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Australian Institute of

Radiography






Medical Imaging Advisory Panel 1
CT Certification (Intermediate)
Study and Resource Guide


Revised: February 2011

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Introduction

Intermediate CT certification encompasses theoretical and clinical components. CT certification is open to
radiographers who possess a current validated statement of accreditation (VSoA) from the Australian
Institute of Radiography.

Intermediate CT certification is available to candidates who have completed an examination set by the
Medical Imaging Advisory Panel 1 (Part A), performed the required clinical component as outlined below
(Part B) and been certified by their supervisor as possessing clinical competency as outlined below (Part
C).

A candidate must meet the requirements of all three components (Parts A, B and C) in order to apply for a
Certificate of Certification

Part A

The formal examination will involve a paper not exceeding 150 multiple choice questions covering topics
such as CT physical principles, image reconstruction and manipulation, QA/QC, radiation protection
and dosimetry, patient positioning, contrast safety, common protocols, CT anatomy and common
pathologies.

The approximate percentage of questions related to each module is listed below:

- Anatomy, physiology and CT pathology 20%
- Contrast agents, radiation protection and dosimetry 20%
- Physical principles, hardware and artifacts 30%
- CT technique 30%

Part B

This clinical component requires the candidates supervisor* to acknowledge completion of the required
clinical examinations (500 examinations in a 12 month period) within a 2 year period of completing Part
A.

The clinical component must encompass a number of examinations from a minimum of 8 of the following
examination types:

- Head
- Neck
- Chest
- Abdomen and pelvis
- Spine
- Extremities
- Intervention
- Angiography
- Paediatric
- Trauma
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Part C

This clinical component requires the candidates supervisor* to acknowledge the candidate

- Evaluates the request form
- Verifies correct patient and correct procedure
- Assesses the patient for contra-indications to the examination
- Explains the procedure including any relevant risks to the patient
- Verifies type, volume and rate for contrast injections
- Adjusts the scan parameters according to patient size and condition and the purpose of the
procedure
- Reviews images before archiving to assess image quality and completeness of the examination
- Can nominate average DLPs for routine examinations
- Assesses the DLP of each examination performed
- Uses appropriate dose reduction strategies to limit patient dose
- Is able to determine remedial steps to improve image quality
- Can identify image artifacts and potential causes of artifacts
- Knows the first-line responses for adverse reactions to IV contrast
- Knows the location of emergency medical equipment


The candidate must maintain clinical competency (Part B and Part C) in order to apply for renewal of their
Certificate of Certification. Failure to maintain the clinical requirement will require the candidate to
re-sit the Part A of the Level 1 component.

*The signing supervisor must be a radiographer. If the candidate is the CT supervisor for their
workplace, the candidates supervisor (eg chief radiographer) must sign the application.




















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Reading Material

These texts are considered by MIAP1 to provide the applicant with a sound understanding necessary to
complete the theoretical component and assist with additional knowledge for the clinical aspects of
Intermediate CT Certification. These texts are recommended only; applicants may choose to use other
sources of information. Topics to be studied are included within this study guide.

CT Texts and Websites

DeMaio, D. (2011). Mosby's Exam Review for Computed Tomography, 2nd edition. Mosby/Elsevier,
St.Louis.
Hofer, M (2007) CT Teaching Manual: A Systematic Approach to CT Reading, Thieme, Stuttgart.
Kalender, W (2000) Computed tomography: fundamentals, sysem technology, image quality, applications,
Publicis MCD Verlag, Munich.
Marincek, B, Ros, P, Reiser, M & Baker, M (2001) Multislice CT: a practical guide, Springer-Verlag,
Berlin.
Prokop, M, & Galanski, M (2003) Spiral and multislice computed tomography of the body, Thieme,
Stuttgart.
Romans, L (2011) Computed Tomography for Technologists: A Comptrehenisve Text, Williams &
Wilkins, Philadelphia.
Seeram, E (2009) Computed Tomography: Physical Priniciples, Clinical Applications and Quality Control,
3rd Edition, WB Saunders Company, Philadelphia.
Silverman, P (2002) Multislice computed tomography: a practical approach to clinical protocols,
Lippincott Williams & Wilkins, Philadelphia.

Journals and periodicals
American J ournal of Neuroradiology
American J ournal of Roentgenology
British J ournal of Radiology
European J ournal of Radiology
J ournal of Computer Assisted Tomography
Radiologic Clinics of North America Radiology Seminars in Ultrasound, CT and MRI

Anatomy texts
Ellis, H., Logan, B., Dixon, A. (1997). Human cross-sectional anatomy. Atlas of body sections and CT
images. Butterworth-Heinemann. ISBN: 0-7506-1241-X
Han, M. (1995). Sectional anatomy: Transverse, sagittal and coronal sections correlated with computer
tomography and magnetic resonance imaging. Igaku-Shoin:.
Kelley, L. and Petersen, C (2007) Sectional anatomy for imaging professionals. Elsevier
Moore, K.L. (1999). Clinically orientated anatomy. 4th edn. William and Wilkins
Webb, W.R. & Gotway, M.B. (2002). Pocket atlas of normal CT anatomy. Lippincott Williams & Wilkins

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Module on anatomy, physiology and CT pathology

Applicants will be expected to be able to identify the following structures on standard CT images
(including coronal, sagittal, MPR, 3D, and CT angiography (CTA) images where applicable) and/or line
drawings. Applicants will also be expected to have a basic knowledge of the spatial relationships of these
structures.

1. Cross-sectional anatomy.

i. Head:
- Skeletal structures: sella turcica, foramen magnum, air sinuses (frontal, ethmoid, sphenoid,),
mastoid air cells, IAM, EAM
- Arteries: vertebrals, basilar, internal carotids, and middle, anterior and posterior cerebrals
- Venous system: cavernous sinus, superior sagittal sinus, straight sinus, transverse sinus, internal
jugular veins, confluence of sinuses
- Intra-cerebral ventricular system: lateral, 3
rd
and 4
th
ventricles, choroid plexus, ambient
(quadrigeminal) and basal (interpeduncular) cisterns
- Meninges: falx, tentorium cerebelli
- Cerebrum and cerebellum: pons, lobes (frontal, temporal, parietal, occipital), fissures (sylvian
fissure, longitudinal fissure, central sulcus) corpus callosum, pituitary and pineal glands,
thalamus, head of caudate nucleus, internal capsule, lentiform nucleus

ii. Neck/Face:
- Skeletal structures: Maxillary sinuses, hyoid bone, styloid process
- Arteries: common carotid, internal carotid, vertebral
- Veins: internal and external jugular, subclavian, brachiocephalic
- Airway structures: cricoid cartilage, thyroid cartilage, epiglottis, pharynx, oesophagus,
- Glands: thyroid, submandibular, parotid

iii. Chest:
- Skeletal structures: ribs, sternum
- Arteries: aorta, brachiocephalic, subclavian, pulmonary trunk
- Veins: IVC, SVC, subclavian, brachiocephalic, pulmonary
- Heart: atria, ventricles, pericardium
- Airways: trachea, bronchi, carina

iv. Abdomen:
- Skeletal structures: pelvis, sacrum, coccyx
- Arteries: abdominal aorta, celiac, SMA, renal, iliac, femoral
- Veins: IVC, renal, SMV, portal, iliac, femoral
- Organs: liver (gall bladder, common bile duct), kidneys, adrenals, pancreas, spleen, bladder,
ureters, prostate, uterus, GI tract: oesophagus, stomach, duodenum, colon
- Muscles: psoas
-
v. Spine: vertebral bodies, foramen, processes, articular surfaces




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2. Physiology.

i. CSF production, circulation and absorption
ii. cardiovascular circulation
iii. portal venous blood supply

3. Pathology:

a. Head:
- hemorrhage: subdural, extra-dural, sub-arachnoid, intra-cerebral
- hydrocephalus
- infarct
- space-occupying lesion
- fracture,
b. Neck/face:
- sinusitis
- goitre
- lymphadenopathy
c. Chest:
- pneumothorax,
- emphysema
- infective disease
- lymphadenopathy
d. Abdomen:
- laceration of kidney/spleen/liver
- haemangioma
- renal/liver cyst
- renal calculus
- appendicitis
- psoas abscess
e. Spine:
- Trauma
- disc herniation
















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Module on anatomy, physiology and CT pathology

SAMPLE QUESTIONS:

1. The lateral ventricles of the brain are connected to the third ventricle by the:
A. Ambient cistern
B. Cerebral aqueduct/Aqueduct of Sylvius
C. Interventricular foramen/Foramen of Monro
D. Foramen of Lushka

Answer: C

2. Which of the following statements about the portal venous system is false:
A. It drains blood from the bowel, spleen, pancreas and gallbladder
B. The portal vein is formed by the joining of the SMV and the splenic vein
C. It transports blood directly to the IVC
D. Portal hypertension can result in the formation of oesophageal varices

Answer: C

3. A differential diagnosis of a haemangioma of the liver can be made from a multi-phase scan of the liver
if:
A. The lesion appears denser during the delayed phase than during the arterial or portal venous
phase
B. The density of the lesion does not change with different phases of contrast enhancement
C. The lesion is less than 3cm in size
D. The lesion shows no enhancement in the arterial phase

Answer: A




















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Module on contrast agents, radiation protection and dosimetry

1. Contrast agents

a. Ionic vs non-ionic contrast
b. Contraindications for oral and intravenous contrast agents
c. Possible side effects
d. Immediate treatment for contrast reactions
e. Contrast-induced renal nephropathy: patients at risk, precautions
f. Allergic-type reactions: patients at risk, precautions
g. Use in pregnancy and lactation
h. Administration routes

2. Radiation protection and dosimetry

i. CT dose parameters: CTDI, DLP
ii. Approximate DLP and effective doses for routine CT of the head, chest and abdomen
iii. Technical factors that influence patient dose
iv. The use of CT during pregnancy
v. Special needs for paediatric patients
vi. Dose minimization techniques


SAMPLE QUESTIONS:

1. Which of the following interactions between x-ray beam and matter results in the largest amount of
patient dose?

A. Characteristic
B. Compton scatter
C. Bremsstrahlung
D. Photoelectric effect

Answer: D

2. Examples of mild adverse reactions to iodinated intravenous contrast media may include:
Nausea
Dyspnoea
Warm, flushed sensation

A. 1 only
B. 1 & 2 only
C. 1 & 3 only
D. 2 & 3 only

Answer: C


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Module on physical principles, hardware and artifacts

1. Physical principles, hardware and artifacts
i. Terminology: pitch, 8ounsfield unit, pixel, algorithm/kernel, interpolation, window
ii. Image quality: noise, high contrast resolution, low contrast resolution
iii. Technology: detector configurations, beam filtration
iv. Artifacts: beam hardening, partial volume artifact, motion artifact, calibration error, metal artifact

SAMPLE QUESTIONS:

1. Increasing the scan field of view

A. Increases the number of detector cells collecting data
B. Increases the range of HU displayed on the image
C. Decreases the pixel size
D. Decreases the display field of view (zoom, target)

Answer: A

2. A CT slice is taken with the following factors: mA =300, scan time =1 second, matrix =512, kVp =
120, slice thickness =10mm. The resulting image is suspected of containing a considerable amount of
volume averaging. Which of the above factors is primarily responsible?

A. mA
B. Scan time
C. Matrix
D. Slice thickness

Answer: D

3. A grid formed from columns and rows of pixels is called a

A. Back projection
B. Convolution filter
C. Matrix
D. Histogram

Answer: C











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Module on CT technique

1. CT technique

i. Effect of acquisition and reconstruction parameters on image noise and high contrast resolution
ii. Effect of scan acquisition parameters on patient dose
iii. Helical vs nonhelical: indications for use, advantages and disadvantages of use
iv. Technique modification for paediatrics, trauma, patient size
v. Contrast timing: available timing techniques, approximate scan delays for arterial, portal-venous,
nephrogram and pancreatic phases.
vi. Routine image techniques for the following examinations:
- Head (routine)
- Inner ear
- Sinuses
- Face (trauma)
- Face (infection/tumour)
- Neck
- Thorax (routine)
- HRCT
- Thorax (CT pulmonary angiography)
- Abdomen (routine)
- Abdomen (multiphase liver)
- Abdomen (pancreas)
- Abdomen (multiphase kidney)
- Abdomen (renal colic)
- Abdomen (angiography)
- Spine (trauma)
- Extremities (trauma)

SAMPLE QUESTIONS:

1. The technique used in obtaining Hi-Resolution CT (HRCT) includes:
A. Thin collimation
B. Utilizing a high spatial frequency algorithm or filter
C. Increased technical factor
D. All of the above
E. A&B

2. The non equilibrium phase of the liver usually occurs how long after injection?
A. 55-120 seconds
B. 2 minutes
C. 3-4 minutes
D. 3-4 hours

3. The adrenals should be included on a routine oncology chest scan because
A. Lung may be seen below the adrenal glands
B. Lung is never seen below the adrenal glands
C. Adrenal glands enlarge with infection
D. Lung tumours can metastasis to the adrenals
Answer: E
Answer: A
Answer: D