ARDMS BREAST REGISTRY EXAMS AND STUDY GUIDE WITH
ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED
RATIONALES ANSWERS 2024
Why should a patient suspicious for debris within a breast cyst be scanned in multiple
positions? - to evaluate changes in the debris level with changes in position
What object should be used when evaluating superficial tissues? - stand off pad
Real time imaging produces a frame rate of - 15 frames/second to avoid lagging
increased probe frequency causes - better resolution, BUT decreased penetration
What transducer is required for the best axial AND lateral resolution? - 10MHz linear
What is the elevational focus of high frequency transducers? - 1-2cm
Why is a linear array transducer preferred? - to avoid beam divergence artifact
Visualization of what structure indicates proper imaging depth of a breast on US? -
pectoralis muscles
What is an appropriate depth to image the breast on US? - 3-6cm
A rectangular shape FOV eliminates - divergence artifact
While trapezoidal FOV increases imaging area, it decreases - lateral resolution in the far
field
What does a targeted exam evaluate? - only a specific area of the breast
What does a survey exam evaluate? - the entire breast for abnormalities
Breast sonography is NOT what? - a screening tool for breast cancer!
When would a curvilinear array be needed? - 1. deep structures
2. pathology is too large for the linear FOV
3. imaging large breasts
What patient position redistributes breast tissue and centers the nipple? - Posterior
oblique
,What patient position puts the breast tissue in a similar position as tissues displayed on
mammography? - Posterior oblique
What position is best to scan the medial breast? - supine
What position is best to scan the lateral breast? - posterior oblique
LPO is used to scan which breast? - the right
RPO is used to scan which breast? - left
What patient position is helpful during ultrasound that will mimic a mass found on a CC
view of mammography or MRI? - sitting upright
What is a pitfall of using a curvilinear array? - measurements may be skewed by beam
divergence
Which pathologies should change shape with compression? (2) - 1. benign cysts
2. lipomas
What pathologies will not change shape with compressions? - malignancies
Compression of scar tissue will decrease - tissue thickness and ultimately posterior
shadowing
When might you need to reduce probe pressure? - visualizing blood flow in superficial
masses and veins
What type of mass is more than 30% compressible? - fatty lesions: a normal lobule or a
lipoma
What is ballottement? - alternating compression and release
When can ballottement be helpful? - demonstrating the mobility of echoes in ducts or
cysts
What are maneuvers for evaluating the nipple or ductal system? (4) - 1. peripheral
compression
2. rolled nipple technique
3. two-handed compression
4. stand off pad
Peripheral compression (3) - 1. transducer in radial position
2. apply pressure to peripheral end (farthest from nipple) while keeping contact with the
breast
3. slide probe to move nipple to the side
,What does peripheral compression reduce? - nipple shadowing
Peripheral compression is helpful in evaluating (2) - 1. patients with nipple discharge
2. ductal extension of a malignancy near the nipple
Rolled nipple technique - 1. put probe over nipple and compress to reduce air
2. roll nipple to the side
The rolled nipple technique is helpful in evaluating (2) - 1. patients with nipple discharge
2. ductal extension of a malignancy near the nipple
Two-handed compression - 1. put one end of probe at the nipple
2. put your hand on opposite side
3. compress the tissues against the probe
What does the two-handed compression technique improve? - the angle of incidence
with subareolar ducts
What does the two-handed compression technique evaluate? (2) - 1. compressibility of
the ductal system and any material in the ducts (inspissated cyst vs. intraductal
papilloma)
2. suspected gynecomastia
What can be used to move the elevational focus to a more superficial level in the
breast? - stand off pad
What is the preferred thickness of a stand off pad? - 1cm thick
Where does a stand off pad of 1cm in thickness move the elevation focus to? - 0.5cm of
the breast tissue
What is an elevation focus of 0.5cm via a stand off pad optimal for? - evaluation of the
nipple
What probe position is recommended by AIUM for screening the breast? - Radial plane
When a solid mass is detected, what scanning plane is recommended to assess ductal
extension? - radial plane
When an intraductal papilloma is identified, what scanning plane is recommended to to
assess ductal involvement? - radial plane
How is the anti-radial plane located in relation to the radial plane? - perpendicular
How many planes should a mass be evaluated in? - at least two planes
, Methods to locate a mass - 1. O'clock method
2. ABC/123 method
3. Quadrant method
What do the letters in the ABC/123 method indicate? - depth of a mass
What do the numbers in the ABC/123 method indicate? - distance from the nipple
ABC/123 annotation method:
letters - A= superficial
B= mid breast
C= near chest wall
ABC/123 annotation method:
numbers - 1= near nipple
2= mid-way from nipple to periphery
3= periphery of breast
Quadrant method - quadrant where mass is located plus distance from the nipple
What can be used to estimate the distance from the nipple to a mass? - the transducer
Which breast structures will appear anechoic? (3) - 1. cyst
2. milk in ducts
3. blood in vessels
Which breast structures will appear hyperechoic? (3) - 1. coopers ligaments
2. stromal tissues
3. skin
Which breast structures will appear hypoechoic? (2) - 1. nipple
2. milk in ducts
Which breast structures will appear isoechoic to breast fat? - TDLU
anechoic synonyms (2) - 1. sonolucent
2. echolucent
hyperechoic synonyms (3)
(more sound reflection, less sound penetration) - 1. sonodense
2. echo dense
3. sonopaque
hypoechoic synonyms
ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED
RATIONALES ANSWERS 2024
Why should a patient suspicious for debris within a breast cyst be scanned in multiple
positions? - to evaluate changes in the debris level with changes in position
What object should be used when evaluating superficial tissues? - stand off pad
Real time imaging produces a frame rate of - 15 frames/second to avoid lagging
increased probe frequency causes - better resolution, BUT decreased penetration
What transducer is required for the best axial AND lateral resolution? - 10MHz linear
What is the elevational focus of high frequency transducers? - 1-2cm
Why is a linear array transducer preferred? - to avoid beam divergence artifact
Visualization of what structure indicates proper imaging depth of a breast on US? -
pectoralis muscles
What is an appropriate depth to image the breast on US? - 3-6cm
A rectangular shape FOV eliminates - divergence artifact
While trapezoidal FOV increases imaging area, it decreases - lateral resolution in the far
field
What does a targeted exam evaluate? - only a specific area of the breast
What does a survey exam evaluate? - the entire breast for abnormalities
Breast sonography is NOT what? - a screening tool for breast cancer!
When would a curvilinear array be needed? - 1. deep structures
2. pathology is too large for the linear FOV
3. imaging large breasts
What patient position redistributes breast tissue and centers the nipple? - Posterior
oblique
,What patient position puts the breast tissue in a similar position as tissues displayed on
mammography? - Posterior oblique
What position is best to scan the medial breast? - supine
What position is best to scan the lateral breast? - posterior oblique
LPO is used to scan which breast? - the right
RPO is used to scan which breast? - left
What patient position is helpful during ultrasound that will mimic a mass found on a CC
view of mammography or MRI? - sitting upright
What is a pitfall of using a curvilinear array? - measurements may be skewed by beam
divergence
Which pathologies should change shape with compression? (2) - 1. benign cysts
2. lipomas
What pathologies will not change shape with compressions? - malignancies
Compression of scar tissue will decrease - tissue thickness and ultimately posterior
shadowing
When might you need to reduce probe pressure? - visualizing blood flow in superficial
masses and veins
What type of mass is more than 30% compressible? - fatty lesions: a normal lobule or a
lipoma
What is ballottement? - alternating compression and release
When can ballottement be helpful? - demonstrating the mobility of echoes in ducts or
cysts
What are maneuvers for evaluating the nipple or ductal system? (4) - 1. peripheral
compression
2. rolled nipple technique
3. two-handed compression
4. stand off pad
Peripheral compression (3) - 1. transducer in radial position
2. apply pressure to peripheral end (farthest from nipple) while keeping contact with the
breast
3. slide probe to move nipple to the side
,What does peripheral compression reduce? - nipple shadowing
Peripheral compression is helpful in evaluating (2) - 1. patients with nipple discharge
2. ductal extension of a malignancy near the nipple
Rolled nipple technique - 1. put probe over nipple and compress to reduce air
2. roll nipple to the side
The rolled nipple technique is helpful in evaluating (2) - 1. patients with nipple discharge
2. ductal extension of a malignancy near the nipple
Two-handed compression - 1. put one end of probe at the nipple
2. put your hand on opposite side
3. compress the tissues against the probe
What does the two-handed compression technique improve? - the angle of incidence
with subareolar ducts
What does the two-handed compression technique evaluate? (2) - 1. compressibility of
the ductal system and any material in the ducts (inspissated cyst vs. intraductal
papilloma)
2. suspected gynecomastia
What can be used to move the elevational focus to a more superficial level in the
breast? - stand off pad
What is the preferred thickness of a stand off pad? - 1cm thick
Where does a stand off pad of 1cm in thickness move the elevation focus to? - 0.5cm of
the breast tissue
What is an elevation focus of 0.5cm via a stand off pad optimal for? - evaluation of the
nipple
What probe position is recommended by AIUM for screening the breast? - Radial plane
When a solid mass is detected, what scanning plane is recommended to assess ductal
extension? - radial plane
When an intraductal papilloma is identified, what scanning plane is recommended to to
assess ductal involvement? - radial plane
How is the anti-radial plane located in relation to the radial plane? - perpendicular
How many planes should a mass be evaluated in? - at least two planes
, Methods to locate a mass - 1. O'clock method
2. ABC/123 method
3. Quadrant method
What do the letters in the ABC/123 method indicate? - depth of a mass
What do the numbers in the ABC/123 method indicate? - distance from the nipple
ABC/123 annotation method:
letters - A= superficial
B= mid breast
C= near chest wall
ABC/123 annotation method:
numbers - 1= near nipple
2= mid-way from nipple to periphery
3= periphery of breast
Quadrant method - quadrant where mass is located plus distance from the nipple
What can be used to estimate the distance from the nipple to a mass? - the transducer
Which breast structures will appear anechoic? (3) - 1. cyst
2. milk in ducts
3. blood in vessels
Which breast structures will appear hyperechoic? (3) - 1. coopers ligaments
2. stromal tissues
3. skin
Which breast structures will appear hypoechoic? (2) - 1. nipple
2. milk in ducts
Which breast structures will appear isoechoic to breast fat? - TDLU
anechoic synonyms (2) - 1. sonolucent
2. echolucent
hyperechoic synonyms (3)
(more sound reflection, less sound penetration) - 1. sonodense
2. echo dense
3. sonopaque
hypoechoic synonyms
