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RD4.1-3 | Interdisciplinary Imaging Communication — Practice Quiz

Practice 8 questions · Untimed · Unlimited attempts

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Q1 RD4.1 1 pt

A house officer sends a CT abdomen requisition that reads only "abdominal pain – please scan." The reporting radiologist phones back asking for more detail. Which single addition to the requisition would MOST improve the radiologist's ability to choose the right protocol and answer the clinical question?

A The patient's full home address and contact number
B A specific clinical question with relevant focused history, e.g. "72-year-old, sudden severe central pain, hypotensive — exclude ruptured AAA"
C A reminder that the consultant wants the scan done today
D The patient's complete past surgical history going back twenty years
E A statement that the patient is anxious about the scan

Correct. The specific clinical question, supported by focused relevant history, is the heart of the requisition — it lets the radiologist pick the right modality, protocol and contrast phase and direct the search pattern.

A high-quality requisition gives the radiologist everything needed to choose the right study, run it safely, and answer a SPECIFIC question — relevant history plus a precise question, not clutter.

The radiologist needs a focused clinical question and relevant history to select the protocol and search pattern, not administrative or unfocused data.

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Q2 RD4.1 1 pt

Which set of safety flags is MOST important to include explicitly on an imaging requisition because it directly affects whether the study can be performed safely?

A Renal function/eGFR, contrast allergy history, pregnancy status, and implanted devices/metalwork
B Marital status, occupation, and next of kin
C Preferred appointment time and ward telephone extension
D The patient's height and shoe size
E The name of the admitting consultant only

Correct. Renal function (contrast nephrotoxicity), allergy history, pregnancy (ionising radiation), and implants/metalwork (MRI safety) are the safety flags that determine whether and how the study can proceed.

Safety flags — renal/allergy/pregnancy/implants — must be on every requisition; they govern contrast safety, radiation justification and MRI compatibility.

Safety flags are the items that change whether the study can safely proceed: renal function, allergy, pregnancy, and implants/metalwork.

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Q3 RD4.1 1 pt

A 45-year-old is admitted with new severe headache. The medical team is unsure whether CT or MRI is the appropriate first study. According to RD4.1, what is the MOST appropriate action?

A Order both CT and MRI simultaneously to be safe
B Order whichever scanner has the shortest waiting list
C Contact the radiologist to clarify the appropriateness of imaging and which study best answers the clinical question (justification)
D Default to MRI because it gives more anatomical detail in every situation
E Cancel imaging and observe clinically for 48 hours

Correct. When in doubt about appropriateness, RD4.1 requires clarifying with the radiologist — a justification conversation that selects the study best matched to the clinical question and avoids unnecessary or unsafe imaging.

Clarifying appropriateness (justification) with the radiologist is one of the three explicit RD4.1 behaviours — it matches modality to the clinical question and respects radiation/contrast risk.

RD4.1 explicitly names clarifying appropriateness with the imaging specialist when in doubt; do not order indiscriminately or default by waiting time.

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Q4 RD4.2 1 pt

Before transporting a ventilated, critically ill patient to CT, the team estimates oxygen needs. The portable cylinder gauge and a fresh-gas flow rate are known. What is the SAFEST way to decide whether the cylinder is adequate?

A Assume a full cylinder always lasts long enough for any hospital journey
B Calculate usable minutes (cylinder contents ÷ fresh-gas flow) and confirm it exceeds the round-trip time PLUS a delay margin
C Take the patient and switch to room air if the cylinder runs low en route
D Estimate by eye whether the cylinder "looks full enough"
E Rely on wall oxygen being available in the CT corridor

Correct. Calculate the oxygen, never guess it: usable minutes equal cylinder contents divided by fresh-gas flow, and must exceed the round-trip time with a safety margin for delays.

Pre-transport oxygen is calculated (contents ÷ flow = usable minutes) and must exceed round-trip time plus a delay margin — never guessed, never assumed adequate.

Oxygen must be calculated, not estimated: contents ÷ flow gives usable minutes, which must exceed round-trip time plus a delay margin.

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Q5 RD4.2 1 pt

A junior doctor wheels a standard steel oxygen cylinder and a non-MRI-compatible infusion pump toward the MRI scanner room. What is the principal hazard, and what is the correct rule?

A There is no hazard once the patient is asleep; any equipment may enter
B Ferromagnetic objects become dangerous projectiles in the always-on magnetic field; only MRI-conditional/safe equipment may enter Zone IV
C The main hazard is acoustic noise, solved by turning the magnet off before entry
D Steel cylinders are safe because they are heavy and will not move
E Non-MRI pumps are fine as long as they are switched off

Correct. The magnet is always on; ferromagnetic items (steel cylinders, ordinary pumps) become lethal projectiles. Only MRI-conditional/MRI-safe equipment is permitted into Zone IV.

MRI projectile hazard: the field is permanently on; ferromagnetic objects fly. Use only MRI-conditional/safe equipment; control access through Zones I–IV.

The static field is always on and exerts a powerful pull on ferromagnetic objects — turning equipment off does not make it safe. Only MRI-conditional equipment may enter Zone IV.

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Q6 RD4.2 1 pt

A ventilated patient in the MRI scanner suddenly arrests. What is the correct immediate response with respect to the MRI environment?

A Begin full resuscitation inside the scanner bore using the nearest available equipment
B Bring the ward crash trolley directly into Zone IV to save time
C Evacuate the patient OUT of Zone IV and resuscitate outside the magnet room, because standard resuscitation equipment is ferromagnetic
D Wait for the magnet to be quenched before doing anything
E Continue the scan and resuscitate simultaneously to avoid repeating imaging

Correct. Standard resuscitation equipment (laryngoscopes, defibrillators, cylinders) is ferromagnetic and unsafe in Zone IV, so the patient must be moved out of the magnet room and resuscitated outside it.

Resuscitate OUTSIDE Zone IV — crash equipment is ferromagnetic. Plan rapid egress from the magnet room as part of every critically-ill MRI transfer.

Crash equipment is ferromagnetic and cannot enter Zone IV; the patient must be removed from the magnet room and resuscitated outside. Quenching is a last resort, not the immediate step.

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Q7 RD4.3 1 pt

A 68-year-old with chronic knee pain has a weight-bearing knee X-ray. Which combination of findings is the classic radiographic signature of osteoarthritis, and what is the underlying pathophysiology?

A Widened joint space with periosteal new bone, from synovial proliferation
B Joint-space narrowing, osteophytes, subchondral sclerosis and subchondral cysts — reflecting cartilage loss and altered load on bone
C Periarticular osteopenia and marginal erosions, from pannus formation
D A lytic lesion with soft-tissue mass, from neoplastic destruction
E Chondrocalcinosis only, with a normal joint space and no osteophytes

Correct. OA shows joint-space narrowing (cartilage loss), osteophytes, subchondral sclerosis and cysts — the radiographic map of cartilage degradation and the bone's response to altered load.

OA clinico-radiological correlation: cartilage loss → joint-space narrowing; abnormal load → osteophytes, subchondral sclerosis and cysts. Treat the patient, not the film — radiographic and symptom severity correlate poorly.

Marginal erosions and periarticular osteopenia describe inflammatory (e.g. rheumatoid) arthritis. OA = narrowing + osteophytes + subchondral sclerosis + cysts.

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Q8 RD4.3 1 pt

A 55-year-old presents with a swollen, tender calf two weeks after surgery. The clinician suspects deep vein thrombosis. Which imaging finding on compression ultrasonography/Doppler confirms an acute DVT, and why is USG chosen?

A Loss of compressibility of the vein (the thrombus prevents the walls from coapting under probe pressure); USG is chosen because it images flow and soft tissue without ionising radiation
B Joint-space narrowing on the longitudinal view; USG avoids contrast
C Wall thickening greater than 3 mm with pericholecystic fluid; USG is portable
D Full compressibility of the vein with brisk flow; USG is cheap
E An echogenic shadowing focus that moves with position; USG is fast

Correct. The hallmark of acute DVT is loss of venous compressibility — a normal vein collapses under probe pressure, a thrombosed one does not. USG/Doppler is preferred as it images soft tissue and flow in real time without radiation.

DVT correlation: thrombus fills the lumen → vein no longer compresses under the probe. Compression USG/Doppler is first-line — real-time soft-tissue and flow imaging, no ionising radiation.

Wall thickening/pericholecystic fluid is cholecystitis; joint-space narrowing is OA. The DVT sign is LOSS of compressibility. Full compressibility is normal.

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