e-AIT

(Applied Imaging Technology)

Paper 1 Exam
Tuesday, 8th September 2015

Level 9, 51 Druitt Street, Sydney NSW 2000, Australia Ph: +61 2 9268 9777 Fax: +61 2 9268 9799
Web: www.ranzcr.edu.au Email: ranzcr@ranzcr.edu.au ABN 37 000 029 863
Case 1- Radiation Biology and Safety

Question 1

The ICRP has developed a system of dose limits for the protection of individuals and populations.

(a) What are the dose limits that apply for the prevention of stochastic effects to (i) occupationally exposed
individuals and (ii) members of the public? Why is there a difference? (4 marks)

(b) What is the dose limit that applies once a female employee becomes pregnant? (1 mark)

(c) Briefly discuss why the effective dose may be a useful dose metric but also indicate its limitations. (3 marks)

(d) For occupationally exposed individuals what are the dose limits that apply to the skin and the lens of the eye,
respectively for the prevention of tissue reactions (deterministic effects)? (2 marks)

Question 2

A pregnant woman undergoes the following examinations at 14 weeks of her pregnancy:

(i) CT of the abdomen and pelvis with and without contrast.

(ii) Mammography.

(iii) Plain abdominal radiography – single AP view.

(iv) Ventilation/perfusion lung scan.

(a) Provide an estimate of the magnitude of any foetal radiation doses involved from each procedure. (2 marks)

(b) Discuss any possible risks to the foetus from these procedures when considered collectively. (4 marks)

(c) Indicate what you might say to the concerned patient to allay any fears she may have. (4 marks)

Question 3

An obese patient presents for an abdominal interventional examination to be conducted on a C-arm X-ray
fluoroscopy system. The X-ray unit has automatic brightness control (ABC) with a range of dose rate options,
including pulsed fluoroscopy, and an image intensifier with variable field size. You anticipate that the procedure will
be difficult and may require considerable fluoroscopy time. In order to minimise the severity of any tissue reactions
occurring in the patient’s skin you need to optimise your procedure.

(a) Discuss the impact of choice of the following system operating parameters and factors on the patient skin dose:

i. Dose rate,

ii. Field size (magnification),

iii. Collimation, and

iv. Radiographic geometry

Provide reasons for your answer where applicable. (8 marks)

(b) After the procedure is completed the fluoroscopy unit indicates that the skin exposure received by the patient
may be about 5 Gy. What possible tissue reactions might you expect and what advice might you offer to the
referring physician? (2 marks)

e-AIT Paper 1 Exam

© The Royal Australian and New Zealand College of Radiologists® 2015
September 2015

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Case 2 - Basic Physics & Technology including Mammography, Fluoroscopy & DSA

Question 1

(a) Describe the electromagnetic spectrum paying particular attention to the radiations used in medical imaging.
The perspective from a frequency, wavelength and/or photon energy should be used. (3 marks)

(b) Distinguish between characteristic X-ray production and the photoelectric effect. (4 marks)

(c) A high voltage of 70 kVp is applied to an X-ray tube. What is the impact of adding a small amount of filtration
(e.g. 2.5 mm Al) on such an X-ray spectrum and why is this beneficial? (1.5 marks)

(d) Relatively large amounts of filtration (e.g. 0.1 mm Cu + 1 mm Al) may be used when performing barium enemas.
Why is it not appropriate to do this routinely for all radiological studies? (1.5 marks)

Question 2

(a) Fluoroscopy based on X-ray image intensifiers is currently being superseded by two types of digital radiography-
based detectors. Compare all three types of image receptor in terms of their construction and operation.
(6 marks)

(b) Modern fluoroscopy systems can be operated in both continuous and pulsed exposure modes. Explain the
difference between these two modes of operation and indicate the major advantages and disadvantages of
each. (2 marks)

(c) Modern interventional and digital subtraction angiography (DSA) systems can be operated in both screening
and acquisition modes. What is the difference between these two modes of operation? (2 marks)

Question 3

(a) Breast compression is useful for optimising X-ray mammographic imaging. Describe how such compression is
generally applied in practice and discuss four advantages of the technique. (5 marks)

(b) Explain the reasons for the anode-cathode orientation and the anode’s focal spot placement for the X-ray tube
used in contact mammography. (4 marks)

(c) What is the major difference between primary diagnosis monitors used for mammographic imaging viewing and
those used for plain radiographic viewing in terms of pixel resolution? (1 mark)

e-AIT Paper 1 Exam

© The Royal Australian and New Zealand College of Radiologists® 2015
September 2015

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Case 3 - Advanced Technology

Question 1

(a) Describe what is meant by CT-AEC, sometimes referred to as “tube current modulation”, in CT scanning.
(2.5 marks)

(b) What is the effect of tube current modulation on patient effective dose and how is this change in dose
accomplished? (2.5 marks)

(c) When a CT scanner is operating under tube current modulation how are dose and image quality affected by
changes in:

i. Pitch (2.5 marks)

ii. Tube rotation time (2.5 marks)

bearing in mind that the effective mAs (mAs/pitch) remains unchanged? In each case give an explanation for
what causes the observed changes.

Question 2

With respect to magnetic resonance imaging, describe the role of the following in producing an image:

(a) Fixed magnetic field (2 marks)

(b) Magnetic field gradients (2 marks)

(c) Radiofrequency field (2 marks)

(d) Flip angles of less than 90⁰ (2 marks)

(e) Head coil. (2 marks)

Question 3

(a) Real time ultrasound instruments make a number of basic assumptions in order to produce an image. State 3
of these assumptions. (3 marks)

(b) When performing real-time imaging using linear or phased array transducers the axial and lateral spatial
resolution both contribute to the overall image spatial resolution.

Explain how each can be optimised, how the optimisation is achieved and stating any trade-offs associated in
achieving higher spatial resolution. (7 marks)

e-AIT Paper 1 Exam

© The Royal Australian and New Zealand College of Radiologists® 2015
September 2015

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Question 4

(a) Gamma cameras are the basic imaging device for much of nuclear medicine imaging. The diagram depicts a
schematic of the major components of a gamma camera detector head. For each of the components labelled
A to C in the diagram, name the component and briefly describe its function in the detector head’s operation.
(5 marks)

(b) Suppose your nuclear medicine practice routinely performs a planar imaging study but you notice that most
patient images appear to have quite a lot of noise that makes them difficult to interpret.

Discuss how the image noise can be reduced without compromising image spatial resolution and give details
of how this can be achieved. (2 marks)

(c) Technetium-99m is often described as an ideal isotope for nuclear medicine SPECT and planar imaging.

State six (6) desirable physical and chemical characteristics a radioisotope suitable for nuclear medicine
imaging will possess. (3 marks)

e-AIT Paper 1 Exam

© The Royal Australian and New Zealand College of Radiologists® 2015
September 2015

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