COMPUTED TOMOGRAPHY

SRTLE: A survival guide

Prepared by
HS-NEGAN

January 8, 2022

1st version
Computed Tomography

SECTION I: Physics and Instrumentation

In general, in both SDCT and MDCT systems a pitch between 1 and 1.5 is most common.
In general, increasing the pitch reduces resolution in the image.

increasing the pitch =

1. scan time will be reduced

2. Radiation is less concentrated
3. Exposure dose will be reduced
4. No more detail in the image (quality will be reduced)
• The range of gantry size is typically 70 to 90 cm.
• The degree of tilt varies among systems, but ±15° to ±30° is usual.

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■Spatial resolution
describes the ability of a system to define small objects distinctly.
■Contrast
resolution refers to the ability of a system to differentiate objects with similar densities.
■Temporal resolution refers to the speed that the data can be acquired commonly seen when imaging the heart.

The amount of the x-ray beam that is scattered or absorbed per unit thickness of the absorber is expressed by
the linear attenuation coefficient, . The attenuation coefficient decreases with increasing photon energy and
increases with increasing atomic number and density

Compensating Filter made from Teflon or aluminum, helps to reduce

patient dose. It makes the x-ray beam more homogeneous.

CT is superior to all other clinical modalities in its contrast resolution

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TO reduce artifacts created by surrounding structures (Axial plane). The coronal plane is preferred for
Scanning the pituitary gland.

Generator
High-frequency generators are currently used in CT

Tungsten is often used for the anode target material because it produces a higher-intensity x-ray beam.

Reducing the scatter improves contrast resolution and decreases patient dose.
Collimators control the slice thickness

Optimal characteristics of a detector:

1. high detector efficiency

2. low, or no, afterglow
3. high scatter suppression
4. high stability

All new scanners possess detectors of the solid-state crystal (i.e., scintillation detectors) variety.

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Raw data includes all measurements obtained from the detector array.
Image data are those which result once the computer has processed the raw data.

• Back projection, also known as summation method or, is a simple procedure that does not require much
understanding of mathematics. Artifact associated with back projection is known as the star pattern
• Filtered back projection is a type of reconstruction method known as the convolution method and
was developed in order to eliminate the star pattern.
• Iterative Reconstruction This new advanced reconstruction technique can reduce image noise, has been
shown to reduce the radiation dose to the patient by as much as 50%.

Analog-to-digital converter (ADC)

The out- put signal from the detectors is an electrical signal (an analog signal that varies continuously in time).
Because a digital computer is used in these imaging systems, the analog signal must be converted into a digital signal
(discrete units) for processing by a digital computer.

Digital-to analog (DAC)

DAC change the digital signal from the computer memory back to an analog format so
that the image can be displayed on the monitor.

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• As window width increases, the scale of contrast increases

• As window level increases, brightness increases

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The term RECONSTRUCTION is used when raw data are manipulated to create pixels that are then
used to create an image.

VS.
The term REFORMATION is used when image data are assembled to produce images in different
planes, or to produce3D images.

Post Processing technique :

(Rendering Techniques (3D)

1. surface-shaded display (surface rendering),

2. volume rendering,
3. maximum intensity projection.
4. minimum intensity projection

• Surface shaded display (SSD).

is similar to taking a photograph of the surface of the structure and used to show the outside shell of the structure.

Only voxels on the surface of the structure are used. The remaining voxels in the image are usually invisible.

• Volume Rendering (VR) .

• Maximum Intensity Projection (MIP)

Reconstruction of an image by selecting the highest- value pixels along any arbitrary line through the data set

and exhibiting only those pixels. This method tends to display bone and contrast-filled structures;

lower-attenuation structures are not well visualized.

• Minimum intensity projection (MinIP)

MinIP involves selecting the voxel with the minimum value from the line for

display. Such images can be useful to display the bronchial tree.

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QUALITY ASSURANCE METHODS:

✓ Spatial Resolution (High-Contrast Resolution) This test is performed monthly

✓ Contrast Resolution (Low-Contrast Resolution) This test is performed monthly
✓ Slice Thickness Accuracy This test is usually performed semiannually.
✓ Laser Light Accuracy This test is usually performed semiannually.
✓ Noise and Uniformity These tests should be performed on a weekly basis.
✓ Linearity is typically measured semiannually.

The following are the recommended ae rates for each gauge:

24 gauge-utilizing injection flow rates <1(recommended for children)
22 gauge-utilizing injection flow rates 1-2
20 gauge-utilizing injection flow rates 2.5-3.5
14-18 gauge-utilizing injection flow rates of >3.5(recommended for adults)

It is important to remember nonionic media are more Viscous than ionic media at similar iodine concentrations.

The CTDIvol is the preferred expression of radiation dose in CT dosimetry.

Bismuth shields have been used in CT as one means of protecting superficial organs such as

the eye (8,9), thyroid (10,11), and breast (12,13) from radiation delivered during medical CT examinations

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SECTION II: Patient Care

BUN and serum creatinine provide information about a patient’s renal function. if a patient will receive an IV contrast.

PT and PTT provide information about the blood’s coagulation ability. This is important for examinations that carry
the risk of excessive bleeding, such as biopsies and fluid drainage.

( Vital signs )
are the best early indicators of a physiologic change in a patient. body temperature, pulse, respirations, and blood pressure.

Respirations: pulse :

• adults, 14 to 20 • Adults :60-100 beats per minute

• adolescent youth, 18 to 22 • athletic adults :45or 60 – 100beats per minute
• children, 22 to 28 • children: 95 – 110 beats per minute
• infants, 30 or greater • infants : 100 – 160 beats per minute

blood pressure : Body temperature :

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Properties of contrast media Water is sometimes used in place

of positive contrast agents.
Can be defined as :

• Negative : Air and carbon dioxide: very high negative contrast ( administered Rectally )
• Neutral : Water : distends the bowel poorly – transit rapidly – dose not obscure mucosal surface
• Positive: Barium and iodine

✓ Two tissues must differ by at least 10 HU to be visibly differentiated on a CT scan

✓ Contrast agents can serve to widen the inherent difference in attenuation between tissues
✓ Administration of contrast media can provide a 40-75 HU increase in the natural difference of attenuation
✓ between tissues

iodinated agents are universally used because they Ideal contrast media molecule
are
1. No electrical charges
1. Water soluble 2. Biologically inert
2. Easy to administer intravascular 3. Carry sufficient iodine molecules
3. Safe 4. Low osmolality
4. Different tissues often enhance differently 5. Low osmolarity
5. iodinated CM is handled differently in normal
6. Low viscosity
versus abnormal tissues
7. High neuro compatibility
8. Suitable for multiple administration routes
(IV, IA, IT GIT)

Properties of iodinated :

Clearance :

Excreted by the kidney and half-life in patient with normal renal function ( 2 h )

viscosity :
The viscosity of the contrast material can be significantly decreased by heating the liquid to
body temperature for injection. the higher the concentration of iodine, the more viscous the solution.
The molecules contained in nonionic contrast media do not disassociate.

Osmolality :

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Factors that influence contrast enhancement and timing

The patient Contrast factors CT scanning factors

Magnitude - Weight & Height - Total iodine mass Scan duration

How long it last - Cardiac output ( concentration volume ) Scan delay
- Age & Gender - Flow rate
- Saline flush
Timing - Cardiac output Injection duration Scan delay
- Venous access ( volume , flow rate ) Scan duration
Saline flush
Viscosity

Injection duration ( time from beginning to the end of injection )

Time to peak enhancement

Arrival Time : increase or decrease inversely proportional to the cardiac output .

1. Arterial enhancement : high rate without increasing volume -Using high flow rate
2. Parenchymal enhancement : not influenced by rate but total iodine dose delivered -Using high concentration

Methods of injection –Right Antecubital vein is the (Injection site)

• Bolus :

Rapid injection of contrast by hand or mechanical injector

• Drip

Allowed to drip in during a period of several time ( for brain scan )

• Split bolus :

2 contrast injection in different time and scan after the second one

For scan im both nephrographic and renal excretory phase in single image to reduce dose

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The most common formula for calculating the dose of intravascular

contrast for pediatric CT studies is 2 mL/kg.

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Contrast media reaction :

Chemotoxic reactions result from the physicochemical properties of the contrast media, the dose, and speed
of injection. Contrast-induced nephropathy is an example of a chemotoxic reaction.

Idiosyncratic reactions include all other reactions. These reactions are largely unpredictable, most often
occur within 1 hour of contrast medium administration, and are not related to the dose.

Children have a lower frequency of contrast reactions than adults.

+
side effects are much less common when LOCM are used.

The most important method of reducing the risk of idiosyncratic contrast medium reaction is to use LOCM.

Risk Factors for Idiosyncratic Reactions

1. Previous Contrast Medium Reaction

2. Asthma
3. Allergies
4. Drugs (b-blockers)

Less than 1% of the dose of contrast agent given to the mother is excreted into breast milk.
Therefore, it is believed to be safe for the mother and infant to continue breast-feeding afterreceiving a contrast agent.

may abstain from breastfeeding for 24 hours (recommended by ACR)

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Computed Tomography

Conventional radiography barium suspension cannot be used in CT. Such full-strength

solutions would cause unacceptable streak artifacts.

Sedation:

✓ The use of sedation is inevitable in pediatric CT scanning.

✓ Sedation protocols and standards should be cooperatively established by the departments of radiology and
anesthesiology to ensure high-quality care for the sedated patient.

✓ Any syndrome or condition with a respiratory risk that contraindicates sedation is recorded and brought to the
attention of the radiologist.

✓ The decision to sedate a child should be a cooperative effort of the radiologist, the nurse, and a parent.

SECTION III: Cross-Sectional (go back to the book for good Image quality)

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SECTION IV: Imaging Procedures and Protocols

Narrow window widths are used to demonstrate the brain, as there is only a small difference in
attenuation between the gray matter and the white matter.

Narrow window widths Contrast resolution Wide window widths Spatial resolution

CT is the most frequently used initial examination for imaging of intracranial hemorrhage (ICH).

CT is the primary imaging modality for emergent indications such as trauma and acute changes in
neurologic status. IV contrast administration is indicated for infection and neoplasm.

Without contrast:

• intracranial hemorrhage (ICH).

• Dementia
• Infarction
• Hydrocephalus
• Cerebral trauma

With contrast:

• Mass
• Lesion
• AVM
• Aneurysm
• Headache
• Metastasis

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Types of Stroke:
Stroke may be divided into two main categories: ischemic, caused by a blockage in an artery, and hemorrhagic,
caused by a tear in the artery’s wall

Arteriovenous malformations (AVMs) need contrast media

Spinal CT imaging: No gantry tilt

The thorax has the highest intrinsic natural

Contrast so, intravenous (IV) iodinated contrast
administration is not necessary.

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Pulmonary angiography has long been considered the gold standard in the diagnosis of acute PE.

Computed tomography angiography (CTA) is the initial imaging modality of choice for stable patients with
suspected pulmonary embolism.

The most reliable sign of an acute embolus is a

low-density filling defect into the vessel lumen.

The use of a saline flush afterthe injection of the iodinated contrast is recommended for CTA pulmonary
studies. This will eliminate beam-hardening artifacts
from dense contrast media within the superior vena
cava that may obscure small emboli.

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ECG Gating
To minimize cardiac motion artifact, most cardiac CT protocols use images acquired during the point of the cardiac
cycle with the least cardiac motion.

Patient should refrain from ingesting caffeine for 12 hours before study.

CT angiography is more accurate than Calcium Score in demonstrating coronary stenoses.

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The use of oral contrast material is imperative to differentiate fluid-filled loop of bowel
from a mass or an abnormal fluid collection.

Patients should be given only clear liquids for at least 2 hours before scanning to ensure that
food in the stomach is not mistaken for pathologic tissue.

Routine soft-tissue window setting (window width approximately 450; window level
approximately 50) will adequately display most abdominal anatomy.

liver windows that are narrower (window width approximately 150; window level
approximately 70).

To differentiate the margins of the pancreas from the duodenum the patient lying in a
right decubitus position.

The normal CT attenuation of the liver in unenhanced studies varies 38 to70 HU.
In healthy subjects the attenuation of the liver is at least 10 HU greater than that of the spleen

Fatty infiltration the liver is at least10 HU lower than that of the spleen.

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CT has become the modality of choice in the detection and characterization of adrenal masses.

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Multiphasic protocols are common for pancreatic indications

Contrast-enhanced CT is the imaging modality of choice for the

diagnosis and staging of acute pancreatitis Axial for (head and tail)

CT arthrography is useful for evaluation of the joint capsule and intracapsular structures and for
finding loose bodies within the joint.

Notes for CT protocols 📝:

✓ KUB patient must drink water before scan

✓ Acute appendicitis doesn’t need Iv except if it is suspected.
✓ PNS patient lying prone (to remove fluid from the sinus)
✓ For PE and aneurysm patient the arterial phase as fast as possible may be 13s is enough.
✓ Contrast stored in CT room
✓ PE patient need contrast media
✓ Anything has low HU like blood thrombosis (hypodense) need cm
✓ Anything has high HU like stone or calcification (hyperdense) doesn’t need cm
✓ Lead apron unnecessary in CT (has no effect) examination
✓ it is recommended to adjust KVP according to body mass.

Asthmatic patient ≠ contrast

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Computed Tomography
1. Which of the following is the proper preparation for patient having lower abdomen CT scan?

A) NPO from midnight prior to scan

B) NPO for 3 hours prior to scan
C) Laxative 1 day before and NPO from midnight
D) NPO for 24 hours and laxative 6 hours prior to scan

2. A 35-year- old woman with complaints of lower back pain is referred to the Radiology Department.
The physician suspects L5-S1 Spondylolisthesis. Which of the following best diagnose this case?

A) Non contrast CT
B) CT myelography
C) MR myelography
D) Contrast enhanced CT

3. Which of the following is the routine patient position in CT procedure?

A) Prone
B) Supine
C) Right lateral decubitus
D) Left lateral decubitus

4. Few samples are taken in CT partial scanning technique that lead to aliasing artefacts.
Which of the following actions must be done?

A) Increase scan time and reduce pitch

B) Decrease scan time and increase pitch
C) Use appropriate filtration and increase kVp
D) Give clear breathing instructions to the patient

5. The CT number for water when expressed as a Houndsfield Unit (HU) has a value of
which of the following?

A) -1000
B) -500
C) 0
D) +500

6. A 50-year-old man presents with sudden onset severe headache and vomiting without a focal
neurologic deficit. History revealed hypertension. CT images show blood in the sylvian fissure.
Which of the following is the most likely diagnosis?

A) Meningitis
B) Epidural hematoma
C) Subdural hematoma
D) Subarachnoid hemorrhage

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7. Prospective gating method is commonly used more than the retrospective method in cardiac CT imaging.
Which of the following is the primary advantage of it?

A) Provides better image quality

B) Reduces the proposed scan time
C) Eliminates possible image artifacts
D) Lowers radiation dose to the patient

8. A patient with a clinical suspicion of cavernous hemangioma is referred to the Medical

Imaging Department for CT scan. Which of the following is the most valuable imaging protocol?

A) Single phasic contrast enhanced adrenals

B) None contrast enhanced pancreas
C) Tri phasic contrast enhanced liver
D) Renal CT angiography

9. Which of the following is an input device for use with the CT imager?

A) Cathode ray tube

B) Magnetic desk
C) Optical desk
D) Key board

10. Which of the following is the motion of the patient couch during a spiral CT?

A) Rotating
B) Stationary
C) Advancing step wise
D) Continuously advancing

11. Which of the following will occur as a result of changing the CT image matrix from 2562 to 5122?

A) Increasing the reconstruction time

B) Decreasing the reconstruction time
C) Increasing the spatial resolution
D) Decreasing the radiation dose

12. Which of the following protocols would help to determine blockage or stenosis of
coronary arteries as result of a buildup of plaque?

A) High resolution CT
B) Routine chest CT
C) CT angiography
D) Calcium scoring

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13. Which of the following is the average gantry aperture (Opening) diameter of CT imaging scanners?

A) 180 cm
B) 150 cm
C) 90 cm
D) 70 cm

14. Given the scaling factor (K) of a CT scanner is 1000 and the
linear attenuation coefficient for bone and water are 0.38 and 0.19 cm1. respectively.
Which of the following is the CT number for bone?

A) 2000
B) 1500
C) 1000
D) 500

15. Which of the following is the standard Bone Window for skull?

A) wl 1500, ww 300
B) wl 300, ww 1500
C) wl 200, ww 800
D) wl 40, ww 100

16. The radiation dose of CT imaging is reduced in the patient by adjusting the parameters.
Which of the following will induce the minimal dose?

A) Decreasing kV, increasing mAs,decreasing pitch

B) Increasing kV, decreasing mAs,Increasing pitch
C) Decreasing kV, increasing mAs, increasing pitch
D) Increasing kV, decreasing mAs,decreasing pitch

17. Which of the following is the recommended slice thickness (mm)/slice overlap (%)
to obtain 3-dimensional image of the spine?

A) 1/30
B) 1/50
C) 2/30
D) 3/50

18. Which of the following is the advantage of iterative reconstruction technique over filtered
back projection in computed tomography?

A) Less radiation dose

B) Faster reconstruction
C) Better handling of noisy images
D) Better representation of bone detail

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19. Which of the following CT imagers finds principal application in cardiac imaging?

A) 2nd generation
B) 3rd generation
C) 4th generation
D) Electron beam

20. What is the term window level refers to when viewing a CT image?

A) Central CT number of the window width

B) Lowest CT number of the window width
C) Highest CT number of the window width
D) Contrast range reconstructed

21. Which of the following is the principal reason that high kvp is employed in CT imaging?

A) Reduce scan time

B) Reduce image noise
C) Reduce reconstruction time
D) Increased beam penetrability

22. An electromechanical device consists of brushes for helical scanning in computed

tomography. Which of the following is the most likely device?

A) Amplifier
B) Slip rings
C) Electron gun
D) Detector collimator

23. Which of the following image modalities are likely to have less scatter radiation affecting the image?

A) CT
B) Fluoroscopy
C) Projection of radiography
D) Conventional tomography

24. Which of the following brain pathologies require a contrast enhanced CT?

A) Infarctions
B) Cystic lesions
C) Hydrocephalus
D) Acute Hematomas

25. Which of the following is the size of the cannula for CT Brain (hand injection)?

A) 22G
B) 18G
C) 16G
D) 14G

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26. Given the following CT protocol parameters: • KVp • mAs • Pitch • Slice thickness
Which of the following parameter combinations should be applied in children in order to improve radiation
protection?

A) Decrease KVP, decrease mAs, decrease pitch and increase slice thickness
B) Decrease KVP, decrease mAs, increase pitch and increase slice thickness
C) Decrease KVP, increase mAs, decrease pitch and decrease slice thickness
D) Increase KVP, decrease mAs, decrease pitch and decrease slice thickness

27. Which of the following CT technique parameters should be applied in a patient with
suspected radiopaque renal stone?

A) Non contrast cuts starting from above kidneys to iliac crest

B) Non contrast cuts starting from above kidneys to symphysis pubis
C) Contrast enhanced delayed phase cuts starting from top to lower pole of kidneys
D) Contrast enhanced arterial, nephogram and pyelogram phase cuts starting from above kidneys to iliac crest

28. Which of the following is the imaging modality that gives the highest radiation dose?

A) MRI
B) C.T scan
C) Conventional X-ray
D) E.C.G (Electrocardiogram)

29. Which of the following could produce ring artifacts in computed tomography imaging?

A) Detectors malfunction
B) Increased scan time
C) Scattered radiation
D) Patient movement

30. Which of the following terms refers to the ability of a CT system to define small objects distinctly?

A) Low-contrast resolution
B) Temporal resolution
C) Contrast resolution
D) Spatial resolution

31. Which of the following is the main advantage of CT over projection radiography?

A) Speed of image acquisition

B) Contrast resolution
C) Energy resolution
D) Spatial resolution

32. A Computed Tomography (CT) result in which of the following images?

A) Analog
B) Linear
C) Digital
D) Curvilinear

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33. Which of the following are the limitations of CT scanning of spine?

A) Very large patient

B) Very thin patient
C) Trauma patient
D) Children

34. A patient is required to extend the arms above the head during a thoracic CT scan.
Which of the following is the possible reason?

A) Maximizes extension of the spine

B) Helps the patient to hold breath
C) Reduces possible artifact formation
D) Minimizes the patient's movement during the Scan

35. Which of the following is the suitable CT scan range for imaging the entire cervical spine?

A) Axis to T1
B) Base of skull to T1
C) Base of the atlas to C7
D) Base of the atlas to T1

36. A patient suspected of lymphoma is evaluated for gastric wall thickening

by a contrast- enhanced [Link] of the following is the best oral contrast media to be used?

A) Pure water
B) Omnipaque
C) Barium sulphate
D) Dilute gastrografin

37. Which of the following is the reference line for obtaining axial CT brain slices?

A) Auricular
B) Orbitomeatal (OML)
C) Interpupillary
D) Mento-meatal

38. How should a technologist prepare the patient in order to obtain a uniform enhancement of the
small bowel with contrast agents in abdomen computed tomography?

A) Drinking the specified amount of contrast over 6 hours before the exam
B) Drinking the specified amount of contrast in intervals 1 hour before the exam
C) Drinking the specified amount of contrast immediately before starting the exam
D) Drinking the specified amount of contrast in 30 minutes intervals four hours beforethe exam

39. A 55-year-old patient develops a hypertensive crisis following a contrast enhanced CT.
History revealed laboratory tests done for adrenal gland. Which of the following is the most likely pathology?

A) Adenocarcinoma
B) Diabetes mellitus
C) Multiple myeloma
D) Pheochromocytoma

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40. What is the CT number for the brain tissue?

A) 30-40
B) 70-90
C) 120-190
D) 200-400

41. By employing high kvp for CT imaging, one can reduce which of the following?

A) Patient dose
B) Image artifacts
C) Compton scatter
D) Image reconstruction time

42. The parameter found only in CT :

A) KVP
B) MAS
C) Pitch
D) Slice thickness

43. Which of the following does the term "Projection" mean in reference to the CT?

A) Speed of image acquisition

B) Mathematics of image reconstruction
C) Size of the X-ray beam projected on the patient
D) Data set representing X-ray attenuation in the patient

44. Which of the following determines the image slice thickness in computed tomography?

A) Reconstruction algorithm
B) Width of the collimator
C) Number of Ct detectors
D) Applied kilovoltage peak

45. Which of the following procedures is most helpful in diagnosing pulmonary thrombo-embolism?

A) Perfusion scan
B) Plain chest X-ray
C) pulmonary angiogram
D) Enhanced CT

46. Which of the following is the major determinant of temporal resolution in computed tomography?

A) Fan-beam angle
B) Detector collimation
C) Gantry rotation speed
D) Reconstruction algorithm

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47. Which of the following brain CT protocol helps to differentiate ischemic
stroke from hemorrhage stroke?

A) HRCT protocol without contrast

B) HRCT contrast enhanced protocol
C) Standard protocol without contrast
D) Standard contrast enhanced protocol

48. Which of the following is the contrast medium of choice to outline the stomach
when performing CT abdomen examinations?

A) Omnipaque
B) Barium sulphate
C) Diluted omnipaque
D) Diluted gastrografin

49. A patient with suspected chest neoplasm is referred to the Radiology

Department for contrast enhanced chest CT scan. Which of the following is the best option for diagnosis?

A) From level of clavicles to the level of iliac crest

B) From level of clavicles to the liver and adrenals
C) From level of clavicles to the level of diaphragm
D) From level of aortic arch to the liver and adrenals

50. Which of the following oral contrast medium is used in the CT scan of the abdomen?

A) CAT
B) Gastrografin
C) Barium sulphate
D) E-Z-HD (Barium Sulfate)

51. Which of the following image post processing techniques provides

accurate vessel diameters and 3D vascular relationship?

A) Maximum Intensity Projection (MIP)

B) Multiplanar Reconstruction (MPR)
C) Surface Shaded Displays (SSD)
D) Volume Rendering (VR)

52. Which of the following is the pixel size for a given reconstructed CT image
if thetechnologist selects a 10 cm Field of View (FOV) at a matrix size of 512 X 512?

A) 0.20 mm
B) 0.51 mm
C) 2.00 mm
D) 5.12 mm

(Pixel size = FOV /Matrix)

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53. Which of the following is the CT protocol of choice for the diagnosis of idiopathic pulmonary fibrosis?

A) Routine contrast enhanced CT

B) Routine non- contrast CT
C) High resolution CT
D) CT Angiography

54. A process uses software to synchronize CT scan to the patient's heart in an attempt to minimize motion
artefacts. Which of the following is it called?

A) Gated CT
B) Back projection
C) Volume rendering
D) Contiguous scanning

55. Which of the following is the maximum tilt for the CT gantry?

A) +20
B) +30
C) +40
D) +45

56. Which of the following IV contrast is used in the CT examination?

A) Omnipaque 300
B) Gastrografin
C) Easy Cat
D) Topcat

57. Which of the following is the typical window settings for soft tissues differentiation visualization?

A) 1000 Window Width ( WW)/100 (WL)

B) 500 wW/10OWL
C) 350 WW/50WL
D) 100 WW/5OWL

58. Which of the following best describes MRI superiority to Computed tomography in
diagnosing disc herniation?

A) Low exposure to X- radiation

B) Short examination scan time
C) Better visualization of soft tissue
D) Better visualization of bony structures

59. Which of the following CT imagers have fastest scan time?

A) 2nd generation
B) 3rd generation
C) 4th generation
D) Electron beam

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60. Which of the following is the most common dosage used per kg body weight for
intravascular contrast volume in pediatric CT studies?

A) 1 ml/kg
B) 2 ml/kg
C) 4 ml/kg
D) 5 ml/kg

61. Which of the following is the primary function of the CT detector?

A) Filter the X-ray beam

B) Amplify the measured X-ray beam .
C) Convert the X-rays to digital signals
D) Reduce the amount of scatter radiation

62. CT protocol requires prothrombin time and partial thromboplastin time result prior to
start the procedures which of the following is the most likely CT?

A) virtual colonoscopy
B) characterization of adrenal mass
C) interventional guided liver biopsy
D) characterization of renal cell carcinoma

63. In the CT scan of the brain for which of the following reason should the slice taken be parallel to the
supraorbital mental line rather than the orbital mental line?

A) improve the contrast resolution

B) reduce beam hardening artifacts
C) reduce radiation exposure to the lens
D) enable better visualization of the ventricles

64. You can’t do the CT scan if the patient had?

A) Ultrasound
B) Barium meal or Enema
C) Bone Scan
D) MRI

65. The maximum weight for the table of the CT scan machine is?

A) 200kg (450 IB)

B) 300kg
C) 350kg
D) 100kg

66. The first CT image was demonstrated by ?

A) Alan Cormack
B) Raymond Damadian
C) Geodfrey Hounsfield
D) Frank Lauterbur

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67. Protocols for most often include thin slices acquired in the axial plane.
Scanning begins at the acromioclavicular joint and terminates a few centimeters
below the most inferior fracture line:

A) Soft-tissue
B) Shoulder trauma
C) Knee
D) Prosthesis

68. What is the meaning of CT scan?

A) Cat Scan Machine

B) Computed Tomography Scan
C) Continuous Tomography Scan
D) Center Teaching Scan

69. What is the preparation for abdomen CT scan?

A) NPO from midnight

B) NPO for 3 hours
C) Give Castor oil 60ml on night of the examination and NPO from midnight.
D) NPO for 24 hours and castor oil 60ml six hours before examination.

70. The recommended collimation for imaging the lung nodules is approximately?

A) 1 mm
B) 2-3 mm
C) 4-5 mm
D) 6-7 mm

71. The recommended collimation for imaging the abdomen is approximately?

A) 1 mm
B) 2-3 mm
C) 4-5 mm
D) 8-10 mm

72. The principal advantage of spiral CT is?

A) Sub second imaging time

B) 1 second imaging time
C) Large volume data imaging
D) Removal of ring artifacts

73. The common uses of CTA procedures are?

A) Identify diseases in bowels

B) Identify diseases and aneurysms in aorta
C) Identify diseases in stomach
D) Identify diseases in spinal cord

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74. EBCT is An image technology and is not substitute for?

A) Congenital cardiac lesion

B) Ventricular muscle mass
C) Cardiac catheterization
D) Calcium deposit in coronary arteries Calcium

75. What the gantry angle in CT for sinuses?

A) 20° center plate tongue

B) 20° center orbit
C) 40° center tongue
D) 40° tongue

76. What the gantry angle in CT for spine?

A) 20° center plate tongue

B) 20° center orbit
C) 40° center tongue
D) 0°

77. For CT examinations is substantially higher when compared with film- screen radiography?

A) Attenuation
B) Radiation dose
C) Noise
D) CT examination

78. 66 years old man has car accident the ER physician referring the patient to the radiology
department to do CT with contrast What is the appropriate action to do?

A) do CT with contrast
B) do CT without contrast
C) consult the radiologist about the patient
D) talk to ER physician that contrast is not suitable

79. To visualize head and tail of the pancreas in abdominal CT?

A) Axial
B) sagittal
C) oblique
D) coronal

80. CT contrast Syringe filled we should move it?

A) towards wall close to patient

B) towards wall away from patient
C) towards cling
D) towards ground

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81. the period Between two procedures in CT with contrast should be at least?

A) 24 h
B) 48 h
C) 72 h
D) 96 h

82. what is the injection site for cardiac CT?

A) Right antecubital vein

B) left antecubital vein
C) Right formal vein
D) Left formal vein

83. Which of the following is the appropriate table height adjustment for a standard CT brain scan?

A) Centre height so that the External auditory meatus is at the centre of the gantry
B) Centre height so that the gonion is at the center of the gantry
C) Centre height so that the acanthion is at the center of the gantry
D) Centre height so that the skull base is at the center of the gantry

84. CT dose for adults?

A) 1 ml/Kg
B) 1.5ml/Kg
C) 2 ml/Kg
D) 2.5ml/Kg

85. CT dose for pediatric?

A) 1ml/Kg
B) 1.5 ml/Kg
C) 2ml/Kg
D) 2.5 ml/Kg

86. In case of CT Lumbar scan what of the following is correct?

A) no gantry tilt
B) 5 gantry tilt
C) 10 tilt of gantry
D) 15 tilt of gantry

87. CT QC daily water phantom test?

A) Weekly
B) Daily
C) Monthly

88. Which of the QC test for CT should be performed on a weekly basis?

A- linearity
B- noise and uniformity
C- radiation dose
D-contrast resolution

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89. Which of the following is the IV contrast medium for routine examination for CT?

A) Omnipaque
B) Barium sulfate
C) Dilated gastrotropin
D) Water

90. Patient come to radiology department have nose and ear bleeding and fracture in her wrist
The first examination should be performed?

A) CT brain
B) X-ray wrist
C) MRI brain
D) CT chest

91. Patient had an accident and was in the hospital for two weeks and exposure to radiation
To calculated effective doses for CT examination?

A) CT does index
B) Dose length product
C) Post processing
D) TLD

92. Child come to radiology department with his mother after falls from a Hight and suspected
skull fracture but the patient uncooperative?

A) Sedation
B) Cancel the examination
C) Send him to home
D) Ask the radiographer to hold him in exam

93. Breastfeeding women who require iodinated contrast for an imaging procedure may be advised
to interrupt breastfeeding and discard their breast milk?

A) at least 12 h
B) at least 24 h
C) at least 48 h
D) at least 72 h

94. CT stop because the heat in the :

A) Filament
B) Tube voltage
C) Focusing cup
D) Detectors

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95. A patient who undergo a CT SCAN without knowing that she is pregnant
what is the appropriate solution ?

A) Obs and gynecology contact

B) Physician contact to measure dose
C) Don’t do anything
D) examination after birth for more accurate results

96. When performing an invasive CT examination, such as an RFA of the liver,

a partial thromboplastin- tin time (PTT) is drawn. What does a partial thromboplastin time test measure?

A) the time required to increase the platelet count by 10%

B) time required to manufacture prothrombin
C) time required to locate an decrease the platelet count by 10%
D) time for normal clot formation in plasma

97. What is the premedication strategy for a patient with a prior allergic reaction to iodinated contrast media
before a contrast-enhanced CT?

A) premedication with steroids and antihistamines

B) increase in fluids for 48 hours before the examination
C) having the patient stop his/her blood thinning medication
D) administration of a negative contrast agent

98. Dose descriptors are used to identify approximate patient doses,

which of the following is the dose descriptor utilized for modern multi-slice CT scanners?

A) multiple-scan average dose (MSAD)

B) dose profile
C) CTDIolume
D) Roentgen

99. What type of needle is equipped with plastic pro- jections on either side that aid in
holding the needle during venipuncture?

A) butterfly needle
B) small gauge straight needle
C) angiocatheter
D) large gauge straight needle

100. What is the relationship between the dose and and the number of detector rows?

A) as number of detector rows increase dose increases

B) as number of detector rows increases dose decreases
C) as number of detector rows increases dose triples
D) there is no relationship between dose and number of detector rows

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101. What is the principle behind the benefit of lower kV in some clinical applications?

A) superior enhancement of iodine

B) inferior enhancement of iodine
C) there is actually no benefit of reducing kVp
D) it increases patient dose

102. Which of the following are contraindications for the administration of IV contrast?

A) asthma
B) shellfish allergies
C) atopic syndrome
D) cardiac dysfunction
E) A&C&D

103. Which of the following pathological conditions must be performed in two planes,
The axial and the coronal, due to the pyramidal shape of their bony structure?

A) mandibular fracture
B) orbital imaging
C) temporal bone imaging
D) sinus imaging

104. In most institutions what is the preferred oral contrast administered to patients
undergoing a CT scan of the pancreas?

A) barium sulfate
B) VoLumen
C) water-soluble iodinated
D) water

105. During what phase of renal enhancement do the renal cortex and medulla
show equal levels of enhancement?

A) Precontrast
B) nephrographic phase
C) corticomedullary phase
D) excretory phase

106. The use of flow control mechanical pressure injectors are recommended
for CT studies of the abdomen and pelvis due to which of the following characteristics?

A) there is a reduced risk of extravasation of the contrast media into the soft tissue
B) side effects such as heat and nausea re reduced
C) contrast media dose and timing can be easily regulated and reproduced in subsequent studies
D) the risk of air embolism is eliminated

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107. What occurs when the inter-space distance between detectors is reduced?

A) detector response time is reduced

B) patient dose is increased
C) signal acquisition time is increased
D) Total detector efficiency is increased

108. A CT examination of the abdomen was performed on a patient complaining of left upper
abdominal [Link] reviewing the image, a blurring occurred at the air/fluid level of the stomach.
What was the possible cause of this artifact?

A) beam hardening
B) edge gradient
C) motion
D) cone beam

109. What type of artifact is found in the pelvis running across the two femoral heads,
especially when a prosthesis is present?

A) edge gradient
B) aliasing
C) cone beam
D) beam hardening

110. Which of the following reconstruction algorithms models photons and electric noise
in the CT system?

A) filtered back projection reconstruction

B) adaptive statistical iterative reconstruction
C) modeled based iterative reconstruction
D) algebraic reconstruction

111. As window level increases

A) contrast scale increases

B) contrast scale decreases
C) brightness increases
D) brightness decreases

112. A phantom should filled with water and the Ct number should not deviate more than?

A) +-3
B) +-4
C) +-5
D) +-6

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113. Patient undergo CT scan and have brain metastasis from lung , which phase that should
take in the procedure ?

A) Early arterial phase

B) Portal venous phase
C) venous phase
D) Delay phase

114. Before sending a client for a CT with contrast dye, what the nurse's most important action?

A) Teach about the need for post-procedure hydration.

B) Verify that the informed consent is complete.
C) Place the side rails of the bed up before transport.
D) Check the client's health record for allergies

115. If the patient have thoracic CT , which type of shield should be used ?

A) Bismuth shields
B) .
C) .
D) .

116. Patient come to radiology department have back pain with nausea and dysuria ,
which of the following is the appropriate procedure for the condition

A) KUB without contrast

B) KUB with contrast
C) lumber without contrast
D) lumber with contrast

117. patient come from ER ( truma) we exam ?

A) Brain
B) Chest
C) Abdomen
D) Brain – Chest – Abdomen

118. Patient with trauma in spine , you should scan ?

A) L2-L3
B) L4-L5
C) Whole lumbar spine
D) The area u think it injured

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119. Phantom in CT filled by

A) Oil
B) Water
C) Gas
D) .

120. The source of radiation in PET/CT

A) Injected pt
B) CT scanner
C) PET scanner
D) Injector

121. Old Patient have CT chest with-out an appointment , which of the following is appropriate action ?

A) Do the exam
B) Make him leave
C) Sent to ER
D) Help him to schedule one

122. The collimator used for Multiphase abdomen in CT

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