About The Fluoroscopy Exam

1. Patient Interactions and Management (9 questions)

A. Patient Identification and Procedure Verification

B. Components of Informed Consent

C. Risk versus Benefit

D. (NEW) Patient Education

1. (NEW) explanation

2. (NEW) respond to inquiries (not limited to: e.g., radiation dose, types of radiation)

E. Procedural Understanding to Reduce Exposure

F. Procedure Radiation Exposure (NCRP #160)

G. Cumulative Dose Education

H. Pregnancy Status (e.g., tests and limitations)

I. Contrast Reactions

1. allergy history (e.g., appropriate pre-medication

2. types of reactions (mild to severe)

J. Patient Record Information

1. patient dose/technical factors

2. (NEW) adverse reactions

3. picture archiving and communication systems (PACS)

4. hospital information systems (HIS)

5. radiology information systems (RIS)

6. (NEW) electronic medical record (EMR) or electronic health record (EHR) systems

K. Standards of Care

L. HIPAA

1. Radiation Physics and Radiobiology (22 questions)

A. Radiation Physics

1. photon interactions with matter

a. Compton effect

b. photoelectric absorption

c. coherent (classical) scatter

d. attenuation by various tissues

2. x-ray production

a. source of free electrons (e.g., thermionic emission)

b. acceleration of electrons

c. focusing of electrons

d. deceleration of electrons

e. target interaction (e.g., x-ray spectrum)

3. x-ray beam

a. frequency and wavelength

b. beam characteristics

c. scatter

d. inverse square law

e. fundamental properties (e.g., travel in straight lines, ionize matter)

B. Radiation Biology

1. radiosensitivity

a. dose-response relationships

b. relative tissue radiosensitivity (e.g., LET, RBE)

c. cell survival and recovery

d. oxygen effect

2. somatic effects

a. short-term versus long-term effects

b. acute versus chronic effects

c. carcinogenesis

d. organ and tissue response (e.g., eye, thyroid, breast, bone marrow, skin, gonadal)

3. embryonic and fetal risks

4. genetic effects

2. Radiation Protection (24 questions)

A. Minimizing Patient Exposure

1. exposure factors

a. fluoroscopy time

b. automatic brightness control (ABC)

c. automatic exposure rate control (AERC)

2. shielding

a. rationale for use

b. types

c. placement

3. beam restriction

a. purpose of primary beam restriction

b. collimators

4. filtration

a. effect on skin and organ exposure

b. effect on average beam energy

c. NCRP recommendations (NCRP #102, minimum filtration in useful beam)

5. equipment features

a. last image hold

b. cumulative timer

c. magnification mode

d. dose mode

6. pediatric dose reduction

7. (NEW) grids

8. (NEW) receptor positioning

9. patient positioning

a. impact on dose

b. patient immobilization devices

10. (NEW) does or time documentation

11. (NEW) dose area product (DAP) meter

12. (NEW) air kerma display

13. (NEW) minimum source-to-skin distance (21 CFR)

B. Personnel Protection

1. sources of radiation exposure

a. primary x-ray beam

b. secondary radiation

c. patient as source

2. basic methods of protection

a. time

b. distance

c. shielding

3. protective devices

a. protective drapes

b. Bucky slot cover

c. shields (e.g., aprons, gloves, eye, face, floating, thyroid)

d. attenuation properties

e. (NEW) cumulative timer

f. (NEW) remote-controlled fluoroscopy

4. minimum lead equivalent (NCRP #102)

5. (NEW) guidelines for fluoroscopy and mobile units (NCRP #102, 21 CFR)

a. (NEW) fluoroscopy exposure rates (e.g., normal, high-level control)

b. (NEW) exposure switch guidelines

6. recommendations for personnel monitoring (NCRP #116)

a. occupational exposure

b. public exposure

c. embryo/fetus exposure

d. ALARA and dose equivalent limits

e. evaluation and maintenance of personnel dosimetry records

7. units of measurement

a. absorbed dose

b. dose equivalent

c. exposure

d. effective dose

e. (NEW) air kerma

8. dosimeters

a. types

b. proper use

1. Equipment Operation (22 questions)

A. Technical Factors

1. mA

2. kVp

3. object-to-image distance (OID)

4. source-to-image distance (SID)

5. focal spot size

6. grids

7. filtration

8. beam restriction

9. automatic brightness control (ABC)

10. automatic exposure rate control (AERC)

11. anatomic alignment

12. exposure compensation

13. magnification mode

14. spot imaging (digital spot)

15. high level control (boost, high dose rate)

16. pulse rate

B. Image Receptors

1. image intensifier

2. flat panel detector

C. Image Display

1. viewing conditions (e.g., luminance, ambient lighting, eye physiology, ergonomics)

2. spatial resolution (e.g., pixel size, pixel pitch

3. contrast resolution/dynamic range

4. DICOM gray scale function

5. (NEW) brightness and contrast

D. Recording Systems

1. digital subtraction angiography (DSA)

2. image capture

3. spot imaging (digital spot)

E. (NEW) Imaging Informatics

1. (NEW) digital imaging and communications in medicine (DICOM)

2. (NEW) picture archiving and communication systems (PACS)

3. (NEW) radiology information system (RIS) (e.g., modality worklist)

4. (NEW) hospital information system (HIS)

5. (NEW) electronic medical records (EMR) or electronic health records (EHR)

2. Image Evaluation and Quality Control (13 questions)

A. Digital Image Characteristics

1. spatial resolution (equipment related)

a. sampling frequency

b. detector element size (DEL) (e.g., size, pitch, fill factor)

c. receptor size and matrix size

d. (NEW) pixel characteristics (e.g., size, pitch)

2. image signal (exposure related)

a. quantum mottle (quantum noise)

b. (NEW) dynamic range

c. signal to noise ratio (SNR)

d. contrast to noise ratio (CNR)

3. (NEW) contract resolution (equipment related)

a. (NEW) bit depth

b. (NEW) modulation transfer function (MTF)

c. (NEW) detective quantum efficiency (DQE)

B. Criteria for Image Evaluation

1. demonstration of anatomical structures (e.g., positioning, motion)

2. identification markers (radiographic or electronic) (e.g., anatomical, patient, date)

3. patient considerations (e.g., pathologic conditions)

4. (NEW) quantum mottle (quantum noise)

5. (NEW) gross exposure error (e.g., loss of contrast, saturation)

6. (NEW) contrast

7. (NEW) spatial resolution

8. (NEW) distortion (e.g., size, shape)

9. image artifacts (e.g., grid lines, dead pixels, distortion)

C. Recognition and Reporting of Malfunctions

1. quality control

a. (NEW) display monitor (e.g., grayscale standard display function, luminance

b. shielding accessory testing (e.g., lead apron and glove testing)

c. exposure rate output

d. spot imager

e. image quality (e.g., resolution)

2. recording and reporting of overexposure