CSC Technology & Digital Applications 2 — Questions and Answers
Question 1: Which CT acquisition strategy best minimizes radiation dose in cardiac CT angiography while maintaining diagnostic image quality?
- Tube voltage reduction combined with iterative reconstruction (Correct answer)
- Increasing tube current to 400 mA throughout acquisition
- Retrospective ECG-gating with a wide temporal reconstruction window
- Administering higher iodine-concentration contrast to compensate for lower kVp
Correct answer: Tube voltage reduction combined with iterative reconstruction
Reducing tube voltage (e.g., 100 kVp) lowers radiation dose, and iterative reconstruction algorithms compensate for the resulting increase in image noise.
Question 2: In cardiac MRI, which sequence is considered the gold standard for assessing myocardial viability?
- Cine steady-state free precession (SSFP)
- Late gadolinium enhancement (LGE) (Correct answer)
- T2-weighted short tau inversion recovery (STIR)
- First-pass myocardial perfusion imaging
Correct answer: Late gadolinium enhancement (LGE)
LGE detects gadolinium accumulation in fibrotic or infarcted myocardium, making it the gold standard for viability assessment.
Question 3: The primary benefit of attenuation correction in SPECT myocardial perfusion imaging is to:
- Eliminate the need for pharmacologic stress agents
- Reduce false-positive defects caused by soft tissue attenuation artifacts (Correct answer)
- Provide higher spatial resolution than PET imaging
- Allow real-time imaging during acute myocardial infarction
Correct answer: Reduce false-positive defects caused by soft tissue attenuation artifacts
Attenuation correction reduces artifactual perfusion defects caused by breast or diaphragm attenuation, improving specificity.
Question 4: Compared to 2D biplane Simpson's method, 3D full-volume echocardiographic LVEF measurement offers which primary advantage?
- Faster acquisition time in patients with poor acoustic windows
- Better agreement with cardiac MRI due to elimination of geometric assumptions (Correct answer)
- Superior temporal resolution for detecting wall motion abnormalities
- Lower operator dependency than any other echocardiographic method
Correct answer: Better agreement with cardiac MRI due to elimination of geometric assumptions
3D full-volume LVEF does not rely on geometric assumptions about ventricular shape, yielding better correlation with cardiac MRI reference values.
Question 5: Intravascular ultrasound (IVUS) is most clinically useful for which purpose during percutaneous coronary intervention?
- Measuring coronary flow reserve in microvascular disease
- Optimizing stent deployment and confirming full stent apposition (Correct answer)
- Evaluating mitral valve anatomy prior to TEER
- Quantifying myocardial perfusion after stenting
Correct answer: Optimizing stent deployment and confirming full stent apposition
IVUS provides cross-sectional images of the vessel lumen and wall, allowing assessment of stent expansion, apposition, and detection of edge dissections.
Question 6: A fractional flow reserve (FFR) value of 0.75 across a coronary lesion indicates:
- A hemodynamically significant lesion where revascularization is likely beneficial (Correct answer)
- A non-significant lesion where medical therapy alone is preferred
- A borderline finding requiring repeat measurement on a different day
- Normal hyperemic coronary flow with no pressure gradient
Correct answer: A hemodynamically significant lesion where revascularization is likely beneficial
FFR ≤0.80 defines hemodynamic significance; a value of 0.75 is clearly below the threshold, indicating revascularization is likely to reduce ischemia and improve outcomes.
Question 7: In electroanatomic mapping during ventricular tachycardia ablation, voltage mapping primarily identifies:
- Normal conduction velocity through the His-Purkinje system
- Areas of low-voltage scar that serve as arrhythmia substrate (Correct answer)
- Regions of high sympathetic innervation
- Zones of myocardial hyperemia near the ablation catheter
Correct answer: Areas of low-voltage scar that serve as arrhythmia substrate
Low bipolar voltage (<1.5 mV) in voltage maps identifies myocardial scar, which provides the substrate for reentrant ventricular tachycardia.
CSC Technology & Digital Applications 2
Which CT acquisition strategy best minimizes radiation dose in cardiac CT angiography while maintaining diagnostic image quality?