Patient Education and Assessment (Mammography)

The biggest risk factor for breast cancer is(A) a family
history of breast cancer(B) a personal history of breast
cancer(C) gender(D) not breastfeeding

(C) gender
-Certain factors increase a woman�s risk for breast cancer. These
are divided into major and minor risk factors. Major risk factors are
those outside of a woman�s control, such as gender and age. Minor
factorsare linked to cancer-causing factors in the environment
or may be related to personal choices, such as using hormone
replacement therapy (HRT). Simply being a woman is the main risk
factor for developingbreast cancer. Breast cancer can affect men
as well, but this disease is much more common among women than among men.

One of the minor risk factors for breast cancer could be(A)
gender(B) aging(C) genetic risk factors(D) not breastfeeding

(D) not breastfeeding
-A risk factor is anything that increases a person�s chances of
getting a disease. Major risk factors cannot be changed. Minor factors
are linked to cancer-causing factors in the environment or may be
related to personal choices, such as breastfeeding.

What is the approximate risk of developing breast cancer for a woman
whose sister has the disease?(A) higher than normal
risk(B) no significant change in risk(C) lower than normal
risk(D) none of the above

(A) higher than normal risk
-Higher-than-normal or major risk factors carry a significantly
higher risk for breast cancer compared with minor risk factors. Breast
cancer risk is higher among women whose close blood relatives have the
disease. Blood relatives can be either from the mother�s side or the
father�s side of the family.

A woman with the greatest risk of developing breast cancer
is(A) age 30 years or below(B) above age 50 years(C)
between ages 30 and 40 years(D) above age 20 but below age 30 years

(B) above age 50 years
-A woman�s risk of developing breast cancer increases with age.
Older women have the greatest risk. At age 30 years, a woman has a
0.44% (or 1 in 227) risk of developing breast cancer. At age 40 years,
the woman has a 0.47% (or 1 in 68) risk of developing breast cancer.
At age 50 years, the risk increases to 2.38% (or 1 in 42). At age 60
years, the risk increases to 3.56% (or 1 in 28). At age 70 years, the
risk is 3.82% (or 1 in 26).

Symptoms of a possible breast disease that will not be demonstrated
on the mammogram may include(A) nipple discharge(B) skin
thickening(C) circumscribed tumors(D) stellate lesions

(A) nipple discharge
-Skin thickening or tumors and lesions will be seen on a
mammogram, whereas nipple discharge is not seen on a mammogram.
Although a nipple discharge can indicate malignancy, most nipple
discharges orsecretions are not indicative of cancer. In
general, if the secretion appears clear, milky, yellow, or green,
cancer is very unlikely. Further testing with high-frequency
ultrasound techniques or other tests, such as a ductography or
galactography, help determine the cause of nipple discharge.

Symptoms of very early DCIS may include(A) skin
thickening(B) nipple discharge(C)
macrocalcifications(D) none of the above

(D) none of the above
-Unfortunately, breast cancer in its early stages is symptomless.
Early ductal carcinoma in situ (DCIS) can show on the mammogram as
clusters of microcalcifications. As the cancer grows, some symptoms
may appear. These symptoms can include lumps in the breast, thickening
of the breast skin, puckering or dimpling of the breast, inverted
nipples, or a discharge from the nipples.

Skin thickening can be malignant but could also be caused by
nonmalignant factors, such as(A) esophageal metastases (B)
bronchial cancer(C) Hodgkin disease(D) sarcoidosis

(D) sarcoidosis
-Skin thickening or lymphedema of the breast can be an indication
of breast cancer but may also be caused by a breast abscess located
behind the nipple, severe infection involving the axillary nodes, or
mediastinal blockage as a result of advanced stage of sarcoidosis (an
inflammatory disease). Malignant skin thickening can be cause by
Hodgkin disease (cancer of the lymphocytes), lung cancer, bronchial
cancer with mediastinal metastases, esophageal cancer with mediastinal
metastases, right heart failure, advanced gynecological malignancy, or
postoperative or postradiation lymphedema.

Risks factors associated with taking hormone replacement therapy
(HRT) include(A) early menopause(B) late
menopause(C) increased risks for birth defects(D)
increased risks for breast cancer

(D) increased risks for breast cancer
-Minor factors are linked to cancer-causing factors in the
environment or may be related to personal choices, such as using HRT.
Simply being a woman is the main risk factor for developing breast
cancer. Breast cancer can affect men as well, but this disease is much
more common among women than among men.

The ACS recommends that(A) women older than 40 years should
have a yearly magnetic resonance imaging (MRI)(B) women younger
than 40 years should have screening mammography every year(C)
new masses or lumps in the breast should be checked by a health care
provider(D) women between ages 20 and 39 years should have a CBE
every year

(C) new masses or lumps in the breast should be checked by a health
care provider
-The guidelines as suggested by the American Cancer Society (ACS)
are� Women ages 40 to 44 years� Annual screening if they
wish� Women 45 years of age with average risk factor�
Annual breast cancer screening if they wish� Women ages 45 to 54
years� Mammography recommended every year� Women ages 55
years and older� Mammography every 1 or 2 years� Screening
should continue as long as a woman is in good health and is expected
to live 10 more years or longer.� Magnetic resonance imaging
(MRI) or ultrasound screening only for women with high-risk factors or
very dense breast� The ACS does not recommend breast examination
for breast cancer screening among average-risk women at any age.

A health care provider should evaluate which of the following breast
changes?1. lumps or swellings2. skin irritation or
dimpling3. milky discharge from the nipple(A) 1
only(B) 1 and 2 only(C) 2 and 3 only(D) 1, 2, and 3

(B) 1. lumps or swellings and 2. skin irritation or dimpling
-Changes, such as a lump or swelling, tenderness, skin irritation
or dimpling, and nipple pain or retraction should be evaluated as
soon as possible. In general, if the nipple discharge is clear,
milky, yellow, or green, cancer is unlikely. If the discharge is red
or red-brown, suggesting blood, it could be caused by a malignant or
benign condition and should be evaluated.

It is necessary for the technologist to document which of the
following?(A) edema(B) dimpling of the skin(C)
pain(D) all of the above

(D) edema, dimpling of the skin and, pain
-All of the above must be documented. Other signs and symptoms
that should be documented include lumps, thickening, nipple
discharge, skin changes, nipple and areola changes, and erythema.

Pre-examination instructions that can be given to the patient
include(A) remove all clothing from the waist down(B)
remove deodorant(C) remove panties(D) A and B

(B) remove deodorant
-The patient should remove all clothing from the waist up, which
is the area of interest. Underarm deodorant should be removed to
prevent any possibility of misdiagnosis. The remnant of the deodorant
can show as microcalcifications on the mammograms.

Benefits of communication with your patient include(A) helps
identify sensitive breast and the reason for the sensitivity(B)
educates the patient(C) reveals fears and
misconceptions(D) all of the above

(D) helps identify sensitive breast and the reason for the
sensitivity, educates the patient and, reveals fears and misconceptions
-Communication is important during the mammography because a
relaxed patient is easier to position. The technologist should strive
to develop a rapport with the patient before starting the
examination. Notonly will the patient be more relaxed but the
patient will also perceive the technologist as competent if her
needs�both physical and emotional�are adequately met during the
examination. For example, a patient who is nervous about the
radiation dose can be reassured by informing her about the actual
dose during mammography and the Mammography Quality Standards Act
(MQSA) regulations in place to ensure that the dose is not exceeded.

In developing patient rapport, the technologist should strive to
enhance the patient�s self-esteem. Thismeans that the
technologist should(A) reflect the patient�s emotions to show
understanding(B) agree unconditionally with anything the patient
says(C) say �I understand� to any comment the patient
makes(D) offer reassurance and encouragement if the patient is
confused or unable to help herself

(D) offer reassurance and encouragement if the patient is confused or
unable to help herself
-The technologist should preserve the patient�s self-esteem by
helping the patient feel good about herself. In enhancing the patient
self-esteem, the technologist should offer reassurance and
encouragement if the patient is embarrassed, confused, or unable to
help herself. The technologist should be specific and sincere and
treat the patient as someone important. However, the technologist
should not show pity or repeat the patient�s remarks word for word.

The two-step method of BSE is to(A) look and feel for changes
in the breast(B) examine the breasts and undergo regular
mammography(C) check for lumps in the breast and keep a journal
of changes in the breast(D) examine the breasts and nipples

(A) look and feel for changes in the breast
-For breast self-examination (BSE), the first step is to look for
changes in either the standing position or the sitting position. A
check should be made for indentations, retracted nipples, dimpling, or
prolonged skin conditions, such as eczema. Other visual changes can
include the development of unequal sized breasts; changes in texture,
color, or contour; and redness or scaliness. Moles and scars should
alsobe noted and recorded. The next step is feeling for changes.
While feeling for changes, the breast should be examined in both the
upright and supine positions by using the pads of three or more
fingers to applyvarying degrees of pressure�firm pressure to
assess deep lesions, medium pressure for intermediate-depth lesions,
and light pressure to assess lesions just below the skin surface. The
entire breast must be checked. In any examination, lotion or powder
can be used to help the fingers glide across the breast. Some women
also prefer to examine their breasts in the shower, where wet fingers
will glide easily over the breast.

When visually inspecting the breast, the changes that should be
recorded include1. changes in breast size and shape2.
changes in texture or color of the breast3. indentations on the
skin of the breast(A) 1 and 2 only(B) 2 and 3
only(C) 1 and 3 only(D) 1, 2, and 3

(D) 1. changes in breast size and shape 2. changes in texture
or color of the breast 3. indentations on the skin of the breast
-The visual stage of a BSE is a check for signs of breast cancer.
These signs can include changes in the size, texture, or color of the
breast; prolonged skin irritation; redness or scaliness; dimpling; or nippleretraction.

The patient�s medical history and documentation will1. provide
the radiologist with information on the patient�s risk factors for
breast cancer2. give the radiologist information about general
symptoms of breast cancer3. provide information about possible
benign breast conditions of the patient(A) 1 and 2 only(B)
2 and 3 only(C) 1 and 3 only(D) 1, 2, and 3

(C) 1. provide the radiologist with information on the patient�s risk
factors for breast cancer 3. provide information about possible benign
breast conditions of the patient
-The first step in evaluating a woman with suspected breast cancer
is obtaining the complete medical history and performing a physical or
clinical examination. The medical history will provide
informationabout the patient�s symptoms and any other health
problems and risk factors for benign or malignant breast conditions. A
clinical examination can locate any lump or suspicious areas and
reveal the texture,size, and shape of the breast. Any changes in
the nipples or skin of the breast will also be noted. Once the medical
and clinical examinations are completed, biopsy or imaging tests, such
as mammography, can beperformed.

Stressing the importance of the BSE can be controversial because
(A) BSE tends to detect only benign breast cancer(B) BSE
will help in the detection of malignant breast conditions(C)
mammography is not 100% effective(D) BSE can cause unnecessary
anxiety in women

(D) BSE can cause unnecessary anxiety in women
-Some studies have called for an end to routine BSE for women 40
to 69 years of age. The theory is that BSE and BSE education do not
reduce death rates but will increase unnecessary performance of biopsy
and cause anxiety. Although the American Cancer Society (ACS) no
longer recommends that all women routinely perform BSE, the Society
still promotes breast awareness and encourages women to be aware of
the normal look and feel of their breasts. Studies have suggested that
women usually find cancer while showering, bathing, or dressing,
rather than during a specific breast examination. Unfortunately,
mammography is not foolproof. Even under ideal conditions, it will not
find all breast cancers 100% of the time.

Which of the following are methods used in BSE?
1. using the pads of the three middle fingers to palpate the
entire breast2. palpating around the breast in a vertical
pattern3. using varying degrees of pressure while palpating of
the breast(A) 1 only(B) 1 and 2 only(C) 1 and 3
only(D) 1, 2, and 3

(D) 1. using the pads of the three middle fingers to palpate the
entire breast 2. palpating around the breast in a vertical
pattern 3. using varying degrees of pressure while palpating of
the breast
-Three different levels of pressure are recommended when examining
the breast: light pressure to feel the tissues closest to the skin,
medium pressure to feel a little deeper, and firm pressure to feel the
tissueclosest to the chest and ribs. The up-and-down pattern
(sometimes called the vertical pattern) is the most effective pattern
for covering the entire breast without missing any breast tissue, and
the pads of the threemiddle fingers (not the fingertips) are the
most sensitive to palpate for abnormalities. The patient should use
small dime-sized circular motions to examine the entire breast.

For a menstruating woman, when is the best time of the month to
perform BSE?
(A) 1 week before the start of menstruation(B) on the first
day of the month(C) on the last day of the month(D) when
the breast is least tender

(D) when the breast is least tender
-The patient should perform BSE 5 to 10 days after the start of
the menstrual period or when the breasts are not tender or swollen.

Which of the following statements is true?
1. Breast cancer death rates in the United States are going
down.2. Breast cancer is the leading cause of cancer-related
deaths among women in the United States.3. The second leading
cause of cancer-related deaths among women in the United States is
breast cancer.(A) 1 and 2 only(B) 2 and 3 only(C) 1
and 3 only(D) 1, 2, and 3

(C) 1. Breast cancer death rates in the United States are going down.
3. The second leading cause of cancer-related deaths among women in
the United States is breast cancer.
-Breast cancer is the second most common cancer among women in the
United States. Certain types of skin cancer are the most common.
Breast cancer is also the second most common cause of
cancer-relateddeath among women. (Lung cancer is the leading
cause of cancer-related death among women in the United States.) In
2013, approximately 39,620 women were expected to die as a result of
breast cancer.Breast cancer incidence and death rates generally
increase with age. Breast cancer death rates have been declining since
1989�with larger decreases among women ages 50 years and younger.
Seventy-ninepercent of new cases and 88% of breast cancer deaths
occurred in women ages 50 years and older. The decrease in the
incidence of breast cancer is thought to be related to the reduced use
of hormonereplacement therapy (HRT) after the published study by
the Women�s Health Initiative in 2002, which linked HRT to breast
cancer risks. The decrease in breast cancer deaths is thought to be
the result of advanced treatment options, earlier detection, and
increased awareness.

Postmenopausal obesity is associated with
(A) a relatively high risk of developing breast cancer(B)
overall reduction in breast cancer risks(C) circulating estrogen
that is produced in fatty tissue(D) a lower overall estrogen level

(C) circulating estrogen that is produced in fatty tissue
-Circulating estrogen is mostly produced in fatty tissue;
therefore, in postmenopausal women, having more fatty tissue can lead
to increased estrogen levels. Weight gain is therefore associated
with increasedestrogen levels and increased likelihood of
developing breast cancer.

In routine mammography, the glandular dose per projection is
generally about
(A) 1�2 mGy (0.1�0.2 rad)(B) 10�20 mGy (1.0�2.0
rad)(C) 0.1�0.2 mGy (0.01�0.02 rad)(D) 2�3 mGy (0.2�0.3 rad)

(A) 1�2 mGy (0.1�0.2 rad)
-With modern mammography equipment, the patient will usually
receive only about 1 to 2 mGy (0.1�0.2 rad) per projection. The
American College of Radiology (ACR) recommends that the average
glandular dose on mammography be no greater than 3 mGy (0.3 rad or
300 mrad) with a grid, or 1 mGy (0.1 rad or 100 mrad) without a grid.

Which age group is likely to get the most radiation dose during
mammography?(A) 20 to 35 years(B) 40 to 50 years(C)
55 to 60 years(D) above 70 years

(A) 20 to 35 years
-Although breast tissue composition is affected by menarche,
hormonal fluctuation (both normal and synthetic) pregnancy, lactation,
menopause, and weight gain or loss, in general, the breasts of young
women are denser than those of older women. Younger breasts will
therefore require more radiation to penetrate and will absorb more
radiation compared with those of older women. Fortunately, the
incidence of breast cancer in this age group is very low.

The 5-year survival rate for a patient with stage 0 breast cancer is
about:(A) 22%(B) 72%(C) 93%(D) 100%

(D) 100%
-�Stage 0 carcinoma� refers to carcinoma in situ, cancer that is
still contained within the duct or lobule. The prognosis for this type
of cancer is 100% survival after 5 years. �Five-year survival rate�
refers to thepercentage of patients who live at least 5 years
after their cancer is diagnosed. Many of these patients live much
longer than 5 years after diagnosis, but 5-year rates are used to
produce a standard way of discussing prognosis. Five-year rates will
exclude patients dying of other diseases from the calculations and is
considered a more accurate way to describe the prognosis for patients
with a particular type and stage ofcancer (Table 1�1).

During mammography, which of the following will affect the average
glandular dose per breast?
1. degree of breast compression2. the half-value layer (HVL)
of the x-ray beam3. breast size and composition(A) 1
only(B) 2 only(C) 3 only(D) 1, 2, and 3

(D) 1. degree of breast compression 2. the half-value layer
(HVL) of the x-ray beam 3. breast size and composition
-The major factors affecting dose are� The imaging
chain�imaging conditions, including the type of mammography
unit.� The x-ray beam energy�the higher the peak kilovoltage
(kVp) and HVL, the lower is the patient dose.� The
compression�greater compression will result in decreased exposure and
therefore decreased dose.� The patient�s breast tissue type
(composition) and thickness�denser glandular breast requires more
exposure compared with fattier breast.

Patients who are allowed to play an active role in applying
compression are usually
1. less likely to tolerate the compression2. more likely to
tolerate the compression3. more relaxed during the
compression(A) 1 only(B) 2 only(C) 1 and 3
only(D) 2 and 3 only

(D) 2. more likely to tolerate the compression 3. more relaxed
during the compression
-Studies have shown that a patient who plays an active role in
applying compression will be able to tolerate the compression better
and will be more relaxed during the compression. The more the patient
knows about compression and understands the procedure, the more she
will be relaxed. To give the patient an active role in compression,
the technologist can allow the patient to apply the compression
orconstantly monitor the patient, stopping the compression when
indicated by the patient. If the sensitivity is extreme and/or hormone
related, mammography could be rescheduled.

In breast imaging, the dose calculation is based on(A) the
entrance skin dose(B) dose absorbed by the glandular tissue of
the breast(C) the average skin dose(D) chest wall
radiation dose

(B) dose absorbed by the glandular tissue of the breast
-The radiation dose in mammography is calculated on the basis of
the average dose to the interior of the breast or the average
glandular dose. In mammography, compared with the skin dose, the
glandular doseis very low because the dose falls off rapidly as
the low photon energy beam penetrates the breast.� Entrance
skin exposure (ESE) for a typical single exposure ?800 to 1200 mrad
(812 mGy); glandular dose during a typical mammogram exposure ?100
mrad (1.0 mGy)� The ACR recommends� 0.3 rad (300 mrad or
3 mGy) with a grid� 0.1 rad (100 mrad or 1 mGy) without a grid

What is the purpose of requesting the patient to provide prior
mammograms before starting the mammogram examination?(A) to see
if the patient has breast cancer(B) to assess the exposure
technique(C) to provide the radiologist with an additional
aid(D) to verify the correct patient

(C) to provide the radiologist with an additional aid
-The previous mammogram cannot be used to verify the patient�s
identity. With digital imaging, most mammography units offer an option
for automatic exposure; therefore, assessment of the exposure
technique is not needed for routine imaging. However, previous
mammograms are invaluable to the radiologist and can help avoid
false-positive or false-negative reports. Having the previous
mammogram can lead to a more accurate reading and reduce the need for callbacks.

The age of a woman taking HRT is likely to be:(A) under 40
years(B) 25 to 35 years(C) over 40 years(D) under 20 years

(C) over 40 years
-Decline in a woman�s hormone levels as a result of aging or
menopause can result in uncomfortable symptoms, such as hot flashes,
vaginal dryness, or osteoporosis. HRT uses estrogen and progesterone
totreat these common symptoms. A woman using HRT is therefore
likely to be over 40 years of age.

The term primipara refers to a woman who(A) has had multiple
pregnancies(B) was pregnant once but lost the baby at 6
weeks(C) carried a pregnancy to over 20 weeks but had a
stillbirth(D) was never pregnant

(C) carried a pregnancy to over 20 weeks but had a stillbirth
-A woman who has had one pregnancy with the fetus attaining a
weight of 500 g or a gestational age of 20 weeks, regardless of the
pregnancy culminating in a live birth or in a single birth or
multiple births, isconsidered a primipara�the status of having
borne one child. A nullipara is a woman who has never borne a child
or carried a fetus to the point of viability

In mammography, information included on the medical history
documentation includes which of the following as they relate to the breast?
1. patient�s history of trauma2. history of surgery3.
unusual skin condition(A) 1 and 2 only(B) 2 and 3
only(C) 1 and 3 only(D) 1, 2, and 3

(D) 1. patient�s history of trauma 2. history of surgery
3. unusual skin condition
-The technologist should document a full clinical history,
including family or personal history of breast cancer, any history of
breast trauma, and history of breast surgery, biopsy, lumpectomy, and
augmentation or reduction. Symptoms to document include skin
thickening, unusual lumps, dimpling or puckering of skin, moles,
eczema, ulcers, nipple changes�especially new changes�and any
abnormalities of accessorybreast tissue or nipples.

All of the following are forms of subjective patient data
except(A) patient has a palpable lump in the right
breast(B) patient complains of severe pain during breast
compression(C) the mood or demeanor of the patient(D)
patient�s complaints of pain and tenderness in the left breast

(A) patient has a palpable lump in the right breast
-Objective data include signs that can be seen, heard, or felt and
other factors, such as laboratory reports. Subjective data include
things that are perceived by the affected individual only (e.g.,
pain). Both objective and subjective data are equally important, and
the technologist should never disregard anything the patient says,
even if it does not align with standard opinions or the patient�s symptoms.

When questioning a patient to obtain an accurate patient
history(A) keep questions general in nature so as not to offend
the patient(B) start with open-ended questions and then follow
up with more direct inquiries(C) do not let the patient talk too
much in order to keep the examination moving(D) use medical
�jargon� to impress the patient with your expertise

(B) start with open-ended questions and then follow up with more
direct inquiries
-The best approach to clinical history documentation is to start
with open-ended questions. This avoids leading the patient and
inserting your opinions or views. Example of a leading question: �Is
the pain inyour right breast?� Example of a non leading
question: �Where is the pain?� Also, listening rather than asking
questions will allow the patient to tell her stories voluntarily. By
listening, the patient�s life experience and educational background
can be assessed. This will determine whether medical or technical
terms can be used rather than highly simplified words in future
questions (Fig. 1�2).

Which of the following are positive questioning skills that the
radiographer can use when verifying the accuracy of patient
information?(A) leading questions(B) open-ended
questions(C) repeating information(D) facilitation

(C) repeating information
-Repeating or rewording the question will help clarify the
information and verify that the patient has not changed his or her
mind. Open-ended questions are used at the start of documentation of
medical history to avoid leading the patient to only some answers.
Leading questions should never be used at the start of any assessment
because its use can insert the technologist�s personal bias into the
patient�s answers.Facilitation will encourage elaboration.

What is the purpose of �probing� questions used when interviewing
patients?(A) clarifies information by asking for specific
details(B) gives the patient time to remember details(C)
allows the patient time to tell his or her story(D) summarizes
the accuracy of the information

(A) clarifies information by asking for specific details
-Probing questions are used to get more details. Listening rather
than asking questions will allow the patient time to tell her stories
voluntarily. Silence will also give the patient time to remember past
events. Repetition, rewording, or summarization of the question can be
used to review the information and verify accuracy.

In gathering more information on a patient�s complaint of pain, a
good probing question to ask would be
(A) �How would you describe the pain?�(B) �When did the pain
first occur?�(C) �If the pain comes and goes, how often does it
occur, and what is the time span between occurrences?�(D) All of
the above are good questions to ask.

(C) �If the pain comes and goes, how often does it occur, and what is
the time span between occurrences?�
-�A� and �B� are good open-ended questions that can be used to
start documentation of clinical history. This avoids leading the
patient to certain answers and inserting the technologist�s opinions
or views. �C�is a probing question that could be used to get
more details.

There are two types of data collection processes. If your patient
says he or she has a bruise on the left breast, this information is
regarded as(A) objective(B) subjective(C) open-ended
scenario(D) probing

(A) objective
-Objective data include signs that can be seen, heard, or felt, as
well as laboratory reports. Subjective data include things that are
perceived by the affected individual only (e.g., pain). Both objective
and subjective data are equally important, and the technologist should
never disregard anything the patient says, even if it does not align
with standard opinions or the patient�s symptoms. Open-ended questions
are questions that can be used to start documentation of clinical
history. This avoids leading the patient to certain answers and
inserting the technologist�s opinions or views. A probing question is
used to get more details.

When questioning your patient, what is the purpose of
repetition?(A) to give the patient time to remember
details(B) to get more detail(C) to summarize(D) to
allow the patient to tell his or her story

(C) to summarize
-Repetition, rewording, or summarization of the question can be
used to review the information and verify accuracy or clarify the
information. In repeating information, precise and clear words must
always be used because words do not always mean the same thing to
patients as they do to the technologist; for example, to the patient,
�lumpectomy� can mean the removal of any lump from the breast, yet the
medical meaning is removal of a cancerous lump. Probing questions are
used to get more details. Listening rather than asking questions will
allow the patient time to tell her stories voluntarily. Silence will
also give the patient time to remember past events.

�Where is your pain?� is an example of(A) a probing
question(B) repetition(C) summarization(D) an
open-ended question

(D) an open-ended question
-This is an open-ended question that can be used to start
documentation of clinical history. This avoids leading the patient to
certain answers and inserting the technologist�s opinions or views. A
probing question is used to get more details. Repetition, rewording,
or summarization of the question can be used to review the information
and verify accuracy or clarify the information.

Which of the following will not result in increased breast cancer
risks?(A) having a mother who took diethylstilbestrol (DES)
while pregnant(B) having a first child before age 30
years(C) history of Hodgkin lymphoma(D) menarche at age 10 years

(B) having a first child before age 30 years
-Pregnancy is thought to have a protective effect against breast
cancer, and the longer a woman goes without getting pregnant, the
greater are the risks. Pregnancy at an earlier age is therefore
beneficial. Starting menstruation early (before age 12 years) is
considered to increase the risk because it increases the number of
menstrual cycles in a woman�s lifetime. Treatment for Hodgkin lymphoma
can often require radiation to the chest area, which can result in
increased breast cancer risk in later years. DES was used to prevent
miscarriages during 1940�1971. Women who took DES and children whose
mothers took DES have an increased risk of breast cancer.

An informed consent is required before performing which of the
following examination?(A) ultrasonography(B)
mammography(C) fine-needle biopsy (FNB)(D) MRI

(C) fine-needle biopsy (FNB)
-An informed consent is required for any invasive procedure that
involves risks. Although the risks are minor, fine-needle biopsy (FNB)
is considered an invasive procedure because the skin is penetrated by
aneedle and cell samples removed. Mammography, ultrasonography,
and magnetic resonance imaging (MRI) are not considered invasive. The
term informed consent implies that the patient has been informed of
the procedures or operation to be performed, the risks involved, the
possible consequences, and any alternatives. By signing the consent
form, the patient or the patient�s representative indicates that he or
she has been informed of and consents to the procedure or treatment.

Phone consent is an example of(A) written consent(B) oral
consent(C) implied consent(D) expressed consent

(B) oral consent
-Consent can be given in written or oral form. Written consent
offers some tangible proof but is subject to scrutiny and disbelief if
other facts relevant to the situation indicate that the patient did
not fully understand what affixing of his or her signature meant in
relation to the medical care. Oral consent is verbal. It is binding
but difficult to prove. Expressed consent can be nonverbal, such as
nodding or lifting the arm when told that an injection is required, or
oral. Implied consent is usually assumed in an emergency situation
where the patient is unable to make a decision.

The patient has to sign an informed consent
1. when there are significant risks associated with the procedure
or test2. for all diagnostic examinations in the imaging
department3. if the procedure is invasive(A) 1 and 2
only(B) 1 and 3 only(C) 2 and 3 only(D) 1, 2, and 3

(B) 1. when there are significant risks associated with the procedure
or test 3. if the procedure is invasive
-An informed consent is required for any invasive procedure that
involves risks. Not all procedures in the imaging department are
considered invasive. The term informed consent implies that the
patient has been informed of the procedures or operation to be
performed, the risks involved, the possible consequences, and any
alternative options. By signing the consent form, the patient or the
patient�s representative indicates that he or she has been informed of
and consents to the procedure or treatment.

Which kind of consent is binding but difficult to prove?(A)
oral(B) written(C) implied(D) printed

(A) oral
-Oral consent is verbal. It is binding but difficult to prove.
Written or printed consent offers some tangible proof but is subject
to scrutiny and disbelief if other facts relevant to the situation
indicate that the patient did not fully understand what affixing of
his signature meant in relation to the medical care (e.g., a
Russian-speaking patient signing a consent form written in English).
Implied consent is usually assumed in an emergency situation where the
patient is unable to make a decision.

Which of the following is not required information that must be
included on any informed consent?(A) name of the
procedure(B) risks and benefits of the procedure(C)
patient height and weight(D) possible alternative procedure

(C) patient height and weight
-Although height and weight are needed for some examinations, such
data are not considered essential information. Any consent must
include the patient demographic information, name, date of birth or
otheridentifier, and the current date. The consent should also
include an authorization clause allowing the physician to perform the
examination; a disclosure clause to explain the procedure, its risks
and benefits,and possible alternatives to the procedure; an
anesthesia clause, if required; a no-guarantee clause for therapeutic
procedures; a tissue-disposal clause if removal of tissue may be
necessary; a patientunderstanding clause�stating that the
patient has received an explanation and understands the explanation;
and a signature clause�including the signature of patient. The concept
of informed consent must be explained to the patient or caregiver by a
qualified clinician, such as a physician, but can be witnessed by a technologist.

Methods of acknowledging the patient and treating the patient
courteously can included all of the following except
(A) using greetings (good morning, good afternoon, etc.)(B)
avoiding eye contact(C) giving your full attention(D)
introducing yourself

(B) avoiding eye contact
-All of these except �B� would be recommended. Technologists
should maintain eye contact or smile and use appropriate language
when greeting patients.

Two disadvantages of mammography screening include1. the
granularity of the breast can impact visualization of cancers2.
mammography will not image all cancers3. the radiation dose from
mammography is dangerous(A) 1 and 3 only(B) 1 and 2
only(C) 2 and 3 only

(B) 1. the granularity of the breast can impact visualization of
cancers 2. mammography will not image all cancers
-The average glandular dose for typical mammography is regulated
by the MQSA standards and is not considered dangerous. The ACR
recommends that the average glandular dose on a single
projectionshould not be greater than 3 mGy (0.3 rad or 300
mrad) with a grid, or 1 mGy (0.1 rad or 100 mrad) without a grid.
With most modern imaging with digital units, even lower doses are
possible. The disadvantage of mammography is related to the fact that
a cancerous lesion will be imaged against the background breast
tissue composition. In an all-fatty breast, the cancer will be easy
to visualize. In dense, glandular breast tissue, it becomes harder to
visualize the cancer. This means that mammography may not be 100%
effective in diagnosing breast cancer. The good news is that
three-dimensional (3D) imaging and the use of adjunctive imaging
modalities will improve the true-positive rate.

The glandular dose is(A) received on the skin of the
breast(B) the significant background dose recorded by
ultrasonography(C) associated with dose to the radiosensitive
cells of the breast(D) a record of the dose to the gonads

(C) associated with dose to the radiosensitive cells of the breast
-Most patient dose reports in radiology involve a fact check of
the entrance skin exposure (ESE) only. However, the biological effect
of mammography is assumed to be more closely associated with the
totalenergy absorbed by the glandular tissue of the breast. This
glandular dose is therefore the dose of choice when calculating
radiation doses associated with mammography. In mammography, compared
with theskin dose, the glandular dose is very low because the
dose falls off rapidly as the low photon energy beam penetrates the
breast. The average glandular dose for typical mammography is
regulated by the MQSA standards: The ACR recommends that the average
glandular dose on a single projection not exceed 3 mGy (0.3 rad or 300
mrad) with a grid, or 1 mGy (0.1 rad or 100 mrad) without a grid.

Having a dense breast will(A) increase the risk of breast
cancer(B) reduce the risk of breast cancer(C) result in
breast cancer(D) help combat breast cancer

(A) increase the risk of breast cancer
-Women with dense breast tissue face a higher risk of missed
breast cancer if mammography is the only screening tool used. Recent
studies are leaning toward breast tissue density being a factor in
breast cancerrisks in younger women. The reason is that breast
cancers tend to develop in dense breast tissue. If a woman has dense
breast tissue, she would have a higher risk of developing breast
cancer compared with awoman of the same age with fatty breast
tissue. Breast ultrasonography, digital mammography, and MRI are more
accurate than mammography for assessing tumor size in breasts with a
higher tissue density.

The technologist should review the previous mammography report
to(A) verify the physician�s signature(B) verify the
technologist�s initials(C) provide the radiologist an additional
aid(D) confirm the type of exam (screen or diagnostic) needed

(D) confirm the type of exam (screen or diagnostic) needed
-The technologist can also benefit by having access to previous
mammograms if the patient has any limitations, either physical or
mental, that will need to be addressed. The report on the
previousmammogram will also verify the need for screening,
short-interval follow-up, or diagnostic mammography. For insurance
purposes, the previous mammogram and report will confirm that the
patient�s screening interval is correct�for example, to confirm that
the last mammogram was, indeed, taken 1 year ago.

Why should the patient remove deodorant before mammography?(A)
Deodorant can mimic malignant calcifications.(B) Deodorant
causes breast cancer.(C) Deodorant blocks the lymph nodes and
allows the spread of cancer.(D) Technologists have difficulty
positioning patients who are wearing deodorant.

(A) Deodorant can mimic malignant calcifications.
-Mammography uses low-dose radiation to image the breast, and many
deodorants and body powders contain aluminum or other metallic
elements that are not easily penetrated by the low peak kilovoltage
(kVp) used in breast imaging. This means that the specks of aluminum
or other metals will show on the mammogram as microcalcifications.
Certain types of breast cancer also show on the mammogram as
microcalcifications; therefore, to avoid confusion, the patient is
advised not to wear any deodorant.