrographic phase imaging. Excretory phase imaging occurs after a delay of 5 to 15 minutes and may be aided by the IV drip administration of approximately 250 mL of normal (0.9%) saline to improve urinary tract opacification.
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