ACVR WRITTEN EXAMINATION OBJECTIVES 2008
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, and image or schematic identification.
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 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literature, particularly for Veterinary Radiology & Ultrasound, outdated, obsolete, or obscure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:
1. General
1.1. Current anatomic nomenclature will be used in questions and expected in answers.
1.2. Candidates must be familiar with ACVR-approved terminology
2. General Musculoskeletal System (canine, feline and equine)
2.1. General bone formation and growth.
2.2. Ages at which ossification centers fuse
2.2.1. Long bones including vertebral column
2.3. Blood supply of long bones
2.3.1.1.immature and mature
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2.3.1.2.differences in large animal versus small animal immature long bone blood
supply
3. . Axial Skeleton (canine, feline and equine)
3.1. Topographic features of vertebrae in all spinal segments.
3.2. Topographic features of bones of the skull and mandible as well as dentition and how
dentition changes with age
3.3. Sinuses, sinus communications and relationships
3.4. Topographic features of the pelvis
3.5. Formulae for the vertebral column, sternum and ribs (including cows)
4. Appendicular Skeleton (canine, feline and equine)
4.1. Topographic features of the long bones and joints as seen on radiographs (including avian)
4.2. Proximal and distal attachments of the major muscles, tendons, and ligaments associated
with the thoracic and pelvic limbs.
4.2.1. On radiographs of the thoracic and pelvic limbs, understand the topographic
features of the skeleton relative to the proximal and distal attachments of major
muscles, tendons, and ligaments
4.2.2. Understand both radiographic and cross-sectional anatomy and relationships
4.3. Transverse and sagittal anatomy of the equine distal extremity, metacarpus/tarsus,
common calcaneal and biceps tendons as it pertains to ultrasound imaging (canine and
equine).
5. Arthrology (canine, feline and equine)
5.1. Classification and topographic features of joints of the head, vertebral column and limbs
5.1.1. Relationship, structure and function of ligaments and intervertebral discs of the
vertebral column
5.1.2. Presence and function of menisci
5.2. Sesamoid bones and their relationship to the joints
5.3. Understanding of the structures that are accentuated on various radiographic projections
(e.g. flexed lateral-medial carpus)
5.4. Comparative arthrology of the bones and joint compartments for the stifle, carpus and
tarsus
6. Cardiovascular System (canine, feline and equine)
6.1. Embryology of the cardiovascular system to understand the development of common
malformations of the heart and great vessels
6.2. Differences between fetal and neonatal circulation
6.3. Arteries arising from aortic arch and common congenital malformations
6.3.1. double aortic arch, persistent right aortic arch, aberrant left subclavian and aortic
coarctation
6.4. Vascular supply to the brain
6.5. Vertebral vascular system
6.6. Branches of the abdominal aorta
6.7. Blood supply of the canine and feline liver, spleen, kidneys, and pancreas
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6.8. Blood supply to thoracic and pelvic limbs
6.8.1. major arterial blood supply and venous drainage
6.8.2. understand supply from aorta to manus/pes and drainage to the cranial or caudal
vena cava
6.9. Portal venous system (hepatic)
6.9.1. normal and congenital/acquired shunting
6.9.2. patent ductus venosus
6.9.3. single extra-hepatic portosystemic shunts
6.9.4. Normal and abnormal angiographic studies of the hepatic portal circulation
6.10. Echocardiographic anatomy in standard right and left parasternal short and long-axis
planes
6.11.
Common cardiac developmental anatomy
6.11.1. patent ductus arteriosus
6.11.2. atrial and ventricular septal defects
6.11.3. valvular stenosis
6.11.4. atrioventricular dysplasias
6.11.5. endocardial cushion defects and conotruncal defects
6.11.6. Tetralogy and pentalogy of Fallot
6.11.7. persistent left cranial vena cava
6.11.8. Normal and abnormal, selective and non-selective angiocardiography
7. Nervous System (canine, feline and equine)
7.1. Anatomical relationships of spinal cord, spinal nerves and meninges
7.1.1. brachial and lumbosacral plexes
7.1.2. major components and innervations of the nerves that originate from these plexes
7.2. Segmental spinal nerve origins, location of exit from the vertebral canal and the function
of the spinal nerves.
7.3. Ventricular system of the brain and its drainage
7.4. Distribution of nerves in the distal extremity of the thoracic and pelvic equine limbs as
related to common nerve blocks performed
7.5. 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)
7.6. Routine radiographic anatomy of the skull
7.7. General understanding of neurologic examination and lesion localization
7.8. Origin of cranial nerves and their function
7.9. Anatomy of the organs of special sense
8. Digestive System (canine, feline and equine)
8.1. Normal anatomic relationships of gastrointestinal tract with all other abdominal organs
(including bovine)
8.2. Comparative anatomy of the ileo-ceco-colic region
8.3. Anatomy of the liver, gallbladder, and pancreas
8.3.1. Comparative anatomy of the bile duct and pancreatic ducts
8.4. Normal sonographic anatomy of the gastrointestinal tract
9. Respiratory System (canine, feline, equine)
9.1. Oropharynx, nasopharynx, laryngeal cartilage and hyoid apparatus
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9.2. Guttural pouches and their anatomic relationships as viewed on routine radiographs and
computed tomography or magnetic resonance – equine
9.3.
9.4. Bronchial tree and lung lobes – compare between species
9.5. Vascular supply of the lung
9.6. Pleural layers
9.7. Mediastinal anatomy and degree of development/fenestrations
9.8. Avian air sac anatomy and connection with primary pulmonary structures (airways, lung,
etc.)
10. Urogenital (canine, feline, equine)
10.1.
Anatomy of the kidney, ureter, and lower urinary tract and the relationship to
reproductive organs
10.1.1. Identification of normal or abnormal structures using, contrast enhanced
radiographic or Covered in alt. imaging
10.2.
Embryology of the urogenital system
10.2.1. development of the kidney, ureters, and urinary bladder
10.2.2. development of gonadal structures
10.2.3. Malformations of the urogenital system including ectopic ureter,
pseudohermaphrodites, renal agenesis, uterus masculinus, and cryptorchidism.
10.3.
Avian normal urogenital anatomy
11. Miscellaneous (canine, feline, equine)
11.1.
Positioning and postural influences on the radiographic appearance of the thorax and
abdomen
11.2.
Effects of inhalation vs. exhalation on anatomic relationships and appearances
11.3.
Location of lymph nodes and drainage patterns
11.4. Cross-sectional and sagittal anatomy of the thorax and abdomen
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12. PHYSIOLOGY/PATHOPHYSIOLOGY
12. Physiology and Pathophysiology of Specific Organ Systems
12.1. Alimentary
12.1.1. Physiologic mechanisms of gastro-intestinal tract function (oral, esophageal,
gastric, intestinal, colonic)
12.1.1.1. Propulsion and bolus formation, esophageal and intestinal motility
12.1.1.2. Hormonal control and alimentary reflexes (e.g., gastrocolic) as they apply
to motility and secretion control
12.1.2. Vomiting vs. regurgitation – applicable pathophysiology
12.1.3. Diarrhea - applicable pathophysiology related to small intestinal versus large
intestinal diarrhea
12.1.4. Transit times in normal and disease states
12.1.5. Ileus
12.1.5.1. Causes and types – mechanical vs. functional
12.1.5.2. Pathophysiology
12.1.6. Gastric dilatation/torsion/volvulus complex
12.1.6.1. Possible etiologic factors
12.1.6.2. Systemic and local pathophysiologic alterations
12.1.6.3. Basis of radiographic appearance
12.1.7. Pancreas
12.1.7.1. Normal exocrine and endocrine physiology
12.1.7.2. Pathophysiology of pancreatitis and pancreatic tumors
12.1.7.3. Pathophysiology of endocrine diseases associated with the pancreas
12.1.8. Hepatobiliary System
12.1.8.1. Normal physiology
12.1.8.2. Pathophysiology of acute and chronic hepatitis, cholangiohepatitis,
cholecystitis, obstructive biliary disorders, biliary rupture and peritonitis, hepatic
lipidosis
12.2. Cardiovascular System
12.2.1. Hemodynamics, flow, timing, and pressure relationships
12.2.2. Origin, source and significance of heart sounds as well as normal values for cardiac
pressures and blood gas evaluations – moved from Specials 31.2.3
12.2.3. Interrelationship and correlation of the above for the normal cardiac cycle and for
abnormal cardiac conditions
12.2.4. Coronary blood flow
12.2.5. Starling's Law of the Heart
12.2.6. Congenital and acquired cardiovascular diseases
12.2.6.1. Common clinical signs
12.2.7. Mechanisms and pathophysiologic effects of congestive heart failure
12.2.8. Pericardial disease and effect on cardiac function
12.2.9. Pathophysiology of canine and feline heart worm infection
12.2.9.1. Cardiopulmonary effects
12.2.10.
Vascular anomalies-hemodynamics: clinical signs and pathophysiology
12.2.10.1. Portosystemic shunts
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12.2.10.2. Arteriovenous malformations
12.2.10.3. Infarction of major vessels and downstream organ
12.2.10.4. Aortic and venous embolism/thrombus
12.2.11.
Lymphatic system
12.2.11.1. Physiology of lymphatic production and flow
12.2.11.2. Pathophysiology of diseases of the lymphatic and mononuclear phagocytic
systems
12.3. Central Nervous System
12.3.1. Spinal cord
12.3.1.1. Pathophysiology of common causes of localized spinal cord disorders
including, but not limited to: intervertebral disc disease, hemorrhage,
fibrocartilaginous embolism, neoplasia, developmental disorders.
12.3.1.2. Embryonic derivation of spinal and vertebral components germane to
clinically encountered congenital disease
12.3.2. Brain
12.3.2.1. Production and flow of cerebrospinal fluid
12.3.2.2. Cerebral vascular accidents/infarctions
12.3.2.3. Characteristics of canine and feline brain tumors.
12.4. Musculoskeletal System
12.4.1. Bone
12.4.1.1. Physiologic sequence and mechanism of normal fracture healing
12.4.1.2. Pathophysiology of bone disease
12.4.1.2.1. metabolic and congenital diseases
12.4.1.2.2. abnormal fracture healing (non-union, delayed union, malunion)
12.4.1.2.3. infection of bone
12.4.1.2.4. bone infarcts and avascular necrosis
12.4.1.2.5. periosteal and periarticular new bone formation
12.4.2. Cartilage
12.4.2.1. Physiology of cartilage growth, development and repair
12.4.2.2. Pathophysiology of osteochondrosis and osteochondritis dissecans
12.4.3. Joints
12.4.3.1. Normal physiology
12.4.3.2. Pathophysiology of degenerative joint disease, including radiographic
features of degenerative joint disease and an understanding of how each of the
described changes occur
12.4.3.3. Pathophysiology of immune-mediated, infectious, and traumatic joint
disease
12.5. Respiratory System
12.5.1. Normal respiration
12.5.1.1. Deleted 2008
12.5.1.2. Lung perfusion and physiologic responses to lung diseases
12.5.2. Methods of oxygen and carbon dioxide transport
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12.5.2.1. General understanding of the blood gas profile (pH, PO2, pCO2, HCO3, base
excess/deficit)
12.5.2.2. Normal physiology of pleural fluid formation.
12.5.3. Abnormal respiration
12.5.3.1. Common causes of respiratory dysfunction including dyspnea and stridor
and their pathophysiologic effects on the thoracic wall, pleural space, upper
respiratory system and bronchi, lungs, pulmonary vasculature and diaphragm.
12.5.3.2. Pathophysiology of pulmonary thromboembolism
12.5.3.3. Pathophysiology of pleural effusions
12.6. Urogenital System
12.6.1. Renal function
12.6.1.1. Mechanism of urine production
12.6.1.2. Methods of renal function assessment
12.6.1.3. Interpretation of abnormal renal function tests (BUN, creatinine, note
species differences between canine, feline and equine)
12.6.1.4. Role of the kidney in the maintenance of blood pressure/electrolytes
12.6.1.5. Renin-angiotensin-aldosterone pathways
12.6.1.6. Erythropoietin and endocrine functions
12.6.2. Organ, hormonal and mineral inter-relationships
12.6.2.1. Interrelations of kidneys, liver, intestine, bone, parathyroid and thyroid
gland on Vitamin D, calcium and phosphate regulation
12.6.2.2. Alterations of the above due to disease
12.6.3. Abnormal renal function
12.6.3.1. Acute vs. chronic renal failure
12.6.3.2. Glomerulonephritis
12.6.3.3. Interstitial nephritis
12.6.3.4. Toxicities
12.6.3.5. Infections
12.6.3.6. Neoplasia
12.6.3.7. Pyelonephritis
12.6.3.8. Feline lower urinary tract disease
12.6.4. Pressure, volume relationship among the ureters, bladder and urethra;
neurophysiology of micturition, the detrusor reflex and vesicoureteral reflux
12.6.5. Genital
12.6.5.1. Radiographically recognizable fetal ossification intervals (canine and
feline)
12.6.5.2. Radiographic findings of fetal death and how the signs develop (dog and
cat)
12.6.5.3. Canine pyometra – pathogenesis, predisposing causes, systemic effects
12.6.5.4. Ovarian disease – congenital, neoplastic, and functional problems, systemic
effects
12.6.5.5. Prostate gland diseases
12.6.5.6. Testicular diseases
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12.7. Endocrine System
12.7.1. Thyroid Gland
12.7.1.1. Iodide trapping and organification into T3/T4
12.7.1.2. Deleted 2008
12.7.1.3. Pituitary-thyroid axis - homeostasis and negative feedback
12.7.1.4. Thyroid hormone function and effects on other organ systems
12.7.1.5. Mode of action/duration of antithyroid medications
12.7.1.6. Systemic effects of I-131 in cats treated for feline hyperthyroidism.
12.7.2. Pituitary Gland
12.7.2.1. Homeostasis and regulation of pituitary gland via portal system and
releasing factors/proteins or neurohypophyseal control of posterior pituitary
12.7.2.2. Pituitary disease – Cushing’s syndrome, tumors, diabetes insipidus, and
hypoplasia
12.7.3. Adrenal Gland
12.7.3.1. Epinephrine and norepinephrine production and regulation
12.7.3.2. Tumors of the adrenal cortex and medulla
12.7.3.3. Glucocorticoids - control and effects
12.7.3.4. Hyperadrenocorticism and hypoadrenocorticism
12.7.3.5. Hyperaldosteronism
12.7.3.6. Mineralocorticoids - control and effects
12.7.3.7. Physiologic effects of adrenal hormones on CNS, cardiovascular system,
respiratory system and metabolic status
12.8. Miscellaneous
12.8.1. Pathophysiologic basis and radiographic findings in immune-mediated diseases:
12.8.1.1. Immune-mediated thrombocytopenia
12.8.1.2. Immune-mediated hemolytic anemia
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13. RADIATION PROTECTION - RADIATION BIOLOGY
13.Physics
13.1. Physics and Chemistry of Radiation Absorption
13.1.1. Differentiate between molecular excitation and ionization.
13.1.2. Differentiate between particulate and electromagnetic (non-particulate) forms of
radiation.
13.1.3. Differentiate between the sites of origin of gamma rays and x-rays.
13.1.4. Know the basic forms of particulate radiations and their interactions or potential
interactions with matter, including: alpha particles, electrons, protons, and neutrons.
13.1.5. Understand the difference between direct and indirect forms of ionizing radiation
injury.
13.1.6. Understand the difference between direct and indirect actions of radiation.
13.1.7. Define the role of ionization and free radical formation and their role in creating
biological effects.
13.2. Basic Atomic and Nuclear Physics
13.2.1. Atomic composition and structure and nuclear binding forces
13.2.2. Nuclear decay charts and radioactive decay
13.2.3. Line of stability and the line of unity
13.2.4. Isotopes, Isobars, Isomers and Isotones
13.2.5. Atomic number and atomic mass; calculation of neutron number
13.3. Modes of Radioactive Decay (particulate and non-particulate emissions including neutrinos
and anti-neutrinos)
13.3.1. Betatron (negatron) decay
13.3.2. Alpha decay
13.3.3. Electron capture
13.3.4. Positron decay (annihilation reaction and photon formation)
13.3.5. Isomeric transition
13.4. Radioactive Decay terminology
13.4.1. Decay constant and relationship with physical half-life
13.4.2. Physical and biological half-life and the calculation of the effective half-life.
Understand the concept of an effective half-life.
13.4.3. Average half-life
13.4.4. Specific activity
13.5. Be familiar with molecular reactions and interactions of radiation with matter.
13.5.1. Deleted in 2008
13.5.2. 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.
13.5.3. Be able to convert rads to Grays and rems to Sieverts.
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14. Radiation Biology
14.1. Know the basic mechanisms of acute and late radiation injury and cell killing
14.1.1. Understand the differences in radiation response between acute and late responding
tissues.
14.2. How does radiation kill cells
14.2.1. Discuss the mechanisms of electromagnetic radiation induced cell killing
14.2.2. Discuss the differences between apoptotic and mitotic cell death related to radiation
induced cellular injury
14.2.3. Understand the differences between lethal damage, sub-lethal damage and
potentially lethal damage
14.3. 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.
14.4. Understand R.B.E. and how R.B.E. may be influenced by other factors.
14.5. Discuss the phases of acute radiation syndrome, including the bone marrow,
gastrointestinal and CNS radiation syndromes.
14.5.1. Include the prodromal symptoms, whole body dose to create the radiation syndrome
and clinical signs associated with acute radiation syndrome.
14.6. Discuss/be familiar with the effects of chronic radiation exposure
14.7. Be familiar with the effects of radiation on the developing embryo/fetus in utero.
14.8. Understand the meaning of the terms, “lethal dose”, and “tolerance dose”.
14.9. Understand the difference between deterministic and stochastic effects related to radiation
induced injury.
15. Oncology/Tumor Biology
15.1. Be familiar with the biological behavior of common canine, feline, and equine tumors.
15.2. 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.
15.3. 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.
16. Radiation Monitoring
16.1. Be familiar with the equipment and devices used for monitoring radiation and the basic
principles involved.
16.1.1. Gas-filled detectors, including the basic principles, ionization chambers,
proportional counters and Geiger-Müeller survey meters.
16.2. Be familiar with the appropriate use and limitations of personnel monitoring equipment
(TLD monitors, pocket dosimeters and film badges) and interpretation of data obtained.
16.3. Be familiar with the regulations pertaining to personnel monitoring, i.e., occupational, nonoccupational, general population, and fetal exposures
16.3.1. Understand patient versus operator exposure levels
16.3.2. Understand radiation safety factors… time, distance, shielding
16.3.3. Understand the concept of lifetime cumulative exposure
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17. Radiation Protection
17.1. How do you protect yourself and other from different types of radiation?
17.1.1. What is the ALARA concept?
17.2. 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.
17.3. Define and apply ALARA concept to standards of radiation protection and safety.
17.4. Be familiar with the radiation protection aspects of handling animals that have been given
either diagnostic (99mTc, 111Indium) or therapeutic radiopharmaceuticals (131I).
17.4.1. Care and handling of the radioisotopes and the radioactive patients
17.4.2. Monitoring external and internal exposure of personnel
17.4.3. Exposure versus contamination
17.4.4. Know the deterministic annual limits for the lens of the eye and localized areas of
the skin, hands and feet.
17.5. Regulatory Aspects
17.5.1. Know the function and responsibility of the various councils and agencies, i.e.,
NRC, NCRP, ICRP, OSHA, and State Governments.
17.5.2.Differences between agreement and non-agreement states
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18. PHYSICS OF DIAGNOSTIC RADIOLOGY
18.History
18.1. Know the history of the discovery of X-rays (briefly)
19. Production of X-rays
19.1. Be familiar with the construction and function of the following components of a diagnostic
x-ray system:
19.1.1. Exposure timers: (pros and cons of each type)
19.1.1.1. Deleted 2008
19.1.1.2. Synchronous timers
19.1.1.3. Electronic timers
19.1.1.4. Photo-timer – automatic exposure control
19.1.2. Inherent and added beam filters and collimator
19.1.3. Milliamperage (mA) regulation
19.1.4. Voltage (kVp) regulation
19.1.5. X-ray tube housing and cooling elements
19.1.6. X-ray tube
19.1.6.1. Anode and anode shaft
19.1.6.2. Cathode, cathode filaments and focusing cup
19.1.6.3. Transformer
19.1.6.4. Focal spot size
19.2. Be familiar with the following concepts and understand their relationship and/or
importance in x-ray production:
19.2.1. Alternating versus direct current
19.2.2. Bremsstrahlung radiation and polychromatic (energetic) x-ray beam
19.2.3. Characteristic radiation
19.2.4. Characteristics of focal spots including actual vs. effective focal spots, the line
focus principle, large versus small focal spots, and requirements for magnification
radiography.
19.2.5. Electron orbits and energy levels
19.2.6. Filtration (inherent and added)
19.2.7. Heat dissipation within the tube and tube housing
19.2.8. Anodes: rotating versus stationary, common anode materials, heel effect and anode
angle (effect on focal spot size and heel effect).
19.2.9. Voltage wave forms including ripple effect, constant potential, high frequency.
Differences between kilovoltage and megavoltage x or gamma rays
19.2.10.
mAs, kVp, & keV
19.2.11.
kW ratings of x-ray tubes and x-ray generators
19.2.12.
Milliamperage (including falling load principle)
19.2.13.
Collimators and primary x-ray beam
19.2.14.
Rectification
19.2.15.
Understand of tube heat units, tube rating charts and anode cooling charts
for routine radiology and fluoroscopy units.
19.2.16.
Line voltage and line voltage compensator
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19.3. Understand the principles of energy transfer in the production of a useful x-ray beam,
including:
19.3.1. Energy transfer at the transformer
19.3.2. Energy transfer at the anode
19.3.3. Energy transfer at the cathode
19.3.4. Energy transfer within the glass envelope and the collimator housing (added
filtration)
20. Physical Properties of X-rays
20.1. Understand the following concepts as they relate to the physical properties of x-rays:
20.1.1. Effect on photographic emulsion.
20.1.2. Fluorescence and phosphorescence
20.1.3. Inverse square law and calculations for determining new mAs factors when
distance changes.
20.1.4. Interactions with matter and ionization of atoms and secondary scatter
20.1.4.1. Understand and be able to discuss photoelectric and Compton interactin,
pair production, and photodisintegration and the radiation energy and physical
density (subject) ranges for which these types of interactions are likely to occur.
20.1.5. Relationship of the speed of light, frequency and wavelength. Relationship of the
x-ray wavelength and energy.
20.1.6. Wavelength of diagnostic x-rays compared to other forms of electromagnetic
radiation (electromagnetic spectrum)
20.1.7. X-ray beam intensity and quality
20.1.8. Half value layer, linear and mass attenuation coefficients
20.2. 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:
20.2.1. Absorption
20.2.2. Scattering
20.2.3. Transmission
20.2.4. Mass and linear attenuation coefficient
21. Equipment and Accessories
21.1. Understand the use, limitations, advantages, disadvantages, care and construction of the
following radiographic equipment:
21.1.1. Cones and collimators
21.1.2. Film
21.1.2.1. Green or blue sensitive film and specific dark room requirements
21.1.2.2. Screen versus non-screen film
21.1.2.3. Specialty film (copy film or subtraction film)
21.1.2.4. Double versus single emulsion film
21.1.2.5. H&D curves
21.1.3. Film identification devices
21.1.4. Film/screen combinations and relative film/screen speeds and contrast
21.1.5. Fluoroscopic screens
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21.1.6. Grids (parallel, crossed, focused, Potter-Bucky):
21.1.6.1. Grid ratios
21.1.6.2. Grid composition
21.1.7. Cassettes and Intensifying screens
21.1.7.1. Quantum mottle, relative speed, conversion efficiency, absorption
efficiency and system resolution (FWHM).
21.1.7.2. Rare earth screens
21.2. Understand the principles of the air-gap technique.
21.3. Understand the principles and mechanics of:
21.3.1. Capacitor discharge and High frequency generators
21.3.2. Fluoroscopy
21.3.3. Automatic exposure control and Image Intensifiers
21.3.4. High frequency generators
21.3.5. Magnification radiography
21.3.6. Spot film devices
22. Darkroom -- understand and be able to explain the practical application of:
22.1. Safelights
22.1.1. Purpose of safelights
22.1.2. Filter specifications for various imaging films
22.1.3. Testing and maintenance of safelight systems
22.2. Chemistry of film processing for various types of film
22.2.1. Chemical components
22.2.1.1. Developer solutions
22.2.1.2. Replenishers
22.2.1.3. Fixer solutions
22.2.1.4. Rinse baths
22.2.2. Actions of various components
22.3. Washing and drying of films after developing and fixing:
22.3.1. Purpose
22.3.2. Acceptable methods
22.4. The difference between manual and automatic processing.
22.5. The correct methods of film storage and the effects of improper film storage.
22.6. Appropriate darkroom design and construction.
22.7. Be familiar with darkroom and film processing quality control.
23. Computed/Digital Imaging
23.1. Be familiar with the use of computers and concepts of digital image formation and storage.
23.1.1. Computer hardware characteristics
23.1.1.1. Storage media
23.1.1.2. Disc drive characteristics
23.1.1.3. Units of performance and storage
23.1.2. Bits, Bytes, Pixel, Voxel, Matrix Size
23.1.3. File Types
23.1.3.1. TIFF, JPEG, DICOM (digital imaging and communication in medicine).
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23.1.4. Understand the basics of PACS (Picture Archival and Communication System) and
know and understand the ACVR guidelines as listed on the ACVR website
23.1.4.1. Including DICOM connectivity
23.2. Computed Radiography (CR)/Digital radiography (DR)
23.2.1. Understand the basics behind photostimulable phosphor (PSP) detection systems.
23.2.1.1. PSP plate technology and image capture.
23.2.1.2. Understand the principles behind the processing of a PSP imaging plate to
the production of an image.
23.2.2. Understand the basics of Flat Panel digital radiography detection systems.
23.2.2.1. Indirect conversion detectors
23.2.2.2. Direct conversion detectors
23.2.3. Understand the difference between Thin Film Transistor (TFT) detectors and
Charge Coupled Device (CCD) – based detectors
23.2.4. Understand what factors contribute to spatial resolution and overall image quality
(including image noise) in CR and DR
23.2.5. Understand how digital system performance is evaluated (MTF and DQE)
23.2.6. Understand the basics of digital image processing/post-processing.
23.2.7. Be able to give the advantages and disadvantages of digital systems (CR and DR)
as compared to one another and film/screen radiology.
24. Radiographic Quality and Artifacts
24.1. Understand the following characteristics of image quality and film film-screen evaluations.
24.1.1. Contrast - understand the differences between subject contrast, film contrast and
radiographic contrast.
24.1.2. Density (radiographic film optical density, base optical density, film fog)
24.1.3. Detail, resolution (including full width half max measurements, FWHM) and
sharpness
24.1.4. Latitude
24.1.5. Modulation transfer function
24.2. Understand the effects of the following factors on image quality
24.2.1. Geometric factors
24.2.1.1. Distortion
24.2.1.2. Magnification
24.2.1.3. Object position
24.2.1.4. Object size and shape
24.2.2. Characteristics of controllable x-ray tube factors
24.2.2.1. Focal spot size
24.2.2.2. Object-film distance
24.2.2.3. Target-film distance
24.2.2.4. Deleted 2008
24.2.3. Signal to noise ratio
25. Technique Chart Formation
25.1. Discuss the importance and relationship of the following terms as they relate to technique
chart formation:
25.1.1. Focal-film distance
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25.1.2. Grids
25.1.3. mA x time = mAs
25.1.4. mAs vs. kVp
25.1.5. Speed of screens and type of film
25.1.6. Subject contrast
25.1.7. Thickness of subject
25.2. Relate the following terms
25.2.1. mAs and radiographic density
25.2.2. kVp and radiographic contrast
25.2.3. kVp and radiographic density
25.3. Given a clinical case needing diagnostic radiographs, design a technique chart using factors
listed in Objective 28.1 & 28.2 above.
26. General
26.1. Be familiar with the method and analysis of tests to compare various imaging systems or
methods to each other in terms of diagnostic accuracy.
26.1.1. The principles of a “gold standard”
26.1.2. 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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27. SPECIAL PROCEDURES
27.General
27.1. Alternative imaging methods and diagnostic tests that may complement or supersede
various special procedures in specific cases.
27.2. Knowledge of the various techniques and materials used to perform angiographic and
angiocardiography procedures
27.2.1. 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.
27.2.2. Pigtail and Swan-Ganz catheters.
27.2.3. Moved to Physiology section)
27.2.4. Expected alterations in these values in common disease processes and congenital
heart defects.
27.3. Understand the principles of fluoroscopic imaging and diagnosis including fine needle
aspirate, biopsy, heartworm extraction and catheter interventional radiology.
28. Contrast media
28.1. Chemical names, relative viscosities, anionic and cationic composition of the ionic and
non-ionic contrast media.
28.1.1. various combinations of methylglucamine (meglumine) and sodium diatrizoate
and iothalamate, ioxaglate
28.1.2. iopamidol, iohexol, iotrolan
28.2. Advantages and disadvantages of ionic and non-ionic contrast media.
28.3. Physiologic effects, including the toxicities, of contrast media
28.4. How to manage adverse effects
28.5. Know the various physical and chemical properties of the different barium sulfate
suspensions.
28.5.1. w/v and w/w formulations
29. 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.
29.1. Gastrointestinal
29.1.1. Esophagography (including evaluation of swallowing)
29.1.2. Upper GI series
29.1.3. Gastrography (positive, negative and double contrast)
29.1.4. Colonography (positive and negative)
29.1.5. Diagnostic imaging procedures to evaluate various esophageal, gastric and
intestinal transit times/function
29.1.6. Differences of various contrast media and methods for evaluation of esophageal,
gastric or intestinal transit times/function
29.2. Genitourinary
29.2.1. Excretory urography
29.2.2. Cystography (positive, negative and double contrast)
29.2.3. Urethrography, vaginourethography
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29.3. Nervous System
29.3.1. Myelography
29.4. Cardiovascular System
29.4.1. Angiocardiography (selective and non-selective)
29.4.2. Angiography
29.4.3. Venography (visceral and peripheral), including all methods of portography
29.4.4. Lymphangiography
29.4.5. Valvuloplasty
29.4.6. Vascular embolization techniques
29.5. Musculoskeletal
29.5.1. Arthrography
29.5.1.1. canine: shoulder
29.5.1.2. equine: shoulder, carpus, and the navicular bursa and tendon sheath
29.5.2. Fistulography
29.5.3. Stress radiography
29.6. Oculonasal
29.6.1. Dacryorhinocystography
29.7. Miscellaneous
29.7.1. Positional radiographs
29.7.2. Peritoneography
29.7.3. Deleted 2008
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30. ALTERNATE IMAGING
30.1. The examination will consist of approximately 40% ultrasonography, 20% nuclear
scintigraphy, 20% computed tomography, and 20% magnetic resonance imaging.
31. Ultrasonography
31.1. Ultrasound
31.1.1. Understand the physical characteristics of the ultrasound beam
31.1.2. Understand the basic interactions of ultrasound with matter, including reflection,
refraction, scattering and attenuation.
31.1.3. 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.
31.1.4. Be aware of the biological effects of ultrasound.
31.1.5. Be familiar with contrast enhancing media used in ultrasound
31.1.6. Understand the factors that affect lateral and axial resolution.
31.1.7. Understand the physical factors influencing the propagation of ultrasound in
tissues and the factors that influence acoustic impedance.
31.1.8. Know the relationship between wavelength, frequency, impedance and the
velocity of sound in tissues.
31.1.9. Understand the properties of ultrasound beam formation and propagation
particularly relative to the near field, focal zone and far field.
31.1.10.
Understand the basics in calculation of reflected interfaces within tissue
and the pulse echo operation (including pulse repetition frequency, pulse duration
and duty factor).
31.1.11.
Deleted 2008
31.1.12.
Be familiar with the use of harmonic imaging, indications,
contraindications and modes of action.
31.1.13.
Be familiar with artifacts produced by improper equipment operation,
improper scanning techniques, and those inherent in ultrasound imaging.
31.2. Methods of Image Formation and Display
31.2.1. Know the various modes of display
31.2.2. Be familiar with real-time imaging systems
31.2.3. Understand use of the controls for real-time equipment
31.3. Image Principles
31.3.1. Deleted 2008
31.4. Doppler Ultrasound
31.4.1. Understand the basics of the Doppler principle and be able to calculate the velocity
of blood flow given various paramenters related to the Doppler frequency shift
31.4.2. Be familiar with transducer characteristics, instrumentation, and controls
31.4.3. Understand the difference between continuous wave, pulsed wave and color flow
Doppler techniques.
31.4.4. Know the clinical application of Doppler and basic interpretation principles
31.4.5. Be able to analyze arterial wave forms using pulsatility index, resistive index and
A/B ratios
31.4.6. Be familiar with Doppler energy and Color Power Doppler imaging techniques
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31.5. Echocardiography
31.5.1. M-mode, 2-D and Doppler examination with recognition of normal and abnormal
Doppler tracings of cardiac valves.
31.5.2. Basic cardiac anatomy from right and left parasternal window
31.5.3. Be able to calculate the pressure gradients using a modified Bernoulli equation
31.6. 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:
31.6.1. Large Animal (equine)
31.6.1.1. Musculoskeletal
31.6.1.1.1. Palmar/plantar tendons and ligaments of the metacarpus/metatarsus in
transverse and longitudinal orientations
31.6.1.1.2. Removed 2008
31.6.1.2. Pleural cavity, peritoneal cavity, and diaphragm
31.6.1.3. GI, abdominal vasculature
31.6.1.4. Renal
31.6.1.5. Hepatic and splenic
31.6.1.6. Ocular
31.6.1.7. Urinary bladder
31.6.1.8. Jugular vein and surrounding anatomy.
31.6.1.9. Umbilical artery and vein and urachus (equine versus bovine differences)
31.6.1.10. Cardiac
31.6.1.11. Genital - Normal gestation, appearance of embryo/fetus in horse –
evaluation with ultrasound
31.6.2. Small Animal
31.6.2.1. CNS (ventricular system, brain)
31.6.2.2. Pleural cavity, peritoneal cavity, and diaphragm
31.6.2.3. Renal /adrenal
31.6.2.4. Hepatobiliary / splenic / pancreatic
31.6.2.5. Ocular
31.6.2.6. Reproductive (ovaries, testicles, uterus, prostate) ultrasound including
normal gestation, appearance of embryo/fetus in dog, cat
31.6.2.7. GI
31.6.2.8. Urinary bladder and gallbladder
31.6.2.9. Abdominal vasculature (portal vein, vena cava, aorta and branches)
31.6.2.10. Thyroid gland
31.6.2.11. Lymph nodes
31.6.2.12. Cardiac
31.6.3. Doppler ultrasonography, know the indications, selection of equipment, scanning
protocol, principles of interpretation, and normal and abnormal Doppler patterns for
the following:
31.6.3.1. Splanchnic vascular beds including the portal venous system, renal, hepatic,
and mesenteric arteries and veins.
31.6.3.2. Heart and peripheral vascular beds
31.6.3.3. Parenchymal vascular beds of the liver, spleen and kidneys.
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32. Nuclear Medicine
32.1. Nuclear medicine generator systems
32.1.1. Parent-Daughter Decay (generator systems)
32.2. Radiation Detectors
32.2.1. Scintillation Detectors - Gamma Camera
32.2.1.1. Gamma camera head including the NaI crystal, photocathode,
photomultiplier tubes
32.2.1.2. Pre-Amplifier, Amplifier, and pulse height analyzer.
32.2.1.3. Rate scalers, cathode ray tube, analog digital converter (ADC)
32.2.1.4. Collimators – low energy-all purpose, diverging, converging, medium
energy, pin-hole, high resolution, high sensitivity.
32.2.2. Gamma Cameras – Resolution/QC
32.2.2.1. Quality control
32.2.2.2. Factors that limit spatial and temporal resolution
32.3. Digital Image Processing
32.3.1. Types of acquisitions - frame mode, list mode, static, dynamic, gated (ECG
synchronized).
32.3.2. Image depth - bit, byte and word
32.3.3. The effect of matrix size on image quality, frame rate and storage capacity
32.3.4. Types of background correction
32.3.5. Cross talk and its quantitative effect on ROI
32.3.6. Regions of interest (ROI), time activity curves and basic filtering operations
including smoothing, edge detection, temporal and spatial operations.
32.4. 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.
32.4.1. Pertechnetate – thyroid imaging, per-rectal portal and trans-splenic scintigraphy.
32.4.2. Macroaggregated albumin (MAA) – pulmonary perfusion and right to left shunt
quantification.
32.4.3. Methylene diphosphonate – three phase bone scans, pulmonary mineralization
studies.
32.4.4. 99mTc-DTPA
32.4.4.1. GFR calculation
32.4.4.2. first pass radionuclide ventriculogram
32.4.4.3. left to right shunt calculation studies
32.4.4.4. radioaerosol studies
32.4.4.5. liquid phase gastric emptying studies
32.4.5. IDA – hepatobiliary scanning and calculation of hepatic extraction fraction, solid
phase gastric emptying
32.4.6. MAG-3 – effective renal plasma flow.
32.4.7. HMPAO – Labeled white blood cells and cerebral perfusion imaging.
32.4.8. Cardiotec (sestamibi or MIBI) – use in myocardial and parathyroid studies
32.4.9. MIBG – adrenal scintigraphy.
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99m
32.4.10.
Tc-red blood cells – MUGA studies, GI bleeds
123 131
32.4.11.
I, I – thyroid scintigraphy.
32.5. Analysis of Scintigraphic Procedures - Know the indications and methods of calculation of
the following procedures:
32.5.1. Portosystemic shunt quantification
32.5.2. Glomerular filtration rate - imaging studies and plasma clearance
33. Computed Tomography
33.1. Computed Tomography
33.1.1. Know the principles of cross-sectional image formation including the concept of
filtered back projection.
33.1.2. Know the various types of detectors and orientations used in CT scanners
(“generations”)
33.1.3. Know the physical principles of helical CT scanners and the advantages and
disadvantages
33.2. Image Reconstruction and Display
33.2.1. Be familiar with back-projection, iterative, and analytical methods of reconstruction
33.2.2. Understand the definition, limitations and the use of Hounsfield Units
33.2.3. Understand the definition and use of window level and window width
33.2.4. Be familiar with CT artifacts and what factors are responsible for creating them
including beam hardening, and target artifacts (third generation detector).
33.2.5. Know the effect of matrix size, image depth, field of view, slice thickness, mA, and
kVp on image quality
33.3. Safety
33.3.1. Be familiar with patient exposure levels during CT procedures.
33.3.2. Know important radiation safety factors for CT scanners.
33.4. Clinical Application
33.4.1. 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:
33.4.1.1. Nasal cavity
33.4.1.2. Orbital region
33.4.1.3. Brain
33.4.1.4. Spine
33.4.1.5. Thorax / mediastinum
33.4.1.6. Abdomen (especially renal, adrenal, hepatic and pelvis)
33.4.1.7. Musculoskeletal system and superficial soft tissues
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34. Magnetic Resonance Imaging
34.1. Basic physics
34.1.1. Know the characteristics of nuclear structure, angular momentum, magnetism and
magnetic dipole moment
34.1.2. Know the basic principles and parameters associated with MRI, including the
following terminology:
34.1.2.1. Larmor frequency
34.1.2.2. Magnetization vectors
34.1.2.3. Radiofrequency pulse
34.1.2.4. Free induction decay
34.1.2.5. Spin-spin relaxation time
34.1.2.6. Spin-lattice relaxation time
34.1.2.7. Pulse sequence
34.1.2.8. Chemical shift and paramagnetic substance
34.1.2.9. Contrast media and magnetic susceptibility
34.2. Basic Principles
34.2.1. Know the following terminology and the role these factors play in MR image
formation:
34.2.1.1. TR, repetition time
34.2.1.2. TE, echo time
34.2.1.3. Excitation, or flip, angle
34.2.1.4. FOV
34.2.1.5. Slice thickness and slice gap
34.2.1.6. Number of averages or excitations
34.2.1.7. Slice selection, phase and frequency encoding gradients
34.3. Instrumentation
34.3.1. Know the basic principles and advantages of the different types of magnets used for
MRI (permanent, resistive, superconductive).
34.3.2. Understand the basic differences between a horizontal magnet design and a vertical
(open) magnet design.
34.3.3. Know the basic differences between commonly used receiver coil types (surface,
quadrature, array) and their use
34.3.4. Know the function of the various components of the MRI scanner
34.3.5. Be familiar with factors that can create image artifacts, including the effect of
commonly used veterinary surgical implants
34.4. Safety
34.4.1. Be familiar with safety concerns of MRI
34.5. Clinical Utility/Indications/Procedures
34.5.1. Know the general method for acquiring the following pulse sequences and their
common clinical uses:
34.5.1.1. T1 pulse sequence
34.5.1.2. T2 pulse sequences (including fast spin echo T2 imaging)
34.5.1.3. Proton density pulse sequence
34.5.1.4. Gradient echo pulse sequence
34.5.2. Know the clinical utility of the following MR imaging procedures:
34.5.2.1. Fat suppression techniques (fat saturation, STIR)
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34.5.2.2. MR angiography (time of flight, phase contrast)
34.5.2.3. FLAIR (fluid attenuated inversion recovery)
34.5.3. Be familiar with MRI contrast media including
34.5.3.1. Doses
34.5.3.2. Hazards
34.5.3.3. Mode of action
34.6. Clinical Applications
34.6.1. 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:
34.6.1.1. Axial skeletal system including: nasal cavity, orbital region, brain and
spine.
34.6.1.2. Abdomen
34.6.1.3. Musculoskeletal system and superficial soft tissues
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