Free Practice Questions for Esame di Stato TSRM

Exam-style questions and explanations by OpenExamPrep.

✓ No registration✓ No credit card

69+ Questions

100% Free

Loading practice questions...

Exam Review

Key Facts: Esame di Stato TSRM Exam

L/SNT3

Undergraduate degree class in technical healthcare professions conferring eligibility

D.I. 19 febbraio 2009

Art. 7 D.I. 19/02/2009

Legislative article granting direct State Qualifying Examination value to the final degree exam

MUR / Ministero della Salute

2 parts

Practical examination of technical competence + degree thesis defense

D.I. 19 febbraio 2009, Art. 7

D.M. 746/1994

Ministerial profile defining the autonomous role of the TSRM

Ministero della Sanità

D.Lgs. 101/2020

Italian statutory decree governing radiation protection and medical exposure standards

Gazzetta Ufficiale

FNO TSRM-PSTRP

National Federation of Orders representing TSRMs and allied technical health professions

Legge 3/2018 (Lorenzin)

The qualifying final examination for the Laurea in Tecniche di Radiologia Medica, per Immagini e Radioterapia (L/SNT3) has Esame di Stato value under Article 7 of D.I. 19 febbraio 2009. It combines a profession-specific practical assessment with preparation and discussion of a thesis; local logistics are university-specific. This OpenExamPrep bank is an independent English-language MCQ study adaptation and does not simulate either mandatory component.

Sample Esame di Stato TSRM Practice Questions

Try these sample questions to review concepts for the Esame di Stato TSRM exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 69+ question experience with AI tutoring.

1During the execution of an anteroposterior (AP) thoracic spine radiograph on a patient with pronounced anatomical thickness variation between the upper and lower thorax, which technical principle should the medical radiology technician (TSRM) apply to achieve uniform receptor exposure?

A.Position the cathode of the X-ray tube toward the caudal (lower) thorax and the anode toward the cranial (upper) thorax

B.Position the anode of the X-ray tube toward the caudal (lower) thorax and the cathode toward the cranial (upper) thorax

C.Increase the tube potential (kVp) while reducing the source-to-image receptor distance (SID) to 80 cm

D.Remove the anti-scatter grid to equalize photon attenuation across the field

Explanation: Due to the anode heel effect, X-ray beam intensity is greater on the cathode side because photons emitted toward the anode side must traverse a greater thickness of target material, undergoing higher self-attenuation. By aligning the cathode over the thicker caudal anatomy (lower thoracic spine/upper abdomen) and the anode over the thinner cranial anatomy, the technician produces a uniform radiographic optical density across the entire detector.

2In a Computed Radiography (CR) cassette system utilizing a photostimulable phosphor (PSP) imaging plate, what physical mechanism is responsible for releasing the stored latent image during plate readout?

A.Thermal stimulation causing spontaneous thermoluminescence of lithium fluoride crystals

B.Optical stimulation by a focused red helium-neon or solid-state laser causing trapped electrons to emit blue-violet photostimulated luminescence

C.Direct electrical read-out via thin-film transistors (TFT) connected to selenium photodiodes

D.Radiofrequency resonance excitation of trapped halogen ions within an amorphous silicon matrix

Explanation: In CR systems, incoming X-ray photons ionize europium-doped barium fluorohalide crystals (BaFX:Eu2+), trapping electrons in metastable energy states (color centers or F-centers). During reader processing, a rastered red laser beam stimulates these trapped electrons to drop back to ground state, releasing energy as blue-violet light (photostimulated luminescence, PSL) that is captured by a photomultiplier tube and digitized.

3When transitioning an adult pelvic radiographic protocol from a non-grid exposure to using an 8:1 anti-scatter grid, how must the TSRM adjust exposure parameters to maintain an equivalent detector exposure (kerma at receptor)?

A.Decrease the milliampere-seconds (mAs) by a factor of 2

B.Increase the tube potential (kVp) by 50% without altering mAs

C.Increase the milliampere-seconds (mAs) by approximately 4 times (Bucky factor multiplication)

D.Maintain identical mAs and kVp because anti-scatter grids only absorb secondary scatter photons without affecting primary beam transmission

Explanation: Anti-scatter grids absorb a substantial fraction of scattered radiation as well as a small fraction of primary photons. The Bucky factor (or grid conversion factor) for an 8:1 grid is approximately 4. Therefore, to deliver the same total photon fluence to the detector and maintain optical density/detector exposure index, the mAs must be increased by approximately a factor of 4.

4In Dual-Energy X-ray Absorptiometry (DEXA) for bone mineral density evaluation, how is the patient's T-score clinically defined and differentiated from the Z-score?

A.T-score compares bone mineral density to an age-, sex-, and ethnicity-matched reference population, whereas Z-score compares it to a young adult healthy reference population

B.T-score represents the standard deviation difference compared to a healthy young adult reference mean at peak bone mass, whereas Z-score compares the patient to an age- and sex-matched peer population

C.T-score measures trabecular volumetric bone density in mg/cm3, whereas Z-score measures cortical areal bone mineral density in g/cm2

D.T-score is used exclusively in pediatric patients under 20 years old, whereas Z-score is mandatory for postmenopausal osteoporosis screening

Explanation: According to World Health Organization (WHO) standards, the T-score is the number of standard deviations (SD) above or below the mean bone mineral density (BMD) of a healthy young adult female reference population at peak bone mass (osteopenia: -1.0 to -2.5 SD; osteoporosis: <= -2.5 SD). The Z-score compares the patient's BMD to the mean of an age-, sex-, and ethnicity-matched cohort, making it especially valuable in premenopausal women, men under 50, and pediatric patients.

5During a digital subtraction angiography (DSA) examination of the abdominal aorta, patient bowel peristalsis introduces severe dark-and-light banding artifacts across the subtracted run. Which post-processing tool should the TSRM utilize first to minimize these misregistration artifacts?

A.Pixel shifting (manual or automated spatial translation of the mask image)

B.Maximum Intensity Projection (MIP) reconstruction

C.Edge enhancement high-pass spatial filtering

D.Inversion of window level without mask re-registration

Explanation: Misregistration artifacts in DSA occur when patient anatomical structures move between the initial pre-contrast mask image and subsequent contrast-filled frames. Pixel shifting allows the TSRM to translate the mask image horizontally or vertically (in whole or sub-pixel increments) over the active frame to realign anatomical edges, substantially eliminating motion artifacts around vessels.

6In digital mammography, what is the primary technical rationale for applying controlled mechanical breast compression during image acquisition?

A.To increase breast thickness so higher tube voltages (kVp) can be utilized to produce characteristic tungsten radiation

B.To reduce tissue thickness, decrease radiation dose, minimize geometric unsharpness (blur), eliminate tissue overlap, and reduce scatter radiation

C.To accelerate the transit time of microcalcifications through glandular ducts

D.To maximize magnification factors by increasing the object-to-image receptor distance (OID)

Explanation: Adequate breast compression flattens the fibroglandular tissue, significantly reducing tissue thickness. This lower thickness decreases the required tube current-time product (mAs) and radiation dose, brings anatomical structures closer to the detector (minimizing penumbra and geometric unsharpness), spreads out overlapping parenchymal structures to uncover subtle lesions, and reduces scatter-to-primary ratio to maximize microcalcification contrast.

7In multi-detector computed tomography (MDCT), how is helical pitch mathematically defined, and what is the effect of increasing pitch from 1.0 to 1.5 while keeping all other technical parameters constant?

A.Pitch is table travel per rotation divided by single detector width; increasing pitch increases patient radiation dose

B.Pitch is table travel per rotation divided by total beam collimation width; increasing pitch decreases patient radiation dose and scan time but may slightly degrade longitudinal spatial resolution

C.Pitch is the gantry rotation time divided by tube current; increasing pitch increases image noise without affecting acquisition time

D.Pitch is total detector rows divided by table travel; increasing pitch doubles the CTDIvol

Explanation: In MDCT, helical beam pitch is defined as table travel per 360-degree gantry rotation divided by the total collimated X-ray beam width (N x T). When pitch is increased above 1.0 (e.g., to 1.5), the patient moves through the gantry faster, leading to lower scan duration and a proportional reduction in CTDIvol and absorbed dose, at the expense of a slightly wider slice sensitivity profile (longitudinal resolution).

8A computed tomography scan of the abdomen reveals an adrenal mass. The TSRM places a circular region-of-interest (ROI) over the non-contrast lesion and records an attenuation value of -35 Hounsfield Units (HU). What is the biophysical meaning of this negative CT number?

A.The linear attenuation coefficient of the lesion is lower than that of pure water, indicating high microscopic intracellular lipid content

B.The mass exhibits dense dystrophic calcification with high photoelectric attenuation

C.The mass is hypervascular and actively trapping iodinated contrast medium from a prior exam

D.The attenuation represents acute intralesional hemorrhage with concentrated clotted hemoglobin

Explanation: By definition, the Hounsfield Unit scale assigns water a value of 0 HU and air -1000 HU based on the equation HU = 1000 x (mu_tissue - mu_water) / mu_water. Adipose tissue has a linear attenuation coefficient lower than water, yielding negative HU values typically between -20 and -100 HU. An adrenal mass exhibiting -35 HU contains abundant intracellular lipid, characteristic of a benign lipid-rich adrenal adenoma.

9On an axial non-contrast brain CT scan, dark streak artifacts and artificial lucencies are observed between the petrous temporal bones in the posterior cranial fossa. What physical phenomenon causes this artifact, and how can the TSRM mitigate it?

A.Patient involuntary cardiac pulsation; mitigated by electrocardiographic gating

B.Beam hardening as lower-energy photons are preferentially absorbed by dense bone; mitigated by increasing tube voltage (kVp) and applying iterative reconstruction algorithms

C.Detector ring calibration failure; mitigated by replacing the anti-scatter collimator blades

D.Aliasing due to insufficient detector sampling frequency; mitigated by decreasing gantry rotation speed

Explanation: As a polychromatic X-ray beam traverses dense bony structures (such as the petrous pyramids), low-energy photons are preferentially attenuated through the photoelectric effect, shifting the mean energy of the surviving beam toward higher energies (beam hardening). This causes underestimation of attenuation along those projection paths, manifesting as dark streaks or 'cupping'. Increasing tube voltage (kVp), using thin slices, and deploying model-based iterative reconstruction effectively minimize this artifact.

10In multi-detector CT, how does automated tube current modulation (ATCM / AEC) operate across the z-axis (longitudinal) and x-y axes (angular) during patient scanning?

A.It maintains a constant tube current throughout the scan while dynamically varying the tube potential (kVp)

B.It dynamically increases tube current (mA) when traversing anatomically dense or thick projections and decreases mA during thinner projections to maintain a pre-selected target image noise level

C.It suppresses table translation whenever radiation detector channels reach saturation limits

D.It holds mA constant in the patient center while pulsing mA exclusively at the gantry periphery

Explanation: Automated tube current modulation (ATCM) adjusts the tube current (mA) in real time. Along the angular plane (x-y modulation), mA rises during lateral views of the shoulders/pelvis where attenuation is high and falls during AP views. Along the longitudinal z-axis, mA modulates according to anatomical thickness based on topogram/scout attenuation profiles, ensuring uniform detector photon fluence and optimizing patient radiation dose according to ALARA.

About the Esame di Stato TSRM Exam

The Esame di Stato abilitante all'esercizio della professione di Tecnico Sanitario di Radiologia Medica is the official Italian qualifying state licensing examination that entitles graduates of the three-year Laurea in Tecniche di Radiologia Medica, per Immagini e Radioterapia (Class L/SNT3) to legally practice as medical radiology technicians across public hospitals of the National Health Service (SSN), research institutes (IRCCS), private accredited clinics, and diagnostic centers. Established by Ministerial Decree D.M. 26 settembre 1994, n. 746, the TSRM is an autonomous healthcare professional responsible for independently executing diagnostic imaging investigations, radiotherapy treatments, and nuclear medicine procedures upon medical prescription, in direct synergy with the medical radiologist, radiation oncologist, nuclear medicine physician, and medical physicist. Under Article 7 of the Interministerial Decree of 19 February 2009 (D.I. 19 febbraio 2009), the final graduation examination has direct legal value as the state qualifying examination and requires both a profession-specific practical examination and preparation and discussion of a thesis. Following the statutory evolution of Legge 42/1999, Legge 251/2000, and the Lorenzin Reform (Legge 3/2018), medical radiology technicians are organized into provincial Ordini TSRM e PSTRP, governed nationally by the FNO TSRM e PSTRP, with mandatory registration in the Albo TSRM required for lawful clinical activity. Independent TSRM State Exam practice by OpenExamPrep provides an English-language MCQ study adaptation, not a simulation of the mandatory practical test or thesis defense.

Exam sponsor: Ministero dell'Università e della Ricerca (MUR) / designated universities in agreement with Ministero della Salute and Federazione Nazionale Ordini TSRM e PSTRP. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Article 7 of D.I. 19 febbraio 2009 gives the final examination for the Laurea in Tecniche di Radiologia Medica, per Immagini e Radioterapia (L/SNT3) the legal value of an Esame di Stato. The national rule requires two components: a practical examination demonstrating profession-specific theoretical, practical, and technical-operational competence, and preparation and discussion of a thesis. It does not prescribe one national item count, duration, numerical cut score, fee, detailed local task type, or delivery language; candidates must use their university's current notice for those logistics. Independent Tecnico Sanitario di Radiologia Medica practice by OpenExamPrep is an English-language four-option MCQ study adaptation, not an official translation, a format simulation, or a substitute for practical or oral performance practice.

Time Limit

Varies by university; no single national duration is published

Passing Score

Set by the university; no single national numerical cut score is published

Exam / Certification Fees

Varies by university; no single national fee is published

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

30 local questions (not an official percentage)

Diagnostic Radiology, CT & MRI Physics & Clinical Acquisition Techniques

Image formation physics in projection radiography (CR/DR systems, exposure parameters kVp/mAs, grid usage, anti-scatter grids), digital fluoroscopy, mammography, interventional angiography, multi-detector CT (MDCT) principles, pitch, reconstruction algorithms (FBP, iterative reconstruction, deep learning), dose modulation (AEC), CT artifacts, MRI physics, nuclear magnetic resonance phenomena, pulse sequences (spin echo, gradient echo, inversion recovery, diffusion-weighted imaging), k-space filling, spatial encoding, MRI artifact mitigation, and RF/static magnetic field safety.

17 local questions (not an official percentage)

Radiation Protection Principles, ALARA, Dosimetry & Italian Legislation (D.Lgs. 101/2020)

Implementation of D.Lgs. 31 luglio 2020, n. 101 transposing EURATOM Directive 2013/59: fundamental principles of justification, optimization (ALARA), and dose limitation; physical dosimetric quantities (absorbed dose, equivalent dose, effective dose, Kerma, air kerma-area product KAP/DAP, CTDIvol, DLP); occupational exposure limits for Class A and Class B exposed workers, lens of the eye limits, extremity and skin limits; classified areas (Zone Controllate and Zone Sorvegliate); Diagnostic Reference Levels (Livelli Diagnostici di Riferimento - LDR); roles of Esercente, Medico Specialista, Medico Prescrivente, TSRM, Esperto di Radioprotezione (EdR), and Specialista in Fisica Medica; personal protective equipment (PPE) and room shielding.

14 local questions (not an official percentage)

Radiotherapy Physics, LINAC, Simulation, Immobilization & Delivery Techniques

Linear accelerator (LINAC) architecture and physics (electron gun, waveguide, bending magnet, target, flattening filter, ion chambers, multileaf collimators); photon and electron percentage depth dose (PDD) curves; virtual CT simulation, respiratory gating, and 4D-CT simulation; patient positioning and custom immobilization (thermoplastic masks, vacuum cushions, breast boards); advanced treatment delivery (3D-CRT, IMRT, VMAT, SRS, SBRT); target volume definitions according to ICRU reports 50, 62, and 83 (GTV, CTV, ITV, PTV, OAR, PRV); image-guided radiotherapy (IGRT) verification modalities (CBCT, planar kV-kV, EPID); and daily radiographer quality assurance routines.

6 local questions (not an official percentage)

Nuclear Medicine Techniques (SPECT, PET/CT), Radiopharmaceuticals & Protocols

Gamma camera and SPECT instrumentation (scintillation crystals, photomultiplier tubes, parallel-hole and pinhole collimators, energy photopeak windowing); PET/CT instrumentation (coincidence detection, annihilation radiation, time-of-flight PET, CT attenuation correction); radiopharmaceutical preparation, Mo-99/Tc-99m radionuclide generators, elution mechanics, radiochemical purity; cyclotron-produced tracers (F-18 FDG) and generator-based tracers (Ga-68 DOTATOC/PSMA); clinical protocols (F-18 FDG oncology imaging, bone scintigraphy, myocardial perfusion SPECT, sentinel node mapping); hot laboratory radioprotection, dose calibrator operation, surface contamination surveys, and radioactive waste management.

2 local questions (not an official percentage)

Contrast Media Management, Emergencies, Deontology & Ordine TSRM-PSTRP Regulations

Pharmacology and physical properties of iodinated and gadolinium-based contrast agents; ionic vs. non-ionic monomers and dimers, osmolality, viscosity; automatic power injector programming, flow rates, and contrast extravasation containment; contrast-induced acute kidney injury (CI-AKI/PC-AKI) prevention, eGFR evaluation (ESUR guidelines); hypersensitivity reactions and anaphylaxis management (intramuscular epinephrine, oxygen therapy, airway management); professional legal framework: D.M. 746/1994, Legge 42/1999, Legge 251/2000, Legge 3/2018 (Lorenzin Reform); FNO TSRM-PSTRP Code of Ethics, informed consent (Legge 219/2017), and health data privacy (GDPR).

Preparing for the Esame di Stato TSRM Exam

What You Need to Know

Passing score: Set by the university; no single national numerical cut score is published
Assessment: Article 7 of D.I. 19 febbraio 2009 gives the final examination for the Laurea in Tecniche di Radiologia Medica, per Immagini e Radioterapia (L/SNT3) the legal value of an Esame di Stato. The national rule requires two components: a practical examination demonstrating profession-specific theoretical, practical, and technical-operational competence, and preparation and discussion of a thesis. It does not prescribe one national item count, duration, numerical cut score, fee, detailed local task type, or delivery language; candidates must use their university's current notice for those logistics. Independent Tecnico Sanitario di Radiologia Medica practice by OpenExamPrep is an English-language four-option MCQ study adaptation, not an official translation, a format simulation, or a substitute for practical or oral performance practice.
Time limit: Varies by university; no single national duration is published
Exam / certification fees: Varies by university; no single national fee is published Official sources

Using Our Practice Resources

Work through all 69 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

Esame di Stato TSRM: Suggested Study Strategy

1Master diagnostic radiology and CT physics, focusing on technical factors (kVp, mAs, filtration), multi-detector CT acquisition geometry, pitch calculations, iterative reconstruction algorithms, and artifact correction.

2Thoroughly memorize the provisions of D.Lgs. 101/2020, including occupational dose limits (effective dose, lens of the eye, extremities), classification of workers (Class A vs Class B), classification of areas (Zone Controllate vs Zone Sorvegliate), and Diagnostic Reference Levels (LDR).

3Understand MRI safety rules and physics: static magnetic field hazards, projectile effect, RF heating (SAR limits), gradient acoustic noise, peripheral nerve stimulation, and common artifact recognition (chemical shift, wrap-around, susceptibility).

4Review radiotherapy clinical workflows: LINAC physics, multileaf collimation, ICRU target definitions (GTV, CTV, ITV, PTV, OAR), 4D-CT simulation, IGRT registration, and daily radiographer quality assurance checks.

5Solidify nuclear medicine principles: Mo-99/Tc-99m generator elution, gamma camera collimator selection, PET/CT coincidence detection, F-18 FDG oncology patient preparation, and hot laboratory decontamination protocols.

6Practice emergency management for intravenous contrast media reactions, including prompt identification of anaphylaxis, first-line administration of intramuscular epinephrine, and preventative hydration protocols for contrast-induced nephropathy according to ESUR guidelines.

Frequently Asked Questions

What is the Esame di Stato for Tecnico Sanitario di Radiologia Medica (TSRM) in Italy and how is it organized?

Under Article 7 of D.I. 19 febbraio 2009, the final examination of the Laurea in Tecniche di Radiologia Medica, per Immagini e Radioterapia (Class L/SNT3) has the legal value of an Esame di Stato. It combines a profession-specific practical examination with preparation and discussion of a thesis; the university constitutes the commission under the applicable national and local rules.

What are the two mandatory components of the TSRM qualifying final examination?

Article 7 of D.I. 19 febbraio 2009 requires two components: a practical examination demonstrating profession-specific theoretical, practical, and technical-operational competence, and preparation and discussion of a thesis. Detailed tasks, order, scoring, duration, and delivery arrangements are set by the university rather than standardized nationally.

What is the legal regulatory framework and professional order governing Italian TSRMs?

The professional profile was established by Ministerial Decree D.M. 26 settembre 1994, n. 746, which defined the TSRM as an autonomous healthcare professional responsible for executing all diagnostic imaging, radiotherapy, and nuclear medicine procedures requiring ionizing radiation, magnetic resonance, or thermal imaging. Subsequent statutory reforms (Legge 42/1999, Legge 251/2000, and Legge 3/2018 - Lorenzin Reform) confirmed professional autonomy and established the multi-professional Orders (Ordini TSRM e PSTRP) and the National Federation FNO TSRM e PSTRP. Mandatory enrollment in the provincial Albo dei Tecnici Sanitari di Radiologia Medica is legally required to practice in Italy.

How does Italian radiation protection law (D.Lgs. 101/2020) define the TSRM's clinical role?

Decreto Legislativo 31 luglio 2020, n. 101 transposes EURATOM Directive 2013/59 and defines the clinical responsibilities in medical radiological procedures. Under D.Lgs. 101/2020, while the medical specialist (radiologist, radiation oncologist, or nuclear medicine physician) holds clinical responsibility for justifying the exposure, the TSRM is legally recognized as having technical responsibility for the practical execution of the exposure, including patient positioning, protocol selection, dose optimization in accordance with ALARA, and operation of protective shielding and imaging equipment.

What are the examination fees, dates, and passing scores?

Fees, dates, duration, grading details, and any repeat procedure are set by the individual university. D.I. 19 febbraio 2009 does not publish a single national fee, timetable, duration, or numerical cut score for this final qualifying examination.

Why does OpenExamPrep offer multiple-choice practice questions for this examination?

D.I. 19 febbraio 2009 does not publish one national delivery language for this university-run final examination. This OpenExamPrep resource uses English four-option MCQs as an independent study adaptation. It is not an official translation, does not simulate the practical examination or thesis defense, and is not a substitute for performance practice or the candidate's university notice.