ACVR WRITTEN EXAMINATION OBJECTIVES 2006
INTRODUCTION
Each of the six sections of the written examination objectives is designed to provide an
ACVR eligible resident with a framework from which to study. The objectives are not all
inclusive but should provide a minimum knowledge base needed to pass the written examination.
A candidate must complete all sections of the written examination during one test period
with a minimum of 70% correct responses in each section. A candidate failing only one section
may retake the failed section during one of the next two test periods. The candidate will be
allowed one attempt to retake and pass the re-examination within the allowed period. If
unsuccessful, then he-she must retake the entire written examination. Candidates who fail more
than one section must retake the entire written examination.
The six-section written examination is given over two days at the location of any member
of the Examination Committee or at other locations as approved by Executive Council. These
sections include: 1.) Anatomy, 2.) Physiology and Pathophysiology, 3.) Physics of Diagnostic
Radiology, 4.) Radiobiology and Radiation Protection, 5.) Physics and Applications of Alternate
Imaging and, 6.) Special Procedures.
The examination tests entry level knowledge in these six subject areas. A candidate
should expect questions using true/false, multiple choice, fill-in-the blank, short answer, image
or schematic identification and essay formats. For the foreseeable future, the format of the
examination will transition to a multiple choice format with questions of other types being
phased-out. Images will be used in the examination and may include normal or abnormal cases.
While emphasis is given to the dog, cat and horse, other species (cow, pig, sheep, goats and
birds) will be included where appropriate and noted. The current literature relevant to
examination sections and diagnostic imaging is a source of examination material. In addition, past
literature pertinent to specific radiographic techniques, special procedures, radiobiology and
alternate imaging are used for questions. While there is no stated specific time limit regarding the
literature, particularly for Veterinary Radiology & Ultrasound, outdated, obsolete, or obscure
material is avoided.
ANATOMY
The candidate will be required to have an understanding of the following:
I) General
A) Current anatomic nomenclature (Nomina Anatomica Veterinaria) will be used in
questions and expected in answers.
B) ACVR-approved terminology for identifying radiographic views will be used as the
standards for the names of radiographic projections.
II) General Musculoskeletal System (canine, feline and equine)
A) General bone formation and growth.
B) Ages at which ossification centers fuse
1) vertebral column, long bones physes and apophyses
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C) Blood supply of long bones
(a) immature and mature
(b) differences in large animal versus small animal immature long bone blood supply
D) Structure and nutrition of articular cartilage
III) . Axial Skeletal System (canine, feline and equine)
A) Topographic features of vertebrae in all spinal segments.
B) Topographic features of bones of the skull and mandible as well as dentition and how
dentition changes with age
C) Sinuses, sinus communications and relationships
D) Topographic features of the pelvis
E) Formulae for the vertebral column, sternum and ribs (include cows)
F) Cross sectional (transverse) and longitudinal (sagittal) anatomy of the skull, spine and
pelvis as it pertains to CT and MRI imaging
IV) Appendicular Skeleton (canine, feline and equine)
A) Topographic features of the long bones (including avian)
B) Proximal and distal attachments of the major muscles, tendons, and ligaments associated
with the thoracic and pelvic limbs.
1) Important topographical features of the muscles, ligaments and their attachment sites
will be emphasized based on routine radiographic examinations.
2) Emphasis will also be placed on anatomy of the shoulder, elbow, carpus, hip, stifle,
tarsus and digits of the limbs.
3) Understand both radiographic and cross-sectional anatomy and relationships
C) Cross-sectional (transverse) and longitudinal (sagittal) anatomy of the equine distal
extremity, metacarpus/tarsus as it pertains to ultrasound imaging. This includes the
common calcaneal tendon and biceps tendon (canine and equine)
V) Arthrology (canine, feline and equine)
A) Classification and topographic features of joints of the head, neck-back-tail, and limbs
1) Relationship, structure and function of ligaments and intervertebral discs of the
vertebral column
2) Nuchal ligament differences among species
3) Presence and function of menisci
B) Be familiar with all sesamoid bones and their associated relationship to the joint
C) Understanding of the structures that are accentuated on various radiographic projections
(e.g. flexed lateral-medial carpus)
D) Comparative arthrology of the bones and joint compartments for the stifle, carpus and
tarsus (canine, feline, equine)
VI) Cardiovascular System (canine, feline and equine)
A) Embryology of the cardiovascular system to understand the development of common
malformations of the heart and great vessels
B) Differences between fetal and neonate circulation
C) Arteries arising from aortic arch and common congenital malformations
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D)
E)
F)
G)
H)
I)
J)
K)
L)
1) double aortic arch, persistent right aortic arch, aberrant left subclavian and aortic
coarctation
Vascular supply to the brain
Superficial venous drainage of the head
Vertebral vascular system
Branches of the abdominal aorta
Blood supply of the canine and feline liver, spleen, kidneys, and pancreas
Blood supply to thoracic and pelvic limbs
1) major arterial blood supply and venous drainage
2) understand supply from aorta to manus/pes and drainage back to the cranial or caudal
vena cava
Portal venous system (hepatic)
1) normal and congenital/acquired shunting
2) patent ductus venosus
3) single extra-hepatic portosystemic shunts
4) hepatic arteriovenous malformations
5) Normal and abnormal angiographic studies of the hepatic portal circulation
Echocardiographic anatomy in standard right and left parasternal short and long-axis
planes
Common cardiac developmental anatomy
1) patent ductus arteriosus
2) atrial and ventricular septal defects
3) valvular stenosis
4) atrioventricular dysplasias
5) endocardial cushion defects and conotruncal defects
6) Tetralogy and pentalogy of Fallot
7) persistent left cranial vena cava
8) Normal and abnormal, selective and non-selective angiocardiography
VII) Nervous System (canine, feline and equine)
A) Anatomical relationships of spinal cord, spinal nerves and meninges
1) brachial and lumbosacral plexes
2) major components and innervations of the nerves that originate from these plexes
B) Segmental spinal nerve origins, location of exit from the vertebral canal and the function
of the spinal nerves.
C) Ventricular system of the brain and its drainage
D) Distribution of nerves in the distal extremity of the thoracic and pelvic equine limbs as
related to common nerve blocks performed
E) Anatomy of the brain, brain stem, including the cranial nerves and spinal cord that can be
recognized with cross-sectional imaging (CT, MRI or US)
F) Routine radiographic anatomy of the skull
G) General understanding of neurologic examination and lesion localization (canine, feline
and equine)
H) Origin of cranial nerves and their function (canine, feline, equine)
I) Anatomy of the organs of special sense (canine, feline, equine)
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VIII) Digestive System (canine, feline and equine)
A) Normal size and anatomic relationships of gastrointestinal tract with all other abdominal
organs (including bovine)
B) Comparative anatomy of the ileo-ceco-colic region
C) Anatomy of the liver, gallbladder, and pancreas
1) Comparative anatomy of the bile duct and pancreatic ducts
D) Normal anatomical variations of the GI tract as observed with contrast studies
IX) Respiratory System (canine, feline, equine)
A) Oropharynx, nasopharynx, laryngeal cartilage and hyoid apparatus
B) Guttural pouches and their anatomic relationships as viewed on routine radiographs and
computed tomography or magnetic resonance – equine
C) Bronchial tree and lung lobes – compare between species
D) Vascular supply of the lung
E) Pleural layers
F) Mediastinal anatomy and degree of development/fenestrations
G) Avian air sac anatomy and connection with primary pulmonary structures (airways, lung,
etc.)
H) Understand basic histology of the lung for air exchange (pulmonary function)
X) Urogenital (canine, feline, equine)
A) Anatomy of the kidney, ureter, and lower urinary tract and the relationship to
reproductive organs
1) Identification of normal or abnormal structures using ultrasonography, contrast
enhanced radiographic or cross-sectional modalities
B) Embryology of the urogenital system
1) development of the kidney, ureters, and urinary bladder
2) development of gonadal structures
3) Malformations of the urogenital system including ectopic ureter,
pseudohermaphrodites, renal agenesis, uterus masculinus, and cryptorchidism.
C) Avian normal urogenital anatomy
XI) Miscellaneous (canine, feline, equine)
A) Positioning and postural influences on the radiographic appearance of the thorax and
abdomen
B) Effects of inhalation vs. exhalation on anatomic relationships and appearances
C) Avian radiographic anatomy including common musculoskeletal and routinely visualized
soft tissue structures
D) Location of lymph nodes and drainage areas
E) Anatomy and embryology of endocrine organs
1) Pituitary gland
2) Thyroid gland
3) Adrenal gland
4) Pancreas
F) Mediastinal structures and topography
G) Cross-sectional and longitudinal (sagittal) anatomy of the thorax and abdomen
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PHYSIOLOGY/PATHOPHYSIOLOGY
I) Physiology and Pathophysiology of Specific Organ Systems
A) Alimentary
1) Physiologic mechanisms of gastro-intestinal tract function (oral, esophageal, gastric,
intestinal, colonic)
(a) Propulsion and bolus formation, esophageal and intestinal motility
(b) Hormonal control and alimentary reflexes (e.g., gastrocolic) as they apply to
motility and secretion control
2) Vomiting vs. regurgitation – applicable pathophysiology
3) Diarrhea - applicable pathophysiology related to small intestinal versus large intestinal
diarrhea
4) Transit times in normal and disease states
5) Ileus
(a) Causes and types
(b) Pathophysiology
6) Gastric dilatation/torsion/volvulus complex
(a) Possible etiologic factors
(b) Systemic and local pathophysiologic alterations
(c) Basis of radiographic appearance
7) Pancreas
(a) Normal exocrine and endocrine physiology
(b) Pathophysiology of pancreatitis and pancreatic tumors
(c) Pathophysiology of endocrine diseases associated with the pancreas
8) Hepatobiliary System
(a) Normal physiology
(b) Pathophysiology of acute and chronic hepatitis, cholangiohepatitis, cholecystitis,
obstructive biliary disorders, biliary rupture and peritonitis, hepatic lipidosis
B) Cardiovascular System
1) Normal heart and major vasculature
2) Hemodynamics, flow, timing, and pressure relationships
3) Origin, source and significance of heart sounds
4) Interrelationship and correlation of the above for the normal cardiac cycle and for
abnormal cardiac conditions
5) Coronary blood flow
6) Starling's Law of the Heart
7) Congenital and acquired cardiovascular diseases
(a) Common clinical signs
8) Mechanisms and pathophysiologic effects of congestive heart failure
9) Pericardial disease and effect on cardiac function
10) Pathophysiology of canine and feline heart worm infection
(a) Cardiopulmonary effects
11) Vascular anomalies-hemodynamics: clinical signs and pathophysiology
(a) Portosystemic shunts
(b) Arteriovenous malformations
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(c) Infarction of major vessels and downstream organ
(d) Aortic and venous embolism/thrombus
12) Lymphatic system
(a) Physiology of lymphatic production and flow
(b) Pathophysiology of diseases of the lymphatic and mononuclear phagocytic systems
13) Pathophysiology of canine and feline dirofilariasis
C) Central Nervous System
1) Spinal cord
(a) Pathophysiology of common causes of localized spinal cord disorders including,
but not limited to: intervertebral disc disease, hemorrhage, fibrocartilaginous
embolism, neoplasia, developmental disorders.
(b) Embryonic derivation of spinal and vertebral components germane to clinically
encountered congenital disease
(c) Spinal cord disease localization based on neurological signs
2) Brain
(a) Production and flow of cerebrospinal fluid
(b) Localization of brain disease based on neurological signs
(c) Cerebral vascular accidents/infarctions
(d) Characteristics of canine and feline brain tumors.
D) Musculoskeletal System
1) Bone
(a) Physiologic sequence and mechanism of normal fracture healing
(b) Pathophysiology of bone disease
(i) metabolic and congenital diseases
(ii) abnormal fracture healing (non-union, delayed union, malunion)
(iii) infection of bone
(iv) bone infarcts and avascular necrosis
(v) periosteal and periarticular new bone formation
2) Cartilage
(a) Physiology of cartilage growth, development and repair
(b) Pathophysiology of osteochondrosis and osteochondritis dissecans
3) Joints
(a) Normal physiology
(b) Pathophysiology of degenerative joint disease, including radiographic features of
degenerative joint disease and an understanding of how each of the described
changes occur
(c) Pathophysiology of immune-mediated, infectious, and traumatic joint disease
E) Respiratory System
1) Normal respiration
(a) Mechanics of ventilation, including: mechanism of air movement, pressurevolume relationships and air space divisions
(b) Lung perfusion and physiologic responses to lung diseases
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2) Methods of oxygen and carbon dioxide transport
(a) General understanding of the blood gas profile (pH, PO2, pCO2, HCO3, base
excess/deficit)
(b) Effects of patient position and anesthesia on the radiographic appearance of the
thorax.
(c) Normal physiology of pleural fluid formation.
3) Abnormal respiration
(a) Common causes of dyspnea and stridor and their pathophysiologic effects on the
thoracic wall, pleural space, upper respiratory system and bronchi, lungs,
pulmonary vasculature and diaphragm.
(b) Pathophysiology of pulmonary thromboembolism
(c) Pathophysiology of pleural effusions
F) Urogenital System
1) Renal function
(a) Mechanism of urine production
(b) Methods of renal function assessment
(c) Interpretation of abnormal renal function tests (BUN, creatinine, note species
differences between canine, feline and equine)
(d) Role of the kidney in the maintenance of blood pressure/electrolytes
(e) Renin-angiotensin-aldosterone pathways
(f) Erythropoietin and endocrine functions
2) Organ, hormonal and mineral inter-relationships
(a) Interrelations of kidneys, liver, intestine, bone, parathyroid and thyroid gland on
Vitamin D, calcium and phosphate regulation
(b) Alterations of the above due to disease
3) Abnormal renal function
(a) Acute vs. chronic renal failure
(b) Glomerulonephritis
(c) Interstitial nephritis
(d) Toxicities
(e) Infections
(f) Neoplasia
(g) Pyelonephritis
(h) Feline lower urinary tract disease
4) Pressure, volume relationship among the ureters, bladder and urethra; neurophysiology
of micturition, the detrusor reflex and vesicoureteral reflux
5) Genital
(a) Radiographically recognizable fetal ossification intervals (canine and feline)
(b) Radiographic findings of fetal death and how the signs develop (dog and cat)
(c) Canine pyometra – pathogenesis, predisposing causes, systemic effects
(d) Ovarian disease – congenital, neoplastic, and functional problems, systemic effects
(e) Prostate gland diseases
(f) Testicular diseases
G) Endocrine System
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1) Thyroid Gland
(a) Iodide trapping and organification into T3/T4
(b) sodium pertechnetate, I-123 and I-131 for imaging normal and pathological states
(c) Pituitary-thyroid axis - homeostasis and negative feedback
(d) Thyroid hormone function and effects on other organ systems
(e) Mode of action/duration of antithyroid medications
(f) Systemic effects of radiotherapy using I-131 in cats treated for feline
hyperthyroidism.
2) Pituitary Gland
(a) Homeostasis and regulation of pituitary gland via portal system and releasing
factors/proteins or neurohypophyseal control of posterior pituitary
(b) Pituitary disease – Cushing’s syndrome, tumors, diabetes insipidus, and hypoplasia
3) Adrenal Gland
(a) Epinephrine and norepinephrine production and regulation
(b) Tumors of the adrenal cortex and medulla
(c) Glucocorticoids - control and effects
(d) Hyperadrenocorticism and hypoadrenocorticism
(e) Hyperaldosteronism
(f) Mineralocorticoids - control and effects
(g) Physiologic effects of adrenal hormones on CNS, cardiovascular system,
respiratory system and metabolic status
H) Miscellaneous
1) Pathophysiologic basis and radiographic findings in immune-mediated diseases:
(a) Systemic lupus erythematosus
(b) Rheumatoid arthritis
(c) Immune-mediated thrombocytopenia
(d) Immune-mediated hemolytic anemia
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RADIATION PROTECTION - RADIATION BIOLOGY
I) Radiobiology Physics
A) Physics and Chemistry of Radiation Absorption
a) Differentiate between molecular excitation and ionization.
b) Differentiate between particulate and electromagnetic (non-particulate) forms of
radiation.
c) Differentiate between the sites of origin of gamma rays and x-rays.
d) Know the basic forms of particulate radiations and their interactions or potential
interactions with matter, including: alpha particles, electrons, protons, and neutrons.
e) Understand the difference between direct and indirect forms of ionizing radiation
injury.
f) Understand the difference between direct and indirect actions of radiation.
g) Define the role of ionization and free radical formation and their role in creating
biological effects.
B) Basic Atomic and Nuclear Physics
a) Atomic composition and structure and nuclear binding forces
b) Nuclear decay charts and radioactive decay
c) Line of stability and the line of unity
d) Isotopes, Isobars, Isomers and Isotones
e) Atomic number and atomic mass; calculation of neutron number
C) Modes of Radioactive Decay (particulate and non-particulate emissions including neutrinos
and anti-neutrinos)
a) Betatron (negatron) decay
b) Alpha decay
c) Electron capture
d) Positron decay (annihilation reaction and photon formation)
e) Isomeric transition
D) Radioactive Decay terminology
a) Decay constant and relationship with physical half-life
b) Physical and biological half-life and the calculation of the effective half-life.
Understand the concept of an effective half-life.
c) Average half-life
d) Specific activity
E) How does radiation kill cells?
a) Discuss the mechanisms of electromagnetic radiation induced cell killing.
b) Discuss the differences between apoptotic and mitotic cell death related to radiation
induced cellular injury.
c) Understand the differences between lethal damage, sub-lethal damage and potentially
lethal damage.
II) Radiation Biology & Interaction of Radiation with Matter
A) Know the basic mechanisms of acute and late radiation injury and cell killing
a) Understand the differences in radiation response between acute and late responding
tissues.
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B) Understand the concept of L.E.T. (linear energy transfer) and how L.E.T. relates to R.B.E.
(relative biological effectiveness) and the oxygen effect.
C) Understand R.B.E. and how R.B.E. may be influenced by other factors.
D) Discuss the phases of acute radiation syndrome, including the bone marrow,
gastrointestinal and CNS radiation syndromes.
a) Include the prodromal symptoms, whole body dose to create the radiation syndrome
and clinical signs associated with acute radiation syndrome.
E) Be familiar with the effects of radiation on the developing embryo/fetus in utero.
F) Understand the meaning of the terms, “lethal dose”, and “tolerance dose”.
G) Understand the difference between deterministic and stochastic effects related to radiation
induced injury.
H) Be familiar with molecular reactions and interactions of radiation with matter.
a) Understand and be able to discuss photoelectric and Compton interaction, pair
production, and photodisintegration and the radiation energy and physical density
(subject) ranges for which these type of interactions are likely to occur.
b) Understand the “wave concept” and the “particle concept” for understanding
electromagnetic radiation. Given two known values of electromagnetic radiation, be
able to calculate the wavelength, energy or frequency of the radiation
c) Understand the concepts of exposure, dose equivalent, absorbed dose, weighting
(quality) factor for electromagnetic and particulate radiation. Understand the
relationship between roentgens, rads, and rems. Be able to convert rads to Grays and
rems to Sieverts.
III) Oncology/Tumor Biology
A) Be familiar with the biological behavior of common canine, feline, and equine tumors.
B) These should include common tumors of the skull, oral cavity, nasal cavity and paranasal
sinuses, brain, spinal cord and peripheral nervous system, pharynx, respiratory system,
circulatory system, appendicular and axial skeleton, integument, gastrointestinal system
(including hepatobiliary and pancreatic), urogenital, bone marrow, lymphoid tissues , and
connective tissues.
C) Common tumor types from these systems should be understood in terms of local
invasiveness, metastatic potential and common metastatic appearance and described
radiographic appearances based on the literature related to veterinary medicine.
IV) Radiation Monitoring
A) Be familiar with the equipment and devices used for monitoring radiation and the basic
principles involved.
a) Gas-filled detectors, including the basic principles, ionization chambers, proportional
counters and Geiger-Müeller survey meters.
B) Be familiar with the appropriate use of monitoring equipment (TLD monitors, pocket
dosimeters and film badges) and interpretation of data obtained.
C) Be familiar with the regulations pertaining to personnel monitoring, i.e., occupational, nonoccupational, general population, and fetal exposures
a) Understand patient versus operator exposure levels
b) Understand radiation safety factors… time, distance, shielding
c) Understand the concept of lifetime cumulative exposure
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V) Radiation Protection
A) How do you protect yourself and other from different types of radiation?
a) What is the ALARA concept?
B) Understand the principle of barrier design, occupancy, workload, filtration, and beam
limiting devices and personnel shielding for the design of radiology rooms and shielding
within the room.
C) Define and apply ALARA concept to standards of radiation protection and safety.
D) Be familiar with the radiation protection aspects of handling animals that have been given
either diagnostic (99mTc, 111Indium) or therapeutic radiopharmaceuticals (131I).
a) Care and handling of the radioisotopes and the radioactive patients
b) Exposure versus contamination
c) Know the deterministic annual limits for the lens of the eye and localized areas of the
skin, hands and feet.
E) Regulatory Aspects
a) Know the function and responsibility of the various councils and agencies, i.e., NRC,
NCRP, ICRP, OSHA, and State Governments.
b) Differences between agreement and non-agreement states
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PHYSICS OF DIAGNOSTIC RADIOLOGY
I) History
A) Know the history of the discovery of X-rays (briefly)
II) Production of X-rays
A) Be familiar with the construction and function of the following components of a diagnostic
x-ray system:
1) Exposure timers: (pros and cons of each type)
(a) Mechanical timers and evaluation of single phase systems with spinning tops for
accuracy
(b) Synchronous timers
(c) Electronic timers
(d) Photo-timer – automatic exposure control
2) Inherent and added beam filters and collimator
3) Milliamperage (mA) regulation
4) Voltage (kVp) regulation
5) X-ray tube housing and cooling elements
6) X-ray tube
(a) Anode and anode shaft
(b) Cathode, cathode filaments and focusing cup
(c) Transformer
(d) Focal spot size
B) Be familiar with the following concepts and understand their relationship and/or
importance in x-ray production:
1) Alternating versus direct current
2) Bremsstrahlung radiation and polychromatic (energetic) x-ray beam
3) Characteristic radiation
4) Characteristics of focal spots including actual vs. effective focal spots, the line focus
principle, large versus small focal spots, and requirements for magnification
radiography.
5) Electron orbits and energy levels
6) Filtration (inherent and added)
7) Heat dissipation within the tube and tube housing
8) Anodes: rotating versus stationary, common anode materials, heel effect and anode
angle (effect on focal spot size and heel effect).
9) Voltage wave forms including ripple effect, constant potential, high frequency.
Differences between kilovoltage and megavoltage x or gamma rays
10) mAs, kVp, & keV
11) kW ratings of x-ray tubes and x-ray generators
12) Milliamperage (including falling load principle)
13) Collimators and primary x-ray beam
14) Rectification
15) Calculation of tube heat units, tube rating charts and anode cooling charts for routine
radiology and fluoroscopy units. Evaluation of x-ray tubes for replacement.
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16) Line voltage and line voltage compensator
C) Understand the principles of energy transfer in the production of a useful x-ray beam,
including:
1) Energy transfer at the transformer
2) Energy transfer at the anode
3) Energy transfer at the cathode
4) Energy transfer within the glass envelope and the collimator housing (added filtration)
III) Physical Properties of X-rays
A) Understand the following concepts as they relate to the physical properties of x-rays:
1) Effect on photographic emulsion.
2) Fluorescence and phosphorescence
3) Inverse square law and calculations for determining new mAs factors when distance
changes.
4) Interactions with matter and ionization of atoms and secondary scatter
5) Relationship of the speed of light, frequency and wavelength. Relationship of the x-ray
wavelength and energy.
6) Wavelength of diagnostic x-rays compared to other forms of electromagnetic radiation
(electromagnetic spectrum)
7) X-ray beam intensity and quality
8) Half value layer, linear and mass attenuation coefficients
B) Understand the interaction between photons and matter as related to how and when they
occur, the differences between them and their role in diagnostic radiology. This includes
the basic interactions related to:
1) Absorption
2) Scattering
3) Transmission
4) Mass and linear attenuation coefficient
IV) Equipment and Accessories
A) Understand the use, limitations, advantages, disadvantages, care and construction of the
following radiographic equipment:
1) Cones and collimators
2) Film
(a) Green or blue sensitive film and specific dark room requirements
(b) Screen versus non-screen film
(c) Specialty film (copy film or subtraction film)
(d) Double versus single emulsion film
(e) H&D curves
3) Film identification devices
4) Film/screen combinations and relative film/screen speeds and contrast
5) Fluoroscopic screens
6) Grids (parallel, crossed, focused, Potter-Bucky):
(a) Grid ratios
(b) Grid composition
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7) Cassettes and Intensifying screens
(a) Quantum mottle, relative speed, conversion efficiency, absorption efficiency and
system resolution (FWHM).
(b) Rare earth screens
B) Understand the principles of the air-gap technique.
C) Understand the principles and mechanics of:
1) Capacitor discharge and High frequency generators
2) Fluoroscopy
3) Automatic exposure control and Image Intensifiers
4) High frequency generators
5) Magnification radiography
6) Spot film devices
V) Darkroom -- understand and be able to explain the practical application of:
A) Safelights
1) Purpose of safelights
2) Filter specifications for various imaging films
3) Testing and maintenance of safelight systems
B) Chemistry of film processing for various types of film
1) Chemical components
(a) Developer solutions
(b) Replenishers
(c) Fixer solutions
(d) Rinse baths
2) Actions of various components
C) Washing and drying of films after developing and fixing:
1) Purpose
2) Acceptable methods
D) The difference between manual and automatic processing, including chemistry.
E) The correct methods of film storage and the effects of improper film storage.
F) Appropriate darkroom design and construction.
G) Be familiar with darkroom and film processing quality control.
VI) Computed/Digital Imaging
A) Be familiar with the use of computers and concepts of digital image formation and storage.
1) Computer hardware characteristics
(a) Storage media
(b) Disc drive characteristics
(c) Units of performance and storage
2) Bits, Bytes, Word, Pixel, Voxel, Matrix Size
3) File Types
(a) TIFF, JPEG, DICOM (digital imaging and communication in medicine).
4) Understand the basics of PACS (Picture Archival and Communication System)
B) Computed Radiography (CR)/Digital radiography (DR)
1) Understand the basics behind photostimulable phosphor (PSP) detection systems.
(a) PSP plate technology and image capture.
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2)
3)
4)
5)
6)
7)
(b) Understand the principles behind the processing of a PSP imaging plate to the
production of an image.
Understand the basics of Flat Panel digital radiography detection systems.
(a) Indirect conversion detectors
(b) Direct conversion detectors
Understand the difference between Thin Film Transistor (TFT) detectors and Charge
Coupled Device (CCD) – based detectors
Understand what factors contribute to spatial resolution and overall image quality
(including image noise) in CR and DR
Understand how digital system performance is evaluated (MTF and DQE)
Understand the basics of digital image processing/post-processing.
Be able to give the advantages and disadvantages of digital systems (CR and DR) as
compared to one another and film/screen radiology.
VII) Radiographic Quality and Artifacts
A) Understand the following characteristics of image quality and film film-screen evaluations.
1) Contrast - understand the differences between subject contrast, film contrast and
radiographic contrast.
2) Density (radiographic film optical density, base optical density, film fog)
3) Detail, resolution (including full width half max measurements, FWHM) and sharpness
4) Latitude
5) Modulation transfer function
B) Understand the effects of the following factors on image quality
1) Geometric factors
(a) Distortion
(b) Magnification
(c) Object position
(d) Object size and shape
2) Characteristics of controllable x-ray tube factors
(a) Focal spot size
(b) Object-film distance
(c) Target-film distance
C) Understand what "film artifacts" mean and be able to identify the following artifacts and
discuss or explain their cause:
1) Artifacts caused during exposure
(a) Double exposure
(b) Extraneous materials blocking the "image path"
(c) Grid cutoff and grid lines
(d) Improper tube-film distance
(e) Overexposure and underexposure
(f) Motion
2) Artifacts caused in processing and film handling
(a) Crescent marks on film
(b) Film scratches
(c) Fingerprints
(d) Improper developing, washing and fixing
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(i) overdevelopment and underdevelopment
(ii) exhausted developing chemicals
(iii) inadequate fixation
(iv) inadequate wash
(e) "Kissing defects" during development and fixation
(f) Static electricity
3) Automatic processing artifacts (Pi lines, curtain run back, cross over guide shoe
artifacts, pick off artifacts, entrance roller scratches)
4) Screen/film artifacts including dirty screens, poor film/screen contact and worn,
damaged or stained screens.
5) Fog including film, heat, light and radiation related fog.
6) Light leak (cassette and darkroom)
D) Be familiar with the characteristic curve of x-ray film and be able to compare two different
types of films as to contrast, speed and latitude using characteristic curves.
VIII) Technique Chart Formation
A) Discuss the importance and relationship of the following terms as they relate to technique
chart formation:
1) Focal-film distance
2) Grids
3) mA x time = mAs
4) mAs vs. kVp
5) Speed of screens and type of film
6) Subject contrast
7) Thickness of subject
B) Relate the following terms
1) mAs and radiographic density
2) kVp and radiographic contrast
3) kVp and radiographic density
C) Given a clinical case needing diagnostic radiographs, design a technique chart using factors
listed in Objective "A" above.
IX) General
A) Be familiar with the method and analysis of tests to compare various imaging systems or
methods to each other in terms of diagnostic accuracy.
1) The principles of a “gold standard”
2) Receiver operating characteristic curve analysis
3) The kappa statistic
4) Be able to compute sensitivity, specificity and accuracy if provided with numerical
data. Be familiar with the concepts of positive and negative predictive values.
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SPECIAL PROCEDURES
I) General
A) Alternative imaging methods and diagnostic tests that may complement or supersede
various special procedures in specific cases.
B) Knowledge of the various techniques and materials used to perform angiographic and
angiocardiography procedures
1) Difference between types of catheters available, the effects of catheter configuration
(i.e., length, number and position of openings) on the injection of contrast and the
advantages and disadvantages of each catheter type.
2) Cournand, NIH, pigtail, Swan-Ganz and Lehman ventriculography catheters.
3) Normal values for cardiac pressures and blood gas evaluations (oximetry)
4) Expected alterations in these values in common disease processes and congenital
heart defects.
C) Understand the principles of fluoroscopic imaging and diagnosis including fine needle
aspirate, biopsy, heartworm extraction and catheter interventional radiology.
II) Contrast media
A) Chemical names, relative viscosities, anionic and cationic composition of the ionic and
non-ionic contrast media.
1) various combinations of methylglucamine (meglumine) and sodium diatrizoate and
iothalamate, ioxaglate
2) iopamidol, iohexol, iotrolan
B) Advantages and disadvantages of ionic and non-ionic contrast media.
C) Physiologic effects, including the toxicities, of contrast media
D) How to manage adverse effects
E) Know the various physical and chemical properties of the different barium sulfate
suspensions.
1) w/v and w/w formulations
F) MRI contrast media
1) Concentration, dose, indications and contraindications
2) Prohance, Magnevist, as examples of gadolinium-DTPA contrast media
III) Special Procedures - Know the indications and contra-indications, technical aspects,
complications, standard imaging protocols (including positioning) and principles of
interpretation for the following contrast procedures.
A) Gastrointestinal
1) Esophagography (including evaluation of swallowing)
2) Upper GI series
3) Gastrography (positive, negative and double contrast)
4) Colonography (positive and negative)
5) Diagnostic imaging procedures to evaluate various esophageal, gastric and intestinal
transit times/function
6) Differences of various contrast media and methods for evaluation of esophageal,
gastric or intestinal transit times/function
B) Genitourinary
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C)
D)
E)
F)
G)
1) Excretory urography
2) Cystography (positive, negative and double contrast)
3) Urethrography, vaginourethography
Nervous System
1) Myelography
2) Imaging techniques for evaluating focal vs. diffuse CNS disorders, including cerebral
blood flow
Cardiovascular System
1) Angiocardiography (selective and non-selective)
2) Angiography
3) Venography (visceral and peripheral), including all methods of portography
4) Lymphangiography
5) Valvuloplasty
6) Vascular embolization techniques
Musculoskeletal
1) Arthrography
(a) canine: shoulder, stifle, carpus and tarsus
(b) equine: shoulder, carpus, metacarpophalangeal and metatarsophalangeal, distal
interphalangeal, and tarsocrural joints and the navicular bursa and tendon sheath
2) Fistulography
3) Stress radiography
Oculonasal
1) Dacryorhinocystography
2) Rhinography
Miscellaneous
1) Positional radiographs
2) Peritoneography
3) Imaging techniques for evaluating the lymphatic system and lymph nodes
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ALTERNATE IMAGING
The examination will consist of approximately 40% ultrasonography, 20% nuclear
scintigraphy, 20% computed tomography, and 20% magnetic resonance imaging.
I) Ultrasonography
A) Ultrasound
1) Understand the physical characteristics of the ultrasound beam
2) Understand the basic interactions of ultrasound with matter, including reflection,
refraction, scattering and attenuation.
3) Know the characteristics of various transducer types (electronic versus mechanical
and linear, curved, phased array, and multifrequency transducers, etc.) and the actions
of a piezoelectric element.
4) Be aware of the biological effects of ultrasound.
5) Be familiar with contrast enhancing media used in ultrasound
6) Understand the factors that affect lateral and axial resolution.
7) Understand the physical factors influencing the propagation of ultrasound in tissues
and the factors that influence acoustic impedance.
8) Know the relationship between wavelength, frequency, impedance and the velocity of
sound in tissues.
9) Be able to differentiate between pressure and intensity as it relates to ultrasound
waves traveling in tissues.
10) Understand the properties of ultrasound beam formation and propagation particularly
relative to the near field, focal zone and far field.
11) Understand the basics in calculation of reflected interfaces within tissue and the pulse
echo operation (including pulse repetition frequency, pulse duration and duty factor).
12) Understand the basics of the Doppler principle and be able the calculate the velocity
of blood flow given various parameters related to the Doppler frequency shift.
13) Be able to calculate the pressure gradients using a modified Bernoulli equation.
14) Be familiar with the differences and applications for pulsed wave Doppler,
continuous wave Doppler and color flow Doppler techniques.
15) Be familiar with the use of harmonic imaging, indications, contraindications and
modes of action.
16) Be familiar with Doppler energy and Color Power Doppler imaging techniques.
B) Methods of Image Formation and Display
1) Know the various modes of display
2) Be familiar with real-time imaging systems
3) Understand use of the controls for real-time equipment
C) Image Principles
1) Understand the meaning and factors affecting axial and lateral resolution
2) Be familiar with artifacts produced by improper equipment operation, improper
scanning techniques, and those inherent in ultrasound imaging.
D) Doppler Ultrasound
1) Know the basic Doppler principle
2) Be familiar with transducer characteristics, instrumentation, and controls
3) Understand the difference between continuous wave, pulsed wave and color flow
Doppler techniques.
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4) Know the clinical application of Doppler and basic interpretation principles
5) Be able to calculate blood flow
6) Be able to analyze arterial wave forms using pulsatility index, resistive index and A/B
ratios
E) Echocardiography
1) M-mode, 2-D and Doppler examination with recognition of normal and abnormal
Doppler tracings of cardiac valves.
2) Basic cardiac anatomy from right and left parasternal window
F) Clinical Application: For 2-D gray-scale ultrasonography, know the indications, selection
of particular equipment, scanning protocol, normal anatomy, principles of interpretation,
and appearance of disease in the following organ systems:
1) Large Animal (equine)
(a) Musculoskeletal
(i) Palmar/plantar tendons of the metacarpus/tarsus in transverse and longitudinal
orientations
(ii) Shoulder, stifle, and metacarpophalangeal and metatarsophalangeal joints
(b) pleural cavity / peritoneal cavity / diaphragm
(c) GI, abdominal vasculature
(d) Renal
(e) Hepatic and splenic
(f) Ocular
(g) Urinary bladder
(h) Jugular vein and surrounding anatomy.
(i) umbilical artery and vein and urachus (equine versus bovine differences)
(j) Cardiac
(k) Genital - Normal gestation, appearance of embryo/fetus in horse – evaluation with
ultrasound
2) Small Animal
(a) CNS (ventricular system, brain)
(b) pleural cavity / peritoneal cavity / diaphragm
(c) renal /adrenal
(d) hepatobiliary / splenic / pancreatic
(e) ocular
(f) reproductive (ovaries, testicles, uterus, prostate) ultrasound including normal
gestation, appearance of embryo/fetus in dog, cat – evaluation with radiology and
ultrasound
(g) GI
(h) urinary bladder and gallbladder
(i) abdominal vasculature (portal vein, vena cava, aorta and branches)
(j) thyroid gland
(k) lymph nodes
(l) cardiac
3) Doppler ultrasonography, know the indications, selection of equipment, scanning
protocol, principles of interpretation, and normal and abnormal Doppler patterns for the
following:
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(a) Splanchnic vascular beds including the portal venous system, renal, hepatic, and
mesenteric arteries and veins.
(b) Heart and peripheral vascular beds
(c) Parenchymal vascular beds of the liver, spleen and kidneys.
II) Nuclear Medicine
A) Nuclear medicine generator systems
1) Parent-Daughter Decay (generator systems)
B) Radiation Detectors
1) Scintillation Detectors - Gamma Camera
(a) Gamma camera head including the NaI crystal, photocathode, photomultiplier tubes
(b) Pre-Amplifier, Amplifier, and pulse height analyzer.
(c) Rate scalers, cathode ray tube, analog digital converter (ADC)
(d) Collimators – low energy-all purpose, diverging, converging, medium energy, pinhole, high resolution, high sensitivity.
2) Gamma Cameras – Resolution/QC
(a) Quality control
(b) Factors that limit spatial and temporal resolution
C) Digital Image Processing
1) Types of acquisitions - frame mode, list mode, static, dynamic, gated (ECG
synchronized).
2) Image depth - bit, byte and word
3) The effect of matrix size on image quality, frame rate and storage capacity
4) Types of background correction
5) Cross talk and its quantitative effect on ROI
6) Regions of interest (ROI), time activity curves and basic filtering operations including
smoothing, edge detection, temporal and spatial operations.
D) Radiopharmaceuticals - know the indication, routes of administration, mechanisms of
location and route of excretion for the following radiopharmaceuticals. Also, know the
clinical scintigraphic procedures related to indications, proper radiopharmaceuticals to be
used, scanning protocol, normal anatomy, common artifacts, and principles of
interpretation and the appearance of disease.
1) Pertechnetate – thyroid imaging, per-rectal scintigraphy.
2) Macroaggregated albumin (MAA) – pulmonary perfusion and right to left shunt
quantification.
3) Methylene diphosphonate – three phase bone scans, pulmonary mineralization studies.
4) 99mTc-DTPA
(a) GFR calculation
(b) first pass radionuclide ventriculogram
(c) left to right shunt calculation studies
(d) radioaerosol studies
(e) liquid phase gastric emptying studies
5) IDA – hepatobiliary scanning and calculation of hepatic extraction fraction, solid phase
gastric emptying
6) MAG-3 – effective renal plasma flow.
7) HMPAO – Labeled white blood cells and cerebral perfusion imaging.
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8) Cardiotec (sestamibi or MIBI) – use in myocardial and parathyroid studies
9) MIBG – adrenal scintigraphy.
10) 99mTc-red blood cells – MUGA studies, GI bleeds
11) 123I, 131I – thyroid scintigraphy.
E) Analysis of Scintigraphic Procedures - Know the indications and methods of calculation of
the following procedures:
1) Portosystemic shunt quantification
2) Glomerular filtration rate - imaging studies and plasma clearance
F) Radiobiology and Radiation Safety (same as for V Radiation Protection)
1) Care and handling of the radioisotopes and the radioactive patients
2) Exposure versus contamination
3) Know basic regulations and governing agencies for radioisotope imaging of veterinary
patients and the release criteria for those patients. This is typically state dependent;
however, familiarity with the procedures and appropriate regulatory state agencies is
expected.
III) Computed Tomography
A) Computed Tomography
1) Know the principles of cross-sectional image formation including the concept of
filtered back projection.
2) Know the various types of detectors and orientations used in CT scanners
(“generations”)
3) Know the physical principles of helical CT scanners and the advantages and
disadvantages
B) Image Reconstruction and Display
1) Be familiar with back-projection, iterative, and analytical methods of reconstruction
2) Understand the definition, limitations and the use of Hounsfield Units
3) Understand the definition and use of window level and window width
4) Be familiar with CT artifacts and what factors are responsible for creating them
including beam hardening, and target artifacts (third generation detector).
5) Know the effect of matrix size, image depth, field of view, slice thickness, mA, and
kVp on image quality
C) Safety
1) Be familiar with patient exposure levels during CT procedures.
2) Know important radiation safety factors for CT scanners.
D) Clinical Application
1) Know the indications, scanning protocol (imaging planes, desirable slice thickness, and
use of contrast), normal anatomy, common artifacts, principles of interpretation and
appearance of disease for regions:
(a) Nasal cavity
(b) Orbital region
(c) Brain
(d) Spine
(e) Thorax / mediastinum
(f) Abdomen (especially renal and adrenal) and pelvis
(g) Musculoskeletal system and superficial soft tissues
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IV) Magnetic Resonance Imaging
A) Basic physics
1) Know the characteristics of nuclear structure, angular momentum, magnetism and
magnetic dipole moment
2) Know the basic principles and parameters associated with MRI, including the
following terminology:
(a) Larmor frequency
(b) magnetization vectors
(c) radiofrequency pulse
(d) free induction decay
(e) spin-spin relaxation time
(f) spin-lattice relaxation time
(g) pulse sequence
(h) chemical shift and paramagnetic substance
(i) contrast media and magnetic susceptibility
B) Basic Principles
1) Know the following terminology and the role these factors play in MR image
formation:
(a) TR, repetition time
(b) TE, echo time
(c) Excitation, or flip, angle
(d) FOV
(e) slice thickness and slice gap
(f) number of averages or excitations
(g) slice selection, phase and frequency encoding gradients
C) Instrumentation
1) Know the basic principles and advantages of the different types of magnets used for
MRI (permanent, resistive, superconductive).
2) Understand the basic differences between a horizontal magnet design and a vertical
(open) magnet design.
3) Know the basic differences between commonly used receiver coil types (surface,
quadrature, array) and their use
4) Know the function of the various components of the MRI scanner
5) Be familiar with factors that can create image artifacts, including the effect of
commonly used veterinary surgical implants
D) Safety
1) Be familiar with safety concerns of MRI
E) Clinical Utility/Indications/Procedures
1) Know the general method for acquiring the following pulse sequences and their
common clinical uses:
(a) T1 pulse sequence
(b) T2 pulse sequences (including fast spin echo T2 imaging)
(c) proton density pulse sequence
(d) gradient echo pulse sequence
2) Know the clinical utility of the following MR imaging procedures:
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(a) Fat suppression techniques (fat saturation, STIR)
(b) MR angiography (time of flight, phase contrast)
(c) FLAIR (fluid attenuated inversion recovery)
3) Be familiar with MRI contrast media including
(a) Doses
(b) Hazards
(c) mode of action
F) Clinical Applications
1) Know the indications, scanning protocol (imaging planes, desirable slice thickness,
pulse sequences, use of contrast), normal anatomy, common artifacts, principles of
interpretation and appearance of disease for the following studies:
(a) Axial skeletal system including: nasal cavity, orbital region, brain and spine.
(b) Abdomen
(c) Musculoskeletal system and superficial soft tissues
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