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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019)

Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) provides real-world examples to reinforce your learning.

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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 1 preview image
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 3 preview imageMosby's ExamReview forComputedTomographyTHIRD EDITIONDaniel N. DeMaio, MEd, RT(R)(CT)ChairDepartment of Health Sciences and NursingDirectorRadiologic Technology ProgramUniversity of HartfordWest Hartford, Connecticut2
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 5 preview imageTable of ContentsCover imageTitle PageCopyrightDedicationPrefaceContent and OrganizationFeaturesAcknowledgmentsPart IChapter 1 IntroductionAmerican Registry of Radiologic Technologists PostprimaryCertification in Computed TomographyNuclear Medicine Technology Certification Board PostprimaryCertification in Computed Tomography4
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 6 preview imageUsing This Review BookText FormatStudy Habits and Test-Taking TechniquesChapter 2 Review of Patient Care in Computed TomographyPatient Assessment and PreparationContrast AdministrationChapter 3 Review of Safety in Computed TomographyRadiation Safety and DoseChapter 4 Review of Imaging Procedures in ComputedTomographyHeadNeckChestAbdomen and PelvisHepatobiliary SystemSpleenPancreasAdrenal GlandsGenitourinary SystemGastrointestinal SystemPelvis and Reproductive SystemMusculoskeletal System5
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 7 preview imageChapter 5 Review of Image Production in Computed TomographyCT System Principles, Operation, and ComponentsImage Processing and DisplayImage QualityArtifact Recognition and ReductionInformaticsPart IIChapter 6 Simulated Examination OneQuestionsChapter 7 Simulated Examination TwoQuestionsChapter 8 Simulated Examination ThreeQuestionsChapter 9 Answer Key—Examination OneAnswersChapter 10 Answer Key—Examination TwoAnswersChapter 11 Answer Key—Examination ThreeAnswers6
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 8 preview imageGlossaryBibliographyIndex7
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 9 preview imageCopyright3251 Riverport LaneSt. Louis, Missouri 63043MOSBY'S EXAM REVIEW FOR COMPUTED TOMOGRAPHY,THIRD EDITIONISBN: 978-0-323-41633-7Copyright © 2018, Elsevier Inc. All rights reserved.Previous editions Copyright 2011, 1996 by Mosby, Inc., an affiliateof Elsevier IncNo part of this publication may be reproduced or transmitted inany form or by any means, electronic or mechanical, includingphotocopying, recording, or any information storage and retrievalsystem, without permission in writing from the publisher. Detailson how to seek permission, further information about thePublisher's permissions policies and our arrangements withorganizations such as the Copyright Clearance Center and theCopyright Licensing Agency, can be found at our website:www.elsevier.com/permissions.This book and the individual contributions contained in it areprotected under copyright by the Publisher (other than as may benoted herein).8
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 10 preview imageNoticesKnowledge and best practice in this field are constantly changing.As new research and experience broaden our understanding,changes in research methods, professional practices, or medicaltreatment may become necessary.Practitioners and researchers must always rely on their ownexperience and knowledge in evaluating and using anyinformation, methods, compounds, or experiments describedherein. In using such information or methods they should bemindful of their own safety and the safety of others, includingparties for whom they have a professional responsibility.With respect to any drug or pharmaceutical products identified,readers are advised to check the most current information provided(i) on procedures featured or (ii) by the manufacturer of eachproduct to be administered, to verify the recommended dose orformula, the method and duration of administration, andcontraindications. It is the responsibility of practitioners, relying ontheir own experience and knowledge of their patients, to makediagnoses, to determine dosages and the best treatment for eachindividual patient, and to take all appropriate safety precautions.To the fullest extent of the law, neither the Publisher nor theauthors, contributors, or editors, assume any liability for any injuryand/or damage to persons or property as a matter of productsliability, negligence or otherwise, or from any use or operation ofany methods, products, instructions, or ideas contained in thematerial herein.Library of Congress Cataloging-in-Publication DataNames: DeMaio, Daniel N., author.Title: Mosby's exam review for computed tomography / Daniel N.DeMaio.Other titles: Exam review for computed tomographyDescription: Third edition. | St. Louis, Missouri : Elsevier, [2018] |Includes bibliographical references and index.Identifiers: LCCN 2017035969 | ISBN 9780323416337 (paperback)Subjects: | MESH: Tomography, X-Ray Computed | Examination9
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 11 preview imageQuestionsClassification: LCC RC78.7.T6 | NLM WN 18.2 | DDC616.07/57076–dc23 LC record available athttps://lccn.loc.gov/2017035969Senior Content Strategist:Sonya SeigafuseSenior Content Development Manager:Ellen Wurm-CutterContent Development Specialist:Sarah Vora/ Charlene KetchumPublishing Services Manager:Deepthi UnniProject Manager:Janish Ashwin PaulDesigner:Ryan CookPrinted in United StatesLast digit is the print number: 9 8 7 6 5 4 3 2 110
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 12 preview imageDedicationFor my family – Christine, Ryan, and Emily.11
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 13 preview imagePrefaceContent and OrganizationMosby's Exam Review for Computed Tomographyis designed toprepare the radiologic technologist for successful completion of theAmerican Registry of Radiologic Technologists (ARRT) AdvancedCertification Examination for Computed Tomography. This reviewtext will also help prepare the nuclear medicine technologist for theComputed Tomography certification examination offered by theNuclear Medicine Technology Certification Board (NMTCB).Because many general radiographers and nuclear medicinetechnologists are now cross-training in computed tomography andare performing computed tomography as part of their dailypractice, this text will be a valuable resource for preparing for theapplicable CT certification examination.This text first offers a thorough review in an outline format of thecontent areas on the ARRT Computed Tomography Examination:Patient Care, Safety, Image Production, and Procedures. The reviewis followed by three 165-question mock examinations and answerkeys.FeaturesSimulated ExaminationsThe format of the questions is similar to the ARRT examination.Answers and rationales are provided for each question.12
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 14 preview imageEvolve ResourcesOne of the most valuable features of this review resource is theaccompanying Evolve site,http://evolve.elsevier.com/DeMaio/CT.The Evolve site contains questions that can be randomly accessed tocompile an unlimited number of variations of mock examinations.Examinations on the Evolve site may be taken in quiz mode withimmediate feedback or in a timed mode to simulate the actualexamination experience.Daniel N. DeMaio13
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 15 preview imageAcknowledgmentsSincere thanks to the superb staff of Elsevier, including SonyaSeigafuse, Sarah Vora, and Janish Paul. Working with editorCharlene Ketchum was an absolute pleasure, and I am veryappreciative of her guidance and support throughout this project.I am truly grateful to Mr. Steven Ahrenstein. Not only did heprovide me with some excellent images for this revised edition, buthe was also my first CT teacher and helped instill within me a lovefor this imaging modality that I still carry to this day.To my friends and colleagues at the University of Hartford,thanks for all that you do in support of me, our programs, and ourstudents. I could not ask for a better group of professionals to workwith.To my students, past and present, it remains a distinct honor forme to be a part of your education in the radiologic sciences. I havethe best job in the world, and so much of that is because of you.To my wife and best friend Christine, our son Ryan, and ourdaughter Emily, you make me the proudest husband and father onthe planet. I love you all more than I'll ever be able to describe withwords on a page.Daniel N. DeMaio14
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 16 preview imagePart IOUTLINEChapter 1 IntroductionChapter 2 Review of Patient Care in Computed TomographyChapter 3 Review of Safety in Computed TomographyChapter 4 Review of Imaging Procedures in ComputedTomographyChapter 5 Review of Image Production in Computed Tomography15
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 17 preview imageC H A P T E R 1IntroductionCHAPTER OUTLINEAMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTSPOSTPRIMARY CERTIFICATION IN COMPUTEDTOMOGRAPHYNUCLEAR MEDICINE TECHNOLOGY CERTIFICATIONBOARD POSTPRIMARY CERTIFICATION IN COMPUTEDTOMOGRAPHYUSING THIS REVIEW BOOKTEXT FORMATSTUDY HABITS AND TEST-TAKING TECHNIQUES1. Do Not Wait Until the Last Minute to Prepare!2. Practice Your Time Management Skills3. Zero in on the Correct Answer4. Have Confidence!American Registry of RadiologicTechnologists PostprimaryCertification in ComputedTomography16
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 18 preview imageTechnologists who wish to enter the postprimary pathway tocertification in computed tomography (CT) must hold a registrationin one of the following supporting categories:• Radiography• Nuclear Medicine Technology• Radiation TherapyTo attain eligibility for American Registry of RadiologicTechnologists (ARRT) certification in CT, technologists mustcomplete a minimum of 16 hours of structured education credits intopics that reflect the certification examination content. In addition,candidates for CT certification are required to documentperformance of core clinical procedures to establish eligibility.Specific educational and clinical requirements and documentationprocedures may be obtained from the ARRT.The ARRT postprimary examination in CT was first offered inMarch 1995. It was designed to give the technologist an opportunityto become certified in the specific modality of CT. The CT registry isa 165-question, multiple-choice examination covering four majorsubject areas in the following manner:• Patient Care: 22 questions• Safety: 20 questions• Image Production: 55 questions• Procedures: 68 questionsThe latest content specifications for the ARRT examination in CTare provided in the box at the end of this chapter. The approximatenumber of test questions for each major topic is provided inparentheses. The computer-based CT certification examination iscurrently given at specific test centers located throughout theUnited States. Please contact the ARRT (www.ARRT.org) foradditional information regarding application procedures,deadlines, testing center locations, and so on.Nuclear Medicine TechnologyCertification Board Postprimary17
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 19 preview imageCertification in ComputedTomographyNuclear medicine technologists certified by the Nuclear MedicineTechnology Certification Board (NMTCB), the CanadianAssociation of Medical Radiation Technologists (CAMRT), or theARRT may be eligible to sit for the new CT certificationexamination offered by the NMTCB. First offered in 2014, this 200-question multiple-choice examination covers much of theinformation included on the ARRT certification examination in CT.However, the NMTCB/CT certification examination also includesinformation pertaining to the hybrid imaging studies that combineCT with molecular imaging techniques such as positron emissiontomography (PET) and single-photon emission computedtomography (SPECT).To attain eligibility for NMTCB certification in CT, technologistsmust complete a minimum of 35 contact hours of instruction in thefollowing topics:• Contrast administration• Cross-sectional anatomy• X-ray physics• CT radiation safetyIn addition, appropriately credentialed nuclear medicinetechnologists must complete a minimum of 500 clinical hours in CT,PET/CT, and/or SPECT/CT. Specific educational and clinicalrequirements and documentation procedures/forms may beobtained from the NMTCB.Using This Review BookThe first edition of this book, titledRegistry Review in ComputedTomography,was developed shortly after I had successfullycompleted the CT registry examination in March 1995. A secondedition published in 2011 was vastly updated and expanded. Thisthird edition incorporates much of the information included in thesecond edition, but has been completely revised and updated to18
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 20 preview imageinclude the latest information on this dynamic imaging modality.This review text is essentially designed for two different groups ofexamination applicants. For the established CT technologist, thereview outline and examination questions help bridge the gapbetween clinical experience and cognitive knowledge. Those of youwho are experienced in CT will already be familiar with much ofthe subject matter covered. This review book allows you to answerquestions concerning the principles and procedures that you putinto practice each day. Used in conjunction with some additionalreference materials, this book should adequately prepare you forthe CT certification examination.Keep in mind that the ARRT and NMTCB CT certificationexaminations are “advanced-level” examinations. Some of thesubject matter may go beyond the standard responsibilities of thestaff CT technologist. Practical experience in CT does not eliminatethe need for study and preparation in order to achieve success onthis examination.Many examinees may be looking to use an advanced-levelcertification examination as a vehicle toward developing a career inCT. This second group of test applicants may have little experiencein CT beyond the ARRT or NMTCB clinical requirements. If you areamong this group, you have a significantly larger amount of workahead of you. It would certainly be advisable to use several of thetextbooks listed as references in the bibliography during the initialstages of preparation. It is extremely important to review thephysical principles of CT imaging along with the many clinicalapplications, such as patient care, scanning protocols, cross-sectional anatomy, and the identification of pathology on the CTimage.Mosby's Exam Review for Computed Tomographywill thenserve as an invaluable tool to test your newly acquired knowledgeand practice “registry-type” questions.Please remember that the best way to reap benefits from reviewbooks such as this one is to concentrate on the material you areunfamiliar with: the questions that youincorrectlyanswer. It is notsufficient to simply grade each examination and calculate yourscore to determine whether or not you passed the examination.Take the time to carefully review each chapter. If you find that youare in need of further explanation, turn to the bibliography for19
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 21 preview imageadditional study materials. Attempt the practice examinations withthe mind-set that they are “dry runs” for the real thing. Aftergrading a practice examination, concentrate on the questions thatyou answered incorrectly. Look up each correct answer, read thebrief explanation given, and then further review the topic in thereview chapter and/or bibliography provided. You have muchmore to learn from the mistakes that you make, and when properlyused, this book will give you the information you need.Text FormatPart I ofMosby's Exam Review for Computed Tomographycontains areview in outline form of the four content areas covered on theARRT certification examination in CT. In addition, informationspecific to the NMTCB certification examination in CT is includedin the outline.Part II contains three examinations and the answers for eachexamination. A brief explanation accompanies each correct answer,and more detailed information about the question's subject may befound in the review chapters.Many of the questions in each examination pertain to an includedCT image. Be sure to use all of the information provided by theimage when attempting to correctly answer these questions. Eachexamination contains 165 multiple-choice questions. The topics forquestions follow the latest content specifications of the ARRT andNMTCB advanced-level examination in CT. Each practiceexamination is weighted by subject area in a similar manner to theARRT certification examination.”Study Habits and Test-TakingTechniquesEach of you preparing to take an advanced-level certificationexamination in CT is a registered and/or licensed medical imagingtechnologist. Most of you have already successfully completed asimilar certification examination in an imaging discipline. Youundoubtedly know how to take standardized examinations, and20
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 22 preview imageyour previous results support this assumption. However, it mayhave been some time since you participated in a standardizedexamination, so here are some points to assist you in yourpreparation.1 Do Not Wait Until the Last Minute toPrepare!Although easier said than done, beginning to study early definitelyimproves your potential for success. The review chapters are justthat—a review! They provide succinct outlines of the pertinentmaterial and will serve as an excellent resource. But you may alsofind yourself in need of additional, more in-depth information.There is a multitude of excellent resources in both print and onlineform. Start with a general text in the physical principles of CT andprogress through the many clinical applications. Also, a largeproportion of the examination pertains to cross-sectional anatomy.Do not rely only on your practical experience in this area. Take careto review the CT images in this text. You may want to refer to thecross-sectional anatomy books listed in the bibliography foradditional review. For some people, this book may be sufficient asthe sole preparatory tool for the CT examination. However, it is nota “quick fix” and will not make up for lack of adequate experience,research, and study.2 Practice Your Time Management SkillsTime management is equally important during preparation andwhile you are taking the actual examination. The ARRT allows you3.5 hours to complete 165 questions. This should be more thansufficient if you take care to keep track of your progress during theexamination. You will be provided with a countdown timer duringthe computerized examination and should follow the standard ruleof not spending too much time on any one question.3 Zero In on the Correct AnswerSuccess on standardized examinations relies on your ability not21
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 23 preview imageonly to choose the correct answer, but also to identify the incorrectones. The process of elimination is your most valued asset whenyou encounter a multiple-choice question. Carefully examine eachanswer, and eliminate those that are obviously incorrect. This stepoften narrows the possible choices and improves your chanceswhen guessing becomes a necessity.4 Have Confidence!You are in the midst of a successful career in medical imaging. Yourinterest in the field and your dedication to continued learning havebrought you here to this advanced-level examination. Haveconfidence in your ability, and put some faith in your preparationand experience: you know the material, so relax, and simply tapinto this knowledge.American Registry of RadiologicTechnologists Computed TomographyCertification Examination: ContentSpecificationsPatient Care (22)1. Patient interactions and management (22)A. Patient assessment and preparation1. Clinical history2. Scheduling and screening3. Education4. Consent5. Immobilization6. Monitoring22
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 24 preview imagea. Level of consciousnessb. Vital signsc. Heart rhythm and cardiac cycled. Oximetry7. Management of accessory medical devicesa. Oxygen delivery systemsb. Chest tubesc. In-dwelling catheters8. Lab valuesa. Renal function (e.g., BUN, eGFR, creatinine)b. Other (e.g.,D-dimer, LFT, INR)9. Medications and dosagea. Currentb. Preprocedure medications (e.g., steroid, antianxiety)c. Postprocedure instructions (e.g., diabetic patient)B. Contrast administration1. Contrast mediaa. Ionic, nonionicb. Osmolarityc. Barium sulfated. Water soluble (iodinated)23
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 25 preview imagee. Airf. Waterg. Other2. Special contrast considerationsa. Contraindicationsb. Indicationsc. Pregnancyd. Lactatione. Dialysis patients3. Administration route and dose calculationsa. IVb. Oralc. Rectald. Intrathecale. Catheters (e.g., peripheral line, central line, PICC line)f. Other (e.g., stoma, intraarticular)4. Venipuncturea. Site selectionb. Aseptic and sterile techniquec. Documentation (e.g., site, amount, gauge, concentration,rate, and number of attempts)5. Injection techniques24
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 26 preview imagea. Safetyb. Manualc. Power injector options1. Single or dual head2. Single phase3. Multiphase4. Flow rate5. Timing bolus6. Bolus tracking6. Postprocedure carea. Treatment of contrast extravasationb. Documentation7. Adverse reactionsa. Recognition and assessmentb. Treatmentc. DocumentationSafety (20)1. Radiation safety and doseA. Radiation physics1. Radiation interaction with matter2. Acquisition (geometry)25
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 27 preview image3. Physical principles (attenuation)B. Radiation protection1. Minimizing patient exposurea. kVpb. mAsc. Pitchd. Collimation/beam widthe. Multidetector configurationf. Gating2. Personnel protectiona. Controlled accessb. Education3. Shieldinga. Traditional (e.g., lead apron)b. Nontraditional (e.g., bismuth)4. Dose measurementa. CT dose index (CTDI)b. Dose length product (DLP)c. Documentation5. Patient dose reduction and optimizationa. Pediatric26
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 28 preview imageb. Adultc. Dose modulation techniques (e.g., SMART mA, automA, CARE dose, and SURE exposure)d. Iterative reconstructione. Dose notificationf. Dose alertImage Production (55)1. Image formation (30)A. CT system principles, operation, and components1. Tubea. X-ray productionb. Warm-up procedures2. Collimation/beam width3. Generator4. Detectorsa. Detector configurationb. Detector collimation5. Data acquisition system (DAS)6. Computer and array processorB. Imaging parameters and data acquisition1. Parameters27
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 29 preview imagea. kVpb. mAsc. Pitchd. Acquisition thicknesse. x, y, z planesf. Scan field of view2. Acquisitiona. Axial/sequentialb. Helical/spiralc. VolumetricC. Image processing1. Reconstructiona. Filtered back projection reconstructionb. Iterative reconstructionc. Interpolationd. Reconstruction algorithme. Raw data vs. image dataf. Prospective/retrospective reconstructiong. Reconstruction thicknessh. Reconstruction interval2. Postprocessing28
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 30 preview imagea. Multi-planar reformation (MPR)b. 3-D rendering (MIP, SSD, VR)c. Quantitative analysis (e.g., distance, diameter, calciumscoring, ejection fraction)2. Image evaluation and archiving (25)A. Image display1. Pixel, voxel2. Matrix3. Image magnification4. Display field of view (DFOV)5. Window level, window width6. Cine7. Geometric distance or region of interest (ROI) (e.g.,mean, standard deviation [SD])B. Image quality1. Spatial resolution2. Contrast resolution3. Temporal resolution4. Noise and uniformity5. Quality assurance and accreditation6. CT number (Hounsfield units)7. Linearity29
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Mosby’s Exam Review for Computed Tomography 3rd Edition (2019) - Page 31 preview imageC. Artifact recognition and reduction1. Beam hardening or cupping2. Partial volume averaging3. Motion4. Metallic5. Edge gradient6. Patient positioning (out-of-field)7. Equipment induceda. Ringsb. Streaksc. Tube arcingd. Cone beame. CappingD. Informatics1. Hard/electronic copy (e.g., DICOM file format)2. Archive3. PACS and electronic medical record (EMR)4. Security and confidentiality5. NetworkingProcedures (68)30
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