question

BSE involves

answer

Looking & feeling for changes in the breast

question

CBE is a check of the breast by who?

answer

Qualified healthcare professional

question

ACS recommends women 20 & older perform BSE

answer

Every month

question

Women 20-39 should have a CBE how often?

answer

Every 3 years

question

Women 40 & older should have screen mammo & CBE how often?

answer

Every year

question

Thorough clinical exam will:

answer

Locate lumps/suspicious areas Nipple changes Skin changes in breast Lymph nodes n armpit & above collarbone

question

Medical/family history provides:

answer

Symptoms & risk factors for breast cancer & benign breast conditions; questions about other health problems

question

Effectiveness & sensitivity of mammogram ------- with age.

answer

Increases

question

Average glandular dose of screen-film mammogram with grid

answer

0.1-0.2 rad

question

Biggest risk factor for breast cancer

answer

Gender

question

High risk factors

answer

Age Genes-brCA1&2... Close blood relative Personal hx breast ca

question

Moderate risk factors

answer

1st degree relative w breast ca Atypical hyperplasia on biopsy High rad dose to chest High bone density after menopause

question

Minor risk factors

answer

No child bearing or after 30 Not breast feeding Early menarche/late menopause Post menopausal obesity Long term use HRT/contraceptive Alcohol consumption Obesity

question

Examples of benign breast disease

answer

Painful cyst Nipple discharge Only detected on mammo: Ca+, circumscribed tumors, lesions, asymmetric densities, skin thickening

question

2 main classes breast cancer

answer

Ductal Lobular

question

Most common breast cancer 90% all cases?

answer

Ductal carcinoma

question

Stage 0 carcinoma, confined to duct

answer

DCIS

question

Cancer has spread from ducts into surrounding stromal tissue & possibly pectoral fascia/ muscle

answer

Invasive/infiltrating Ductal carcinoma

question

Lobular carcinoma accounts for --- to ----% all breast cancers

answer

5-10

question

Not seen on mammo in 50% cases, abnormal cells grow w/in lobules not penetrating lobule walls

answer

Lobular carcinoma in situ

question

Difficult to perceive on mammo, may show as spider web or cause skin retraction

answer

Invasive lobular carcinoma

question

Other breast carcinomas account for less than 10% & have ----- prognosis than infiltrating Ductal/lobular cancers

answer

Better

question

Single most effective tool in detection breast cancer

answer

Mammogram

question

Describe malignant asymmetric density on mammogram

answer

Speculated/stellate lesion w solid central tumor & radiating structures

question

Malignant circumscribed lesions

answer

Ill-defined & high density radiopaque, except few rare are low density

question

Ductal ca+

answer

Granular or casting type Ca+ & usually appear in clusters

question

2 types mammography screening

answer

Conventional-analog Digital-w cassette or wo

question

2 types digital detectors

answer

Direct Indirect (Both are cassette-less)

question

Uses high frequency sound waves & based on pizoelectric effect

answer

U/S

question

Highly vascular lesions are often

answer

Malignant

question

MRI based on magnetic properties of ----- ------- in the body.

answer

Hydrogen atoms

question

--------- --------- ----------- involves injecting contrast while breast is under compression

answer

Contrast digital mammography

question

Dual energy subtraction used for what 3 reasons?

answer

Enhance masses Eliminate obscuring structures Separate soft tissue from contrast or Ca+ deposits

question

3 types nuclear medicine studies used w/mammography

answer

PET Breast scintigraphy Lymphoscintigraphy

question

PET imaging uses ------ based on the need that cancer cells have for sugar

answer

FDG-fluorodeoxyglucose

question

Breast scintigraphy aka ------- Or by the trade name -------.

answer

Scintimammography Miraluma

question

Breast scintigraphy uses what isotope? What kind of camera?

answer

Tc-99m sestamibi Gamma

question

_______ can be used to reduce blind dissection of axillary nodes & resultant side effects

answer

Lymphoscintigraphy

question

Lymphoscintigraphy aka

answer

Sentinel node mapping

question

Lymphoscintigraphy uses injection of radio isotope where?

answer

Around the tumor

question

Principle behind Lymphoscintigraphy

answer

First node, sentinel node, receives drainage from a tumor & can be used to predict presence or absence of tumor in remaining nodes

question

Technology that uses 11 low dose images taken during 7-11 seconds; x-ray tube rotates 50 deg. arc around breast

answer

Digital tomosynthesis

question

which technology produces high resolution 3D , cross section images of breast?

answer

Digital tomosynthesis

question

CT laser mammography based on what principle?

answer

angiogenesis

question

______ involves removal of content of cyst and is often performed under u/s guidance

answer

cyst aspiration

question

FNA ideal for cyst eval. and aspiration. Uses ___ to ____ gauge needle

answer

22-25

question

which breast intervention usually requires a cytotechnologist eval of sample

answer

Fine needle aspiration

question

3 treatments for breast cancer

answer

surgery, drugs (chemo/hormone therapy), radiation therapy

question

_________ removes breast tissue and some of underarm lymph nodes

answer

modified radical mastectomy

question

_______ is removal of entire breast

answer

mastectomy

question

which mastectomy removes entire breast, lymph nodes, and chest wall muscles?

answer

radical mastectomy (RARELY PERFORMED)

question

most breast conserving surgery

answer

lumpectomy

question

two common types of flap techniques

answer

TRAM, latissimus dorsi flap

question

more common form of radiation treatment

answer

external beam

question

internal beam radiation usually lasts ______ to ____ days and can begin _____ after surgery.

answer

7-9; day

question

how long does external beam radiation usually last? and how long after surgery can it begin?

answer

5-7 weeks; 1 month after surgery

question

which of 3 treatments is systemic treatment?

answer

chemotherapy (affects all cells of body)

question

common antiestrogen drug

answer

tamoxifen

question

antiestrogen drug less toxic than tamoxifen?

answer

raloxifene

question

SERMS

answer

selective estrogen receptor modulators

question

3 uses of hormonal treatment using SERMS

answer

prevent estrogen from latching onto tumor cell receptors shrink/stop recurrence of breast cancer lower risks breast cancer in postmenopausal women

question

2 newer flap techniques

answer

DIEP; gluteal free

question

____ used to evaluate nipple discharge, duct expansion, defects, or irregularities

answer

ductography

question

_____ is prelude to surgical biopsy & necessary if stereo localization not available

answer

preop localization

question

pre op localization can be performed w/which modalities

answer

mammo u/s

question

______ biopsy recommended with lesions that are difficult to approach or close to breast surface.

answer

open surgical

question

which intervention can be used to confirm finding of FNA or FNB

answer

open surgical biopsy

question

_____ uses 22-25 g needle to remove cell samples from nonpalpable lesions for cytological analysis.; often used with stereo localization

answer

FNB-fine needle biopsy

question

Method of locating nonpalpable lesions by using computer to calculate precise location.

answer

Stereotactic breast localization/biopsy

question

Intensity of x-ray beam is less on _____ side of tube due to _____ effect.

answer

anode; anode heel

question

Cathode side of x-ray tube is always directed to the _______, the thickest area of the breast.

answer

base

question

Material used for exit port or window of x-ray tube

answer

borosilicate glass or beryllium (Be)

question

Why is the exit window of x-ray tube NOT made of regular glass?

answer

regular glass window would harden the emerging beam by eliminating soft characteristic radiation

question

KVp range will depend on ______ material available

answer

target/filtration

question

How does Kvp range affect contrast?

answer

contrast higher in thinner breast; lower in thicker breast

question

Increased kvp allows ____ dose but reduced _____

answer

lower; contrast

question

The ______-_____ combination will essentially shape the x-ray beam, providing the necessary kvp range to penetrate dense/fatty breasts.

answer

target-filter

question

older mammography generators were _______.

answer

three phase

question

All modern generators are _________.

answer

high frequency generators

question

Common target/filter combo: molybdenum target with _____ mm molybdenum filtration or 0.05 mm rhodium filtration.

answer

0.03

question

Common target/filter combo: rhodium target with _____mm rhodium filtration

answer

0.025

question

Common target/filter combo: molybdenum and tungsten alloy target with ____ or ____ filtration

answer

molybdenum; rhodium

question

Common target/filter combo: molybdenum and rhodium alloy target with _____ or _____ filtration

answer

molybdenum; rhodium

question

Common target/filter combo: tungsten target and _____ or rhodium filtration (some digital units)

answer

silver

question

Flat surface of compression paddle must be ____ to IR

answer

parallel

question

Chest wall of compression paddle should not extend beyond chest wall edge of IR by more than ____% of SID

answer

2

question

Lip of compression paddle should have a _____ angle at the chest wall

answer

right

question

lip along the chest wall should be ---to---- cm in height

answer

2-4

question

True or False: A shadow of vertical edge of compression paddle should not be visible on the image

answer

True

question

Recommended focal spot sizes in mammography are ___ (smaller/routine work) & ____(magnification).

answer

0.4mm; 0.15mm

question

Most commonly used focal spot size for routine work

answer

0.3mm

question

most commonly used focal spot size for magnification

answer

0.1mm

question

Size and shape of focal spot size are determined by what 3 things?

answer

size and shape electron beam hitting anode design and relationship filament coil to focusing cup angle of anode

question

In mammography, the aim is to have the _____ focal spot with the ____SID

answer

smallest; longest

question

SID in mammo is fixed

answer

50-80cm

question

_____ cassette systems are used in mammography to provide the best spatial resolution

answer

single-screen

question

AEC controls length of exposure and determines___ of the final image

answer

density

question

Two types AEC found in modern mammography

answer

ionization chamber; phototimer

question

Underexposure occurs when the AEC cell is not placed over the _____ area of the breast.

answer

densest

question

Magnification will _____ scatter and as the mag factor increases, pt. skin dose ____.

answer

reduce; increases

question

Magnification causes ____ in image resolution; compensated by_____

answer

decrease; small focal spot size

question

Common magnification factor is 1.5; others can be 1.6, 1.7,____, or ____.

answer

1.85; 2x

question

Factors affecting image quality: _____ due to long exposure times poor ______ contact increased ______ decreased______ increase in _____ size relationship bw OID & ______ characteristics of _____

answer

motion screen-film OID SID focal spot SID screen

question

Faster screens have _____ spatial resolution

answer

lower

question

Mammography films are _____ emulsion and ____ contrast

answer

single; high

question

High contrast films generally have limited ______ latitude

answer

exposure

question

______ screen cassette systems are used in mammography to provide best spatial resolution

answer

single

question

two common types of film processors for mammography

answer

standard 90 sec. processing extended processing

question

extended processing extends ______ to improve image contrast and reduce pt. dose

answer

developing time

question

Factors affecting film processing include (3)

answer

developer time developer temp chemistry composition (developer and fixer)

question

Grids are used to improve radiographic contrast by ______ the amount scattered radiation that reaches the IR.

answer

decreasing

question

The use of grids will ALWAYS result in ______ dose to the patient.

answer

increased

question

Mammography grids are ______ than conventional radiography grids

answer

thinner

question

interspace material

answer

carbon fiber; wood

question

Grid strip is made of ______

answer

lead

question

mammography grid ratios

answer

3:1; 5:1

question

grid frequency

answer

30-50 lines/cm

question

_____ focused grid-movement in ____ direction only and focused to SID

answer

Linear; one

question

HTC (high-transmission cellular) grid: _____grid that reduces scatter in2 directions ___ as grid strip _____ as interspace material ____ grid ration

answer

crossed copper air 3.8:1

question

Cones, collimators, and diaphragms are known as ____ ____ devices

answer

beam restricting or limiting

question

Collimation should not extend beyond any edge of IR by more than ___ % of SID

answer

2

question

Decreasing the x-ray field will require _____ in exposure to maintain constant density

answer

increase

question

2 main digital mammography systems

answer

cassette-based; cassette-less

question

cassette-less systems can be considered to be___ or ____ conversion systems

answer

direct; indirect

question

_____ _____ is the flat-panel detector often used in the direct system

answer

amorphous selenium

question

____ ____ ____ arrays are used to transfer electronic signals from the selenium photoconductor to a computer

answer

thin-film transistor (TFT)

question

In cassette-based systems, the imaging plate has a ______ ______ with an active ingredient-europium-activated barium fluorohalide which is activated when exposed to x-rays

answer

photostimulable phosphor

question

In all digital systems, the spatial resolution will depend on ______.

answer

pixel size

question

_______ is the smallest discrete picture element of an image, usually a single dot

answer

pixel

question

Increased pixel size will _____ resolution and increase ____.

answer

increase; noise

question

______ prereads the mammograms, identifying areas of suspicion or areas needing additional workup

answer

CAD

question

picture archiving and communication system, enables teleradiography and filmless libraries which can be accessed via telephone, internet, or off-site location

answer

PACS

question

Digital systems approved by FDA

answer

GE Senographe 2000D Fischer Imaging SenoScan LoRad Digital Breast Imager Hologic/LoRad Selenia FFDM system GE Senographe DS Siemens Mammomat Novation DR GE Senographe Essentials Fuji Computed Radiography Mammography Suite (FCRMS)

question

Guidelines for QA and processor quality control are determined by _____ & _____

answer

MQSA; ACR

question

Darkroom cleanliness

answer

daily

question

processor qc

answer

daily

question

mobile unit qc

answer

daily

question

screen cleaning

answer

weekly

question

analysis of fixer retention in film

answer

quarterly

question

darkroom fog

answer

semiannually

question

screen-film contact

answer

semiannually

question

monitor cleaning

answer

Daily

question

compression indicator

answer

weekly

question

laser imager test (including SMPTE detector calibration/flat field)

answer

weekly

question

SNR & CNR, MTF

answer

weekly

question

Automatic optimization of parameters (AOP)

answer

monthly

question

Monitor calibration and SMPTE pattern

answer

weekly

question

viewboxes and viewing conditions

answer

weekly

question

phantom images

answer

weekly

question

visual checklist

answer

monthly

question

repeat/reject analysis

answer

quarterly

question

compression test

answer

semiannually

question

review of medical physicist's survey report

answer

annually

question

The ____ must perform all the manufacturer-recommended digital qc test.

answer

medical physicist

question

Primary responsibility of interpreting radiologist

answer

interpreting the mammography and ensuring that they are of optimal diagnostic quality

question

______ responsible for yearly review of medical audit with lead qc mammographer

answer

radiologist

question

Minimizes artifacts on radiographs caused by bits of dirt, dust or food b/w screen and film

answer

darkroom cleanliness

question

confirms and verifies that processor chemical system is working properly according to specifications

answer

processor quality control

question

processor qc should be carried out _____

answer

daily, at beginning of day before processing any films

question

instruments for processor qc

answer

21 step sensitometer; densitometer

question

processor qc records should be saved for how long?

answer

1 year

question

sensitometric images saved for how long?

answer

last full month

question

ensures screens are free of dust or potential artifacts

answer

screen cleanliness

question

screen cleanliness performed how often?

answer

weekly and anytime dust or artifacts noted by mammographer or radiologist

question

mammography viewboxes should have luminance level of at least

answer

3000 cd/m2

question

purpose of phantom images

answer

to ensure that image density, contrast, uniformity, and quality are maintained at optimum levels

question

thickness of mammo phantom

answer

4-4.5 cm

question

phantom should have a ____ mm thick acrylic disc

answer

4

question

Mammo phantom should always be viewed by same 5 things

answer

person, view box, viewing conditions, type magnifying glass, time of day

question

_____ ensures mechanical integrity and safety of mammo equipment and accessory devices

answer

visual checklist

question

visual check list includes (4)

answer

indicator lights, displays, mechanical locks, detents

question

Overall repeat rate should not exceed ____% but rate lower than ___% is acceptable once QA program is operational

answer

2; 5

question

To be statistically meaningful, a volume of ______ patients needs to be measured.

answer

250

question

Purpose of fixer retention in film analysis

answer

determine quantity of residual fixer (hypo) in processed film

question

If there's an excess of hypo retained on film, what has to be done?

answer

processor wash tanks and water flow rates and fixer replenishment rates must be assessed

question

Materials for darkroom fog test

answer

mammo or routine x-ray unit, densitometer, radiopaque card, watch or timer

question

screen-film contact will influence image _____.

answer

sharpness

question

which test requires use of copper wire mesh screen of at least 40 wires/in grid density?

answer

screen/film contact and identification

question

Optical density of final image should be b/w _____ when measured near chest wall side of film.

answer

0.7-0.8

question

Any cassette having a large area (>1cm in diameter) of poor contact that cannot be eliminated must____.

answer

be replaced.

question

Multiple small areas of poor contact (less than 1cm) are considered ______.

answer

acceptable

question

Adequate compression ranges from ----to---- in automatic mode

answer

25-45 lb (111-200 NEWTON)

question

the initial automatic compression should not exceed ____

answer

45 lb pressure

question

______ act was enacted on October 27, 1992

answer

MQSA

question

Only organizations authorized to issue MQSA certification

answer

FDA; SAC (States as Certifiers)

question

Mammograms and medical records of patients must be kept for a period of not less than ____ years or not less than ____ if no additional mammos of pt. performed at the facility

answer

5; 10

question

Records (mammography report) must include (5)

answer

pt name additional pt. identifier date of exam name of radiologist interpreting mammo final assessment finding

question

All facilitIes must send each patient a summary of mammography report written in lay terms within ____ days of the exam.

answer

30.

question

Concerned findings must be sent within ___ to ___ days

answer

3; 5

question

____ or ____results are acceptable

answer

verbal; written

question

Most commonly used assessment category

answer

BIRAD

question

HIPAA

answer

Health Insurance Portability and Accountability Act

question

How does HIPPA affect medical audit and why?

answer

does NOT; bc MQSA documentation patient information can be released w/o pt. authorization

question

Film in CR and DR has been replaced by ____

answer

storage phosphor screen

question

other names for storage phosphor screen

answer

image recorder (IR), image plate (IP), photostimulable phosphor (PSP)

question

Before a mammography facility can legally perform mammograms, it must ____.

answer

be certified

question

Provisional certification (for 6 mo) is usually issued by _____as soon as the accreditation has been accepted.

answer

FDA

question

which test checks communication bw AWS, detector, and printer

answer

SMPTE

question

_____ checks auto-timing with auto kVp and or auto selection of target and filter

answer

AOP-automatic optimization of parameters

question

SNR/CNR check ensures_____ and checks consistency of ____

answer

contrast is within acceptable range; CNR

question

flat field calibration checks image quality of detector including (5)

answer

brightness nonuniformity; high frequency modulation HFM SNR nonuniformity bad ROI bad pixel verification

question

_______ verifies consistent quality of images acquired by detector and displayed on AWS monitor/printer

answer

phantom test on monitor/printer

question

Breasts are ____ glands of reproductive system with ____ function.

answer

accessory; secreting milk for newborn

question

Areola contains many small protrusions on its surface called____ ______.

answer

Morgagni tubercles

question

Nipple contains ___to____ orifices (collecting ducts) that transfer milk from _____ _____.

answer

15-20; lactiferous ducts

question

____ _____ (layer of adipose tissue and connective fascia) separates breast from pectoral muscle

answer

retromammary space

question

____ _____ are the supportive structures of breast

answer

coopers ligaments

question

Breast receives its arterial supply from branches of ____ _____ & ____ ____

answer

internal mammary; lateral thoracic arteries

question

Venous network under nipple drains into _____ and ____ mammary veins

answer

axillary; internal

question

Primary lymphatic drainage of breast is to the ____.

answer

axilla

question

Majority of normal axillary lymph nodes is less than _____ and has kidney shaped appearance

answer

2 cm

question

Average female breast consists of ____ lobes containing glandular lobules.

answer

15-20

question

Majority of breast diseases occur in ______

answer

TDLUs (terminal duct lobular units)

question

Five categories of malignant and benign lesions

answer

circular/oval spiculate/stellate calcifications thickened skin syndrome como of any of these 2 or more

question

____ _____ have a distinct central mass

answer

malignant stellate/spiculated

question

3 basic forms of malignant calcifications

answer

casting granular powderlike

question

characteristics of malignant circular/oval lesions

answer

high density; smooth or lobulated and randomly orientated

question

_____ lesions are commonly associated with malignant type calcifications

answer

malignant speculated/stellate lesions

question

fine linear branching Ca+ seen as linear, fragmented or occasionally branching Ca+ with irregular contours

answer

casting type Ca+

question

Multiple clusters of powderlike Ca+

answer

powderlike Ca+

question

Granular type Ca+ resemble _____ and are usually grouped close together in single/multiple clusters

answer

sugar or crushed stone

question

______ _____ are irregular in form, size and density

answer

granular type Ca+

question

If spicules reach skin or muscle, it may cause _____.

answer

localized skin thickening or skin dimpling (retraction)

question

sharp, dense, fine lines of variable length radiating in all directions

answer

malignant stellate/spiculated lesions

question

_______ conditions may cause skin thickening

answer

benign or malignant

question

skin thickening syndrome will cause skin to appear obviously thickened, generally in ______ portion of breast.

answer

lower dependent

question

example of radiolucent, benign circular/oval lesion

answer

oil cyst, lipoma, galactocele

question

Benign circuular/oval lesion (radiolucent and radiopaque combined)

answer

lymph node, hematoma, fibroadenolipoma, galactocele

question

capsule which is a thin curved radiopaque line surrounding (benign circular)

answer

fibroadenoma

question

benign spherical or ovoid with smooth borders aligned in direction of nipple

answer

cyst

question

example of circular benign lesion with low density

answer

fibroadenoma, cyst

question

circular benign lesion with halo sign

answer

cyst

question

other benign circular lesions

answer

abscess, calcified hematoma, sebaceous cyst

question

characteristics of benign spiculated lesions

answer

NO solid, dense or distinct central mass NEVER associated with skin thickening/retraction very fine linear densities translucent oval area at center

question

______ is an exception and can appear as a benign spiculated lesion presenting with skin retraction/thickening

answer

traumatic fat necrosis

question

example of benign spiculated lesion with translucent oval center

answer

radial scar

question

very fine linear densities or lower density spicules

answer

radial scars; traumatic fat necrosis

question

characteristics of benign Ca+

answer

smooth contours high uniform density evenly scattered homogenous sharply outlined, spherical/oval pear like ringlike, hollow eggshell like large size, bizarre shape bilat and evenly scattered following course of ducts

question

plasma cell mastitis

answer

smooth contour, high uniform density, BENIGN Ca+

question

(benign) Ca+ arteries

answer

evenly scattered homogenous

question

(benign ca+)sharply outlined, spherical or oval

answer

Ca+ hematoma

question

(benign ca+)pear like, resemble tea cups or pearl drops on lateral projection

answer

milk of Ca+

question

ringlike hollow (benign ca+)

answer

sebaceous gland

question

eggshell like appearance (benign ca+)

answer

oil cyst/ papilloma

question

large size, bizarre shape (benign Ca+)

answer

hemangiomas

question

bilat and evenly scattered following course of ducts throughout parenchyma (benign ca+)

answer

plasma cell mastitis

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