Instrumentation

Question 1

🎗What is B-Mode?

Answer 1

Brightness mode principle, offers a gray scale image

Question 2

🎗What is the optimal transducer frequency for breast imaging?

Answer 2

10.0 to 18.0 MHz for superior axial and lateral resolution (detail) while maintaining penetration to chest wall

Question 3

🎗A _____ transducer (wide frequency range) is optimal.

Answer 3

broadband

Question 4

🎗What’s the trade-off between high and low frequency probes?

Answer 4

High frequency has superior detail but low penetration.

Low frequency has superior penetration but less detail.

Question 5

🎗What probe design is optimal for breast imaging?

Answer 5

Linear array

Question 6

1) rectangular image
2) direct contact perpendicular to chest wall
3) accurate measurements by avoiding beam divergence artifact
4) accurately guides interventional procedures

Answer 6

Why is the linear array optimal?

Question 7

When might a curved array be used?

Answer 7

If a mass is too large to fit on a linear image (larger field of view, but lost resolution).

Question 8

What’s the difference between the 1-D Linear and 1.5-D Matrix Array?

Answer 8

1-D has a single element across the short axis of the probe and a fixed elevation focus.

1.5-D has multiple elements across the short axis and can focus in both directions (better detail)

Question 9

An imaging depth between __ and __ cm should be adequate.

Answer 9

3 and 6 cm

Question 10

🎗This adjusts the brightness of each echo.

Answer 10

Gain (the amount of amplification applied)

Question 11

🎗This controls the level of brightness of all echoes appearing on an image

Answer 11

Overall Gain

Question 12

🎗This allows for the brightness to be controlled at varying depths throughout the image.

Answer 12

TGC (Time Gain Compensation)

Question 13

This is the state-of-the-art feature that optimizes overall gain and TGC.

Answer 13

Auto Gain Optimization (‘the magic button’)

Question 14

What’s the ALARA Principle?

Answer 14

Output power should be set ‘As Low As Reasonably Achievable’.

Question 15

What happens when the power is decreased?

Answer 15

The image gets darker.

Question 16

Can the brightness be increased without increasing the power?

Answer 16

Yes, by increasing the gain

Question 17

Does increasing the gain have any effect on patient exposure to ultrasound energy?

Answer 17

No

Question 18

🎗When should the sonographer decrease the Output Power?

Answer 18

If your image is too bright, decrease the output power. If your image is too dark, increase the receiver gain.

Question 19

Multiple focal zones will yield the best ____ throughout the entire image at the expense of a ________.

Answer 19

best resolution; slower frame rate

Question 20

Multiple focal zones are recommended, but if a single focus is used, set it at the ____.

Answer 20

depth of the area of interest

Question 21

Define elevation plane focus

Answer 21

the focus in the short axis or elevation plane (short side) of an electronic transducer

Question 22

🎗What’s the elevation plane focus in a 10 MHz probe? (conventional linear array)

Answer 22

1.5 cm

Question 23

What kind of gray scale and dynamic range is used for breast imaging?

Answer 23

BROAD gray scale and HIGH dynamic range - provides a lot of gray shades to show subtle detail.

Question 24

Acoustic enhancement

Answer 24

generally associated with a cyst or benign lesion

Question 25

Shadowing

Answer 25

generally associated with a solid/malignant lesion

Question 26

🎗Reverberation

Answer 26

artifactual linear echoes parallel to a strong interface. May have a distinct 'stepladder ' or 'Venetian blind' appearance

Question 27

Side or Grating Lobe

Answer 27

secondary sound sources off the main sound beam that place artifactual eches within a cyst

Question 28

Slice (Section) Thickness

Answer 28

unwanted echoes from the thickness of the sound beam in the elevation plane that place artifacts within a cyst

Question 29

🎗Nipple Shadowing

Answer 29

shadowing in the subareolar region may be eliminated by angling the transducer posterior to the nipple or by using the 'rolled nipple' technique

Question 30

🎗Volume Averaging

Answer 30

decreases contrast resolution and spatial resolution (both axial and lateral). Places unwanted echoes in cysts.

Question 31

What are four reasons artifacts or unwanted echoes may show up in cysts?

Answer 31

reverb, side/grating lobe, slice/section thickness, and volume averaging

Question 32

Power doppler is [MORE or LESS] sensitive to low-velocity flow.

Answer 32

More

Question 33

Doppler is most helpful in distinguishing... (3 things)

Answer 33

1) cystic vs solid 2) inflamed vs non-inflamed 3) complicated cyst vs complex cyst or intraductal papilloma

Question 34

Doppler will NOT tell you the difference between... (1 thing)

Answer 34

benign vs malignant

Question 35

What kind of transducer pressure should be used with doppler breast scanning?

Answer 35

Minimal. Small vessels are easily compressed.

Question 36

🎗Doppler technique: In order to optimize, the sonographer should establish a technique for ___ velocity flow states.

Answer 36

Low

Question 37

Techniques for low-velocity flow states include: (4 things)

Answer 37

1) Low velocity scale (5-6 cm/s) 2) Low filter setting 3) Optimal color gain setting 4) Increased PRF for high-velocity flow velocities

Question 38

Spatial compounding is

Answer 38

used to combine multiple scan lines acquired from different directions (angles).

Question 39

Advantages of spatial compounding

Answer 39

sharper margins and reduced speckle

Question 40

Disadvantages of spatial compounding

Answer 40

reduces enhancement and shadowing, appears blurry

Question 41

Technique wherein the system ignores echoes from the transmitted frequency and captures echoes from the received frequency

Answer 41

Harmonic Imaging

Question 42

1) Improves detail resolution 2) Improves contrast resolution 3) Reduces artifact chose in breast cysts

Answer 42

Advantages of harmonic imaging (3)

Question 43

Disdavantage of harmonic imaging (1)

Answer 43

May lose detail in the far field

Question 44

Diagnostic method that evaluates the elastic properties of tissue

Answer 44

elastography

Question 45

Which is more stiff - malignant tumors or benign?

Answer 45

malignant

Question 46

What uses mechanical compression to deform the tissues and measure the reaction?

Answer 46

Strain elastography

Question 47

Is the strain elastography color map qualitative or quantitative?

Answer 47

qualitative

Question 48

Soft tissues will be [BLUE or RED] with strain elastography.

Answer 48

Blue

Question 49

Stiff tissues will be [BLUE or RED] with strain elastography.

Answer 49

Red

Question 50

What is the measurement used in strain elastography to represent not only the stiffness of the lesion, but the stiffness of the surrounding tissue involved in the cancer?

Answer 50

E/B Ratio

Question 51

What do the E and B stand for in E/B Ratio?

Answer 51

Elastogram, B-Mode

Question 52

What indicates a desmoplastic reaction (cancer invading the surrounding tissue)?

Answer 52

E/B Ratio of greater than 1 = BIRADS 5

Question 53

What is a common artifact of strain elastography that appears in breast cysts?

Answer 53

The 'Tri-Laminar' or 'BGR' artifact - all three colors are displayed within the cyst.