TEST TEST TEST TEST TEST TEST 3 Flashcards
1
Q
a suspicious lesion that turns out negative after a diagnostic work up will be deemed
A
A false positive
2
Q
A neoplasm that originates in lymph tissues, but is not actually breast cancer
A
lymphoma
3
Q
Immediately behind the niple is the pouch like orfice called the ____ or____ ____
A
ampulla
lactiferous sinus
4
Q
placement of the calcifications within the breast
A
distribution
5
Q
a biopsy technique in which a fine needle is used to aspirate or remove cells from a localized breast lesion for pathological evaluation
A
fine needle aspiration
6
Q
what is used in mammography to assure radiation dose not enter into the lung field
A
half field geometry
7
Q
a female hormone which stimulates the development of the rbeast and later is essential for starting and continuing milk production
A
prolactin
8
Q
all mammography machines are created to produce what
A
high contrast images at a low patient dose
9
Q
Routine mammography work utlizes the __ focal spot
A
large
10
Q
small clumps of immune celks that act as filters for the lymphatic system
A
lymph nodes
11
Q
benign condition of fat cells beneath the skin
A
lipoma
12
Q
The breast extends vertically from the clavicle at what rib?
A
2nd or 3rd
13
Q
If microcalcifications are present in a specimen, they should be ____ and ___
A
counted and noted
14
Q
pixel size determines
A
spatial resolution
15
Q
consent given verbally
A
oral consent
16
Q
the size of the image matrix is determined by the
A
number of pixels
17
Q
calcifications that are often seen in the breast after surgery and radiation therapy
A
sutural calcifications
18
Q
External beam radiation usually begins _____ ____ after surgery
A
1 month
19
Q
what is the maximum allowable dose per view in mammography
A
300 mrad
3mGy
20
Q
What QC test: assess the quality and consistency of images
A
phantom images
21
Q
curved radiopaque line seen around lesions containing fat
A
halo sign
22
Q
a thin flat triangular muscle that lies deep to the pectoraliz major muscle and covers the serratus anterior and the external oblique muscles
A
pectoralis minor
23
Q
where is the lateral border of the breast
A
mid-axillary line
24
Q
Which feature of calcifications would be least likely to be benign
a. clustered together
b. found in both breasts
c. scattered
d. well defined
A
clustered together
25
what is the kev of molybdenum
17.6-19.7
26
The repeat rate should be analyzed if the rate changes from the previous measure rate by more than
2%
27
The ACR and AMA recommend a SBE how often and starting at what age
every year at 40
28
Phantom imaging: if the same evaluation is reading the results the objects in each group should not decrease by more than \_\_\_form one pahtom evaluation to the next
1/2
29
what equipment is needed for viewing conditions
window cleaner, soft towels, illumination levels, and assure sources of bright light arent present
30
what benign feature are you looking for when you do a LM or an ML
milk of calcium
31
women with dense breasts are how muych more likely to develop breast cancer
1.5 to 2 times higher
32
calcifications \>0.5 mm in diameter
coarse
33
the absorbed dose is ___ the entrance skin exposure
significantly lower than
34
lack of breast compression is most likely to cause
motion unsharpness
35
rare and aggressive cancer cells that block lymph vessels in teh skin of the breast that starts with reddenign and swelling of the breast
inflammatory carcinoma
36
accessory glands of the female reproductive system
mammary glands
37
how many pounds of pressure do you exert on the pahntom in teh spot compression indicator
10-15 lbs
38
What is the most common type of breast cancer
ductal carcinoma
39
True or false
monitor manufacturer automated QC is elective if offered with the monitor
false - if it is offered it its mandatory
40
pear-like densities resembling teacups or pearl drops on the lateral projections
milk of calcium
41
under MQSA how many mammograms must you perform every 2 years to stay legal
200
42
univeral language for the storage and transmission of images for the medical community
DICOM
43
a missed malignancy on a screening mammogram is referred to as a what
false negative
44
area of hardening can mimic malignancy
radial scar
45
radiolucent, low density, smooth boarders, halo sign and capsule are all characteristics of a ___ lesion
benign
46
true or false
failures of the critical visual checklist tests must be corrected before clinic use of the equipment
true
47
Computer aided detection (CAD) has 2 major roles
detection/classification
48
true or false
When evaluating the DBT phantom, scroll to the slice or slab in which the test objects are best visualized
true
49
smaller the pixel, the ____ the spatial resolution
higher
50
Surgery and reconstruction after breast cancer does not fall under ___ \_\_\_\_
cosmetic surgery
51
evaluation of lactiferous ducts when there is spontaneous nipple discharge
galactography or
ductography
52
which modality has greater accuracy in samplin dense masses and and requires only 1 pass
vacuum assisted biopsy
53
the larger focal spot may be ___ but is generally __ mm
0. 4
0. 3
54
what is the corrective action time frame of a failed compression thickness indicator
30 days
55
collimation should not extend beyond the detector edge by more than what percent
2% of the SID
56
The most substantial limitation for a FNB is
the rate of insufficient sampling
57
occur in the TDLU when the extralobular terminal duct becomes blocked and the normal ductal secretions are not reabsorbed quickly enough and fluid begins to accumulate
cysts
58
The principle of mobile versus fixed tissue is used in mammography positioning to image the maximum
medial breast on the MLO
59
the pathological examination of body tissue that has been removed from the body
biopsy
60
During pregnancy and lactations, the breast has an increased amount of
a. morgagnis tuberccles
b. glandular tissue
c. montgomery glands
d. all of the above
all of the above
61
what does the actual focal spot measure
the area on the anode that is exposed to electrons
62
line pairs per millimeter is the unit of
spacial resolution
63
What quadrant would 7:00 clock in the right breast lie
lower outer
64
symptoms of warm, orange peel, flattening or inversion of the nipple or aching and burning
inflammatory carcinoma
65
what is the advantage of proper compression
a. reduced motion
b. separation of glandualr tissue
c. lower dose
d. all of the above
all of the above
66
Breast entrance exposure, AEC reproducibility, average glandular dose and radiation output rate evaluation. Physicists test how often and what is it
annually
measure typical entrance exposure to calculate the associated average dose
67
What is the most common cancer killer in the United States
lung cancer
68
the greater the bit depth, the more accurate is the __ \_\_\_
digital signal
69
What hormone is reponsible for ductal proliferation
estrogen
70
what type of capture turns x-rays into light
indirect
71
Typically the breast is located on the thorax between the levels of
2nd and 3rd
6th and 7th ribs
72
Both the ___ \_\_\_ and the ___ \_\_\_ of lymphatic vessels drain the breasts lymph
superficial plesus
deep plexus
73
How odten should the detector valibration frequency be doen
weekly
74
what are the name of the artifacts that appear sas non uniformities, blotches or streaks
broad area artifacts
75
This technique is used to obtain cellular material from teh area in question fro cytological analysis
fine needle biopsy
76
parenchymal tissue in the breast that shows up black or dark
adipose tissue
77
calcifications forming multiple flake like irregular clusters that can be microcalcifications or macrocalcifications and typically of intermediate concern
amorphous or indistinct
78
this layer is a soft polymer that protects the back of the IP
backing layer
79
what blood vessels are larger and more superficially located
veins
80
The posterior region on the chest is located where
closest to the chest wall
81
Most palpable lesions are best sampled under ___ guidance
ultrasound
82
what is the interface material of mammogrpahy linear grids
carbon
83
How long do breast centers have to keep a returning patients mammograms
5 years
84
the breast is made up of ___ tissue, __ (secretory) components, ___ vessels and ___ vessels
adipose, glandular, lymphatic, blood
85
what are the hormone receptors on the surface and inside of ells
proteins
86
an adjuvant therpay that involves the use of drugs to treat cancer that may have spread beyond the breast
chemotherapy
87
With menopaise comes a drop in what hormones
estrogen and progesterone
88
what is the name of th erpay used to shrink tumors before surgery
neo-adjuvant therapy
89
which statement is true regarding magnification in mammography
a. grids are used to decrease scatter
b. dose to the breast is unchanged
c. dose is decreased to the breast
d. grids are not used in magnification
grids are not used in magnification
90
grids with strips arranged in straight lines in one direction
linear
91
The photo conductor converts __ to \_\_\_
xrays to electrons
92
Which of the following represents tea cups on the ML or LM view
milk of calcium
93
a visual change in either breast contour or the nipple, often caused by an alteration in the tension of a coopers ligament on the skin or nipple
retraction
94
The removal of the contents of a cyst for testing or analysis
aspiration or fine needle aspiration
95
consent assuemd in an emergency situation where the patient is unable to make a decision
implied consent
96
The detectors ability to respond to different exposure levels
dynamic range
97
\_\_\_ removes a sample of tisue unlike a FNB which removes ____ and \_\_\_\_
core biopsy
fluid
cells
98
what is the ideal size paddle to use to compress the pahntom during the weekly phantom evaluation
the largest paddle used clinically
99
the minimum frequency for the phantom to be performed is
weekly
100
the most common disorder that results in excessive deveopment of the male breast as a result of physiologival, hormonal, or pharmacological factors
gynecomastia
101
artifact caused by dust is more common in
computer radiography systems
102
calcifications 1 mm in diameter and often associated with ducts are what shape
linear or rod-like
103
The anterior region on the breast is located where
located behind the nipple
104
What is the purpose of the image quality evaluation by the physicist
evaluation of the SNR and CNR
105
A follow up BIRAD recommendation: must indigate suggested biopsy method is what category
category 4
106
What is the recommendations of the USPSTF for screening mammogram
40-49 on individual basis
50-74 mammogram every 2 years
after 75 no screenings
107
what is the #1 diagnosed cancer in woen in the US each year
breast cancer
108
The cancer is confined to the duct and does not invade the duct walls
ductal carcinoma in situ (DCIS)
109
A category 3 BIRAD equates to
probably benign
110
Under MQSA which of the following is NOT mandatory
having an M as a mammogrpahy technologist
111
morgagni tubercles are formed by opening of the ducts of the ____ \_\_\_\_
montgomery glands
112
a single binary digit of data, such as "0" or "1"
bit
113
The most lateral aspect of the breast
axillary tail or tail of spence
114
What is the name of the drug that is used to combat HER2+ breast ancer
herceptin
115
What does the E in EQUIP stand for
enhancing
116
phosphor cystal in the flat panel detector system are classified as ___ phosphors
turbid
117
\_\_\_ ___ and ____ \_\_\_\_ is controlled mainly by the processing software and the algortithms that can be applied
image brightness
image contrast
118
\_\_\_\_ ___ or ___ \_\_\_ is usually a result of increased cellular activity in ducts and surrounding tissues
sclerosing adenosis
ductal hyperplasia
119
the compression thickness indicator QC performance criteria needs to be accurate to what degree
+/- 0.5cm
120
Core biopies are done under guidance fo what 3 modalities
mammo, US, MRI
121
What breast tissue is best visualized on the MLO view
lateral tissue
122
true or false
lateral tissue is at the highest risk of beign missed on the CC view
true
123
When positioning the MLO the height of the image receptor should be no higher than the patients what
axilla
124
the averaging of each pixels frequency with surrounding pixels values to remove high frequency noise
smoothing
125
what is an advantage of a honeycomb grid
less dose to patient
126
Indirect capture steps
1. xrays to scintillator
2. scinillator (cesium iodide) converts - xrays to light
3. light to photo diodes
4. converts light to electric signal
4. electrical signal sent to workstation
127
true or false
neo-adjuvant therpay is indicated for large tumors to shrink the size and conserve tissue
true
128
What i the most common error in a core biopsy
understanding the multifocality
129
discrete calcifications with irregular margins, vary in size and shape. 30% are malignant
fine heterogenous
130
Weekly densities of the weekly test films are with ___ of the operation level
+/- 0.15
131
most side effects from radiation will occur in ___ -\_\_\_\_ months
6-12
132
What has the lowest false negative rates but is the most invasive and highest complication rate
open surgical biopsy
133
is copious discharge of blood from the breast
mastorrhagia
134
often is the pectoral muscle seen on the CC view
30-40%
135
how many mammography credits are required by MQSA every how many years for mammography tehcnologists
15 credits every 3 years
136
malignant type calcifications are often \_\_\_\_\_
microcalcifications
137
DEL
detector element size
138
True or false
in an axillary tail view, the IMF is optimized
false- the axillary tail is optimized
139
The middle region on the brest is located where
middle of the breast
140
What type of chemotherapy treatment is geiven before surgery to help shrink the cancerous tumor
neoadjuvant
141
In what year did the final MQSA regulations go into effect
1999
142
"T" in cancer staging
grades the tumore size and the spread of the skin or chest wall under the breast. 0-4 higher numbers indicate a larger tumor
143
an examination of the breast by the patient
breast self exam
144
what are the two roles of filtration
remove soft photons that increase dose
remove high energy that decrease contrast
145
if borders are ___ or ____ more testing will be needed to determine benign or malignancy
irregular or obscured borders
146
focal spot measurements report the actual or effective focal spot
effective
147
the removal of a tumor with excision of surrounding tissue. Lymph nodes are sometimes removed during this procedure
lumpectomy
148
what type of breast would you use a rhodium/rhodium combination on
super thick
149
True or false
for a rolled MLO inferior, your top hand travels superiorly
false - it travels the direction of the view (inferiorly)
150
fibrous and glandular tissues is ____ rodiolucent and will show as lower optical densities on mammograms
less
151
if a radiologist sees a lesion in the MLO but no teh CC what could you be asked to perform
a 90 degree lateral
152
which of the following is a rare and very aggressive breast cancer in which the cancer cells block lymph vesseles
inflammatory carcinoma
153
a cancer with marked predominance of connective tissue
scirrhus
154
What are two things that influences noncompliance
painful experience
unsympathetic technologist
155
True or false
Breast cancer cells can be ER+ , PR+ or ER- and PR-
true
156
what is the corrective action for a visual checklist
immediate
157
a thin tough layer of plastic that protects the phosphor layer from damage
protective layer
158
the effective focal spot is ___ than the actual focal spot, this is known as the ___ \_\_\_\_\_\_ \_\_\_\_\_
smaller
line focus principle
159
which of the following can you NOT count toward your 200 mammograms required every 2 years
a. needle localization
b. magnification view
c. diagnostic views
d. spot compression view
needle localization
160
how often is the manufacture calibrations evaluations preformed
manufacturers recommendation
161
Which of the following procedures might be done for unilateral bloody nipple discharge
galactography
162
where are the largest number of breast cancers found in the breast
upper outer quadrant
163
According to the ACR, for the MLO view, what angle should be used for a patient taller and more slender
50-60 degrees
164
Treatment of breast cancer with high energy radiaton to destroy the cancer cells in teh chest wall, axilla and breast
radiation therapy
165
what is the atomic number of a molybdenum filter
42
166
which target filter combination woudl never be used in mammography
Rh/Mo
167
what type of breast would you use a moly/rhodium combination on
thicker
168
have a central fibrous core with radiating arms made up of benign epithelial growth and sclerosis
radial scars
169
what is used to indicate where a biopsy has occurred
clip placement
170
To increase the changes of an even intensity beam across the breast, the thinnest part of the breast (near the nipple) is positioned at the ___ side
anode
171
What is the most commonly performed minimally invasive technique for biopsy
core biopsy
172
The layer of adipose or fatty tissue that separates the breast from the pecoral muscle
retromammary space
173
when scoring fibers score as ___ point if ___ or more of the fiber is visible and ___ point if the fiber appears to be equal or greater than ___ mm and less than ___ mm in length
1 pt: 10-8mm
1/2 pt: 5-8mm
174
what therpay is used for tripe negative breast cancer
chemotherapy
175
what equipment is needed for a visual checklist
visual checklist
176
Most reports of patent dose involve a fact check of the ____ only
enterance skin exposure (ESE)
177
The majority of breast disease occur in the \_\_\_\_
TDLUs
178
When hanging a CC correctly, where is the lateral aspect of the breast
on the top of the image
179
which target filter combination is used for a larger than overage but not extremely dense breast
Mo/Rh
180
increase OID results in what two things
mag views
increased dose
181
light shining down on the viewboxes
illuminance
182
what is the best modality for evaluating implants
MRI
183
an open grid compression paddle is used for which view
tangential
184
calcifications of the skin
dermal calcifications
185
The ____ \_\_\_ is the area that electrons stikes on the target
focal spot
186
whatis the anem of the artifacts that appear as non-uniformities, blotches or streaks
broad area artifacts
187
waht are two types of implant ruptures
extracapsular rupture
incapsular rupture
188
situated or occuring immediately beneath the skin
subcutaneous
189
crystals that produce lateral spreading of light, which reduces spaital resolution
turbid phosphors
190
true or false
ER/PR negative tumors have few or no hormone receptors
true
191
a condition of carrying a pregnancy past the point of viability of delivery a child
parity
192
what is the advantage of a tungsten target
decrease dose
193
aluminum is used as the filtration in
digital breast tomosynthesis tubes with tungsten targets
194
maignant cells extend from the lactiferous ducts to the nipple with or without masses
pagets disease
195
true or false
the labeling code for magnification is MAG
false -M
196
\_\_\_\_ tissue predominates in older women
fatty
197
according to the ACR, for the MLO view what angle should be used for a patiet shorter and heavier
30-40 degrees
198
viewbox luminance and room illuminate evaluation. Physicists test how often?
annually
199
\_\_\_ can reduce the need for a surgical biopsy
fine needle biopsy
200
which of the following is only a diagnostic view
tangential
201
if the calcifications are \<0.5 mm in diameter
round or punctuate
202
For needle localization procedures, which views are used to localize the lesion
the CC and 90 degree
203
\_\_\_ ____ \_\_\_ irradiates less healthy breast tissue
internal beam radiation
204
ALND
axillary lymph node dissection
205
what is the purpose of a filter
remove soft photons that do not contribute to image quality and to remove higher energy which reduces contrast
206
what is the purpose of the viewign conditions
checking the radiologist viewing condition
207
between the nipple orfice and the ampulla is a connecting duct called the ____ \_\_\_\_
lactiferous duct
208
what is the name of the endocrine disorder found in males
gynecomastia
209
what is the most commonly diagnosed breast cancer in the US
invasive ductal carcinoma
210
True or false
The corrective action procedure has to be documented for an inspector
false
211
True or false
the procedure fo LIP oversight of the QA/AC records does not have to be written policy
True
212
what material is used in the xray tubes window to allow photons to pass through
berylium
213
What 3 factors determine the mammo spectrum
kvp
anode material
filter in the beam
214
what percentage of breast cancers occur in women with no family history
85%
215
the smaller the pixel the higher the ___ \_\_\_
spatial resolution
216
what are the rules for lossless compression
2:1 ratio
only format for FFDM
no data loss
217
what focal spot size is used for standard mammography imaging
0.3mm
218
true or false
Ideally the repeat rate should be between 2-5%
false - ideally the repeat rate will be \<2%
219
True or false
if an artifact is noticed on the phantom evaluation and foudn to come from the monitor you have 30 days to fix it
false - it needs to be fixed before th monitor is used
220
beneath the nipple/areolar complex; subcutaneous
subareolar
221
what is a milk filled lesion
galactocele
222
True or false
ACS no longer recommends that all women routinely perform the BSE
true
223
In analog units, the filters used are often the same element as what
the xray tube target
224
can mimic a radial scar
postsurgical scarring
225
producing definitive slides of biopsied tissue for pathology; takes 24 hours
permanent section
226
the beryllium exit window on the x-ray tube enhances contrast by
transmistting more low energy photons
227
what is the k-edge of a rhodium filter
23.3 kev
228
As the size of the focal spot decreases, the heating of the target is concentrated into a ___ area
smaller
229
When do the ARRT required additional mammograms need to be supervised
if you perform all 200 mammograms before taking the 40 hour course
230
Which of the following is not considered to be a risk of developing breast cancer
a. alcohol conspuption
b. smoking
c. being diagnosed with a benign breast condition in one breast
d. being diagnoed with hyperplasia
smoking
231
a benign process consisting of widened ducts containing thickened material
duct ectasia
232
which of the following does NOT need to be on a medical report
a. the name of the patient
b. the name of the interpreting physician
c. the name of the mammography tech
d. the name of the facility
the name of the mammography tech
233
Coopers ligaments attach posteriorly to
deep facial tissue in front of the pectoral muscle
234
what is the k-edge energy of a molybdenum filter
20 kev
235
Which of the followign is a reason facilities are getting a level 2 violation
a. interpreting physician not included in teh EQUIP process
b. EQUIP procedure is only verbally explained to inspector - nothing written
c. QA/QC peer review
d. RT reviews done only quarterly
interpreting physician not included in the EQUIP process
236
what is the purpose of a repeat analysis
determine the number and cause of repeates
237
image brightness is adjusted by changing
window level
238
the muscle lying immediately posterior to the breast is the
pectoralis major muscle
239
what are the personnel requirements to remain legal in mammography
15 CEU every 3 years
200 mammograms every 2 years
240
difference between simple and modified mastectomy
lymph node removal
241
development of benign cystic spaces within the ducts as a result of monthly hormone fluctuations that cause cysts to form throughout the breast tissue
fibrocystic changes
242
breast cancer is hereditary in about \_\_-\_\_% of cases
5-10
243
ERT is used on women who no longer have a \_\_\_\_
uterus
244
Using ultrasound, a thin, watery fluid with smooth borders. Anechoic
cyst
245
automatic compression should never exceed __ lbs ( ____ N) on the intial power drive
45 lbs
200 N
246
True or false
breast cancer cells can be ER+, PR+ or ER-, PR-
true
247
A mass or fast growing tissue which may be either benign or malignant
tumor
248
in routine mammography the glandular dose per projection is generally about
1-2 mgray
249
what is the characteristic radiation range produced by a molybdenum target
17-19 kev
17.9-19.5
250
The ___ \_\_\_ in digital allows visualization of the skin and penetration of dense breast tissue
wide latitude
251
True or False
Bening lesion will not change much in size or shape over time or will grow evenly, whereas malignant lesions can grow significantly over a 1-year period.
true
252
in what year was the mammography quality standards act passed
1992
253
how often is the radioliogist review workstation QC performed
monthly
254
lesions with a halo sign usually indicated the presence of a ____ lesion
benign
255
the microscopic examination of tissue
histological analysis
256
breasts that are similar in size, shape and composition of anatomy so that one breast is a mirror image of the other
symmetry
257
what focal spot size is used with magnification
0.1mm
258
one individual cell in a matrix
pixel
259
the breast is supplied with ___ and ____ function by the anterior and lateral cutaneous branches of the 4th, 5th and 6th intercostal nerves
sensory
sympathetic
260
a term applied to tumors which on section show a lobulated cauliflower appearance
phylloides
261
an average womans breast will typically have how many lobes
15-20
262
coopers ligaments are also known as
suspensory ligaments
263
True or false
EQUIP does not require the lead interpretive physician to oversee the QA/QC
false - the LIP is ultimately responsible to make sure QA/QC is done and corrective action taken is necessary
264
factors perceived by the affected individual only
subjective data
265
in edge enhancement the more pixels involved in the averaging the ___ the image appears
smoother
266
What is the newest type of breast implant placement
subfacial
267
what size needle would be used for vacuum assisted core biopsy
7-14 guage
268
not aligned along the trabecular stucute of the breast
multiple lobulated
randomly orientated
269
was passed by the United States Congress in october 1994 to ensure quality mammography for all patients and to improve and standardize breast imaging
mammography quality standards act (MQSA)
270
ratio of the height of the lead strips to the distance between them
grid ratio
271
The compression paddle used for a magnification is what
spot compression paddle
272
The final stage of any interventionla process is the ____ \_\_\_\_
pathology review
273
the number of bits per pizel determines the __ \_\_\_
bit depth
274
Ultrasound characteristic of a benin lesion is \_\_\_(white) thin capsule
hyperechogenic
275
On the MLO view, the pectoral muscle should be visualized down to where
the level of the nipple (PNL)
276
fast growing tissues
proliferation
277
True or false
written documentation of the clinical image review is required
true
278
MQSA became a law on
10/27/1992
279
which form of mastectomy removes only the breast tissue
simple mastectomy
280
what is one of the roles of filtration in mammography
removes high energy photons which decreases contrast
281
looks like a random pattern
architectural distortion
282
This begins in the connective tissue and is a primary or secondary tumor. These tend to be large at diagnosis.
sarcoma
283
single or in clusters where a cluster of microcalcifications are described as three to five calcifications within an area no larger than 0.5 -1.0 cm
number
284
which compression paddle is used with the compression thickness indicator QC test
spot compression paddle
285
PSP is associated with
computed mammography
286
\_\_\_\_\_\_ will reword the questions to clarify information and can be used to verify that the patient has not changed his or her mind
repetition
287
under the nipple, veins form a venous network called the \_\_\_\_
virculous venosus
288
During a CBE, lump are felt in the lower breast more easily when the patient is
supine
289
fine, linear, or branching calcifications that can be fragmented with irregular contours and are often malignant are what type of calcification
casting type
290
Which fo the following is not a lymph node location in the breast
a. clavicular
b. axillary
c. thoracic
d. intramammory
thoracic
291
molybdenum has characteristic radiation at what energies
17.9 and 19.5
292
amount of light coming out 3000 cd/m22
luminance
293
What type of view is done without the permission from a radiologist
supplemental
294
compression paddle alignment evaluation. Physicists test how often and what is it
annually
paddle is flat and parallel to the breast
295
A firm round lump that develops following surgery, reconstruction or a needle biopsy is called what
fat necrosis (oil cyst)
296
What type of therapy is administered after sugery to attempt to keep any outlying cancer cells
adjuvant therapy
297
The taking of a sample specimen for cytological or histological analysis
breast biopsy
298
which principle has to do with the actual focal spot and the effective focal spot
line focus principle
299
\_\_\_\_\_\_ is used to give the patietn time to remember and ensure accuracy
silence
300
how often should the phantom imaging be done
weekly
301
the small focal spot ranges from \_\_- to ___ but hte most common size is \_\_\_
0. 15-0.1mm
0. 1mm
302
According to the ACR for the MLO view what angle should be used of ra patient of average height and weight
40-50 degrees
303
Under breast ultrasound, a lesion that is taller than wide might indicate what
a suspicious lesion
304
2 linear grids with one placed on top of the other with the grid lines perpendicular to each other is called
crossed
305
What percentage of the lymphatic drainage travels through the axillary lymph nodes
75%
306
These glands secrete a fatty lubricant, which protects the nipples during nursing
montgomery glands
307
308
what is the main purpose of the cleavage view
to visualize medial tissue
309
calcifications that are sharply outlined, spherical or oval are typically
benign
310
How long should a facility maintain records of a serious complaint
3 years
311
true or false
survival rate is the same in early breast cancer whether you do a lumpectomy and radiation or a mastectomy
true
312
assessing the mammography site qc program should be done how often
annually
313
damaged or dead tissue. Firm and round, does not increase risk of breast cancer
fat necrosis (oil cyst)
314
how long are facilities required to keep records of a patient who died shorly after the 1st mammogram
10 years
315
True or false
failures of less critical visual checklist tests must be corrected before clinical use of the equipment
false - the less critical test must be corrected within 30 days
316
Borders that are ____ are a strong indication for malignancy
spiculated
317
Estrogen and progesterone are produce by the
ovaries
318
mammary glands are sometimes referred to as ___ \_\_\_\_ \_\_\_\_\_
modified sebaceous glands
319
the removal of the breast
mastectomy
320
what corrective action must be taken for viewing conditions
replace fluorescent tubes every 18-24 months and replace them all at once
321
the target is angled to allow a larger area for the electrons to strike while maintianing a small effective focal spot
line-focus principle
322
pertaining to neoplasm
neoplastic
323
Implants can be placed in front of the pectoral muscle ____ or ____ implants, or behind the pectoral muscle ___ or \_\_\_
retromammary/subglandular
subpectoral/retropectoral
324
what imaging procedure might be used when a summation artifact or superimposition is seen on a 2D screening mammogram
3D breast tomosynthesis
325
what is kev
photon energy
326
what size focal spot is used with magnification
0.1mm
327
what is the most common type of mastectomy
modified radical mastectomy
328
\_\_\_ tissue predominates in younger women
glandular
329
what is the minimum number of test objects that need to be visualized in the phantom evaluation
2 fibers, 3 speck groups, 2 masses
330
DMIST
digital mammographic imaging screening trial
331
who wil oversee your proof of 15 mammography credits every 3 years to remain legal
your annual MQSA inspector
332
CA stands for waht in teh EQUIP section for mammography
corrective action
333
the process of lobular regression
involution
334
which non surgical treamtent uses a seed inserted into the breast
brachytherpay
335
secretion of fluid from the nipple; spontaneous or elicited with pressure
nipple discharge
336
what is a disadvantage of a linear grid
higher dose to patient
337
anechoic
no echoes (black)
338
the energy released from the metastable is the form on a ___ -\_\_\_ light
blue-purple
339
What is the corrective action if an artifact is noticed on the phantom and found to come from the monitor
it needs to be fixed before it can be used
340
These usually form as a result of fat necrosis or are calcifying hematomas
oil cyst
341
True or false
the procedure for documenting procedures when images are of poor quality does not have to be a written procedure
true
342
The breast extends medially from the ____ to the \_\_\_\_
mid-sternum to mid axillary line
343
What feature of the high transmission cellular grid allows these grids to maintain equal or less radiation dose ot the patient compeared with linear grids
copper strips and air interspace
344
True or false
the base of the breast is the inframammary fold
false
345
Frequency processing or spatial frequency filter is the averaging of the signal strength of one pixel with the strength of adjacent pixel or neighboring pixels
edge enhancement
346
fibrous, glandular and fatty tissue surrounded by a thin capsule of connetive tissue. thought of as a breast within a breast
hamartoma
fibroadenolipoma
347
348
Monitor calibrations use what two patterns
SMPTE pattern
AAPM tasks group 18 pattern
349
k-edge is determined by what
atomic number of the filter material
350
what 2 imaging factors are grids used to control
scatter and contrast
351
The ducts gradually ___ in size as they approach the nipple
increase
352
Which of the followign would not be considered critical on the visual checklist QC test
a. cleaning solutions need to be available
b. the breast support must not be cracked
c. locks working correctly
d. collimator light working properly
collimator light working properly
353
what anode will result in more penetrating xray beam to penetrate through the large dense breasts
rhodium
354
what structure keeps the epithelial cell layer intact
basement membrane
355
FAD
focal architectural distortion
356
irregular conspicuous calcifications that are generally 0.5-1.0 mm. About 15% are malignant
course heterogeneous
357
what are the rules for lossy compression
30:1 ratio
not allowed for FFDM
some data is lost
358
what is the order the 3 views should be palced in triangulation
CC,MLO,ML
359
kVp accuracy and reproducibility evaluation. Physicist tests how ofte and what is it
annually
kvp within +/- 5%
360
What are the 5 general tests of QC
1. phantoms images
2. visual checks
3. repeat analysis
4. viewbox and viewing conditions
5. compression force
361
The main direction of drainnage from teh central and lateral half of the breast tends to be into the ___ group of axillary lymph nodes
pectoral
362
name the characteristic of a lesion that is typically malignant
a. oval
b. circumscribed
c. found in both breasts
d. spiculated
spiculated
363
benign tumors composed of stromal and epithelial elements. May slightly increase risk for breast cancer
fibroadenoma
364
What are the layers of a detector
protective layer
phosphor layer
conductive layer
support layer
light shield layer
backing layer
365
SIEP
superficial inferior epigastric perforator
366
Excisional biopsy is used to remove
entire lesions
367
RWS MQSA MP requirements
3MP monitors
analog = 50 lux
digital = 20 lux or less
368
How do the mammography machines compression paddles accommodate breasts that dont compress flat
compression paddles tilt
369
The first menses is called
menarche
370
the breast extents to mee the adominal wall at the level of what rib
6th or 7th rib
371
calcification of different shapes, irregular in form, size and optical density and are typically malignant
pleomorphic or granular
372
why is the rhodium anode used in a mammography unit
larger breast that need a more penetrating beam
373
Ultrasound characterisitics of irregular boarders, taller than wide, hypoechoic, and blood flow indicated what
a suspicisous lesion
374
what very rare breast cancer (less than 1%) starts in the connective tissue of the breast
sarcoma
375
True or false
Daily image reading takes away the need for periodic clinical image review
false - thi is one of the reasons for level 2 violation
376
MQSA only allows what type of compression
lossless
377
tumor growing in the ducts inside the nipple. Finger like, may cause nipple discharge or bleeding
papilloma
378
The latent image on the PSP can last several hours but will lose __ of its energy in _ hours
25%
8 hours
379
RWS stands for
review workstation
380
looks like cancer cells growing in the lobules but do not grow through the walle. Does increase your risk of breast cancer
lobular carcinoma
381
DMIST showed what?
that digital mammo is better at finding cancer in pre-menopausal women with dense breasts
382
adenosis with sclerosing of the intralobular stroma. This can present as calcifications or masses and is considered a benign and not a premalignant condition
sclerosisng adenosis
383
what is the performance criteria for a visual checklist
they should all pass
384
Whta is the interface materia in mammography grids
carbon
air
385
which cancer is refered to as the "sleeper cancer" and patients will complain of breast thickening instead of a lump
invasive lobular carcinoma
386
True or false
EQUIP requires the need for a procedure to be in palce for corrective action when images are of poor quality
true
387
When is the best time to conduct BSE
few days after the end of the menstrual period or 5-10 days after the start of your period
388
External beam radiation treatments usually last how long
5-8 weeks
389
defined as a calcification that are \<0.5 in in diameter seen with the acini or a terminal duct lobular unit. usually benign
round or punctate
390
The flap is completetly removed and microsurgery is neded to recreate blood supply when the flap is positioned as a breast mold
free flap
391
The ADC coverts ___ signal to ____ that can be read by a computer
analog
digital
392
\_\_\_ rather than asking questions will allow patients to tell thier stories unasked.
listening
393
Internal beam radiation therapy usually lasts for how long
5-9 days
394
DIEP flap
deep inferior epigastric perforator
395
what percent of breast cancer is linked to BRCA
5-10%
396
What is the name of the wide duct behind the nippel that widents t act as a milk reservoir during lactation
lactiferous sinus
397
The compression thickness indicator QC performance cirteria needs to be accurate to what degree
+/- 0.5 cm
398
semi ridgid material provides the imaging sheet with strength and is a base for the other layers
support layer
399
A lesion located in the upper outer quadrant of the left breat is located what clock position
2:00
400
Any HVL assessment must include an assessment of both ____ and ___ filtration
inherent
added
401
the boundary between photons that are not attenuated and photons that iwll be attenuated
k-edge
402
True or false
lobular carcinoma in situ are cancer cells that live inside the lobule but never have the abilit to break out
true
403
With a HER2+ breast cancer, the ___ are over stimulated
protein receptor
404
how often should artifact evaluation be done
weekly
405
Where is the superior border of the breast
clavicle
406
what is something that mammography is better at seeing than breast ultrasound
calcifications
407
what is the performance criteria for the repeat analysis
ACR repeat rate should be 2% but lower than 5% passes
408
which diagnostic view is the best to image calcifications
magnification
409
radiation therapy to the chest before age __ poses an icreased risk
30
410
The supporting elements of an organ
parenchyma
411
when is the triangulation technique necessary
during spot mags
412
How many masses must be seen on a QC image
2 masses
413
True or false
written documentation of the clinical image review is required
true
414
In the PSP computer reader the photomultiplier tube
collects the blue/purple light given off by trapped electrons
415
grids are used to improve radiographic ____ by decreasing the amount of scatter radiation
contrast
416
how many days after a leveal 1 citation on a MQSA inspection does the facility have to correct
15 working days
417
the grid ratio of mammography grids usually varines from ___ to ___ with the average being \_\_\_
3: 1 - 5:1
4: 1
418
What corrective action is taken for failed repeat analysis
a reason must be documented for changes more than 2% from the last analysis
419
which view below would best demonstrate skin calcifications
a. tangential
b. XCCL
c. XCCM
d. rolled view
tangential
420
True or false
The corrective action taken for poor image quality has to be documented in the department
true
421
grids with linear strips but slanted to match the divergence xray beam are what kind of grid
focused
422
if a mammography technologist falls out of legal status, what must she do to become legal again
perform 25 supervised exams
bring mammography credits up to 15
423
what is the average kvp range of mammography
25-35 kvp
424
what is the performance citeria for viewing conditions
illuminance should be under 20lux
425
what is the minimum frequency of the compression thickness indicator
monthly
426
which breast cancer is difficult to treat
triple negative
427
what is the detector in indirect capture made of
cesium iodine scintillator
428
What are the standard magnifications
1.5 and 1.8
429
The removal of the entire breast, lymph nodes and chest wall inside under the breast
radical mastectomy
430
what vein in teh rbeast comes off the axillary vein and drains the lateral breast
lateral thoracic vein
431
The lobes contain numerous ____ \_\_\_\_ held together by connective tissues, blood vessels and mammary ducts
glandular lobes
432
what is a malignant condition of the nipple
pagents disease
433
tyepe of mastectomy where there is removal of the breast along
simple
434
The retromammary space is seen on the mediolateral projection in mammography imaging but only on ___ of the CC projections
20%
435
what is the name of the drug tha tis used to combat HER2+ breast cancer
herceptin
436
star shaped referring to an unusual arrangement of breast fibers sometimes seen on mammography suspicisous for breast cancer, although it occurs with benign conditions also
stellate
437
Tamozifen is recommended as a single therapy for how many years
5
438
what is considered the blind ending of the duct and is where most breast cancers begin
terminal ductal lobular unit
439
in full field digital mammography, what determines which light field will be chosen to use with each patient
the size of the compression paddle
440
visibility of antomy can be affected by 5 characteristics
- artifacts
- geometry
- blur
- contrast sensitivity
- noise
441
what are the steps of direct capture
1. xrays
2. photoconductor - xrays to electrons
3. TFT
4. workstation
442
If a lesion is nonpalpable what type of imaging is an option to determine its exact locaton before biopsy
stereotactic breast biopsy
443
True or false
there is required quarterly frequency of LIP oversight of QA/QC records
false- quarterly is recommended byt there is no required frequency
444
Rhodium has bremstrauling radiation at what energies
20
23.22
445
Device used to convert films to an analog system to a digital image is called
film digitizer
446
What modality is used for assisting with NON-vacuum core biopsy
breast ultrasound
447
what is the preferred method of treatment for post menopausal women who are ER+ or PR+
aromotase inhibitors
448
\_\_\_ as it relates to calcifications describes the form and structure of the calcifications
morphology
449
describes milk secretion from the breast
lactation
450
what is another name for a linear grid
focused
451
Identification of the nature of the cancer
breast cancer staging
452
\_\_\_ ___ controls the brightness displayed
window level
453
what cell layer lies between the epithelium and the basal memebrane
myoepithelium
454
what type of breast would you use a moly/moly combination on
average
455
what are the two type of targeted treatments
molecular
hormonal
456
what is the interspace material of a honeycomb grid
air
457
Collimation assessment: physicists test how often and what is it
annually
assures xray field aligns with light fields
458
Minimum automatic compression not be less than \_\_\_lbs ( ___ newtons (N))
25lbs
111 newtons
459
crystals growing in column and have less lateral spread of light and better spatial resolution
needle phosphores
460
small,hazy, faint calcifications with no clearly defined shape or form . About 20% are malignant
amorphous or indistinct
461
What is another term for brachytherapy
internal beam raidation
462
in what part of the breast do most breast cancers arise
terminal ductal lobular unit
463
what layer of the plate reduces static electricity and absorbs light to increase sharpness
conductive layer
464
grid ratio is the
height divided by the distance
465
during the anode heel affect a portion so the xray beam at the anode side of the tube will pass through the anode, resulting in
a lower intensity beam
466
stereotactic equipment uses ___ to determine location
triangulation
467
what is the purpose of the visual checklist
lights, locks, dentents all working
468
What therapy is used for 5 years following breast cancer treatment for women who are premenopausal and ER+ or PR+
Tamoxifen
469
true or false
The labelign code for a rolled medial view is RM
true
470
Calcifications are best sampled with _____ with ___ guidance
stereotactic
mammography
471
What is the universal language used for storage and transmission of patient information
HL7
472
the pigmentation of the areola is dependent on ___ \_\_\_
estrogen levels
473
The size and shap eof the focal spot can be affect by what 3 factors
- size and shae of electron beam hitting the anode
- design and relationship of the filament coil to the focusing cup
- angle of the anode
474
\_\_\_\_\_\_ _______ use non directed or non leading methods to avoid leading the patient to give onyl certain reposnses and to allow unbiased input
open ended questions
475
how often does ACR accreditation need to happen
every 3 years
476
how often should the compression thickess be done
monthly
477
tumor made of closelt stromal or mesenchymal cells as opposed to epithelial cells (carcinoma) usually highly malignant
sarcoma
478
which of the following is an indications of cyst aspiration
a. posterior enhancement
b. lesiosn with thick walls/separtion
c. macrolobulation
d. hyperechoic
lesions with thick walls/separation
479
A high DQE means the system is more efficient in converting ___ \_\_\_\_ ___ or the system has a high ___ \_\_ on the TFT array
input xray signals
fill factor
480
The breast receives its arterial supply from the
axillary artery
481
Fatty tissue is ____ radiolucent and therfore shows a higher optical density areas on a mammogram
more
482
How often do the physicists test the AEC
annually
483
Artifact Evaluation. Physicists test how often and what is it
annually
assess degree of sources of artifacts
484
true or false
ultrasound is a good way to measure changes in masses treated with neo-adjuvant therapy
true
485
the process of testing and maintaining the highest possible standards of quality in equipment performane and the acquistition of radiographic images
quality control
486
Modern mammography units utilize a ___ grid to improve contast
moving
487
abnormal depression of the sternum; funnel breast
pectus excavatum
488
what is the name of the principle that allos a large area of coal spot heating while keeping the effective spot small
line focus principle
489
what characteristic of a stellate lesion leads to suspicion
dense center
490
Between the ages of 20-39 the ACS recommends CBE every
3 years
491
bluish purple liht from electrons as the transition from higher energy to a lower energy is the
phtostimulable luminesence (PSL)
492
Which compression paddle is used with the compression thickness indicator test
spot compression paddle
493
what glands secrete a lubricating and abcteriostatic solution during pregnancy and lactation
montgomery glands
494
in triangulation if a lesion moves down on the ML comprared to teh MLO where will the lesion be on the CC view
lateral
495
What is the frequency of the repeat analysis
as needed, on at least 250 patients
496
fibrous bands that predominate in teh upper parts of the breast
coopers ligament
497
Type of reconstruction where a flap of skin fat and muscle are taken from the back
lat dorsi flap recontruction
498
A typical lymph node is less than __ in size and is ___ shaped in appearance
2cm
kidney shaped
499
full field digital mammography machine QC must use the QC manual from the
manufacturer
500
The main direction of drainnage from the medial half of the breast tends to be into the ___ \_\_ lymph nodes
internal mammary
501
produces large calcifications, whether peridcutal or intraductal and are the result of secretions within dialted ducts
ductal ectasia
plasma cell mastitis
502
overall, which race statistically will be more likely to develop breast cancer
caucasion
503
The subareolar region on the breast is located where
lies immediately beind the areola
504
PNL
posterior nipple line
505
The flap reamains attached to its orginal blood supply and it is tunneled under skin ot the breast area
pedicle flap
506
what is the term for a woman who has given birth to one child only
primiparity
507
what is the difference between kvp and kev
kvp : max kilovoltage
kev: intensity
508
Defines information collected from the patient and can be seen, heart or felt
objective data
509
Chemotherapy is a ____ treatment
systemic
510
True or false
tamoxifen is a form of chemotherapy
false - it is a receptor modulator
511
Nomial focal size of 0.3mm means
that the effective focal spot is 0.3mm
512
What is the #1 risk factor in the developing breast cancer
gender
513
what is the atomic number of a rhodium filter
45
514
what are the 3 advantages of tube tilt
allow smaller target angle
allows greater anode heating capacity
reduces anode heel effect
515
man made object which simulates the average composition of the breast.
phantom
516
\_\_\_ is the term used to indicate pregnancy beign carried to a point of viability (24-26 weeks)
parity
517
The general term used when describing reshaping of the breast
mammoplasty
518
\_\_\_ ___ controls the ratio of black to white displayed and therefore contrast
window width
519
contrast can be altered after the exposure by altering the ___ \_\_\_\_ and is independent of the kVp used to acquire the image
window width
520
OID should be as small as possible to minimize \_\_\_\_
magnification
521
\_\_\_ can be performed to evaluate suspicious nipple discharge
ductography
522
how many openings to milk ducts are there in a nipple
5-15
523
Hormone replacement therpay will do what to the breast
increase glandular breast tissue
524
the circulus venosus drains into the ____ and ___ veins
axiallary vein
internal mammary vein
525
SOD should be as long as possible to reduce ___ \_\_\_\_
skin dose
526
Incisional biopsies are used to remove
parts of the lesion
527
an area of fibroglandular tissue seen on two projections
focal asymmetry
528
describes a woman who has never given birth to a vialble offspring
nulliparity
529
The skin of the breast is ____ at the base and ___ at the nipple
thickest
thinner
530
What is the ideal shap eof the pectoral muscle on the MLO view
convex
531
illuminance should be close to ____ or under \_\_\_\_
0
20 lux
532
a circumscribed growth of skin, congenital orgin; a mole
nevus
533
What is the equation for the magnification factor
SID/SOD or
image size/object size
534
What are the most commona circular oval lesion
cysts and fibroadenomas
535
this layer holds and traps excited electrons at higher energy levels
conductive layer
536
which of the following would be a lesion that is caused by trauma to the breast
a. galactocele
b. fibroadenoma
c. hematoma
d. hamartoma
hematoma
537
Radiolucent or radiopaque and any combination in between is called ____ \_\_\_\_\_
optical density
538
which of the following is a surgical treamtent for the breast
a. chemotherapy
b. radiation
c. TRAM
d. non-adjuvant therapy
TRAM
539
involves applying radiation from the inside out
internal beam radiation
540
what percent of breast cancer is found in males
1%
2470
541
a surgical procedure in whcih the entire breast, the pectoral muscle underneath and the lymph nodes in the axilla are removed
radical mastectomy
542
compression allows reduced radiation to the breast by
decreasing breast thickness
543
if your laser printer fails and starts to fall into a warming trak what do you do ? can you still use it?
contact service
may continue to use
544
what 3 factors determine the mammography x-ray spectrum
kv, anode, filter material
545
what is the frequency of the repeat analysis QC test
as needed
546
When scoring the phantom always count the number of visible objection until ____ or ____ is reached then stop counting
0 or 0.5
547
the scintillator converts ___ to \_\_\_
xray to light
548
How often is the acquisition monitor QC performed
monthly
549
a surgical procedure in which ony a portion of the breast is removed, including the cancer and a surrounding margin of health breast tissue
partial or segmental mastectomy
550
acts as an activator and is reposible for the storage properties of the PSP
phosphor layer
551
with CNR as contrast increase noise \_\_\_
decreases
552
in a flat panel detetor spatial resolution is controleld by the
detector element size
553
What is the name of the duct that transports the milk from the lobes to the nipple
lactiferous duct
554
retromammary space is filled with
adipose tissue
555
\_\_\_\_ _____ are used to get more details about the problem
probing questions
556
AEC system performance: physicists test how often and what is it
annually
checks AEC function
557
controlled by digital acquisition and the capabilites of the monitor
resolution
558
Name the duct that is inside the lobule
intralobular terminal duct or subsegmental duct
559
many small protrusions on the surgace of the areola
morgagni tubercles
560
evaluations of mammography equipment is performed by the
medical physicist
561
on the CC view, the central rays exit the breat where
inferiorly
562
What does RIS stand for
radiology information system
563
On breast ultrasound, which of the following would be an indication of a simple cyst
a. posterior enhancement
b. smooth borders
c. anechoic
d. all of the above
all of the above
564
The fibrous and glandular tissues within the breast are described as
fibroglandular densities
565
\_\_\_ filtration includes the glass or metal window of the xray tube, oil in the tube house the mirror of the collimation assembly and the compression paddle
inherent
566
Mammography grids generally have a ___ grid ratio than general radiography grids
lower
567
AJCC
The american joint committee on cancer
568
\_\_\_\_ ___ is the dose of choice when calculating radiation doses associated with mammography
glandular dose
569
The upper outer quadrant whcih extends inot the axilla
tail of spence
570
muscle, fat, and skin from abdomen used to create a new breast mound
TRAM flap
571
Moly filters attenuate all kevs above
20
572
what diagnostic procedure is used to dianose a papilloma
ductogram
573
how mmay years must a breast center keep a serious complaint
3 years
574
What is the corrective action for a failed phantom image QC
immediate
575
The greater the magnification factor, the great is the ___ \_\_\_ to the patient
skin dose
576
\_\_\_\_ is used to verify the accuracy of the information
summarization
577
How many pounds of pressure should be exerted on the phantom during evaluation
12 pounds of pressure
578
what is kv
voltage applied to the generator
579
What are 7 major risk factors for breast cancer
abnormal breast biopsy
age
gender
genetic risk factors
family hx
personal hx
radiation therapy
580
HRT is used by women who still have a \_\_\_
uterus
581
the process of removing tissue and fat from teh abdomen and transferring that tissue to recontruct the breast is called
DIEP: deep inferior epigastric perforator flap
582
You can count a fiber as a full point if you see at least how many millimeters of the fiber
8mm
583
which breast imaging study is expensive, has high false positive rates and only detects 50% of early breast cancer
breast MRI
584
When imaging a speciment for calcifications _____ and _____ should always be used
compression
magnification
585
In a flat panel detector, the spatial resolution is controlled bu the
DEL
586
HIS stands for
hospital information system
587
What do we used DICOM for
a. storing images
b. randmistting images
c. printing images
d. all of the above
all of the above
588
mobile borders, fat containing, smooth, circumscribed
benign
589
what is the largest field of view in mammography
24 x 30 cm
590
The __ the grid ratio the __ the contrast and the ___ the dose
higher
higher
higher
591
what muscle lies immediately below the breast
pectoralis major
592
Of the 8 imaging evaluation criteria, which 2 are the ones failed most often
positioning/compression
593
The muscle that runs from the lateral aspect of the breast across the mid-axillary line to the lower back
latissimus dorsi
594
There are a total of ____ specks per group, ___ form a ____ with __ in the middle
6 specks
5
pentagon
1
595
this layer prevents light fron erasing the data on the image recorder or strikign through the backing layer
light shield layer
596
what is the purporse of the compression thickness indicator
ensure the indicated scompression thickness is within tolerance
597
what grid reduces scatter in two directions
honeycomb
598
what is the name of the breast anatomy that attaches the breast to the abdominal wall
inframammary fold
599
how many specs must be seen on QC image
3
600
During a CBE, lump are felt in the upper breast more easily when the patient is
upright
601
how many days does a breat center have to take corrective action after a level 2 FDA violation
30 working days
602
the final MQSA regulations went into effect
04/28/1999
603
80% of all breast cancer is
invasive ductal carcinoma
604
If a radiologist sees a lesion on the MLO but not the CC, what coudl you be asked for perform
ML for triangulation
605
Preprocessing is automatic and occurs before the image is visualized at the AWS, enhancing of the ___ and ___ \_\_\_ occurs
contrast
image sharpness
606
what type of grid reduces scatter in one direction
linear
607
True or false
ductal carcinoma in site (DCIS) in invasive
false
608
what is the true detail QC test
MTF (modulation transfer function)
609
a malignant neoplasm or growth that can be visualized on mammography
carcinoma
610
variation in optical density, distributation, number, morphology, or size over time
change over time
611
is inflammation of the breast tissue
mastitis
612
evenly scattered, homogenous calcifications are generally
benign
613
what is the minimum frequency of the commpression thickness indicator
monthly
614
what two imaging factors are grids used to control
scatter and constrast
615
\_\_\_\_ is most often used because a regular glass or metallic window would harden the emerging beam by eliminating the low photons needed for breast imaging
beryllium
616
What percentage of breast cancers can be linked to a BRCA gene mutation
5-10%
617
fat and skin from the abdomen (no muscle ) are used to make a flap
DIEP
618
How much compression should be applied to the breast
until the breast is taut
619
the breast extends laterally to the ____ \_\_\_
latissimus dorsi
620
True or false
On the MLO view, the receptor should be placed posterior to the latissimus dorsi mucle
false - it should be placed anteriorly
621
The average female breast will evenutally develops how many lobes
15-20
622
Who recommends fewer instance of mammgrpahy screenings because too many may lead to overdiagnosis and over treatment
USPSTF
623
What is the most common supplemental view
XCCL
624
The breast tissue removed during a biopsy is called a \_\_\_
specimen
625
What type of implants are no longer allowed in the USA
silicone injections
626
How many fibers, speck groups and masses are embedded in the ACR DM phantom
6 fibers, 6 speck groups, 6 masses
627
2 type of radiation in mammography
bremmstrauhling
characteristic
628
The overall process of testing and maintaining the highest possible quality in the acquistion and interpretation of radiographic images
quality assurance
629
why are MA stations fixed in mammograph
to prevent tube burn out
630
Mammography is generalyl ackowledeged to have a ___ - ___ error rate
10-15%
631
MQSA requires RWS monitors to be at least how many megapixels
5
632
True or false
It is acceptable to perform an axillary trail view when you performed a poorly positioned MLO on an average patient
false
633
True or false
written documentation of the IPs oversight of the QC/QA program is required
false
634
what is the main purpose of performing the CC view
to visualize the medial portion of the breast
635
the design of the lip of the compression paddle affects all of the followign except
a. prevents the posterior and axillary fat from overlapping the body of the breast
b. allows uniform compression of the posterior breast tissue
c. helps increase structural strength of the compession paddle
d. ensures greater compression of the anterior breast tissue
ensures greater compression of the anterior breast tissue
636
which type of implant has a greater risk of capsular contracture
silicone gel
637
As the xray beam leaves the target of the anode, it is filtered in what two ways
inherent filtration
added filtration
638
Refers to treatment of postmenopausal women with hormones to maintain thier hormone levels to decrease symptoms and complicatiosn that could arise from declining estrogen levels
hormone replacement therapy
639
what cell layer does breast cancer begin
epithelial cell layer
640
What are the two main criteria in breast examination
looking for changes
feeling for changes
641
a female hormone produced by the ovarys corpus luteum only during specific time of a womans menstrual cycle
progesterone
642
circular or oval in size/shape with smooth borders
circumscribed
643
abnormal prominance of the sternum; pigeon chest
pectus carinatum
644
name the characteristic of a lesion that is most likely to be considered benign
a. irregular borders
b. well circumscribed
c. painless
d. hard and fixed
well circumscribed
645
which breast cancer is thought to be the earliest form of breast cancer and is confined to a duct
ductal carcinoma in situ
646
what needle size is used in a fine needle aspiration
18-25 guage
647
What alertnative projection could be used in addtion to CC when imaging at patient with a pacemaker
LMO
648
what is the purpose of the artifact evaluation
looking for dead pixels, banding, ghosting
649
To increase the changes of an even intensity beam across the breast, the thickest part of the breast (near the chest wall) is positioned at the ___ side
cathode
650
the formation of fibrous tissue stemming from connective and supportive stroma
fibrosis
651
a mehtod for performing high resolution limited angle tomography at mammagraphic dose levels
tomosynthesis
652
True or false
a periodic clinicalimage rewview of all active RTs and IPs is required at least quarterly
false - it is recommended to be quarterly but only required annually
653
What focal spot is used for mag views
small
654
according to MQSA standards, teh collimation should not extendbeyond any eduge of the image receptor by more than ___ of the SID
2%
655
the amount of sound passing through when using ultrasound
acoustic enhancement
656
which views are used to separate superimposed tissues
rolled view
657
how many years must a breast center keep a non-returning patietns mammograms
10 years
658
The ACR recommends tha the average glandular dose on a single mammogram projection shoul dnot be greater than
3mGy (0.3 rad or 300 millirad) with a grid
1mGy (0.1 rad or qoo mrad) without a grid
659
The two most prominent hormones tha tare active in breast development are ____ and \_\_\_
estorgen and progesterone
660
The anatomic structures that support the breast are
coopers ligaments
661
Rules for scoring specks
How many for a full point?
How many for a half point?
4-6 = 1 pt
2-3 = 0.5 pt
1= 0 pt
662
What separates the epithelial cell layer from basement membrane
myoepithelial cells
663
the condition of having carried more than 1 pregnancy past the point of viability (24-26 weeks) regardless of the outcome
multiparity
664
Who standardizes staging
the american joint committee of cancer
665
The central axis of the xray beam runs ___ to the place of the detector at the chest wall
perpendicular
666
Mammography tubes have anode angles ranging from, ___ degree to __ degrees
0-16
667
the two main classificatiosn of breast cancer are ____ and ___ carcinoma
ductal
lobular
668
which of the following increases a womans risk of developing breast cancer
a. early menstruation and late menopause
b. having her first child before age of 30
c. removal from hormone replacement therapy
d. having multiple children
early menstruation and late menopause
669
What has the most rapidly dividing cells
those of the terminal ductal lobular units (TDLUs)
670
a benign, lobulated neoplasm composed of bening epithelial tissue and located in the walls of dcuts of the breast. Has a "berry like" shape
intraductal pipilloma
671
what exam is the best way to look for an implant rupture
breast MRI
672
what is a disadvantage of a tungsten target
lowers contrast but can be brought back through digital processing
673
what two types of grids are used in mammography
linear
honeycomb
674
How many fibers must be seen on a QC image
2
675
what muscle lies to the lateral aspect of the breast
serratus anterior
676
calcification with smooth contours and high uniform optical density are usually
benign
677
what causes the heel effect
the angling of the anode
678
f you are diagnosed with a BIRAD D breast composition, your breast composition is
extremely dense
679
a lobulated benign tumore derived from the epithelium; usually inside the mammary duct near the nipple; may produce clear or bloody discharge
papilloma
680
where should you stand when positioning the CC view
on the medial side of the patient
681
milk production begins in the ___ or the ___ \_\_\_\_ ___ \_\_\_
lobules
terminal ductal lobular units (TDLUs)
682
What type of theraoy slows or stops the growth of hormone sensitive tumors by blocking the bodys ability to produce hormones
Hormone therapy
683
True or False
a woman diagnosed with certain benign conditions has a slightly higher risk of developing breast cancer
true
684
True or false
most MQSA inspection violations are related to image quality
true
685
Increased or decreased glandularity of the breast can be related to ___ or ____ \_\_\_\_
menarche
hormonal fluctuations
686
lobular carcinoma accounts for ___ to ___ % of all breast cancer
5-10
687
Evaluation of system resolution: what is it
evaluation of limiting resolution
688
if you are diagnosed with a BIRAD C breast composition, your breast composition is
heterogenously dense
689
a condition when the lactiferous duct becomes blocked and causes a greenish discharge
ductal ectasia
690
the ___ \_\_\_\_ of the system is controlled by the number of pixels
image resolution
691
abnormal cells inside the milk duct
ductal carcinoma in situ (DCIS)
692
a high DQE means a ____ dose
lower
693
rhodium produces characteristic radiation in what kev range
20-23 kev
694
brightness can be altered after expusre by altering the ___ \_\_\_ and is independent of the mAs used to acquire the image
window level
695
which of the following would be anindication of a suspicious lesion
a. posterior shadowing
b. smooth borders
c. hypoechoic
both A and C
696
what type of radiation is determiend by the anode material and is confied to a few photon energies only.
characteristic radiation
697
True or false
On the MLO view, it is acceptable not to demonstrate the IMF
false
698
what is the performance criteria of the phantom image
2 fibers, 3 specks, 2 masses
699
a stereotactic biopsy is typically used when a radiologist sees what
suspicisous calcification
700
pocket of fat thar is encapsulated by a thin fibrous capsule common in post- menopausal women
lipoma
701
smoothing reduces ____ and \_\_\_\_
noise and contrast
702
what technique is used to get the breat pulled onto the image receptor for the CC view
bi maual pull
703
approximately how many women will die from breast cancer
female: 40,000
male: 460
704
substatial and has volume
a mass
705
What is the lifetime risk of contracting breast cancer for a woman
1 in 8
706
the cancer has spread form the ducts into the surrounding stromal tissue and may or may not extend into the pectoral fascia and muscle
invasive or infiltrating ductal carcinoma (IDC)
707
what is the grid inerspace material of a linear grid
carbon
708
decreasing the target angle will further decrease the ___ \_\_\_\_ \_\_\_
effective focal spot
709
mens lifetime risk of breast cancer
1 in 1000
710
\_\_\_ uses gestures such as a head nod, or saying "yes" or "okay" to encourage elaboration
facilitation
711
Matching the filter to the same element as the xray tube target will allow what
k-characteristic xrays to pass while blocking thehigher and lower energy bremsstrahlung xrays
712
what can help lesses the recurrence rate following lumpectomy
chemotherapy
713
what is the frequency of the viewing conditions
monthly
714
what tissue is lost on the MLO if the image receptor is too high
inframammary fold
715
what are the mobile borders of the breast
inferior and lateral
716
Women who do not have regular menstruation should perform BSE when
on the same day every month
717
what is the grid ration used in mammography
3:1 - 5:1
718
What happens to a womans risk of developing breast cancer if she has 2 first degree relatives with breast cancer
triples
719
\_\_\_ ___ of the imaging system is the minimum separation between two objects at which they can be distinguished as two separate objects in the image
spatial resolution
720
True or false
a womans breast cancer risk is 2-3 times higher than normal if she has proliferative lesions with atypia
false - its 4-5 times higher
721
skin, fat and muscle from the upper back or thighs or buttocks are used to make a flap
latissimus flap
722
what is the lifetime risk for women
1 in 8
723
a clip is placed after a breast biopsy if
a. a mass is small
b. to continue surveillance
c. lesion is suspicious
d. all of the above
all of the above
724
in what cell layer does breast cancer begin
epithelial cell layer
725
what is the most common placement type for implants
subglandular
726
what is the most common diagnostic view
medial lateral (ML)
727
Together the lobule and the extra lobular terminal duct make up the
TDLU: terminal ductal lobular unit
728
true or false
the lateral medial view maximizes visualization visualization of the lateral tissue
false - the medial side is closest to the detector and best visualized
729
perforating (artery) branches of the ____ and the ___ also supply the breast
internal thoracic artery
intercostal artery
730
short exposure times minimize ___ \_\_\_
motion blur
731
As MTF increases, resolution \_\_\_
increases
732
\_\_\_\_ filtration is usually an Al equivalent material positioned in the path of the emerging beam, thus affecting its penetrating power, which is defined by HVL
added
733
Universal language at the storage and transmission of patient information for the medical community
HL7
734
most common radiatio in the form of a broad spectrum of photon energyies, the max energy is determined by the kv selected
bremsstrauling
735
abnormal growth of tissue
tylectomy
736
A bunch of eight bit is called a \_\_
byte
737
the smaller the pixels, the greater the ___ \_\_\_\_
spatial resolution
738
Preprocessing is automatic and occurs before the image is visualized at the AWS, ___ \_\_\_\_ is used to correct the raw data
automatic rescaling
739
the sentinel node biopsy is performed to determine what
if the breast cancer has metastisized
740
Which part of the breast is best visualized on SIO
upper inner and lower outer
741
Consent given by the patient before any invasive procedure or a proceudre of significant risk
informed consent
742
\_\_\_\_ treatment will determine the exact genetic profle of the altered cancer cells and design a treatment plan bsed ont eh nature of these cells
molecular
743
what are 4 indications for a breast MRI
- new cancer staging
- implants
- evaluation of scarring
- evaluation of high risk patient
744
show mammogrpahically as high optical density tumors with lucent cetners and eggshell like calcifications.
oil cysts
745
What is the number 1 advantage of screening mammography
it is the most effective tool for early detection of breast cancer
746
How often is the radiologist monitor suppose to be cleaned
daily
747
What kind of chemotherapy is given in addition to another breast cancer treatment
adjuvant chemotherapy
748
true or false
4 specks visible in a speck group iwll count as 1/2 of a full point
false - 4-6 specks is a full point
749
what condition occurs when there is an overgrowth of cells in the lobules
lobular hyperplasia
750
consent signed at the time of admission to a hospital or health care setting
general consent / authorization for treatment
751
Each lobe can have ___ to ___ terminal ductules
10 to 100
752
mastectomy patients have what change of reurrence, if zero axillary nodes were involved originally
6
753
Compression of a specimen reduces tissue thickness, thus improving ____ \_\_\_\_
subject contrast
754
irregular, speculated margins, with prior surgery, fixed
malignant
755
what are two things that influence compliance
pleasant experience
understanding technologist
756
what is the most common supplemental view
XCCL
757
an enlargement and or devleopment of new lobular units
adenosis
758
759
what is the kev range of rhodium anode
20.3-22.7
760
what is the frequency of the visual checklist
monthly and after any service
761
increased cellular activity in ducts or lobes. Not a form of breast cancer but is a risk factor
atypical ductal or lobular hyperplasia
762
The TFT collects what
electrons
763
wihtout modification magnification will reduce the ___ of the image beause of geometric unshaprness
resolution
764
Change occuring in the epithelial cells, which exhibit characteristics of apocrine sweat glands
apocrine metaplasia
765
what type of radiation is important for determining xray beam penetration through the breast and optimal constrast
characteristic
766
what maneuver is used to open the IMF on the MLO view
the up and out maneuver
767
Breast tissue consists mostly of adipose, fibrous and glandular tissue, all of which have relatively low ___ \_\_\_
atomic number
768
what is the main difference between the acquisition monitor and rewview workstation monitor QC
the RWS QC contains a phantom evaluation
769
mammography tends to understate the _____ of a lesion
multifocality
770
a term used to describe generalized skin thickening
peau d'orange
771
what is the earliest form of breast cancer
ductal carcinoma in situ (DCIS)
772
A tracking system to track positive pathology is required to comply with ___ regulations
MQSA
773
What equipment is needed for the phantom image QC
ACR DM phantom
774
what is the tube angle for a sterotactic and on what axis
15 degrees
x-axis
775
Preprocessing is automatic and occurs before the image is visualized at the AWS, aplication of processing algorithms to generate a \_\_\_\_
histogram
776
HIS is a data infomration system that manages what
a. legal
b. financial
c. medical
d. all of the above
all of the above
777
TRAM reconstruction stands for transverse rectus abdominus
myocutaneous
778
what is the typical SID in mammography
65-66 cm
779
What does angling the anode do
creates the anode heel effect and creates a bigger field of view
780
The abdnomal cells grow withing the lobules but do not penetrate through the lobule walls and often is not seen mammographically
lobular carcinoma in situ (LCIS)
781
which type of biopsy device would you used if the patient has a blood clotting disorder
core biopsy - non vacuum
782
what would the recommendation be for a category 0 BIRAD
must indicate what additional imaging study is recommended
783
a technique used to reduce toral breast size for cosmetic or medial reasons
reduction
784
Why would we never use a Rh/Mo target
it filters out the needed bremsstrauling radiation needed
785
What is the name of the lateral border of the breast that we use to position the MLO
mid axillary line
786
an area of fibroglandular tissue seen onlu in one projection
asymmetry
787
These lesions can have a solid central tumor with radiating structures and ill defined borders
spiculated or stellate lesions
788
what are the back up tomes for grid and non grid
600 mAs -grid
300 mAS - non grid
789
The biological effect of mammography is assuemd to be more closely associated with the ___ \_\_\_ ___ by the glandular tissue
total energy absorbed
790
true or false
most local recurrences occur in the first 5 year
true
791
which of the following would not count as a repeat
a. good images in retrospect
b. poor positioning
c. additional viws needed to visualize the entire breast
d. patient motion
additional views needed ot visualize the entire breast
792
True or false
ER/PR negative tumors have few or no hormone receptors
true
793
the axillary artery gets its blood supply from teh ____ and the \_\_\_\_
lateral thoracic artery
acromiothoracic branches
794
what type of anode is used in mammo because they produce characteristic radiation at optimal energies to penetrate the average non dense breast with optimal contrast
molybdenum
795
On the MLO view, what breast tissue is at risk of being missed
medial
796
the emission of the bluish -purple light from electrons as they transition from higher to lower energy
photostimulable luminescence
797
cancer that begings in the lobules of the breast
invasive lobular carcinoma
798
a conical projection in the center of the areola which acts as the outlet of milk
nipple
799
describes an increase in the number of eptithelia cells lining the duct
epithelia hyperplasia
800
The main direction of drainnage from teh central and lateral half of the breast tends to be into the ___ group of axillary lymph nodes
pectoral
801
What hormone is responsible for lobular proliferation and growth
progesterone
802
what is the result of an improper up and out maneuver on the MLO
camels noes
803
The posterior nipple lline (PNL) should be no more than how many cm difference between the CC and MLO
within 1 cm
804
in direct capture what is the photoconductor made of
amorphous selenium
805
molybdenum target produces what type of interaction
photelectric
characteristic
806
the first lymph node that drains lymph from a specific area of the body
sentinal node
807
AWS stands for
acquisition workstation
808
a radiographically dense, encapsultated round and movable benign tumor seen frequently in women \<30 years of age and developes from epithelia and fibroblastic tisues
fibroadenoma
809
fibroadenomas are caused by higher than normal ___ level
estrogen
810
descriptive term used for the plates used in both idrect and indirect DR digital systems
flat panel detector
811
Where does the resolution measure the sharpest
anode
812
what is the best way to get rid of skin folds on the CC
the fingerprint roll
813
4 specks visible in a speck group will count as how many points
1
814
layer of fat directly beneath the skin
subcutaneous fat layer
815
True or false
hormone receptors are proteins found on the surface and inside of some cancer cells
true
816
Which is a indication for chemotherpay
positive lymph nodes
817
what equipment is needed for the repeat analysis
all rejected mammos
818
Are minute calcium deposits in the breast that could indicate the presence of malignancy, although they can be benign
microcalcifications
819
a box of cells with numeric values arranged in rows and columns
matrix
820
What is the reason why moly anode is used for the average breast size
characteristic radiation
821
Mammary glands are a specific type of ____ or ___ sweat glands that are specialized to manufacture colostrum and milk
sudoriferous
aprocrine
822
which of the following would be used to evaluate breast problems at a cellular level
a. FNA
b. galactogram
c. cyst aspiration
d. core biopsy - no vacuum
FNA
823
mammography grids absorb what percentage of scatter
75-85%
824
TRAM flap
transverse rectus abdominis myocutaneous glap
825
beam quality assessment/half value layer evaluation. Physicists tests how often and what is it
annually
assure half value layer
826
DELs are located within the
TFT
827
828
The lowest attachement of the breast to the anteiror chest wall.
inframammary fold
829
why should the detector caibration frequency be done weekly
individual elements of the detector matrix may drift in sensitivity to different x-ray intensities
830
to feel; examine by touch
palpation
831
what happens if you get a repeat of an EQUIP violation level 2 the following year
you receive a level 2 violation that must be corrected within 15 days
832
a non invasive nuclear medicine examination that may be used to investigate a breast abnormality that has been discovered on mammography
scintimammography
833
Cancer that begins growing in the duct, but then gorws into the fatty tissues on the breast
invasive/infiltrating ductal carcinoma
834
Greater number of pixels equals greater ___ \_\_\_\_
image resolution
835
ACR guidelines for when women should start mammograms
40
30 if high risk
836
The number of shades of gray demonstrated
bit depth
837
true or false
tamoxifen is a hormone inhibitor that blocks estrogen from attaching to the cancer wall
true
838
when imaging the CC view you bring the height of the image recetor to what level
the level of the inframammary crease
839
what is the difference between indirect caputre and direct digital capture
indirect - light
direct - no light
840
what is another name for a honeycomb grid
HTC (high transmission cellular)
841
what is another name for asymmetrical breast tissue
focal architectural distortion (FAD)
842
the amoutn of aluminum it takes to cut an xray beam by 50% is called
half value layer
843
Grids are not used with ___ mammography
magnification
844
How often do physicists test the mammogrpahy unit assembly and what do they do
annually
check all locks, detents and mechanical devices
845
Breast cancer staging N1 means
1 or 2 lymph nodes invovled
846
a benign condition that looks like a breast within a breast
hamartoma
847
Rules for scoring masses
if they are not circular but visible or 1/2 moon shaped they are scored a
0.5
848
A common tube tilt is \_\_degrees
6
849
The AJCC standardized staging
T
N
M
T - tumor size
N- denotes lymph node spread
M- assesses distant metastasis
850
In the United States, what percentage of breast cancers are found in males
1%
851
what is the space that lies between the glandular tissue and the pectoral muscle
retromammary fat space
852
\_\_\_\_ can be used for diagnosis both cystic and solid lesions
fine needle biopsy
853
Consent given in writing
written consent
854
an inflammatory cancerous affection of the areola and nipple; usually associated within underlying ductal carcinoma
pagets disease
855
what cancer does not typically form a lump but feels more like thickening or fulness
invasive lobular carcinoma
856
ACS guidlines for MRI on a high risk patient are
once a year, 6 months apart from a mammogram
857
what is the best view for visualizing milk of calcium
ML or LM
858
If a patient is a returning patient, how long does the facility have to retain images for
minimum of 5 years
859
the process of increasing the size of the breast is termed
augmentation
860
the amount of light (PSL) emitted by the PSP during the reading process is related to the level of ___ received by the receptor, knonw as __ \_\_\_\_
exposure
speed class
861
True or false
a periodic clinical image review of all active RT and IPs required at least quarterly
false - it is required annually
862
\_\_--\_\_\_% of normal breasts will show asymmetrical densities in the outer
3-5%
863
Rules for scoring masses
If a small part is missing, or if there are different dnesities in the whole mass or 75% of the circular border is visible it is scored as
1
864
the greater the number of pixels the great the ____ \_\_\_\_
image resolution
865
ACS guidlines for breast cancer screening
30-44 informed consent
45-54 yearly
55+ every other year
866
from the internal mammary nodes, drainage tends toward the ___ \_\_\_\_ and others may cross the ___ margin thus comminucating with the opposite breast
mediastinal nodes
costal margin
867
What is the frequency of the the phantom image QC
weekly
868
Which of the following would typically be found in the axilla
a. fibroadenoma
b. oil cyst
c. lymph nodes
d. lipomas
lymph nodes
869
The ACS recommeneds a CBE how often and at what age
every 3 years from 20-39
every year after 40
