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CME Objectives and Tests

The Radiological Society of North America is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Radiological Society of North America designates each test of this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit^TM. Physicians should claim only those credits commensurate with the extent of their participation in the activity.

The American Medical Association has determined that physicians not licensed in the U.S. who participate in this CME activity are eligible for AMA PRA Category 1 Credit. This event is an Accredited Self-Assessment Program (Section 3) as defined by the Maintenance of Certification program of the Royal College of Physicians and Surgeons of Canada.

Disclosure
As an ACCME-accredited provider of continuing medical education, the RSNA must ensure that all decisions about educational content were made free of the control of a commercial interest. Furthermore, the RSNA must be able to show that all individuals in a position to control educational content have disclosed all relevant financial relationships with any commercial interest. The RSNA must then resolve all identified conflicts of interest prior to education being delivered to learners.

In accordance with ACCME policy, William W. Olmsted, MD, Editor, RadioGraphics, and Education Editor, RSNA, discloses the following financial relationship: Stockholder, General Electric Company.

Goals and Objectives

Goals
The goal of the articles designated as CME features and their accompanying tests is to increase awareness about the radiologic characteristics of a variety of pathologic conditions and basic physics principles.

Educational Objectives
The overall objectives for the RadioGraphics CME activity are included here. In addition, each article designated as a CME feature is accompanied by specific learning objectives for that article.

After reading the CME feature articles, physicians will be able to:

• Identify and describe the basic physics principles for a variety of imaging modalities.
  
• Identify and describe a variety of pathologic conditions.
  
• Understand and synthesize physical principles underlying diagnostic and therapeutic techniques.
  
• Analyze and correlate anatomic, pathologic, and radiologic findings for a variety of pathologic conditions.
  

Evaluation
Participants must answer correctly a minimum of 80% of the questions on each test accompanying a designated article to earn the 1.0 credit. Participants will receive notification of credit earned for each test. In addition, participants are asked to evaluate the quality of the CME feature articles.

Instructions

• Turn to page S224A for the answer form and complete all registration information or see www.rsna.org/education/rg_cme.html to complete the following tests online as well as to access additional online-only CME tests.
  
• Answer each question by darkening the appropriate space on the form. Each question has only one answer.
  
• Send the form or a photocopy to RadioGraphics CME, Radiological Society of North America, 820 Jorie Blvd, Oak Brook, IL 60523 or fax number 630-571-7837.
  
• Tests are valid for credit for 3 years from the date of publication. Credit is awarded on the date that an answer form is received (ie, answers for a 2001 test received in 2003 are valid for credit in 2003, not 2001).
  
• We recommend that participants keep photocopies of the following items: (a) both sides of the answer form and (b) the first pages of the articles on which the tests are based. Occasionally, mailed or even faxed answer forms are not received. With a photocopy, a participant can resend his or her answers if needed.The first page of each article contains the title, abstract, and learning objectives for that article. If these pages are filed with the postcards that notify participants of credit earned, this information can be used as documentation about the nature of RadioGraphics CME credits if requested by an accrediting agency.
  

Test 1: Cerebral Venous Thrombosis and Multidetector CT Angiography: Tips and Tricks (pp S5–S18)

1. Which of the following cerebral structures is part of the deep venous system?
   1. Anastomotic vein of Trolard.
      
   2. Anastomotic vein of Labbé.
      
   3. Vein of Galen.
      
   4. Torcular herophili.
      
   
   
2. Which of the following statements about the cerebral venous anatomy is true?
   1. The intracranial venous system is less variable than the arterial anatomy.
      
   2. The left transverse sinus is dominant in the majority of cases.
      
   3. An atretic posteromedial segment of the left transverse sinus is common.
      
   4. The occipital sinus is constant.
      
   
   
3. Which of the following statements about the granulations of Pacchioni is true?
   1. They are most commonly found in the straight sinus.
      
   2. They usually appear hypoattenuating relative to brain parenchyma.
      
   3. They usually appear hyperattenuating relative to brain parenchyma.
      
   4. They decrease in number with age.
      
   
   
4. Cerebral venous thrombosis most commonly involves which of the following sinuses?
   1. Superior sagittal sinus.
      
   2. Straight sinus.
      
   3. Cavernous sinus.
      
   4. Transverse sinus.
      
   
   
5. Which of the following findings best suggests the diagnosis of cerebral venous thrombosis at unenhanced CT?
   1. Parenchymal hemorrhage.
      
   2. Brain edema.
      
   3. High attenuation in a dural sinus or vein.
      
   4. Hydrocephalus.
      
   
   
6. Which of the following findings best suggests the diagnosis of superior sagittal sinus thrombosis at CT venography?
   1. Dilatation of transcortical medullary veins.
      
   2. Empty delta sign.
      
   3. Dense triangle sign.
      
   4. Tentorial enhancement.
      
   
   
7. Which of the following statements about CT venography is illustrated by the case shown in Figure 12?
   1. Wide window settings are helpful in detection of filling defects in sinuses and veins.
      
   2. MIP images have higher sensitivity than MPR images for depiction of cerebral venous structures.
      
   3. Integral display offers improved visualization of the deep cerebral venous system.
      
   4. Bone structures must be removed for volume-rendered display.
      
   
   
8. As illustrated by the case shown in Figure 13, thrombosis of superficial and cortical veins is best displayed on which of the following types of images?
   1. Unenhanced source images.
      
   2. 3D integral images from CT venography.
      
   3. 3D MIP images from CT venography.
      
   4. 3D volume-rendered images from CT venography.
      
   
   
9. DSA remains essential for diagnosis of cerebral venous thrombosis in what situation?
   1. Thrombosis of the anterior third of the superior sagittal sinus.
      
   2. Cortical venous thrombosis.
      
   3. Deep cerebral venous thrombosis.
      
   4. Cerebral venous thrombosis associated with subarachnoid hemorrhage.
      
   
   
10. What is the main sign of cerebral venous thrombosis with a standard MR imaging protocol?
    1. Lack of expected flow void in cerebral veins or sinuses.
       
    2. Parenchymal hemorrhage.
       
    3. High signal intensity of an intraluminal thrombus on T1-weighted images.
       
    4. High signal intensity of an intraluminal thrombus on diffusion-weighted images.
       
    
    

Test 2: Imaging of Cerebral Venous Thrombosis: Current Techniques, Spectrum of Findings, and Diagnostic Pitfalls (pp S19–S41)

1. In which of the following cerebral venous structures is thrombosis most commonly seen?
   1. Superficial cortical veins.
      
   2. Superior sagittal sinus and transverse sinuses.
      
   3. Structures of the deep venous system.
      
   4. Straight sinus.
      
   
   
2. Which of the following entities is not a component of the deep system of cerebral veins?
   1. Internal cerebral vein.
      
   2. Basal (Rosenthal) vein.
      
   3. Labbé vein.
      
   4. Septal vein.
      
   
   
3. Which of the following factors primarily explains the variability of signal intensity in an intraluminal venous thrombus over time?
   1. Recanalization effects.
      
   2. Endogenous and exogenous thrombolytic effects.
      
   3. Differing paramagnetic effects of hemoglobin breakdown products.
      
   4. Changing flow in the thrombosed venous segments.
      
   
   
4. At which of the following stages of venous thrombus evolution is hyperintense signal typically seen in the thrombus on T1- and T2-weighted MR images?
   1. Chronic (more than 15 days after symptom onset).
      
   2. Acute (within 5 days after symptom onset).
      
   3. After extensive recanalization.
      
   4. Subacute (6–15 days after symptom onset).
      
   
   
5. Edema or hemorrhage in the temporal lobe most commonly occurs in association with thrombosis in which of the following venous structures?
   1. Superior sagittal sinus.
      
   2. Sigmoid sinus.
      
   3. Straight sinus.
      
   4. Transverse sinus.
      
   
   
6. Which of the following phrases best describes the appearance of transverse sinus stenoses in patients with idiopathic intracranial hypertension and elevated cerebrospinal fluid pressure?
   1. Round, well-defined intraluminal filling defects.
      
   2. Irregularly shaped intraluminal filling defects.
      
   3. Smooth-bordered narrowing indicative of extraluminal compression.
      
   4. Irregular-bordered narrowing indicative of extraluminal compression.
      
   
   
7. Which of the following venous structures is typically the site of stenosis in patients with idiopathic intracranial hypertension?
   1. Inferior portion of the superior sagittal sinus.
      
   2. Sigmoid sinus.
      
   3. Unilateral transverse sinus.
      
   4. Lateral segment of both transverse sinuses.
      
   
   
8. Which of the following sets of structures are typically connected by the inferior petrosal sinuses?
   1. Cavernous sinus and sphenoparietal sinus.
      
   2. Superior sagittal sinus and occipital sinus.
      
   3. Transverse sinus and cavernous sinus.
      
   4. Jugular bulb and cavernous sinus.
      
   
   
9. In which of the following locations is dural sinus hypoplasia or atresia most commonly found at MR venography?
   1. Middle level of the superior sagittal sinus.
      
   2. Medial part of the left transverse sinus.
      
   3. Lateral part of the transverse sinus and sigmoid sinus.
      
   4. Right transverse sinus.
      
   
   
10. Which of the following venous structures is the most common location of arachnoid granulations seen on MR images acquired with standard clinical MR imaging protocols?
    1. Sigmoid sinus.
       
    2. Confluence of the sinuses.
       
    3. Lateral part of the transverse sinus.
       
    4. Straight sinus.
       
    
    

Test 3: New Techniques in CT Angiography (pp S45–S62)

1. In multidetector CT, in-plane spatial resolution is not substantially influenced by which of the following factors?
   1. Detector geometry.
      
   2. Number of detector rows.
      
   3. Convolution kernel.
      
   4. Reconstruction increment.
      
   
   
2. Optimized protocols for injection of contrast material in CT angiography include which of the following techniques?
   1. Manual injection of contrast material.
      
   2. Detection of the arrival of contrast material (bolus tracking, test bolus).
      
   3. Standardized start delay of 20 seconds.
      
   4. Flow rates of up to 2 mL/sec.
      
   
   
3. What is the preferred image processing technique for determination of lumen diameter in CT angiography?
   1. Shaded surface display.
      
   2. Maximum intensity projection.
      
   3. Multiplanar reformation.
      
   4. Curved planar reformation.
      
   
   
4. What visualization technique provides the best 3D representation in CT angiography?
   1. Thin-slab maximum intensity projection.
      
   2. Maximum intensity projection.
      
   3. Multiplanar reformation.
      
   4. Volume rendering.
      
   
   
5. As shown in Figure 5, the representation of the lumen on volume-rendered images is independent of which of the following factors?
   1. Opacity value.
      
   2. Upslope steepness of the trapezoid.
      
   3. Hounsfield unit values included in the trapezoid.
      
   4. Assigned color of the trapezoid.
      
   
   
6. The performance of segmentation algorithms in CT angiography is reduced in which of the following situations?
   1. Regions of close contact between vessels and bones.
      
   2. Bridging of bones by osteophytes.
      
   3. High luminal contrast.
      
   4. Small scanning range.
      
   
   
7. Which of the following factors does not interfere with automatic techniques for lumen measurement?
   1. Presence of branching vessels.
      
   2. Presence of wall calcifications.
      
   3. Presence of plaque ulcers.
      
   4. Grade of stenosis < 50%.
      
   
   
8. Incomplete removal of calcified atherosclerotic plaque with multidetector CT angiography is related to which of the following factors?
   1. Vessel pulsation.
      
   2. Beam-hardening artifacts.
      
   3. Small reconstructed field of view.
      
   4. Eccentric vessel lumen.
      
   
   
9. As shown in Figure 20, use of bone subtraction CT angiography for follow-up after aneurysm therapy is problematic for which of the following reasons?
   1. Elimination of bone.
      
   2. Elimination of foreign material.
      
   3. Loss of 3D representation.
      
   4. Need for excessive user interaction.
      
   
   
10. Detection of infraclinoid aneurysms with multidetector CT angiography can be improved by applying what technique?
    1. Maximum intensity projection.
       
    2. Bone suppression or bone subtraction.
       
    3. Nonenhanced CT.
       
    4. Large field of view reconstruction.
       
    
    

Test 4: State-of-the-Art Imaging of Acute Stroke (pp S75–S95)

1. Which of the following window settings likely would have the highest sensitivity for the detection of acute ischemic stroke on unenhanced CT images?
   1. 80 HU (width), 20 HU (center).
      
   2. 8 HU (width), 32 HU (center).
      
   3. 300 HU (width), 50 HU (center).
      
   4. 1200 HU (width), –600 HU (center).
      
   
   
2. According to the Alberta stroke program early CT score system, which of the following scores implies diffuse ischemic involvement of the middle cerebral artery territory?
   1. 0.
      
   2. 2.
      
   3. 6.
      
   4. 10.
      
   
   
3. Which of the following values represents an approximation of the normal cerebral blood flow in human gray matter?
   1. 20 mL/100 g/min.
      
   2. 30 mL/100 g/min.
      
   3. 40 mL/100 g/min.
      
   4. 50 mL/100 g/min.
      
   
   
4. Which of the following feature combinations likely represents salvageable tissue, or a penumbra, on CT perfusion images?
   1. Normal cerebral blood flow, normal cerebral blood volume, and increased mean transit time.
      
   2. Normal cerebral blood flow, decreased cerebral blood volume, and increased mean transit time.
      
   3. Decreased cerebral blood flow, normal or increased cerebral blood volume, and increased mean transit time.
      
   4. Increased cerebral blood flow, normal cerebral blood volume, and decreased mean transit time.
      
   
   
5. Which of the following equations indicates the relation of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) according to the central volume principle?
   1. CBF = CBV/MTT.
      
   2. CBV = CBF/MTT.
      
   3. CBF = 2 · MTT/CBV.
      
   4. CBV = MTT²/CBF.
      
   
   
6. Which of the following CT techniques can be used alone to evaluate perfusion of the entire brain in a single examination?
   1. Dynamic CT perfusion imaging.
      
   2. Unenhanced CT.
      
   3. Perfused-blood-volume mapping.
      
   4. CT angiography.
      
   
   
7. Which of the following imaging methods has the highest sensitivity for the detection of acute ischemic stroke within the first 6 hours after onset?
   1. Unenhanced CT.
      
   2. Conventional MR imaging.
      
   3. Diffusion-weighted MR imaging.
      
   4. CT angiography.
      
   
   
8. Which of the following features is suggestive of a penumbra on MR images?
   1. Matching defects on diffusion-weighted images and perfusion-weighted images.
      
   2. A region of abnormality that appears larger on diffusion-weighted images than on perfusion-weighted images.
      
   3. A region of restricted diffusion without any perfusion abnormality.
      
   4. A region of perfusion abnormality with a normal diffusion-weighted signal intensity.
      
   
   
9. On the CT perfusion maps in Fig 9a and 9b, subtraction of the area inside the white oval from the area inside the black oval gives the area of what entity?
   1. Irreversible ischemic core.
      
   2. Irreversible ischemic core plus the penumbra.
      
   3. Penumbra.
      
   4. Vasogenic edema.
      
   
   
10. In Fig 15a and 15b, the region demarcated by the arrows likely represents which of the following entities?
    1. Irreversible ischemic core.
       
    2. Irreversible ischemic core plus the penumbra.
       
    3. Penumbra.
       
    4. Vasogenic edema.
       
    
    

Test 5: Multichannel CT: Evaluating the Spine in Postoperative Patients with Orthopedic Hardware (pp S97–S110)

1. Which of the following methods is optimal for evaluating the integrity of hardware?
   1. Physical examination.
      
   2. Ultrasonography.
      
   3. Bone scintigraphy.
      
   4. Helical CT.
      
   
   
2. Which of the following parameters is related to section thickness with both single-channel and multichannel CT?
   1. Detector array configuration.
      
   2. Beam collimation.
      
   3. Available raw data files.
      
   4. Gantry rotation speed.
      
   
   
3. Which of the following statements best describes effective section thickness?
   1. It results from the inability of the reconstruction algorithm to exactly recreate the transverse planes through the patient’s body.
      
   2. It is generally thinner than the nominal section thickness.
      
   3. It is unrelated to the reconstruction filter used.
      
   4. It is generally equal to the nominal section thickness.
      
   
   
4. Which of the following statements about isotropic imaging is true?
   1. It increases artifacts.
      
   2. It results in identical spatial resolution in all planes.
      
   3. It results in poor image resolution in the axial plane.
      
   4. It results in poor-quality reformatted images.
      
   
   
5. What is the function of the DAS in multichannel CT?
   1. It stores raw data.
      
   2. It improves the filtered back projection data and reduces artifacts.
      
   3. It converts anisotropic voxels to isotropic voxels.
      
   4. It controls the circuit that collects and transmits data from the detector rows.
      
   
   
6. The use of which of the following modifications at CT will reduce metal-related artifacts?
   1. An edge-enhancement (bone) algorithm.
      
   2. A small focal spot.
      
   3. A smooth reconstruction (soft-tissue) algorithm.
      
   4. Intravenous contrast material.
      
   
   
7. Which of the following guidelines should be followed when designing CT protocols?
   1. A high kilovolt peak (140 kVp) should be used for plastic hardware.
      
   2. A low current is recommended for cobalt-chrome hardware.
      
   3. A kilovolt peak of 140 kVp is recommended for metal hardware.
      
   4. A small focal spot should be used when dense metal is present.
      
   
   
8. Which of the following statements about hardware with a larger cross-sectional area is true?
   1. It results in lower x-ray beam attenuation.
      
   2. It produces more missing projection data.
      
   3. It produces fewer artifacts.
      
   4. It requires a low kilovolt peak (120 kVp) to minimize artifacts.
      
   
   
9. In Figure 7, which of the following entities is the cause of failed back surgery syndrome and canal stenosis at C4–C5?
   1. Disk herniation.
      
   2. Osteophyte.
      
   3. Improper screw placement.
      
   4. Retrolisthesis of C4 on C5.
      
   
   
10. In Figure 10, the area of soft-tissue attenuation at L5-S1 (arrow) is caused by which of the following entities?
    1. Pedicle screw.
       
    2. Fibrosis.
       
    3. Diskitis.
       
    4. Osteophyte.
       
    
    

Test 6: Role of 3D CT in the Evaluation of the Temporal Bone (pp S117–S132)

1. Which part of the incus articulates with the stapes?
   1. The body.
      
   2. The short process.
      
   3. The long process.
      
   4. The lenticular process.
      
   
   
2. The sound amplification that occurs within the tympanic cavity is important because ———.
   1. It causes outward bulging of the oval window, which in turn allows sound transmission through the scala tympani.
      
   2. It provides energy to cause displacement of endolymph within the semicircular canals.
      
   3. It aids in overcoming the inertia of perilymph within the osseous labyrinth.
      
   4. It allows transmission of mechanical energy through the delicate osseous spiral lamina.
      
   
   
3. The scala vestibuli and scala tympani communicate within the cochlea at which of the following anatomic locations?
   1. The hamulus.
      
   2. The helicotrema.
      
   3. The spiral lamina.
      
   4. The modiolus.
      
   
   
4. The three semicircular canals of the bony labyrinth are the ——— canals.
   1. Anterior, posterior, and lateral.
      
   2. Anterior, superior, and lateral.
      
   3. Superior, posterior, and lateral.
      
   4. Superior, inferior, and lateral.
      
   
   
5. On a semiopaque 3D VR CT image of the medial wall of the tympanic cavity, the cochlear promontory is seen ——— to the oval window.
   1. Anteroinferior.
      
   2. Posteroinferior.
      
   3. Superior.
      
   4. Lateral.
      
   
   
6. The cochlear division of the eighth cranial nerve passes through the fundus of the IAC via an opening located at its ——— aspect.
   1. Anteroinferior.
      
   2. Posteroinferior.
      
   3. Anterosuperior.
      
   4. Posterosuperior.
      
   
   
7. The geniculate ganglion marks the transition between which of the following portions of the facial nerve?
   1. The labyrinthine and tympanic segments.
      
   2. The labyrinthine and mastoid segments.
      
   3. The tympanic and mastoid segments.
      
   4. The mastoid segment and chorda tympani.
      
   
   
8. The facial nerve exits the temporal bone through which of the following openings?
   1. The mastoid canaliculus.
      
   2. The foramen spinosum.
      
   3. The stylomastoid foramen.
      
   4. The tympanic canaliculus.
      
   
   
9. On conventional CT scans and 3D reformatted CT images, a dilated vestibular aqueduct will have which of the following appearances?
   1. A balloon shape, with a diameter approximately that of the posterior semicircular canal.
      
   2. A diameter of 0.5–1.0 mm, larger than that of the posterior semicircular canal.
      
   3. A diameter of 1.0–1.5 mm, larger than that of the posterior semicircular canal.
      
   4. A diameter of over 1.5 mm, larger than that of the posterior semicircular canal.
      
   
   
10. In Figure 19, 3D VR CT images improved pre-surgical planning by better demonstrating which of the following structures compared with conventional CT?
    1. The malleus.
       
    2. The incus.
       
    3. The incudomalleolar joint.
       
    4. The posterior semicircular canal.
       
    
    

This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content