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質問 # 23
During 3-D volume acquisition, the quality of the images is most dependent upon which factor?
- A. Rendering method utilized
- B. Number of slices acquired
- C. Power output
- D. Speed of post-processing image compression
正解：B
解説：
During 3-D volume acquisition in ultrasound, the quality of the images is most dependent on the number of slices acquired. This is because the more slices (or planes) that are captured, the more detailed and accurate the reconstruction of the 3-D volume will be. This allows for better spatial resolution and more precise visualization of anatomical structures. Other factors, such as power output, rendering methods, and speed of post-processing, also affect image quality but are secondary to the number of slices in terms of fundamental image acquisition quality.
Reference: ARDMS Sonography Principles and Instrumentation (SPI) Review, 3-D Ultrasound Imaging section.
質問 # 24
Which artifact is seen as a result of an increase in echo amplitude in the tissue located distal to an anechoic structure?
- A. Reverberation
- B. Enhancement
- C. Comet tail
- D. Mirror image
正解：B
解説：
Enhancement artifact occurs when an anechoic (or low-attenuation) structure, such as a cyst or fluid-filled structure, allows the ultrasound beam to pass through it with minimal attenuation. As a result, the tissues located distal to this anechoic structure appear brighter (increased echo amplitude) on the ultrasound image because the sound waves are less attenuated by the anechoic structure, leading to higher intensity echoes returning from the distal tissue. This increased brightness beyond the anechoic area is known as enhancement.
Reference:
ARDMS Sonography Principles and Instrumentation guidelines
Kremkau, F. W. (2015). Diagnostic Ultrasound: Principles and Instruments. Elsevier.
質問 # 25
What is the primary factor that improves lateral resolution?
- A. Beamwidth
- B. Frame rate
- C. Propagation speed
- D. Frequency
正解：A
解説：
Lateral resolution refers to the ability of the ultrasound system to distinguish two structures that are side by side, perpendicular to the direction of the sound beam. This resolution is primarily improved by reducing the beamwidth. A narrower beamwidth allows for better differentiation between adjacent structures, enhancing the lateral resolution. Higher frequency transducers can also help achieve a narrower beamwidth, but beamwidth is the primary factor.
Reference:
ARDMS Sonography Principles & Instrumentation Guidelines
Hagen-Ansert SL. Textbook of Diagnostic Ultrasonography. 8th ed. St. Louis, MO: Mosby; 2017.
質問 # 26
In this image, what does the data below the baseline represent?
- A. Mirror image artifact
- B. Blood flow directed towards the transducer
- C. Wall filter setting too high
- D. Aliasing and retrograde blood flow
正解：D
解説：
In the provided image, data below the baseline represents blood flow moving away from the transducer, which can indicate retrograde flow. When using spectral Doppler, the baseline separates flows towards and away from the transducer. Aliasing occurs when the velocity of blood flow exceeds the Nyquist limit, causing the display to wrap around and appear on the opposite side of the baseline. This phenomenon is common in high-velocity flow situations and results in part of the flow being displayed below the baseline. Retrograde flow further supports this, as it shows blood moving in the opposite direction to the expected flow.
Reference:
ARDMS Sonography Principles & Instrumentation Guidelines
Kremkau FW. Sonography Principles and Instruments. 9th ed. Philadelphia, PA: Elsevier; 2016.
質問 # 27
What reduces speckle and increases visualization of specular reflectors and attenuated structures?
- A. Extended field of view
- B. Pixel interpolation
- C. Spatial compounding
- D. Elastography
正解：C
解説：
Spatial compounding involves acquiring multiple frames from different angles and averaging them. This technique reduces speckle noise, which is a granular interference pattern, and enhances the visualization of specular reflectors (smooth surfaces that reflect sound in a single direction) and attenuated structures (structures that reduce the intensity of the sound beam). By averaging frames from different angles, spatial compounding improves image quality and contrast resolution.
Reference:
ARDMS Sonography Principles and Instrumentation guidelines
Hedrick, W. R., Hykes, D. L., & Starchman, D. E. (2005). Ultrasound Physics and Instrumentation.
質問 # 28
What is effected by increasing the color scale?
- A. The color box width decreases
- B. The Nyquist limit is increased
- C. The color priority decreases
- D. More colors are displayed
正解：B
解説：
The Nyquist limit, which is the maximum detectable velocity before aliasing occurs, is directly related to the pulse repetition frequency (PRF). Increasing the color scale on the ultrasound machine effectively increases the PRF. When the PRF is increased, the Nyquist limit is also increased, allowing for the measurement of higher velocities without aliasing.
Reference:
ARDMS Sonography Principles and Instrumentation guidelines
Kremkau, F. W. (2015). Diagnostic Ultrasound: Principles and Instruments. Elsevier.
質問 # 29
At which angle to blood flow would the maximum Doppler shift occur?
- A. 90 degrees
- B. 30 degrees
- C. 60 degrees
- D. 0 degrees
正解：D
解説：
The Doppler shift is highest when the angle between the ultrasound beam and the direction of blood flow is 0 degrees. This is because the cosine of 0 degrees is 1, maximizing the Doppler frequency shift. As the angle increases towards 90 degrees, the cosine value decreases, reducing the Doppler shift.
Reference:
ARDMS Sonography Principles and Instrumentation guidelines
Hoskins, P. R., Thrush, A., Martin, K., & Whittingham, T. A. (2010). Diagnostic Ultrasound: Physics and Equipment.
質問 # 30
Which statement describes the purpose of using a spectral Doppler wall filter?
- A. To eliminate the lower velocity signals
- B. To eliminate the higher velocity signals
- C. To widen the area in which the Doppler shift is sampled
- D. To clean up the audio signals
正解：A
解説：
The purpose of using a spectral Doppler wall filter is to eliminate lower velocity signals. Wall filters are designed to remove low-frequency Doppler shifts caused by the motion of the vessel walls or surrounding tissues, which are generally of no diagnostic value. By eliminating these lower velocity signals, the wall filter helps to clean up the Doppler signal and reduce clutter, allowing for a clearer and more accurate display of blood flow velocities.
Reference:
ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide
"Diagnostic Ultrasound: Principles and Instruments" by Frederick W. Kremkau
質問 # 31
What relates bandwidth to operating frequency?
- A. Nyquist limit
- B. Quality factor
- C. Autocorrelation
- D. Focal zone
正解：B
解説：
The quality factor (Q-factor) is a dimensionless parameter that describes the efficiency of the transducer in terms of bandwidth and operating frequency. It is defined as the ratio of the operating frequency to the bandwidth. A higher Q-factor indicates a narrower bandwidth relative to the operating frequency, resulting in more precise frequency characteristics but potentially reduced axial resolution. Conversely, a lower Q-factor indicates a broader bandwidth, which improves axial resolution but may result in less precise frequency characteristics.
Reference:
ARDMS Sonography Principles & Instrumentation Guidelines
Kremkau FW. Sonography Principles and Instruments. 9th ed. Philadelphia, PA: Elsevier; 2016.
質問 # 32
Which type of structure is best visualized with low persistence?
- A. Dynamic
- B. Echogenic
- C. Anechoic
- D. Static
正解：A
解説：
Low persistence is best used for visualizing dynamic structures. Persistence is a setting that controls the averaging of successive frames to reduce noise and improve image quality. While high persistence can be beneficial for imaging static structures by providing a smoother image, it can blur or smear moving structures, making it difficult to visualize motion accurately. Low persistence settings allow for better temporal resolution and are therefore ideal for observing dynamic or moving structures such as the heart or blood flow.
Reference:
ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide
"Diagnostic Ultrasound: Principles and Instruments" by Frederick W. Kremkau
質問 # 33
Which artifact results from decreased attenuation?
- A. Reverberation
- B. Enhancement
- C. Ringdown
- D. Comet tail
正解：B
解説：
Enhancement is an artifact that results from decreased attenuation. When an ultrasound wave travels through a medium with lower attenuation compared to surrounding tissues, it loses less energy. Consequently, the structures located deeper than the low-attenuation medium appear brighter on the ultrasound image. This artifact is commonly observed behind fluid-filled structures, such as cysts or the urinary bladder, where the sound waves encounter minimal resistance and thus less attenuation. Reference:
ARDMS Sonography Principles and Instrumentation guidelines
"Diagnostic Ultrasound: Principles and Instruments" by Frederick W. Kremkau
質問 # 34
What is the term for an ultrasound system's ability to display low-level echoes?
- A. Lateral resolution
- B. Axial resolution
- C. Slice thickness
- D. Sensitivity
正解：D
解説：
Sensitivity is the term for an ultrasound system's ability to display low-level echoes. It refers to the system's capacity to detect and accurately display weak echoes returning from tissues. High sensitivity allows the sonographer to visualize structures that produce faint echoes, such as small or low-contrast lesions. This parameter is critical for ensuring that subtle pathological changes are not missed during imaging. Reference:
ARDMS Sonography Principles and Instrumentation guidelines
"Sonography: Principles and Instruments" by Joan P. Baker and Marveen Craig
質問 # 35
Which pulsed-wave Doppler adjustment would be appropriate to correct the aliasing seen in this image?
- A. Increase the Doppler pulse repetition frequency.
- B. Increase the spectral Doppler gain.
- C. Decrease the spectral Doppler gain.
- D. Decrease the Doppler pulse repetition frequency.
正解：A
解説：
Aliasing in pulsed-wave Doppler occurs when the sampled Doppler frequency exceeds the Nyquist limit, which is half of the pulse repetition frequency (PRF). This results in an incorrect representation of the blood flow velocities, causing the waveform to wrap around and appear on the opposite side of the baseline. To correct aliasing, the PRF should be increased, which raises the Nyquist limit and allows for accurate measurement of higher velocities without aliasing. Increasing the PRF effectively reduces the likelihood of aliasing artifacts in the Doppler signal.
Reference:
American Registry for Diagnostic Medical Sonography (ARDMS). Sonography Principles and Instrumentation (SPI) Examination Review Guide.
質問 # 36
What produces increased attenuation within soft tissue?
- A. Lower frequency of the ultrasound beam
- B. Lower intensity of the ultrasound beam
- C. Higher intensity of the ultrasound beam
- D. Higher frequency of the ultrasound beam
正解：D
解説：
Attenuation refers to the reduction in the intensity of the ultrasound beam as it travels through tissue. Higher frequency ultrasound beams experience more attenuation because they are absorbed and scattered more than lower frequency beams. This is due to the fact that higher frequency waves have shorter wavelengths and interact more with the small particles in tissues, causing greater energy loss.
Reference: ARDMS Sonography Principles and Instrumentation, Chapter on Ultrasound Physics and Instrumentation.
質問 # 37
In this image obtained from a tissue-mimicking phantom, which area of the sector is used to evaluate the dead zone?
- A. Option C
- B. Option B
- C. Option A
- D. Option D
正解：C
解説：
The dead zone in ultrasound imaging refers to the region closest to the transducer where imaging is not possible due to the high amplitude of the initial pulse. In a tissue-mimicking phantom, this is the area where no useful imaging data can be obtained. The purpose of evaluating the dead zone is to ensure that it is as small as possible to maximize the usable imaging depth. In the provided image, Option A represents the area closest to the transducer face, which is typically used to evaluate the dead zone. The other areas are further away and are used for evaluating other parameters such as resolution or depth penetration.
Reference:
American Registry for Diagnostic Medical Sonography (ARDMS) Sonography Principles and Instrumentation guidelines.
質問 # 38
Which component of a contrast agent causes a marked mismatch in impedance between the agent and blood?
- A. Serous liquid
- B. Gas
- C. Solid
- D. Viscous liquid
正解：B
解説：
Contrast agents used in ultrasound imaging typically consist of microbubbles filled with gas. The significant mismatch in acoustic impedance between the gas in the microbubbles and the surrounding blood creates strong reflectors of the ultrasound waves, enhancing the echogenicity of blood and improving the visibility of blood flow and tissue perfusion. The high contrast provided by the gas-filled microbubbles makes them particularly effective as ultrasound contrast agents.
Reference:
ARDMS Sonography Principles & Instrumentation Guidelines
Kremkau FW. Sonography Principles and Instruments. 9th ed. Philadelphia, PA: Elsevier; 2016.
質問 # 39
Which transducer was most likely used to create this image?
- A. Endocavity
- B. Phased array
- C. Curvilinear
- D. Linear array
正解：C
解説：
The image shown is typical of an abdominal ultrasound, which commonly utilizes a curvilinear transducer. Curvilinear transducers have a wider field of view at depth, making them ideal for imaging large structures within the abdomen. These transducers emit a curved beam, allowing for better penetration and a broader field of view, which is necessary for comprehensive abdominal examinations. The curvature of the image, the wide field of view, and the depth of penetration all suggest the use of a curvilinear transducer.
Reference:
American Registry for Diagnostic Medical Sonography (ARDMS). Sonography Principles and Instrumentation (SPI) Examination Review Guide.
質問 # 40
Which change improves temporal resolution during color flow imaging?
- A. Increase field of view
- B. Decrease transmit frequency
- C. Increase line density
- D. Decrease packet size
正解：D
解説：
Temporal resolution is improved by increasing the frame rate. One way to increase the frame rate is by decreasing the packet size (also known as ensemble length) in color Doppler imaging. The packet size refers to the number of pulses used to determine the Doppler shift at each location. A smaller packet size means fewer pulses are required, which allows for quicker data acquisition and thus a higher frame rate. Increasing the field of view, decreasing transmit frequency, and increasing line density would all decrease the frame rate and thus degrade temporal resolution.
Reference:
American Registry for Diagnostic Medical Sonography (ARDMS) Sonography Principles and Instrumentation guidelines.
質問 # 41
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