NIS numbers

Question 1

magnetic field strength above which a patient with an implanted cardiac pacemaker should NOT be allowed

Answer 1

5 Gauss (0.5 mT)…………………… (1 Gauss = .0001 Tesla, or 1 Tesla = 10,000 Gauss)

Question 2

reversal of midazolam

Answer 2

Flumazenil 0.2 mg IV

Question 3

hearing protection must be provided for MRI exams in which sound pressure exceeds:

Answer 3

99 decibels

Question 4

what radiation level can ring dosimeters detect

Answer 4

30 mrem of gamma and 40 mrem of beta

Question 5

how many hospital deaths per year were attributable to medical errors

Answer 5

44,000-98,000 deaths

(2000 IOM To Err is Human)

Question 6

societal cost of medical erros

Answer 6

$17-29 billion dollars

(2000 IOM To Err is Human)

Question 7

how many Americans experience a diagnostic error or know someone how did?

Answer 7

1 out of 6 ppl

Question 8

What % of postmortem exams were associated with diagnostic erros

Answer 8

10%

Question 9

ASA class I

Answer 9

A normal healthy patient

Question 10

ASA Class II

Answer 10

A patient with mild systemic disease

Question 11

ASA Class III

Answer 11

A patient with severe systemic disease

Question 12

ASA Class IV

Answer 12

A patient with severe systemic disease that is a constant threat to life

Question 13

ASA Class V

Answer 13

A moribund patient who is not expected to survive without the operation

Question 14

ASA Class VI

Answer 14

A declared brain-dead patient whose organs are being removed for donor purposes

Question 15

ages where kids experience a gradual transition to self determination

Answer 15

12-18 years

Question 16

Age cut off for medical decision making

Answer 16

< 12 yo cannot make their own decisions.

Between 12-18 is a gray area and you have to determine 3 things:

1. legal determination of maturity
2. evidence the child is sufficiently mature to make own decisions
3. conditions exempting parental consent

Question 17

time peroid for hand washing with soap and water

Answer 17

15 seconds

Question 18

time period for washing hands with hand sanitizer

Answer 18

20 seconds

Question 19

All MR sites should have a handheld magnet ( >________Gauss)

Answer 19

All MR sites should have a handheld magnet ( >1000 Gauss)

……” or handheld ferromagnetic detection device, which allows for testing of external objects and some superficial internal implants”

pg 21

Question 20

insulating pads for the MRI scanner are necessary to keep skin at least _______ from surfaces (scanner or skin)

Answer 20

1 -2 cm

insulating pads for the MRI scanner surfaces (scanner or skin)

Question 21

volume of liquid Helium in MR scanners

Answer 21

typically 1500 to 2000 L

Question 22

temperature of liquid helium in MRI scanners

Answer 22

-269 C, 4 K

Question 23

When the magnet is quenched, what is the increase in volume from He liquid to gas

Answer 23

760 fold increase in volume

Question 24

incidence of severe life threatening allergic like reactions

Answer 24

estimated to be 0.01% to 0.04%

Question 25

incidence of allergic like CT contrast rxn

Answer 25

\< 1% most of which were mild

Question 26

risk of another allergic like rxn to the same class of contrast media if you have had a rxn before

Answer 26

5 x increased risk

Question 27

increased risk of adverse contrast rxn in a patient with allergies or asthma

Answer 27

2-3 x increased risk

Question 28

time period in which thyroid cancer pts should not receive CT IV contrast before I-131 treatment

Answer 28

No IV contrast 4-6 weeks before I-131 treatement contrast will saturate the thyroid and could render treatment ineffective

Question 29

even if pre-medicated, if a breakthrough contrast rxn occurs what % are similar severity to the initial contrast rxn

Answer 29

80% "Even with appropriate use of an accepted premedication regimen, breakthrough reactions occur in a small number of high-risk patients. When they do occur, they are of similar severity to the initial reaction about 80% of the time, less severe about 10% of the time, and more severe about 10% of the time." pg 25

Question 30

PC-AKI is defined as kdiney injury within what time perioid of contrast administration

Answer 30

24-48 hours

Question 31

CIN is most likely to develop in pts with GFR \< _____ mL/min/1.73 m²

Answer 31

GFR \< 30 ...or AKI

Question 32

Administration of large or multiple doses of contrast media within __________ may also be a risk factor for AKI

Answer 32

24-48 hours pg 26

Question 33

AKI should be diagnosed whenever:

Answer 33

1) an absolute serum creatinine increase of at least **0.3 mg/ dL**; or 2) a percentage increase in serum creatinine of at least 50% (1.5-fold above baseline); or 3) a reduction in urine output to **0.5 mL/kg/h for at least 6 hours.**

Question 34

usual clinical course of PC-AKI (time periods)

Answer 34

* a rise in serum creatinine beginning **within 24 hours** of contrast media administration, * peaking at about **4 days** * and then usually returning to baseline by **7 to 10 days.**

Question 35

If a potentially at-risk patient’s condition is stable, a creatinine value within _____________ of contrast administration is generally considered sufficient.

Answer 35

30 days pg 27

Question 36

The American College of Radiology Committee on Drugs and Contrast Media currently recommends that no precautions are necessary in diabetic patients taking metformin, **unless the eGFR is \< _____________ mL/min/1.73 m2** (in which case the patient should not be taking metformin anyway)

Answer 36

\<30

Question 37

a diabetic patient is on metformin and their GFR is \< 30, so you hold their metformin. How long do you hold it for?

Answer 37

withheld for **48 hours after contrast media administration** and only reinstituted if the renal function is reassessed and found to be acceptable.

Question 38

how much maternally administered contrast media enters breast milk?

Answer 38

1%

Question 39

Of contrast media that makes it into breast milk, what % is absorbed through an infant's Gi tract?

Answer 39

1%

Question 40

The reported overall rate of extravasation with power injection for CT ranges from \_\_\_\_\_\_\_\_\_\_\_\_\_%

Answer 40

The reported overall rate of extravasation with power injection for CT ranges from **_0.1% to 1.2%._**

Question 41

if indwelling lines have been in for _______ is there an increased risk for extravasation when power injecting with CT IV contrast?

Answer 41

24 hours Patients are believed to be at increased risk for extravasation when: * more peripheral access sites are used (such as the hand, wrist, foot, and ankle) rather than the antecubital fossa, * when utilized indwelling lines have been in place for more than 24 hours (in which case some degree of phlebitis may be present), * and when there are multiple punctures into the same vein.

Question 42

What % of extravasation injuries resolve without adverse sequelae?

Answer 42

98% In the remaining 2% of injuries, some patient morbidity develops because contrast media can damage adjacent tissue, likely due to a combination of direct toxic effects and its hyperosmolality. Adverse effects are usually self-limited, most commonly consisting of prolonged pain or swelling.

Question 43

Severe extravasation injuries (compartment syndrome) occur in \_\_\_\_\_\_\_\_\_% of patients with extravasations.

Answer 43

\<1%

Question 44

% gad excreted into breast milk

Answer 44

0.04%

Question 45

% gad contrast absorbed by baby's gut after drinking breast milk from mom who just got gad

Answer 45

1%

Question 46

who gets NSF

Answer 46

CKD with GFR \< 30 mL/min/1.73 m² **specifially:** 1. Stage 4: GFR 15-29 mL/min/1.73 m² 2. Stage 5: GFR \< 15 mL/min/1.73 m²

Question 47

pt with eGFR \< 30 mL/min/1.73 m2. What three high risk GBCM are absolutely contraindicated

Answer 47

1. gadodiamide [Omniscan®], 2. gadoversetamide [OptiMark®], 3. gadopentetate dimeglumine [Magnevist®]

Question 48

mild reaction to contrast media time frame

Answer 48

usually resolve in 20-30 min and do NOT require medical treatment

Question 49

for hypotensive patient, what position do you put them in?

Answer 49

Elevate legs at least 60 degrees (Trendelenburg position)

Question 50

% of radiologists named in medical malpractice lawsuits each year

Answer 50

7%

Question 51

indemnity payment (a sum of money paid as compensation) average in malpractice cases

Answer 51

$480,000

Question 52

how much time does the average radiology spend in their career with an unresolved open malpractice claim?

Answer 52

19 months

Question 53

level 1 results must be communicated within what timeframe? (tension pneumothorax, ruptured aortic aneurysm, acute intracerebral hemorrhage, and pneumoperitoneum)

Answer 53

60 minutes

Question 54

level 2 results must be communicated within what timeframe?

Answer 54

12 hours

Question 55

reading room ambient lighting

Answer 55

25-50 lux

Question 56

maximum gray value luminance for diagnostic monitors

Answer 56

350 dd/m2

Question 57

maximum gray value luminance for mammo monitors

Answer 57

420 cd/m²

Question 58

lossless compression of file size

Answer 58

3:1

Question 59

lossy compression ratio

Answer 59

10:1

Question 60

compression ratios of lossy and lossless

Answer 60

Lossy is 10:1 lossless is 3:1

Question 61

how much downtime is allowed per year

Answer 61

50 minutes of downtime per year

Question 62

high availability systems are expected to perform at:

Answer 62

"four nines"... or 99.99% of uptime

Question 63

CPR compression rate

Answer 63

100-120/min at 2 in depth

Question 64

ACR appropriateness criteria rating 7-9

Answer 64

Usually appropriate

Question 65

ACR appropriateness criteria rating 4-6

Answer 65

May be appropriate

Question 66

ACR appropriateness criteria rating 1-3

Answer 66

Usually NOT appropriate