Revised Textbook Edition Digital Radiography & PACS

Fleitz Continuing Education Jeana Fleitz, M.E.D., RT(R)(M) The X-Ray Lady 6511 Glenridge Park Place, Suite 6 Louisville, KY 40222 Telephone (502) 425-0651 Fax (502) 327-7921 Web address www.x-raylady.com email address x-raylady@insightbb.com Revised Textbook Edition Digital Radiography & PACS Approved for 9 Category A CE Credits by American Society of Radiologic Technologists (ASRT) Course Approval Start Date 01/01/08 Course Approval End Date 02/01/13 Florida Radiologic Technology Program 9 Category A CE Credits (Technical) Provider Approval #3200615 Course Approval Start Date 12/01/07 Course Approval End Date 01/31/14 Iowa Department of Public Health Bureau of Radiological Health 9 Category A CE Credits for General x-ray & Limited Chest, Chest/Extremities Course Approval Start Date 12/24/07 Course Approval End Date 05/01/13 Kentucky Radiation Operator Certification Program Course Approval Start Date 2007 Course Approval End Date 02/01/13 Please call our office after the course approval end date for course renewal status Please let us know if your mailing address or email address changes. Thank you. A Continuing Education Course for Radiation Operators

Digital Radiography and PACS Course Description This homestudy course titled Digital Radiography and PACS introduces the technologist to digital imaging and how it functions and the differences between digital radiography and conventional film/screen radiography. The course provides a basic overview of the concepts of latent image formation for both conventional and digital imaging processing, with an introduction to PACs and how digital image processing integrates with digital storage systems. Objectives: Upon completion of this course, the participant will: 1. Select the best action to take when image-processing errors occur that affect image clarity. 2. Given basic errors associated with optimal receptor exposure, selection of exposure factors, and controlling and monitoring patient radiation exposure select the correct response. 3. Differentiate between myths and facts associated with digital imaging systems. 4. Given common situations related to exposure recognition failure or histogram analysis error, select the correct response. 5. Select the best corrective action to take when errors occur in image contrast, recorded detail and image artifacts. 6. List the basic quality control tasks that the radiographer must perform when using digital radiography systems. 7. Define teleradiography and recall basic facts about the system operation. 8. Recall the radiographer s responsibility in maintaining patient confidentiality when using digital radiography and PACs systems. 9. Recognize basic guidelines for selection of digital imaging and PACS systems. 10. Recall important facts concerning radiation dose and digital imaging systems. 11. Identify correct statements regarding quality control and quality assurance of digital imaging and PACS systems.

Fleitz Continuing Education Jeana Fleitz, M.Ed., RT(R)(M) "The X-Ray Lady" 6511 Glenridge Park Place, Suite 6 Louisville, KY 40222 Telephone (502) 425-0651 Fax 502-327-7921 E-mail address xraylady@insightbb.com Web Address www.x-raylady.com Homestudy Course Directions Directions To complete this course read the reference included with your homestudy course. We suggest that you read the reference prior to answering the post-test questions. Complete the post-test questions. If you have difficulty in answering any question, refer to the reference. Complete the Answer Sheet and Course Evaluation Complete the post-test and record your responses on the answer sheet and complete the course evaluation. You may mail your answer sheet to 6511 Glenridge Park Place, Suite 6, Louisville, KY 40222. If you mail your answer sheet and course evaluation, retain a copy before mailing. We request that you do not fax your answer sheet unless you are within two weeks of your expiration date. If you fax your answer sheet and course evaluation, obtain verification from the machine that the fax was delivered or call our office for verification. OR Use the Online Answer Sheet on our website homepage at www.x-raylady.com. After completing the ONLINE Answer sheet, just hit submit to send via email. Remember to also complete the online course evaluation. Grading and Issuance of a Certificate Your answer sheet will be scored within 1-2 days of arrival in our office. To obtain continuing education credit, you must have a cumulative average score of at least 75%. Verification of awarded continuing education for this course will be submitted to the following states: KY, IA, FL. For ARRT and all other states, please self-report to the state radiation certification agency in your state and the ARRT and any other organizations. You will be awarded a certificate verifying satisfactory completion of this course, or notification if you do not. We are now emailing certificates so be sure to include your email address. Please let us know if you prefer to receive a copy in the mail and allow 4-5 days to receive your copy. Need Additional Information You may call our office (502) 425-0651 voice mail. Our office hours are 9 a.m. 6 p.m. Monday through Friday. The office operates on Eastern Standard Time and is closed on major holidays. You may also e-mail us at xraylady@insightbb.com. For information, about courses or to order online, visit our web site at www.x-raylady.com. The X-ray Lady Refund and Exchange Policy, Certificate Replacement Policy, and other related policies are included in each course.

Jeana Fleitz The X-Ray Lady 6511 Glenridge Park Place, Suite 6 Louisville, KY 40222 Telephone (502) 425-0651 Website www.x-raylady.com Email us at xraylady@insightbb.com Important Information Refund Policy (8/2011) Applies to Hardcopy Courses Customers have 30 days from the date of the original purchase to receive a refund. After 30 days customers may receive a credit towards future purchases for any materials/book returned to us. All refunds and credits will be subject to a $5 re-stocking fee per course. There will be no refunds or credits for shipping & handling charges once a course has already shipped to you. Refunds will not be issued until the course material/book is received in our office and considered to be in excellent condition. Customers are responsible for the shipping costs when returning materials to our company for a refund. Credits expire after one year from the issuance date. Refund Policy (8/2011) Applies to Ebook Courses No refunds will be issued for Ebook courses once the materials have already been sent. Customers wishing to return an Ebook course will have 30 days from the original date of purchase to receive a credit towards a future purchase minus a $5 processing fee. Credits expire after one year from the issuance date. Exchange Policy (1/2009) An exchange of a course may be made up to 30 days after the date of purchase. Customers are responsible for the shipping costs when returning materials for an exchange. After materials have arrived at our office and are inspected and are in excellent condition the replacement materials will be shipped. Customers are responsible for payment of new shipping costs and any difference in price for the replacement course The following applies to both the Refund and Exchange Policies Refunds will be issued in the same manner as the original order (i.e., credit card/check). Refunds on materials purchased with a personal or company check will be refunded with a cashier s check after initial check payment has cleared the banking process. No refund/exchange will be made for courses that are within one month of the course approval expiration date. About Your Certificates and Faxing Your Answer Sheets Effective 3-1-08: All course certificates will be sent via e-mail unless we are otherwise notified. Be sure to add our e-mail to your address book so that your certificate is not sent to your junk/bulk mail. If you have a new or different e-mail please notify our office or make note of it on your answer sheet. Please DO NOT FAX your course answer sheet(s) and evaluation form(s) to us unless your certificate is going to expire within two weeks of the date you complete the course. Instead we request that you maintain a copy of your answer sheet for each course you complete, and mail these to us at the address listed above OR use our online generic answer sheet on our website at www.x-raylady.com (the link is in the top right hand corner on the homepage). Certificate Replacement Charge A $5 replacement fee per certificate will be charged for any request that occurs 30 days after the issuance date on the original certificate. We can send a duplicate certificate via your email address or U.S. mail service. If you request that your replacement certificate be faxed, there will be a $3 fee per page. Please retain your course certificates in case the ARRT or state licensing agency conducts an audit of your records. Because of the staff time required to research and prepare a replacement certificate, we assess a charge for this service. This will not affect the majority of customers.

Jeana Fleitz, M.Ed., RT(R)(M) The X-Ray Lady 6511 Glenridge Park Place, Suite 6 Louisville, KY 40222 Telephone (502) 425-0651 Fax (502) 327-7921 Email Address xraylady@insightbb.com Web Address www.x-raylady.com Disclaimer Notice This course has been evaluated and approved for a specified amount of continuing education by the agencies listed on the cover. The provider of this course does not imply or guarantee that completion of this course automatically ensures renewal or initial issuance of any state, national, or federal x-ray certification or licensure requirements. It is the responsibility of the individual, completing this course, to understand and to comply with state, national, and federal x-ray certification and licensure regulations regarding initial and renewal requirements. Further, the provider of this course claims no responsibility for determining if the topic or amount of continuing education credit is appropriate for any person. The field of radiography and medicine is ever changing. Readers are advised to check the most current product information provided by equipment and supply manufacturers. The provider of this course does not assume any liability for any injury and/or damage to persons or property arising from information contained in this course. The information contained in this course should not be used for medical diagnosis or treatment. Users of this information are encouraged to contact their physician or health care provider for any health related concerns. The X-Ray Lady, LLC is neither responsible nor liable for any claim, loss, or damage resulting from the use of this course. Earning CE Credit This activity may be available in multiple formats or from different sponsors. Continuing education credit can be awarded only once for the same activity.

Digital Radiography and PACS Posttest (Revised Textbook Version) 1. In medicine, digital imaging was first used with the introduction of: a. ultrasonography b. magnetic resonance imaging (MRI) c. computed tomography (CT) d. nuclear medicine scanning 2. Early picture archiving and communications systems (PACs) were developed by the: a. aviation industry b. U.S. military c. Department of Homeland Defense d. federal prison system 3. Improved image quality in computed radiography (CR) and digital radiography (DR) opened the way for to convert to a digital format. a. CT b. MRI c. ultrasonography d. mammography 4. Computed radiography was first introduced commercially in the U.S. in 1983 by Medical Systems. a. Fugi b. Phillips c. General Electric d. Hitachi 5. Conventional x-ray and CR requires all of the following, except: a. traditional x-ray room b. x-ray table c. wall Bucky d. detector 6. In DR the image will appear in to seconds. a. 1 2 b. 3 5 c. 7 10 d. 15 20

7. Today most CR storage phosphor plates are made of: a. fluoride lithium b. barium fluorohalide c. calcium tungstate d. sodium fluoride 8. In DR there are no cassettes. a. True b. False 9. In conventional radiography, radiographic contrast is primarily controlled by: a. time of exposure (s) b. milliamperage (ma) c. kilovoltage peak (kvp) d. milliamperage-seconds (mas) 10. For CR and DR, mas has more influence on: a. shape distortion b. quantum mottle c. image noise d. reticulation of the image 11. The first full scale PACs in the U.S. was installed at the Veterans Medical Center in Baltimore in: a. 1965 b. 1978 c. 1993 d. 1999 12. Common computer output devices are: a. monitors b. printers c. speakers d. all of the above

13. A byte is made up of bits. a. 10 b. 8 c. 6 d. 4 14. The motherboard is the largest circuitry board inside the computer. a. True b. False 15. For the letter x, the binary code is: a. 01010010 b. 01100110 c. 01111000 d. 01111010 16. The central processing unit (CPU) is the personal computers (PC) box. a. True b. False 17. The connections for the information to flow within the computer is provided for by the: a. universal serial bus (USB)basic b. input/output system (BIOS) c. central processing system (CPU) d. random access memory (RAM) 18. The random access memory (RAM) is only temporary; once the computer has been turned off, the RAM is wiped clean. a. True b. False 19. Ports, on a computer, link: a. adapter cards and drives b. printers and scanners c. keyboards, mice, and other peripherals d. all of the above

20. By using universal serial bus (USB) ports on a computer, the user can connect up to devices to one single USB port. a. 30 b. 55 c. 127 d. 242 21. The main repository for programs and documents on a personal computer (PC) is the: a. hard drive b. sound card c. network card d. port 22. A digital versatile disk (DVD) holds up to times more than the compact disk (CD) drive. a. three b. seven c. nine d. thirteen 23. A wireless type of mouse device is considered a mouse. a. PS/2 b. serial c. infrared d. Bus 24. With the advent of wireless connections, keyboard makers use either infrared or radiofrequency (RF) signals. a. True b. False 25. A basic picture element on a display is known as a: a. matrix b. dot c. crystal d. pixel

26. All of the following are true regarding dot pitch, except: a. it is an arrangement of pixels b. is a measurement of how close the dots are located to one another within a pixel c. may be expressed as aperture grille or slot pitch d. the smaller the dot pitch of a display, the finer the resolution 27. Most modern PACs use a platform on their servers. a. windows-based b. UNIX c. LINUX d. Local area network (LAN) 28. Devices other than computers that can also be found on a network are: a. printers b. scanners c. barcode readers d. all of the above 29. A small area networked with a series of cables or wireless access points that allow computers to share information and devices on the same networks is a: a. modem b. LAN c. BUS d. Wide are networks (WAN) 30. The maximum number of peers that should be connected in a peer-to-peer network is: a. 2 b. 4 c. 6 d. 10 31. There can be multiple servers on a server-based network but there must be a dedicated server that controls the network. a. True b. False

32. The most commonly used wire as the connection medium in LANs is: a. twisted-pair wire b. coaxial cable c. fiberoptic cable d. infrared transmitter-wire 33. The biggest advantage of wireless connections is: a. privacy and confidentiality b. low cost c. mobility and convenience d. resolution of the connection 34. A network is the simplest device that can be used to connect several pieces of equipment together for network connection purposes. a. interface card b. hub c. switch d. bridge 35. A device used to read portions of messages and direct them to their intended target is referred to as a network. a. modem b. switch c. bridge d. router 36. When larger networks can be segmented, a network is created. a. modem b. switch c. bridge d. router 37. When devices communicate through a network interface card (NIC) each computer on the network will have the same address. a. True b. False

38. There are common topology configuration layouts possible on the devices connected on a network. a. two b. four c. six d. eight 39. Topology in which a network has multiple pathways interconnecting devices and networks is a: a. ring b. BUS c. Mesh d. Star 40. The first version of digital imaging and communications in medicine (DICOM) was completed in: a. 1969 b. 1975 c. 1985 d. 1992 41. The DICOM standard is made up of different parts ranging from image display to media storage. a. 24 b. 16 c. 8 d. 4 42. Unique identifier numbers are created based on all of the following, except: a. vendor number b. equipment serial number c. date, time, patient or processing number d. patient s ability to pay for the study 43. As images are compressed at higher values, some loss of image detail can occur. a. True b. False

44. Data travels along the network using an agreed on set of rules known as a net-work protocol. a. True b. False 45. All of the following are true regarding the CR cassette, except: a. looks like a conventional radiography cassette b. is backed by a thin sheet of aluminum c. contains calcium tungstate screens d. contains an antistatic material 46. In CR cassettes located between the active layer and the support that absorbs the stimulating light but reflects emitted light is the layer. a. color b. support c. backing d. conductive 47. With CR systems, the purpose of the reader is to: a. trap the electron signal b. release stored electrons c. convert the electrons to ions d. magnify the stored electrons 48. Although there will be variances among manufacturers, the typical throughput is cassettes per hour based on average hospital department workflow. a. 25 b. 50 c. 75 d. 100 49. In film/screen radiography resolution is determined by: a. the range of the kilovoltage used b. centimeter size and pathology c. type of image processing system used d. crystal size and thickness of the phosphor layer

50. Fuji Medical Systems reports that a 1-mR exposure at 80 kvp and a source-to-image distance of 72 inches will result in a luminescence value of 200, hence a speed class of: a. 100 b. 200 c. 300 d. 600 51. Imaging plates should be erased at least or when in doubt about the presence of exposure to the plate to remove background radiation and scatter. a. once a day b. every 48 hours c. once a week d. once a month 52. In CR, if a knee examination is to be performed and the examination selected is for the skull, this will result in: a. improper brightness b. improper contrast c. unacceptable action d. all of the above 53. In CR, it is not recommended that kvp values less than 45 or greater than be used because those values may be inconsistent and produces too little or too much excitation of the phosphors. a. 120 b. 95 c. 80 d. 75 54. Quantum noise results when: a. too much kvp is used b. the kvp range is low c. insufficient light is produced d. the exposure time is too long 55. Typically, high-resolution imaging plates are most often used for: a. extremities b. mammography c. examinations requiring increased detail d. all of the above

56. When using a stationary grid if the grid lines and the scanning laser are parallel, a wavy artifact known as a pattern occurs. a. moiré b. pi c. cross-hatch d. rhombic 57. All of the following are true regarding grid frequency, except: a. refers to the number of grid lines per centimeter or lines per inch b. the finer the grid line in the image the less they interfere with the image c. typical grid frequency is between 80 and 152 lines/inch d. the higher the frequency the greater the positioning latitude 58. For mobile radiography, a grid ratio of would be proper. a. 3 : 1 b. 6 : 1 c. 12 : 1 d. 18 : 1 59. Parallel grids should not be used at distances less than inches. a. 48 b. 52 c. 65 d. 72 60. A sensitivity number (s) of 400 is the exposure of an S number of 200. a. four times b. three times c. twice d. half 61. The semiautomatic mode is especially useful for all of the following, except: a. odontoid process b. lumbosacral spot film c. sinuses d. hip with a prostheses

62. Cracks in the imaging plate appear as areas of on the image. a. radiolucency b. dark lines c. pinpoint dots d. static discharge streaks 63. A white grid-type pattern and white areas that correspond to the hinges results when the cassette is exposed with the back toward the source. a. True b. False 64. Detective quantity efficiency (DQE) refers to: a. conversion of CR to DR b. efficiency of resolution of the image c. how effectively scatter radiation is absorbed by the grid d. how efficiently a system converts the x-ray input signal into a useful output image 65. Automatic rescaling means that images are produced with: a. less magnification than is actually present b. uniform density and contrast regardless of the amount of exposure c. minimal scatter radiation d. the greatest degree of collimation 66. Smoothing is also known as: a. low-pass filtering b. high-pass filtering c. modulation transfer d. windowing 67. In CR veil glare may be effectively eliminated by: a. filtering b. image sampling c. aliasing d. shuttering

68. Image stitching technique eliminates the need for: a. large (36 inch) cassettes b. image annotation c. edge enhancement d. image sampling 69. An archive server in a PACs system is comparable to a room. a. waiting b. viewing c. processing d. file 70. Mammography requires a megapixel resolution to provide the viewing capacity needed. a. 5 b. 4 c. 3 d. 2 71. One of the most important features on a physician review station is the ability to: a. manipulate image density and contrast b. increase or decrease edge enhancement c. filter out extraneous white light d. view current and previous reports along with the images 72. How a set of images will be displayed on the monitor is referred to as protocol. a. scrolling b. hanging c. aliasing d. switching 73. The most common measurement function found on PACs stations is: a. distance b. resolution c. magnification d. degree of angulation

74. Archive technology continues to make drastic improvements each year; the storage capacity is said to double every to months. a. 1 2 b. 3 6 c. 8 12 d. 18 24 75. When data is broken up into pieces it is referred to as : a. enhancing b. digitizing c. striping d. mirroring 76. The most common redundant array of independent disks (RAID) level used for a PACs archive is a RAID : a. 0 b. 1 c. 3 d. 5 77. The first ultra density optical disk (UDO) was introduced in: a. 1978 b. 1989 c. 2000 d. 2004 78. Tape libraries being offered in 2006 held between 24 and disks. a. 800 b. 638 c. 424 d. 128 79. A type of storage that is connected directly via cable connections and shows up on the computer as different partitions for use is referred to as: a. DAS b. NAS c. PNP d. SAN

80. Disaster recovery involves: a. rebooting the CR or DR system b. making copies of each tape of disk and sending them to an off-site location c. manual operation directions in case of a system crash d. designation of key personnel in case of a crisis 81. All of the following are true regarding CCD film digitizers, except: a. uses fluorescent bulbs that shine through the film b. are more expensive than laser digitizers c. can take up to 80 seconds to scan one film d. can have problems with extreme light and dark areas on the film 82. Dry imagers use to process the latent image. a. heat b. chemicals c. infrared d. lasers 83. Film can and will be used in the filmless radiology department because: a. A backup ability to print is needed in case the PACS goes down b. When a PACS is installed, there are a few departments that are difficult to convert to PACS initially c. Films are required for legal cases when a copy needs to be viewed in court d. All of the above 84. One sheet of dry laser film costs approximately $. a. 5.50 b. 3.00 c. 2.35 d. 0.48 85. Quality control measures are taken to ensure that radiologic procedures are: a. performed safely b. appropriate for the patient c. performed efficiently and produce a high quality image d. all of the above

86. Continuous quality improvement (CQI) tends to focus on: a. people b. services c. processes d. organizations 87. The American College of Radiology (ACR) suggests that quality control tests be performed at least: a. semi-annually b. monthly c. weekly d. daily 88. The weakest link in the digital imaging chain often is the: a. printer b. workstation c. scanner d. monitor 89. For luminance, reflection, noise and glare test, the technologist should verify that all luminance patches are clearly visible. a. 32 b. 24 c. 16 d. 8 90. The TG-18-QC test pattern is used to test for: a. reflection b. geometric distortion c. luminance response d. luminance dependencies 91. All annual testing and acceptance testing should be performed by a qualified: a. medical physicist b. densitometry technologist c. quality control technologist d. board certified radiologist

92. After acceptance testing of the workstation processing speed, if no changes are seen on the weekly-established pattern, the procedure can then be done on a basis. a. annual b. semi-annual c. quarterly d. monthly 93. Compression is used to: a. reduce the technologist s workload b. minimize strain on the image processing system c. increase speed of the network transfer of images d. expand capability of the network 94. The first line of defense in preventing, recognizing and reporting QC issues is the: a. radiologist b. medical physicist c. referring physician d. radiologic technologist 95. Daily QC duties for technologists includes: possible responses a. 2 and 3 b. 3 and 4 c. 2, 3, & 4 d. 1, 2, 3, & 4 1. inspect and clean cassettes 2. inspect hinges and latches and laser printers 3. erase imaging plates 4. verify digital interfaces and network transmission 96. Reject analysis requires: a. repeat reason b. number of repeats c. the responsible technologist(s) d. all of the above

97. Image plates (IPs) should be removed from the cassette and inspected visually for: possible responses a. 1 and 2 b. 3 and 4 c. 1, 2, & 3 d. 1, 2, 3, & 4 1. dirt and hair 2. lint 3. scratches 4. cracks 98. Because IPs contains a small amount of, they must be discarded according the state and U.S. Environmental Protection Agency (EPA) regulations. a. lead b. arsenic c. barium d. copper 99. A system of preventative maintenance (PM) typically takes place on a basis. a. monthly b. quarterly c. semi-annual d. annual 100. When tested, the reproducibility of exposures produced should be plus or minus % within established exposure parameters measured in multiple exposures. a. 2 b. 5 c. 9 d. 11