This document contains rationales for questions on the 2007 ACR Diagnostic Radiology In-Training Exam related to breast radiology. The rationales discuss the correct answers and explain why the other answer options are incorrect based on imaging findings and characteristics of different breast diseases. Invasive lobular carcinoma is identified as the most likely diagnosis for one case based on its appearance on mammography of being seen best on one view only or at least.
Gallium-67 citrate scintigraphy is preferred over In-111 leukocyte scintigraphy for the detection of disk space infection. While both agents are sensitive for osteomyelitis, gallium-67 has been shown to be more sensitive for disc space infection compared to In-111 leukocyte imaging. This is due to potentially confusing normal bowel activity seen on gallium-67 scans that could obscure abdominal pathology. In-111 leukocyte imaging is generally preferred for evaluating other infectious/inflammatory conditions like abdominal abscesses and infected joint prostheses due to less potential for false positives from normal biodistribution.
The document provides rationales for questions on an interventional radiology exam. It includes descriptions of imaging findings and the correct answers for 7 multiple choice questions. For each question, it summarizes the key imaging findings and explains why the correct answer is right and the other options are wrong based on those findings and published references. The questions cover topics like cholangiocarcinoma, splenic artery occlusion, pneumothorax management, mesenteric ischemia, Eustachian valve, gonadal vein reflux, and popliteal artery entrapment syndrome.
This document contains rationales for questions on the 2007 ACR Diagnostic Radiology In-Training Exam related to cardiac radiology. Question 102 asks which statement about cardiomyopathies is true. The correct answer is that cyclosporine immunosuppressive therapy can cause left ventricular hypertrophy. Cyclosporine is used after cardiac transplantation and can result in left ventricular hypertrophy as a side effect.
The document provides rationales for questions on a diagnostic radiology exam. Question 29 asks about an image showing changes in the small bowel. The most likely diagnosis is graft versus host disease based on the classic "ribbon bowel" appearance seen in the image. Graft versus host disease produces a total absence of mucosal folds in the small bowel, typically seen in the ileum rather than jejunum as seen in the image. This appearance is distinct from other potential diagnoses that may also cause small bowel abnormalities.
The document discusses several radiology cases involving the brain and spine. Question 291 presents CT scans of a woman with headaches and asks for the most likely diagnosis of a fat-containing extraconal orbital mass. Question 292 shows MR images of a woman with extremity weakness and asks for the most likely diagnosis of multiple brain and spine lesions. Question 293 presents MR images of a man with back pain and asks for the diagnosis of a posterior spinal mass seen on the images.
A post-menopausal woman presented with an asymptomatic 3.0 cm simple ovarian cyst. Of the following statements, the one that is TRUE is that the cyst should be removed if the patient has an increased serum CA-125 level. A simple cyst under 5.0 cm in diameter in a post-menopausal woman has a very low risk of malignancy and can be followed with serial ultrasounds without surgery. The most common neoplasm found on surgical removal of these cysts is a serous cystadenoma, not a fibrothecoma.
This document contains 3 figures and associated questions from a diagnostic radiology in-training examination. Figure 1 shows images from an F-18 FDG PET study in a man with abdominal pain. Figure 2 shows a posterior Tc-99m bone scintigram in a man with back pain. Figure 3 shows an anterior whole body Tc-99m bone scan in a woman with head and neck pain and a history of thyroid cancer. The questions assess the examinee's ability to interpret the images and select the most likely diagnosis.
This document provides rationales for answers on a diagnostic radiology exam related to musculoskeletal radiology. The case presented involves radiographs and MRI images of various musculoskeletal injuries and conditions. The correct diagnosis for each case is provided along with explanations for why the other answer choices are incorrect. Key details that help distinguish between similar conditions are emphasized, such as findings that are more or less typical for a given diagnosis. A variety of musculoskeletal injuries, abnormalities, and diseases are discussed.
Gallium-67 citrate scintigraphy is preferred over In-111 leukocyte scintigraphy for the detection of disk space infection. While both agents are sensitive for osteomyelitis, gallium-67 has been shown to be more sensitive for disc space infection compared to In-111 leukocyte imaging. This is due to potentially confusing normal bowel activity seen on gallium-67 scans that could obscure abdominal pathology. In-111 leukocyte imaging is generally preferred for evaluating other infectious/inflammatory conditions like abdominal abscesses and infected joint prostheses due to less potential for false positives from normal biodistribution.
The document provides rationales for questions on an interventional radiology exam. It includes descriptions of imaging findings and the correct answers for 7 multiple choice questions. For each question, it summarizes the key imaging findings and explains why the correct answer is right and the other options are wrong based on those findings and published references. The questions cover topics like cholangiocarcinoma, splenic artery occlusion, pneumothorax management, mesenteric ischemia, Eustachian valve, gonadal vein reflux, and popliteal artery entrapment syndrome.
This document contains rationales for questions on the 2007 ACR Diagnostic Radiology In-Training Exam related to cardiac radiology. Question 102 asks which statement about cardiomyopathies is true. The correct answer is that cyclosporine immunosuppressive therapy can cause left ventricular hypertrophy. Cyclosporine is used after cardiac transplantation and can result in left ventricular hypertrophy as a side effect.
The document provides rationales for questions on a diagnostic radiology exam. Question 29 asks about an image showing changes in the small bowel. The most likely diagnosis is graft versus host disease based on the classic "ribbon bowel" appearance seen in the image. Graft versus host disease produces a total absence of mucosal folds in the small bowel, typically seen in the ileum rather than jejunum as seen in the image. This appearance is distinct from other potential diagnoses that may also cause small bowel abnormalities.
The document discusses several radiology cases involving the brain and spine. Question 291 presents CT scans of a woman with headaches and asks for the most likely diagnosis of a fat-containing extraconal orbital mass. Question 292 shows MR images of a woman with extremity weakness and asks for the most likely diagnosis of multiple brain and spine lesions. Question 293 presents MR images of a man with back pain and asks for the diagnosis of a posterior spinal mass seen on the images.
A post-menopausal woman presented with an asymptomatic 3.0 cm simple ovarian cyst. Of the following statements, the one that is TRUE is that the cyst should be removed if the patient has an increased serum CA-125 level. A simple cyst under 5.0 cm in diameter in a post-menopausal woman has a very low risk of malignancy and can be followed with serial ultrasounds without surgery. The most common neoplasm found on surgical removal of these cysts is a serous cystadenoma, not a fibrothecoma.
This document contains 3 figures and associated questions from a diagnostic radiology in-training examination. Figure 1 shows images from an F-18 FDG PET study in a man with abdominal pain. Figure 2 shows a posterior Tc-99m bone scintigram in a man with back pain. Figure 3 shows an anterior whole body Tc-99m bone scan in a woman with head and neck pain and a history of thyroid cancer. The questions assess the examinee's ability to interpret the images and select the most likely diagnosis.
This document provides rationales for answers on a diagnostic radiology exam related to musculoskeletal radiology. The case presented involves radiographs and MRI images of various musculoskeletal injuries and conditions. The correct diagnosis for each case is provided along with explanations for why the other answer choices are incorrect. Key details that help distinguish between similar conditions are emphasized, such as findings that are more or less typical for a given diagnosis. A variety of musculoskeletal injuries, abnormalities, and diseases are discussed.
This document provides rationales for questions from the 2007 ACR Diagnostic Radiology In-Training Exam related to ultrasound imaging. It discusses the correct answers and rationales for questions regarding various pathologies seen on ultrasound of the uterus, testes, kidneys, abdomen and fetal anatomy. Key details include identifying a cornual pregnancy based on its location, tubular ectasia of the rete testis in an older male, medullary nephrocalcinosis seen as echogenic renal pyramids, the left renal vein in the transverse abdominal image, and measuring fetal head circumference at the level of the thalami and cavum septi pellucidi.
The document discusses rationales for questions on the 2007 ACR Diagnostic Radiology In-Training Exam related to nuclear radiology. It provides details and images from various nuclear medicine studies, including thyroid scintigraphy, bone scintigraphy, renal scintigraphy, CNS shunt study, pulmonary perfusion scan, PET imaging, and radioimmunotherapy. For each question, it discusses the correct answer and explains why the other answer options are incorrect based on the findings and characteristics of the studies.
This document contains a radiology case study with 4 images (Figures 1-4) and accompanying questions. Figure 1 shows a lateral cervical spine x-ray. The diagnosis is ankylosing spondylitis based on diffuse bony ankylosis throughout the cervical spine. Figure 2 shows MRI images of the knee with a diagnosis of discoid meniscus due to excessive meniscal tissue. Figure 3 shows x-rays of the leg with a diagnosis of Brodie's abscess, seen as an elongated lytic lesion in the tibia. Figure 4 shows knee images of a 13-year-old boy with a diagnosis of chondroblastoma, seen as a well-defined lesion in the proximal tib
This document contains rationales for exam questions related to neuroradiology. Question 70 describes images showing increased T2 signal in the dorsal columns of the cervical spinal cord. The most likely diagnosis is subacute combined degeneration, which is caused by vitamin B12 deficiency and commonly presents with numbness in the hands. Question 71 concerns images of a child with seizures and developmental delay, showing features of holoprosencephaly. Question 72 discusses images of a man with seizures, showing a punctate calcification with ring enhancement, most consistent with cysticercosis given the patient's Hispanic ethnicity.
- Echogenic intracardiac focus is most commonly seen as a normal variant on prenatal ultrasound but should prompt careful examination for other abnormalities.
- While it represents a normal variant, echogenic intracardiac focus has been associated with trisomy 13 and 21 but not trisomy 18.
- The majority (90%) of echogenic intracardiac foci are located in the left ventricle, not the right ventricle as stated in one response option.
This document contains a multiple choice question and rationales from a pediatric radiology exam. The question shows MRI images of a 22-week fetus and asks for the most likely diagnosis. The rationales eliminate the other answer choices of posterior urethral valves, multicystic dysplastic kidneys, and bilateral ureteropelvic junction obstruction. The correct answer is Autosomal Recessive Polycystic Kidney Disease, as the images show enlarged, fluid-intensity kidneys without urine production, typical of this condition.
This document provides rationales for questions on the 2005 American College of Radiology Diagnostic In-Training Examination for interventional radiology residents. It includes the questions, images associated with some questions, findings for each image, and rationales for the correct answers. The questions cover topics such as locations of dialysis catheters, diagnoses for angiograms, standards for uterine artery embolization, and indications for percutaneous nephrostomy.
This document provides rationales for questions on the 28th Annual In-Training Examination for Diagnostic Radiology Residents. It includes explanations for answers to 5 multiple choice questions related to pediatric radiology cases. The questions cover topics such as autosomal recessive polycystic kidney disease, everting ureterocele, necrotizing enterocolitis, non-accidental trauma, and vein of Galen aneurysm. The rationales discuss the findings in the images and explain why each answer choice is right or wrong based on those findings and typical presentations of the diseases.
The 48-hour whole body In-111 pentetreotide images showed multiple focal areas of increased tracer uptake in both lobes of the liver, consistent with neuroendocrine tumor hepatic metastases. There was also a large focal area of increased uptake in the epigastric region in the expected location of the pancreas body. The most likely diagnosis given these findings is islet cell carcinoma of the pancreas. Pheochromocytoma, carcinoid tumor, lymphoma, and colon adenocarcinoma are less likely given the imaging findings.
A 15-year-old female volleyball player presented with low back pain without trauma. Bone scan showed increased uptake in the left L5 lamina. SPECT localized this to the pars interarticularis. Radiographs were normal. This is most consistent with a stress fracture of the left L5 pars interarticularis, a common injury in young athletes.
The document describes 3 radiology case studies involving the gastrointestinal system:
1) A case of scleroderma diagnosed based on an x-ray showing dilation of the small bowel with closely spaced folds.
2) A case of appendicitis diagnosed on CT showing an enlarged appendix with periappendiceal inflammation and an appendicolith.
3) A case of a gastric leiomyoma diagnosed on barium study and CT showing a rounded filling defect in the stomach with central ulceration arising from the gastric wall.
A 23-year-old woman presented with hearing loss. CT showed a soft tissue mass in the left middle ear cavity eroding the scutum and demineralizing the ossicles. The most likely diagnosis is cholesteatoma, a common middle ear soft tissue mass.
A 68-year-old woman presented with left eye pain and proptosis. Angiography showed early filling of both cavernous sinuses and ophthalmic veins, indicating a carotid-cavernous fistula.
MR of a 6-month-old boy with vomiting showed a large enhancing mass in the left lateral ventricle with flow voids. The most likely diagnosis is a choroid plexus
This document contains 5 clinical case scenarios involving interventional radiology procedures (questions 265-269). Each case is accompanied by an image and 4 possible answers. The correct answer is identified and a brief rationale is provided for each case. Question 270-279 continue testing knowledge of interventional radiology with additional multiple choice questions related to procedures, techniques, and disease processes.
- The document discusses a chest radiograph and CT images of a 51-year-old man with shortness of breath. It shows bilateral perihilar opacities on chest radiograph and thin-walled cysts, ground glass opacities, and reticular opacities on CT.
- The most likely diagnosis is Pneumocystis carinii pneumonia. Findings are consistent with PCP including bilateral often perihilar reticular and ground glass opacification that may become confluent and cysts that are commonly multiple and have predilection for upper lobes.
- Other choices such as pulmonary alveolar proteinosis, cardiogenic pulmonary edema, idiopathic pulmonary fibrosis are
The document discusses images from radiology exams of the pelvis and genitourinary system. Figure 1 shows a sagittal MRI of the pelvis showing diffuse thickening of the junctional zone, consistent with adenomyosis. Figures 2A and 2B show an intratesticular mass on ultrasound, indicating seminoma. Figures 3A-C show an ovarian teratoma on ultrasound and MRI of the pelvis in a pregnant patient. Figure 4 shows a bladder tumor on CT scan in a patient with hematuria. Figure 5 shows a hysterosalpingogram indicating Asherman's syndrome. Figures 6A-C show renal cell carcinoma extending into the renal vein, stage IIIA by
This document appears to be a series of questions and answers from a diagnostic radiology in-training examination. The questions cover topics in genitourinary tract radiology and ask examinees to identify diagnoses, classifications, or characteristics based on provided radiographic images and clinical scenarios. Rationales are given for each answer that provide additional radiologic and clinical details.
The document discusses gastrointestinal radiology and contains questions and answers about various gastrointestinal conditions and imaging findings. Question 226 asks which finding on helical CT with dynamic bolus contrast enhancement is the best prognostic indicator of acute pancreatitis. The correct answer is the presence of pancreatic necrosis.
Presentation1, pet ct, functional mri and ct angiography in bone tumour.Abdellah Nazeer
This document discusses the use of PET/CT, functional MRI, and CT angiography in evaluating bone tumors. It provides the following key points:
1) PET/CT uses radioactive tracers like FDG to detect cancer cells through their increased glucose metabolism, allowing detection of tumors at early stages. The degree of FDG uptake does not necessarily correlate with a bone tumor's malignant potential.
2) Functional MRI techniques like diffusion weighted imaging and magnetic resonance spectroscopy provide additional tumor characterization by revealing water mobility and choline metabolites related to cellularity.
3) CT angiography is useful for determining a tumor's relationship to major blood vessels, though its role is now limited due to the capabilities of other modalities
The document is the rationales section from an in-training examination for diagnostic radiology residents sponsored by the American College of Radiology. It contains multiple choice questions in physics related to topics like radiation dose, CT, MRI, fluoroscopy, and radiography. For each question, the correct answer is identified and supported by a short explanation citing relevant references.
Presentation2, radiological imaging of gastrointestinal schwannoma.Abdellah Nazeer
This document discusses radiological imaging findings of gastrointestinal schwannomas. Some key points:
- Gastrointestinal schwannomas most commonly occur in the stomach (60-70% of cases). On CT and MRI, they often appear as well-defined, hypodense masses that demonstrate homogeneous enhancement with contrast.
- While radiological imaging findings are nonspecific, gastrointestinal schwannomas typically have the appearance of a solitary mass, and immunohistochemical staining can aid in diagnosis.
- Schwannomas can also occur in rare locations like the pancreas, adrenal gland, retroperitoneum, abdominal wall, pelvis and liver. Imaging characteristics vary depending on the location but may include cystic degeneration
This document provides rationales for questions from the 2007 ACR Diagnostic Radiology In-Training Exam related to ultrasound imaging. It discusses the correct answers and rationales for questions regarding various pathologies seen on ultrasound of the uterus, testes, kidneys, abdomen and fetal anatomy. Key details include identifying a cornual pregnancy based on its location, tubular ectasia of the rete testis in an older male, medullary nephrocalcinosis seen as echogenic renal pyramids, the left renal vein in the transverse abdominal image, and measuring fetal head circumference at the level of the thalami and cavum septi pellucidi.
The document discusses rationales for questions on the 2007 ACR Diagnostic Radiology In-Training Exam related to nuclear radiology. It provides details and images from various nuclear medicine studies, including thyroid scintigraphy, bone scintigraphy, renal scintigraphy, CNS shunt study, pulmonary perfusion scan, PET imaging, and radioimmunotherapy. For each question, it discusses the correct answer and explains why the other answer options are incorrect based on the findings and characteristics of the studies.
This document contains a radiology case study with 4 images (Figures 1-4) and accompanying questions. Figure 1 shows a lateral cervical spine x-ray. The diagnosis is ankylosing spondylitis based on diffuse bony ankylosis throughout the cervical spine. Figure 2 shows MRI images of the knee with a diagnosis of discoid meniscus due to excessive meniscal tissue. Figure 3 shows x-rays of the leg with a diagnosis of Brodie's abscess, seen as an elongated lytic lesion in the tibia. Figure 4 shows knee images of a 13-year-old boy with a diagnosis of chondroblastoma, seen as a well-defined lesion in the proximal tib
This document contains rationales for exam questions related to neuroradiology. Question 70 describes images showing increased T2 signal in the dorsal columns of the cervical spinal cord. The most likely diagnosis is subacute combined degeneration, which is caused by vitamin B12 deficiency and commonly presents with numbness in the hands. Question 71 concerns images of a child with seizures and developmental delay, showing features of holoprosencephaly. Question 72 discusses images of a man with seizures, showing a punctate calcification with ring enhancement, most consistent with cysticercosis given the patient's Hispanic ethnicity.
- Echogenic intracardiac focus is most commonly seen as a normal variant on prenatal ultrasound but should prompt careful examination for other abnormalities.
- While it represents a normal variant, echogenic intracardiac focus has been associated with trisomy 13 and 21 but not trisomy 18.
- The majority (90%) of echogenic intracardiac foci are located in the left ventricle, not the right ventricle as stated in one response option.
This document contains a multiple choice question and rationales from a pediatric radiology exam. The question shows MRI images of a 22-week fetus and asks for the most likely diagnosis. The rationales eliminate the other answer choices of posterior urethral valves, multicystic dysplastic kidneys, and bilateral ureteropelvic junction obstruction. The correct answer is Autosomal Recessive Polycystic Kidney Disease, as the images show enlarged, fluid-intensity kidneys without urine production, typical of this condition.
This document provides rationales for questions on the 2005 American College of Radiology Diagnostic In-Training Examination for interventional radiology residents. It includes the questions, images associated with some questions, findings for each image, and rationales for the correct answers. The questions cover topics such as locations of dialysis catheters, diagnoses for angiograms, standards for uterine artery embolization, and indications for percutaneous nephrostomy.
This document provides rationales for questions on the 28th Annual In-Training Examination for Diagnostic Radiology Residents. It includes explanations for answers to 5 multiple choice questions related to pediatric radiology cases. The questions cover topics such as autosomal recessive polycystic kidney disease, everting ureterocele, necrotizing enterocolitis, non-accidental trauma, and vein of Galen aneurysm. The rationales discuss the findings in the images and explain why each answer choice is right or wrong based on those findings and typical presentations of the diseases.
The 48-hour whole body In-111 pentetreotide images showed multiple focal areas of increased tracer uptake in both lobes of the liver, consistent with neuroendocrine tumor hepatic metastases. There was also a large focal area of increased uptake in the epigastric region in the expected location of the pancreas body. The most likely diagnosis given these findings is islet cell carcinoma of the pancreas. Pheochromocytoma, carcinoid tumor, lymphoma, and colon adenocarcinoma are less likely given the imaging findings.
A 15-year-old female volleyball player presented with low back pain without trauma. Bone scan showed increased uptake in the left L5 lamina. SPECT localized this to the pars interarticularis. Radiographs were normal. This is most consistent with a stress fracture of the left L5 pars interarticularis, a common injury in young athletes.
The document describes 3 radiology case studies involving the gastrointestinal system:
1) A case of scleroderma diagnosed based on an x-ray showing dilation of the small bowel with closely spaced folds.
2) A case of appendicitis diagnosed on CT showing an enlarged appendix with periappendiceal inflammation and an appendicolith.
3) A case of a gastric leiomyoma diagnosed on barium study and CT showing a rounded filling defect in the stomach with central ulceration arising from the gastric wall.
A 23-year-old woman presented with hearing loss. CT showed a soft tissue mass in the left middle ear cavity eroding the scutum and demineralizing the ossicles. The most likely diagnosis is cholesteatoma, a common middle ear soft tissue mass.
A 68-year-old woman presented with left eye pain and proptosis. Angiography showed early filling of both cavernous sinuses and ophthalmic veins, indicating a carotid-cavernous fistula.
MR of a 6-month-old boy with vomiting showed a large enhancing mass in the left lateral ventricle with flow voids. The most likely diagnosis is a choroid plexus
This document contains 5 clinical case scenarios involving interventional radiology procedures (questions 265-269). Each case is accompanied by an image and 4 possible answers. The correct answer is identified and a brief rationale is provided for each case. Question 270-279 continue testing knowledge of interventional radiology with additional multiple choice questions related to procedures, techniques, and disease processes.
- The document discusses a chest radiograph and CT images of a 51-year-old man with shortness of breath. It shows bilateral perihilar opacities on chest radiograph and thin-walled cysts, ground glass opacities, and reticular opacities on CT.
- The most likely diagnosis is Pneumocystis carinii pneumonia. Findings are consistent with PCP including bilateral often perihilar reticular and ground glass opacification that may become confluent and cysts that are commonly multiple and have predilection for upper lobes.
- Other choices such as pulmonary alveolar proteinosis, cardiogenic pulmonary edema, idiopathic pulmonary fibrosis are
The document discusses images from radiology exams of the pelvis and genitourinary system. Figure 1 shows a sagittal MRI of the pelvis showing diffuse thickening of the junctional zone, consistent with adenomyosis. Figures 2A and 2B show an intratesticular mass on ultrasound, indicating seminoma. Figures 3A-C show an ovarian teratoma on ultrasound and MRI of the pelvis in a pregnant patient. Figure 4 shows a bladder tumor on CT scan in a patient with hematuria. Figure 5 shows a hysterosalpingogram indicating Asherman's syndrome. Figures 6A-C show renal cell carcinoma extending into the renal vein, stage IIIA by
This document appears to be a series of questions and answers from a diagnostic radiology in-training examination. The questions cover topics in genitourinary tract radiology and ask examinees to identify diagnoses, classifications, or characteristics based on provided radiographic images and clinical scenarios. Rationales are given for each answer that provide additional radiologic and clinical details.
The document discusses gastrointestinal radiology and contains questions and answers about various gastrointestinal conditions and imaging findings. Question 226 asks which finding on helical CT with dynamic bolus contrast enhancement is the best prognostic indicator of acute pancreatitis. The correct answer is the presence of pancreatic necrosis.
Presentation1, pet ct, functional mri and ct angiography in bone tumour.Abdellah Nazeer
This document discusses the use of PET/CT, functional MRI, and CT angiography in evaluating bone tumors. It provides the following key points:
1) PET/CT uses radioactive tracers like FDG to detect cancer cells through their increased glucose metabolism, allowing detection of tumors at early stages. The degree of FDG uptake does not necessarily correlate with a bone tumor's malignant potential.
2) Functional MRI techniques like diffusion weighted imaging and magnetic resonance spectroscopy provide additional tumor characterization by revealing water mobility and choline metabolites related to cellularity.
3) CT angiography is useful for determining a tumor's relationship to major blood vessels, though its role is now limited due to the capabilities of other modalities
The document is the rationales section from an in-training examination for diagnostic radiology residents sponsored by the American College of Radiology. It contains multiple choice questions in physics related to topics like radiation dose, CT, MRI, fluoroscopy, and radiography. For each question, the correct answer is identified and supported by a short explanation citing relevant references.
Presentation2, radiological imaging of gastrointestinal schwannoma.Abdellah Nazeer
This document discusses radiological imaging findings of gastrointestinal schwannomas. Some key points:
- Gastrointestinal schwannomas most commonly occur in the stomach (60-70% of cases). On CT and MRI, they often appear as well-defined, hypodense masses that demonstrate homogeneous enhancement with contrast.
- While radiological imaging findings are nonspecific, gastrointestinal schwannomas typically have the appearance of a solitary mass, and immunohistochemical staining can aid in diagnosis.
- Schwannomas can also occur in rare locations like the pancreas, adrenal gland, retroperitoneum, abdominal wall, pelvis and liver. Imaging characteristics vary depending on the location but may include cystic degeneration
Change management presentation (persembahan pengurusan perubahan) by eruan & inna (student of University Technology of Malaysia) - Master Degree of Management and Administration for Education
This document is a resume and portfolio for graphic designer Kristin Hartung. It includes sections on her objective, education, experience working as a freelance designer and for various companies, leadership roles, computer skills, and examples of her logo, brochure, invitation, poster, and other graphic designs. The designs showcase her skills in creating clean, modern, eye-catching visuals for businesses across different industries and media.
The document discusses two projects - the ICT4eTwinners Project and the SMILE Project. It provides links to the projects and summarizes their objectives. The SMILE Project, funded by Facebook, consisted of an online learning laboratory for 100 teachers to investigate educational uses of social media. It included research on trends and best practices and dissemination of results. The document also lists some top tools for developing a personal learning network, including Glogster Edu, Symbaloo, Scoop.it, Pinterest, Learnist and Mightybell.
This document discusses how to build an online presence through social media and search engine optimization. It provides tips on creating profiles on websites like LinkedIn, Twitter, and Google to share information and help others find your expertise. RSS feeds and social bookmarking tools like Delicious and Diigo are recommended for gathering and organizing information from blogs, news, and research. New businesses are advised to engage interactively with customers and fans through social media rather than restrict access to content.
NewStar Software Services is an IT solutions company headquartered in Hyderabad, India with offices in Toronto and New Jersey. It offers a Network and Infrastructure Management System (NIMS) to design and implement end-to-end network architectures for enterprises. NIMS provides LAN/WAN connectivity, networking hardware, data storage, firewalls, and customized network setups for businesses. NewStar's case studies describe implementing networks connecting multiple branches of organizations across cities and states.
PowerPoint Template - Put graphics center stageLee Bandy
This document discusses content delivery messages techniques for presenting a topic. It is divided into four sections on content, delivery, message, and technique, with each section instructing the reader to place graphics front and center and write a caption. The overall document provides guidance on featuring a topic prominently through visuals and captions.
The document is about a school in Parnu, Estonia called Parnu Toimetulekukool that provides education for children with special needs. It is the 5th anniversary of the school. The article was written by Signe Leht.
Leadership and Career Development for the New Information ProfessionalLisa Chow
This document provides career development tips for new information professionals. It discusses doing a self-assessment using SWOT analysis and setting 1- and 5-year goals. Career strategies discussed include developing a professional brand, online presence, and finding a mentor. Tips for the online presence include using tools like SlideShare, Google Sites, and Google Analytics. The document encourages getting involved in professional associations, attending conferences, and going beyond one's job title. It concludes by having the reader revisit goals and write down a specific goal for each discussed career strategy area.
Travel With Us offers a variety of travel packages including cruises, island vacations, and exclusive getaways. They target customers of all ages, from teens to families and couples. Their employees are energetic, excited about travel, and able to book trips and ensure customer happiness. Both short-term and long-term, their goals are to book many customers and become a well-known travel agency through commercials, billboards, flyers and word-of-mouth from satisfied customers.
This document discusses Lucian Duma's #edtech20 project, which aims to teach, learn, and play using free Web 2.0 tools and social media in education in a safe manner. The project provides groups on various platforms like Facebook, LinkedIn, and Twitter to connect educators. It emphasizes using these new technologies for collaboration and knowledge sharing while maintaining safety.
Este documento anuncia los eventos y celebraciones de la Semana Santa en la Iglesia de San Antonio. Incluye el horario del Domingo de Ramos, Jueves Santo, Viernes Santo y Sábado Santo, con misas, vía crucis, procesiones y confesiones. También invita a la comunidad a participar en una cena de confraternización después de la Vigilia Pascual del Sábado Santo.
This document discusses building an enterprise architecture through multiple projects over time. It describes how the architect plays an active leadership role in each project from start to finish. The document then introduces the Encore EAI team and their experience with technologies like Tibco, Informatica, and IBM. It provides an overview of their clients in industries like healthcare, finance, and government.
2014 SLA@Pratt Skill Share - Librarians in the 21st Century: Designing a Care...Lisa Chow
This document provides an overview of a presentation on designing career strategies for librarians in the 21st century given by Lisa Chow and Sandra Sajonas. The presentation discusses evolving roles for librarians, trends in the profession, and practical career strategies. These include thinking about micro-careers, working collaboratively outside traditional titles, focusing on technology, conducting self-assessments, developing networks and mentors, maintaining an online presence, continuing education, publishing, presenting, and exploring non-traditional job opportunities.
This document discusses principles of financial and cost accounting. It asserts that there are only 14 types of cash flows and 28 types of accounting transactions that need to be understood. These transactions can be organized using a "Churchill Chart" to determine the costs of activities. Only accounting categorized as costs using this method can be validly claimed as costs. The document emphasizes that cost-based accounting is necessary for correctly assessing performance, accountability, and control. Diagrams of the Churchill Chart and an accounting flow chart are provided to illustrate the accounting principles.
The document discusses breast radiology questions from an exam. Question 188 describes a case where a fibroadenoma was found on biopsy initially and a follow up mammogram 6 months later. The most likely diagnosis is a phyllodes tumor based on the description of phyllodes tumors typically appearing mammographically. Question 189 describes mammogram images and the most likely clinical presentation is peau d'orange skin in the left breast, indicative of inflammatory breast cancer. Question 190 involves calcifications on a mammogram and ductal carcinoma in situ is considered the most likely diagnosis.
The document summarizes two mammography cases:
1. A 45-year-old woman post-lumpectomy shows curvilinear calcifications at the biopsy site, consistent with dystrophic calcification.
2. Images of a 65-year-old woman show poor contrast due to high kVp and low mAs. Decreasing kVp and increasing mAs would increase contrast.
The document describes 4 cases involving mammography findings. Case 1 shows pleomorphic calcifications in a ductal distribution, indicating comedocarcinoma. Case 2 shows unilateral lymphadenopathy on mammogram with no other abnormalities, making colon cancer the least likely diagnosis. Case 3 shows a spiculated mass with associated calcifications extending beyond the mass, most consistent with ductal carcinoma in situ. Case 4 shows a hypoechoic well-defined mass on ultrasound with a tubular structure, indicating an intraductal papilloma.
This document presents an educational exhibit on identifying subtle signs of breast cancer at mammography through a series of case examples. It emphasizes three key concepts: 1) paying attention to mammographic technique and positioning, 2) developing a standard search pattern, and 3) comparing current exams to prior exams. The cases demonstrate how adherence to these concepts can enhance diagnostic accuracy by helping detect subtle changes indicative of cancer that may otherwise be overlooked. The document reviews important signs of appropriate positioning and areas radiologists should focus their search, such as the glandular-fat interface and lymph nodes. Comparing prior exams allows subtle tissue changes to be noticed.
The document provides information about various breast imaging techniques and biopsy procedures. It discusses the appearance of masses and lesions on mammography including characteristics like shape, margin, density, and enhancement patterns. It also describes different types of calcifications and their typical benign or suspicious morphologies. Additionally, the document outlines procedures for fine needle biopsy, core needle biopsy, and vacuum-assisted biopsy. Key details about each technique are given, such as how samples are obtained and analyzed to determine if a growth is benign or malignant.
The study of different presentations of breast lumps in radiographic. acta me...Sanjeev kumar Jain
This document discusses the use of ultrasound imaging in evaluating various breast lumps and pathologies. It provides pictorial examples of how different breast conditions appear on ultrasound scans. These include cysts, fibroadenomas, papillomas, lymph nodes, abscesses, fat necrosis, and different types of breast cancer. Ultrasound is found to be useful in characterizing breast lumps as solid or cystic and guiding biopsy procedures. While features can improve diagnosis, interobserver variability remains a limitation. An illustrated lexicon system helps standardize ultrasound findings. In summary, breast ultrasound is presented as a valuable tool for evaluating palpable lumps and abnormalities found on mammography.
This document summarizes various breast imaging modalities. It discusses the role of mammography, ultrasound, MRI, PET, and other techniques in evaluating the breast. Mammography remains the primary screening tool but has limitations related to breast density. Ultrasound helps diagnose palpable lesions and differentiate cysts from solid masses. MRI detects additional cancers but has limitations of cost and availability. Combined modalities provide improved evaluation of the breast compared to single techniques alone.
This document provides an overview of mammography, including definitions, indications, equipment, technique, findings, and assessment categories. It defines mammography as an x-ray examination of the breast to detect changes. Key indications include focal signs in women aged 40 or older and screening for high-risk women. Equipment has advanced from film-screen to digital mammography and tomosynthesis. Standard views are mediolateral oblique and craniocaudal. Findings can include masses, asymmetries, distortions, and calcifications, which are categorized based on characteristics like shape, margin, density, and distribution.
This document discusses various imaging modalities used for breast cancer screening and diagnosis, including mammography, ultrasound, MRI, CT, and PET scans. It provides details on mammography techniques for screening and diagnostic purposes. Key findings from studies on screening mammography for different age groups are summarized. Guidelines on screening from organizations like ACS, NCCN, and NCI are also outlined. The use of ultrasound and MRI as supplemental tools for diagnosis is discussed.
Recent advances in mammography include the transition to digital technologies like full-field digital mammography (FFDM) and breast tomosynthesis. FFDM provides higher contrast resolution than film screen mammography, reducing missed cancers. New techniques like contrast-enhanced digital mammography and breast tomosynthesis further improve detection by reducing tissue overlap and enhancing lesion conspicuity. These digital technologies allow for improved cancer screening while maintaining or reducing radiation dose compared to conventional mammography.
A comprehensive study about new and upcoming modalities in imaging and screening of breast lesions with description about every new modalities with their advantages and pitfalls.
This document provides an overview of breast MRI, including anatomy, techniques, and characteristics of different breast lesions. Breast MRI is very sensitive for cancer detection, especially in dense breasts. Dynamic contrast enhanced MRI is used to evaluate lesion morphology, enhancement patterns, and kinetics. Benign lesions like cysts and fibroadenomas have characteristic appearances, while malignant lesions often appear irregular or spiculated with rapid early enhancement and washout. Non-mass enhancement can indicate cancers like DCIS and requires analysis of distribution and internal pattern. Computer aided diagnosis evaluates kinetic curves but does not replace visual analysis.
MRI can detect breast lesions with high sensitivity but has variable specificity in differentiating benign from malignant lesions. MR spectroscopy provides additional metabolic information that can improve specificity by detecting elevated choline levels associated with malignant tumors. Response to chemotherapy can also be assessed non-invasively with MR spectroscopy by monitoring changes in choline levels within 24 hours of treatment. Limitations include difficulty with small lesions, dense breasts, and lactating breasts.
The document discusses various medical imaging modalities including x-rays, computed tomography (CT), and digital mammography. It describes the basic principles and historical development of these technologies, how images are formed, and what types of anatomical features and abnormalities they can detect. Key advances include the development of digital systems that allow image manipulation and remote consultation. While promising, digital mammography still faces challenges around resolution and cost.
This document discusses breast procedures used to diagnose, stage, and treat breast disease. It covers breast ultrasonography, which can evaluate palpable or mammographically indeterminate breast lesions and guide biopsies. Ductal lavage is described as an investigational method to retrieve breast duct epithelial cells for analysis via a catheter inserted into the duct. Ductoscopy is mentioned as an emerging endoscopic technique to directly visualize the mammary duct lining and biopsy system, currently being evaluated for evaluating nipple discharge, high-risk patients, and determining intraductal disease extent in breast cancer patients. Core needle biopsy is highlighted as the standard minimally invasive biopsy technique replacing excisional biopsy for diagnosis due to being less invasive, costly and exp
PRIMARY SQUAMOUS CELL CANCER OF BREAST: A CASE REPORTKETAN VAGHOLKAR
Primary squamous cell cancer (SqCC) of the breast is a rather rare disease. These tumors are known to be
quite aggressive in nature and are usually found to be treatment-resistant. Currently, there is no standard treatment
guideline for the management of primary SqCC of the breast. In this case report, we present a case of primary SqCC of
the breast in 60-year old postmenopausal women presenting as pigmented lesion over the right breast (no lump). Initial
skin biopsy (core) done by dermatologist revealed squamous cell cancer in situ (Bowen’s disease); however surgical
resection of the lesion and subsequent histopathological examination revealed primary SqCC (no secondary sites were
found elsewhere in the body).
Introduction to mammography and its equipment.
Different views on mammography & supplementary views.
Birads mammographic lexicon
Birads ultrasound lexicon
Imaging of suspicious mammary lymph nodes
Categories in BIRADS 2013.
This study evaluated the sensitivity of breast MRI for detecting breast cancers. Of 222 cancers, MRI correctly identified 213 but missed 9 cancers (sensitivity of 96.8%). The 7 true false-negatives included 4 DCIS lesions and 3 invasive cancers. False-negative lesions were often small or obscured by surrounding enhancing breast tissue. While MRI is highly sensitive for breast cancer, a small percentage of cancers can be missed, particularly DCIS and cancers in a background of diffuse parenchymal enhancement.
Breast imaging has evolved substantially beyond just mammography to include ultrasound, MRI, and breast interventional radiology. These technologies help detect and diagnose breast diseases. Breast tomosynthesis is an advanced form of mammography that creates 3D images and has been shown to improve accuracy and reduce false positives compared to standard mammography. Ultrasound and MRI are also important tools that breast imaging radiologists use to evaluate lesions, with MRI being the most sensitive but also having a high false positive rate. Image-guided breast biopsies now allow radiologists to obtain tissue samples directly rather than just localizing lesions for surgeons.
This document contains rationales for questions from the 2007 ACR Diagnostic Radiology In-Training Exam related to pediatric radiology. It provides the correct answer and an explanation for each question, referencing imaging findings and typical presentations of various pediatric conditions like congenital cystic adenomatoid malformation, hematometrocolpos, pulmonary sling, Hirschsprung's disease and more. Key anatomic and imaging features are discussed in the rationales to explain why each answer choice is right or wrong.
This document contains rationales for questions from the 2007 ACR Diagnostic Radiology In-Training Exam. The rationales provide explanations for the correct answers to multiple choice questions related to diagnostic radiology topics including test sensitivity and predictive values, medical ethics, and radiation safety. Specifically, one rationale discusses how the positive predictive value of a diagnostic test increases as the prevalence of a disease increases in a population. Another rationale examines the ethical requirement for physicians to be honest with patients about medical errors or complications. A third rationale identifies radon exposure as contributing the most to background radiation levels in the US.
The document discusses rationales for exam questions related to chest radiology. Question 202 discusses a CT scan showing a smooth, round upper lobe mass with eccentric calcifications and air-trapping. The most likely diagnosis is a carcinoid tumor. Question 203 shows chest radiographs of a man with cough, demonstrating a classic right upper lobe collapse with a "Reverse S of Golden" suggestive of a central mass. Question 204 involves a CT scan showing post-intubation tracheal narrowing below the thoracic inlet.
The document discusses randomized controlled trials and which statements about them are true. It states that option C, "Randomization reduces the risk of an imbalance in factors which could influence the clinical course of the patients," is true. Randomization helps balance both known and unknown prognostic factors between treatment groups in a randomized controlled trial.
This document contains a series of chest radiograph and CT images along with questions about cardiac findings.
Image 1 shows calcification of the aortic valve on a lateral chest x-ray, consistent with aortic stenosis.
Image 2 shows calcifications in the wall of the left atrium on a non-contrast CT, related to prior endocarditis from rheumatic heart disease.
Image 3 demonstrates enlargement of the central pulmonary arteries and diminished peripheral vasculature on chest x-ray, characteristic of pulmonary hypertension due to emphysema (cor pulmonale).
Image 4 shows a defect in the superolateral aspect of the atrial septum on CT, consistent with a sinus
The document appears to be excerpts from an examination for diagnostic radiology residents, including four multiple choice questions and associated images regarding musculoskeletal diagnoses. Question #202 asks about a lateral tibial lesion in a child and provides images. The most likely diagnosis is osteofibrous dysplasia, characterized by a lobulated lucency in the anterior cortex associated with anterior bowing of the tibia.
This document contains information about the 28th Annual In-Training Examination for Diagnostic Radiology Residents, including sample test questions and rationales. The test is sponsored by the Commission on Education and Committee on Residency Training in Diagnostic Radiology of the American College of Radiology. Sample multiple choice questions are provided about various neuroradiology topics, such as diagnoses for different brain and spine imaging findings. Rationales are given for each answer choice.
1. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
Section VII Breast Radiology
139. You are shown a left MLO view and spot compression view of the left breast
(Figures 1A and 1B). No definite abnormality was seen on the CC views. What
is the MOST LIKELY diagnosis?
A. Ductal carcinoma in situ
B. Radial scar
C. Invasive lobular carcinoma
D. Medullary carcinoma
RATIONALES:
A. Incorrect. Ductal carcinoma in situ usually presents as calcification and
does not usually cause distortion unless there is an invasive component.
B. Incorrect. A radial scar usually has a dark center with radiating lines as
opposed to the image, which has a white center due to the presence of a
mass. Usually a radial scar is visualized on both views.
C. Correct. Invasive lobular carcinoma is commonly seen on one view only
or a least best visualized on one view. It is the hardest cancer to detect
on mammography because it grows one cell at a time. It most commonly
presents as an area of distortion or spiculation. The size is often difficult
to measure on mammography and ultrasound.
D. Incorrect. Medullary carcinoma typically presents as a round mass, which
grows rapidly.
References: Ikeda, Debra. “Breast Imaging” pp. 97-99.
2. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
140. You are shown a screening right MLO (Figure 2A) and magnification views
in the MLO (Figure 2B) and CC (Figure 2C) projections. Which is the MOST
appropriate BI-RADS code?
A. Category 0
B. Category 2
C. Category 3
D. Category 4
RATIONALES:
B. Correct. Hamartomas are unusual circumscribed benign breast lesions
composed of variable amounts of fat, glandular tissue, and fibrous connective
tissue. The classic mammographic appearance is virtually diagnostic. The
lesion is circumscribed and contains both fat and soft-tissue density surrounded
by a thin radiopaque capsule. When diagnostic features are present, routine
annual mammography is appropriate and this should be coded Bi-RADS
category 2.
.
References:
Basset. Diagnosis of Diseases of the Breast. 2nd
ed. Elsevier Saunders Co.,
Philadelphia, PA. 2005.
3. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
141. You are shown a T2-weighted (Figure 3A) and T1-weighted (Figure 3B) post
contrast subtraction sagittal MRI of a 45-year-old woman. What is the MOST
LIKELY diagnosis?
A. Fibroadenoma
B. Lipoma
C. Lobular carcinoma
D. Simple Cyst
RATIONALES: Figure 1A, T2 weighted imaging, shows a well circumscribed mass of
homogeneous high signal intensity. Figure 1B shows the same mass to “drop out” on
the subtraction image. No evidence of contrast enhancement is seen within or
surrounding the mass.
A. Incorrect. On MRI imaging of the breast, fibroadenomas are predominantly
solid with variable enhancement. This mass is fluid filled and has no
enhancement.
B. Incorrect. Lipomas should follow fat signal on both T1 and T2 weighted
imaging. No high signal would be seen on either image.
C. Incorrect. Breast cancers are typically solid with irregular margins and have
marked enhancement. While imaging characteristics of breast cancer are
variable, a well circumscribed fluid filled mass is not characteristic for breast
cancer.
D. Correct. This well circumscribed fluid filled mass is classic for a benign simple cyst.
References:
Jackson VP. The Radiologic Clinics of North America, Breast Imaging. November
1995 Volume 33, Number 6.
4. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
142. You are shown an MLO image (Figure 4A) as well as a magnification image
(Figure 4B) and an ultrasound image (Figure 4C) of the inferior right breast.
Which one of the following is the MOST LIKELY diagnosis?
A. Silicone granuloma
B. Invasive ductal carcinoma
C. Fat Necrosis
D. Fibroadenoma
RATIONALES:
A. Correct. The mammogram image shows a well circumscribed dense mass
inferior and anterior to the breast implant with additional dense material adjacent
to the implant itself. US show a classic hyperechoic mass with snowstorm
appearance.
B. Incorrect. While breast cancer lesions can be well circumscribed on
mammogram and US, most invasive ducal carcinomas are of decreased
echogenicity on US and would typically have posterior shadowing as opposed to
a snowstorm appearance.
C. Incorrect. Fat Necrosis may appear as a mass on well circumscribed mass on
mammogram. They may also have increased echogenicity on US. However,
given the snowstorm appearance on US, density of mass on mammogram and
the proximity to the implant make silicone granuloma more likely
D. Incorrect. Fibroadenomas may be well circumscribed on mammogram and US
but are typically homogeneously hypoechoic at US.
References:
1) Stavros, AT. Breast Ultrasound. Lippincott Williams & Wilkens.
Philadelphia, PA. 2004.
2) McGahan JP, Goldberg BB. Diagnostic Ultrasound A Logical Approach.
Lippincott-Raven. Philadelphia, PA. 19
5. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
143. You are shown a screening MLO mammogram (Figure 5A) and the same
view taken 1 year later (Figure 5B). What should be recommended next?
A. Ultrasound examination
B. Additional mammographic images
C. 6-month follow up
D. Stereotactic biopsy
RATIONALE
A. Incorrect. The increased density in the upper aspect of the right breast may
not be a true finding and requires spot compression views of the breast to see if it
persists. Ultrasound evaluation without knowing the location of the lesion is of
limited usefulness and should not be the preliminary workup.
B. Correct. Additional mammographic workup should be performed including spot
compression views to see if the area of increased density persists and if so
triangulation to localize the finding on the craniocaudal view.
C. Incorrect. When a new finding is seen on mammography it requires a workup
mammographically and with a possible ultrasound before it is placed into a
BIRADS™ 3 category.
D. Incorrect. Before a biopsy should be considered the finding needs to be
authenticated. A mammographic workup is required.
6. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
144. You are shown a right straight lateral (90 degree) magnification view (Figure
6). Which one of the following is the MOST LIKELY diagnosis?
A. Invasive lobular carcinoma
B. Ductal carcinoma in situ
C. Sclerosing Adenosis
D. Milk of calcium
A. Incorrect. The most common presentations of invasive lobular carcinoma are a
spiculated mass, an ill-defined or obscured mass, and architectural distortion.
Occasionally, lobular carcinomas are diffusely infiltrating and may show only subtle
findings on mammography.
B. Correct. Ductal carcinoma in situ (DCIS) is usually detected on mammography, with
calcifications being the mammographic hallmark. The calcifications are typically fine,
linear, discontinuous, and branching, often in a ductal distribution.
C. Incorrect. Adenosis is an abnormality of the lobules. Mammographically, the
findings are often nonspecific and include diffuse ill defined nodular densities or multiple
round or punctate calcifications. This should be considered a histologic diagnosis rather
than a typical imaging diagnosis.
D. Incorrect. Calcifications of milk of calcium have a layering appearance or crescent
shape on horizontal beam (straight lateral) views.
References:
Basset. Diagnosis of Diseases of the Breast. 2nd
ed. Elsevier Saunders Co.,
Philadelphia, PA. 2005.
7. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
145. Which quality control test must be performed DAILY?
A. Phantom image evaluation
B. Repeat analysis
C. Processor QC
D. Darkroom fog
A. Incorrect. Evaluation of the phantom image should be performed at least weekly but
is not required to be performed on a daily basis.
B. Incorrect. The repeat analysis should be performed quarterly.
C. Correct. Processor QC should be performed daily at the start of the workday before
any patient films are put through the processor.
D. Incorrect. Darkroom fog should be tested semiannually.
146. Increased dynamic range in digital mammography as compared to screen-
film mammography results in which of the following?
A. Increased temporal resolution
B. Increased contrast resolution
C. Reduced spatial resolution
D. Radiation dose is decreased
A. Incorrect. Temporal resolution is not affected by increased dynamic range.
B. Correct. Different exposure levels mapping to a wider range allows for increased
contrast in a digital image.
C. Incorrect. increased dynamic range does not affect spatial resolution
D. Incorrect. increased dynamic range does not affect radiation dose
References: Mahesh M, AAPM/RSNA Physics
Tutorial for Residents: Digital Mammography: An Overview, RadioGraphics 2004;
24:1747–1760
8. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
147. In film-screen mammography, film performs multiple functions that are
coupled together. In digital mammography, these same functions are decoupled
so that each may be optimized independently. Which of the following are the
multiple functions?
A. Image acquisition, scatter rejection, and archive
B. Image acquisition, display, and magnification
C. Image acquisition, display, and archive
D. X-ray absorption, scatter rejection, and display
RATIONALES:
A. Incorrect – scatter rejection is accomplished by a grid
B. Incorrect – magnification can not be accomplished with film alone
C. Correct
D. Incorrect – x-ray absorption is accomplished by a phosphor screen, scatter rejection
is accomplished by a grid
References: Mahesh M, AAPM/RSNA Physics
Tutorial for Residents: Digital Mammography: An Overview, RadioGraphics 2004;
24:1747–1760
9. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
148. Concerning nipple discharge, which of the following statements is TRUE?
A. Discharge associated with breast cancer usually arises from a single duct.
B. Intraductal papillary carcinoma is the most common cause of bloody
discharge.
C. Green discharge is suspicious for underlying malignancy.
D. Galactography is used to distinguish benign from malignant discharge.
A. Correct. Benign nipple discharge usually arises from multiple ducts, whereas nipple
discharge from a papilloma or DCIS usually occurs from a single duct.
B. Incorrect. The most common mass producing bloody nipple discharge is a benign
intraductal papilloma. Only approximately 5% of women with bloody nipple discharge
are found to have malignancy at biopsy.
C. Incorrect. Nipple discharge is of particular concern if it is spontaneous and from a
single duct, or if the discharge is clear or bloody.
D. Incorrect. Galactography is more sensitive than mammography in the detection of
intraductal lesions but it cannot accurately distinguish between benign and malignant
findings.
References:
1. Ikeda DM. The Requisites: Breast Imaging. Elsevier Mosby,
Philadelphia, PA. 2004.
2. Bassett LW, Jackson VP, et al. Diagnosis of Diseases of the
Breast. Elsevier Saunders, 2nd
Edition, Philadelphia, PA 2005.
10. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
149. Concerning fibroadenomas, which of the following statements is TRUE?
A. Posterior acoustic enhancement is diagnostic on ultrasonography.
B. Calcifications typically develop centrally within the mammographic mass.
C. Dark internal septations and persistent enhancement are characteristic
findings on MRI.
D. The presence of cystic spaces on ultrasonography indicates malignant
degeneration.
A. Incorrect. On ultrasound, they may demonstrate posterior acoustic enhancement or
shadowing. Neither feature is diagnostic.
B. Incorrect. As the fibroadenoma ages, it may become sclerotic and less cellular.
Popcorn like calcifications subsequently develop at the periphery of the mass and
ultimately, the entire mass may be replaced by dense calcification.
C. Correct. On MRI, fibroadenomas have the classic appearance of an enhancing oval
or lobulated mass with well circumscribed borders. They contain dark internal
septations with a gradual initial enhancement rate and a persistent enhancement curve.
D. Incorrect. Fibroadenomas are typically hypoechoic on sonography but may contain
cystic spaces. The presence of cystic spaces does not necessarily indicate malignant
degeneration.
References:
1. Ikeda DM. The Requisites: Breast Imaging. Elsevier Mosby, Philadelphia, PA.
2004.
11. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
150. Which one of the following risk factors places a patient at the HIGHEST risk
for developing breast cancer?
A. Moderate/florid ductal hyperplasia
B. Lobular carcinoma in situ
C. Sclerosing adenosis
D. Atypical ductal hyperplasia
RATIONALES:
A. Incorrect. Moderate hyperplasia raises risk slightly for breast cancer.
B. Correct. High risk for breast cancer with lobular carcinoma insitu( 8-10X
increase)
C. Incorrect. Moderate increased risk for this.
D. Incorrect. Moderate increased risk for this.
References: Cardenosa, Gilda. “Breast Imaging Companion” second edition.
Pp. 3-4. The following cause a high risk for breast cancer: Aypical ductal
hyerplasia with positive family history of a first degree with breast cancer, LCIS
and well-differentiated ductal carcinoma insitu. High risk means 8-10 x increased
risk. Other factors as mentioned in question increase risk on slightly or
moderately.
12. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
151. Which of the following ultrasonographic findings is MOST commonly
associated with a galactocele?
A. Oval mass
B. Anechoic mass
C. Mass with angular margins
D. Mass with microlobulated margins
RATIONALES:
A. Correct. A galactocele is usually oval to round in shape.
B. Incorrect. A galactocele will have internal debris and be hypoechoic or mixed
echogenicity on ultrasound.
C. Incorrect. Angular margins are associated with malignancy.
D. Incorrect. A microlobuated mass infers malignancy and galactocele is usually
oval and smooth.
References: Ikeda, Debra. “ Breast Imaging” pp. 128-129. A galactocele is
usually low density on mammography and has internal echoes on ultrasound with
smooth borders and configuration. It can have through transmission of sound or
shadowing. When aspirated white milky fluid is obtained.
152. Which of the following findings on MRI is MOST suggestive of a malignant
breast mass?
A. Mild enhancement curve
B. Enhancement washout curve
C. Homogeneous enhancement
D. Dark internal septations
RATIONALES:
A. Incorrect. Breast cancer will enhance brightly with marked uptake not mild
enhancement.
B. Correct. Washout curves are highly suspicious of malignancy.
C. Incorrect. Breast cancer will enhance heterogeneous reflecting areas of
varied activity and necrosis.
D. Incorrect. Septations are usually not present and if present will be bright.
References: Morris, Elizabeth and Laura Leiberman. “Breast MRI” pp. 173-183.
ACR Lexicon for Breast MRI. A breast cancer will enhance brightly with rapid
uptake and rapid washout of contrast. The enhancement pattern will be
heterogeneous representing areas of varied activity and possible necrosis.
Septations are usually not present and if present will enhance and be bright.
13. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
153. Using ACR Accreditation criteria for clinical image evaluation, which is
recommended for pectoralis muscle?
A. A concave shape on the MLO view
B Visible on the CC view
C. Equal in size on the CC and MLO views
D. Extends to the level of the posterior nipple line
RATIONALES:
A. Incorrect. The pectoral muscle should have a convex shape on the MLO view.
B. Incorrect. The pectoral muscle does not have to be demonstrated on the CC
view. There should be as much tissue on the CC in relation to the MLO within 1
cm.
C. Incorrect. The pectoral muscle will not be the same size on both views and
usually is much smaller on CC view.
D. Correct. The pectoral muscle should extend to the posterior nipple line on the
MLO view.
References: Cardenosa, Gilda “Breast Imaging Companion” pp. 100-109. The
ACR criteria state the requirements for correct positioning of the both the CC and
MLO views. The MLO view should have a convex pectoral muscle and extend
to within 1 cm of the PNL. The inframammary fold should be opened and the
nipple in profile. The breast tissue should be adequately compressed. On the
CC view, there should be at least at much tissue within 1 cm as on the MLO.
14. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
154. Which one of the following is an indication for evaluation of the breast with
contrast-enhanced MRI?
A. Suspected implant rupture
B. Extent of tumor in dense breasts
C. Cystic masses in both breasts
D. Cloudy discharge with negative galactogram
RATIONALES:
A. Incorrect. Contrast is not necessary for evaluation of implant rupture. Images
with fat saturation and silicone and water saturation would be helpful.
B. Correct. Contrast can help to locate other foci of tumor and more accurately
evaluate tumor size as well as lymph node involvement.
C. Incorrect. Cystic masses do not require the use of contrast but can be
detected by T1 and T2 imaging.
D. Incorrect. White discharge is usually benign. Bloody or clear discharge could
be evaluated with MRI and contrast may be helpful.
References: Ikeda, Debra. “Breast Imaging” pp. 210-213.
15. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
155. Regarding Paget’s disease, which one of the following is CORRECT?
A. It is characterized by bleeding and ulceration of the nipple-areolar complex.
B. It is classically diagnosed as an irregular mass on mammography.
C. It results from a chronic irritation of the nipple-areolar complex epidermis.
D. It is typically treated with partial breast irradiation.
RATIONALES:
A. Correct. Paget’s disease is characterized by a chronic erythematous,
ulcerating and bleeding nipple-areolar complex. These findings may cause
itching, bleeding or a burning sensation of the nipple.
B. Incorrect. Paget’s is classically diagnosed when there is a high degree of
clinical concern based on physical exam findings. This is confirmed with skin
biopsy. While, mammographic findings may include skin or nipple thickening,
calcifications or a retroareolar mass, as many as one third of all patients have no
mammographic finding.
C. Incorrect. Paget’s may appear similar to dermatitis with chronic inflammation
but the disease results from the extension of malignant cells up thru the ducts to
the nipple surface epithelium.
D. Incorrect. Depending on the extent of involvement, treatment routinely includes
surgery. Surgical options include: a breast conserving procedure if the area of
involvement is small and there is little or no invasive component or a total mastectomy
with or without axillary sampling if the mass is larger and has a significant invasive
component. Breast irradiation as a single method of treatment is not considered
adequate or appropriate treatment and should be considered only in conjunction with a
definitive surgical procedure.
References:
1. Bassett LW, Jackson VP, Fu KL, Fu YS. Diagnosis of Diseases of the Breast.
2nd
Edition. Elsevier Saunders, Phildelphia, PA. 2005, pp 527-528.
2. Powell DE; Stelling CB. The Diagnosis and Detection of Breast Disease.
Mosby, St. Louis, MO. 1994, pp 334.
16. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
156. Approximately what percentage of breast cancers occur in men?
A. 1%
B. 5%
C. 10%
D. 15%
RATIONALES:
A. Correct. Given data from the American Cancer Society, it is estimated that 1720 new
cases of male breast cancer will be diagnosed in 2006. This is in contrast to the
estimated 212,900 new cases of female breast cancer that will be diagnosed in the
same time period. This suggests that approximately one out of every 100 new breast
cancers will be in a male patient.
157. Concerning invasive lobular carcinoma, which one of the following is
TRUE?
A. The most common mammographic finding is a dominant mass with
calcifications.
B. It accounts for approximately 20% of all breast cancer cases.
C. An ill-defined hypoechoic mass on ultrasonography is typical.
D. It is easily distinguished from invasive ductal carcinoma on mammogram and
ultrasound.
RATIONALES:
A. Incorrect. Invasive lobular carcinoma (ILC) is probably the most difficult type
of breast cancer to identify using any imaging modality. This type of breast
cancer is most commonly seen on mammogram as a spiculated mass or area of
architectural distortion. However, many ILC tumors are subtle and are difficult to
detect due to a diffusely infiltrative nature. Calcifications are not typical but may
occur in up to 20% of cases.
B. Incorrect. ILC accounts for approximately 10% of all breast cancer cases and
is the second most common type after invasive ductal carcinoma (IDC) not
otherwise specified.
C. Correct. ILC is usually seen on ultrasound as an ill defined solid mass of
decreased echogenicity. There is often considerable post tumoral shadowing.
D. Incorrect. Unfortunately, there are no specific distinguishing factors between ILC and
IDC on any imaging modality including mammogram, US, MRI and PET. However, the
overall subtle nature of ILC makes it one of the most difficult tumors to detect.
References:
1. Bassett LW, Jackson VP, Fu KL, Fu YS. Diagnosis of Diseases of the
Breast. 2nd
Edition. Elsevier Saunders, Philadelphia, PA. 2005.
17. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
2. Cardenosa. Breast Imaging Companion. 2nd
. Lippincott Williams & Wilkins
Philadelphia, PA. 2001
Powell DE; Stelling CB. The Diagnosis and Detection of Breast Disease. Mosby,
St. Louis, MO. 1994.
158. Concerning complex sclerosing lesions (radial scars), which one of the
following is TRUE?
A. They are typically related to prior trauma or an invasive surgical procedure.
B. They usually present as palpable masses at clinical exam.
C. Mammographic features include a circumscribed mass with a central lucency.
D. They have been shown to be associated with tubular carcinoma and atypical
hyperplasia.
RATIONALES:
A. Incorrect. Complex sclerosing lesions, radial scars, are not related to prior
trauma or surgery and are not in fact “scars” at all. The etiology of radial scars is
unknown.
B. Incorrect. Radial scars are typically seen on mammography or are incidentally
found at excisional biopsy but are not characteristically palpable on physical
exam
C. Incorrect. Classic mammographic features of a complex sclerosing lesion
include a spiculated mass with a central lucency. This is often considered to
represent entrapped fat.
D. Correct. Radial scars do have an association with tubular carcinoma, invasive ducal
carcinoma, DCIS and atypical hyperplasia. Because of this relationship and to avoid
sampling error at core needle biopsy, it is often felt that surgical excision is required to
exclude any related malignancy.
References:
1. Bassett LW, Jackson VP, Fu KL, Fu YS. Diagnosis of Diseases of the
Breast. 2nd
Edition. Elsevier Saunders, Philadelphia, PA. 2005.
2. Cardenosa. Breast Imaging Companion. 2nd edition
. Lippincott Williams &
Wilkins Philadelphia, PA. 2001
18. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
159. Regarding phyllodes tumor, which one of the following is TRUE?
A. Benign and malignant phyllodes tumors can be distinguished using
ultrasonography.
B. Phyllodes tumors typically occur in women younger than age 40.
C. Up to 15% of malignant phyllodes tumors will have lymphatic metastasis.
D. Approximately 20% of all phyllodes tumors will recur locally after surgical
excision.
RATIONALES:
A. Incorrect. Benign and malignant phyllodes tumors are indistinguishable on
mammography and ultrasound. When small, there are also indistinguishable from
fibroadenomas. If the mass is larger in size with an inhomogeneous echotexture
and peripheral cystic spaces, the malignant variant may be suggested.
B. Incorrect. Phyllodes tumors typically occur 10-20 years later than
fibroadenomas with an age of presentation between 40 and 50.
C. Incorrect. While less than 20% of malignant phyllodes tumors will
metastasize, metastasis is classically via a hematogenous route to the lungs and
bone.
D. Correct. There is a high recurrence rate, 20% or greater, with phyllodes tumors. The
borderline and malignant types have the highest rate of recurrence. Recurrence is more
likely if surgical margin is less than 2 cm.
References:
1. Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast. 2nd
edition. Lippincott Williams & Wilkins, Philadelphia, PA. 2000.
19. 2007 ACR Diagnostic Radiology In-Training Exam Rationales
160. Concerning tubular carcinoma, which is CORRECT?
A. It has a less favorable prognosis than invasive ductal carcinoma.
B. It is typically a well-circumscribed mass.
C. Microcalcifications are frequently associated.
D. It is commonly histologic grade 1.
RATIONALES
A. Incorrect. Tubular carcinoma has a more favorable prognosis than invasive
ductal carcinoma.
B. Incorrect. Tubular carcinomas are not typically well circumscribed. They are
slow growing and have an irregular shape and are spiculated.
C. Incorrect. Microcalcifications occur infrequently (10-15%) in tubular carcinoma.
D. Correct. Tubular carcinomas are well differentiated and nearly always grade1.
161. Concerning duct ectasia, which of the following is TRUE?
A. It must be bilateral to make the diagnosis mammographically.
B. The associated calcifications may contain internal lucencies.
C. It carries an increased risk for breast cancer.
D. It is associated with previous bacterial infection.
RATIONALES
A. Incorrect. In duct ectasia the secretions in the ducts often calcify, producing
the typical secretory calcifications seen as rod like calcifications. These
calcifications are commonly diffuse and bilateral but can be unilateral and more
focal.
B. Correct. The calcifications in duct ectasia can contain internal lucencies when
the calcifications occur on the outside of the duct.
C. Incorrect. Ductal ectasia does not increase a woman’s risk of breast cancer.
D. Incorrect. Duct Ectasia is a chemical mastitis.