2024

Ethiopian Health Professionals Licensing Examination(EHPLE)

INFORMATION BOOKLET
MEDICAL RADIOLOGY TECHNOLOGY

Institute of
Educational Research
Message From the State Minister, Ministry of Health -Ethiopia

Mrs. Frehiwot Abebe

Improving healthcare quality is a global priority for sustainable development, with high quality
healthcare being a key component of universal health coverage. One strategy to maintain health
care standards is through provision of health professional competency assessment. Consequently,
in 2019, the Ministry of Health Ethiopia, initiated the Ethiopian Health Professionals Licensing
Examination (EHPLE) for undergraduates in seven health disciplines, which has since expanded
to include 13 health disciplines.

The main goal of this competency assessment is to identify health professionals with minimal
competencies necessary to perform their duties safely and competently, thus enhancing the quality
of health care services. This initiative is overseen by a dedicated Health and Health Related
Institutions and Professionals’ Regulatory Lead Executive Office (LEO), comprising four desks,
which plays a pivotal role in strengthening the system and enabling the LEO to conduct the
competency exam more extensively and with improved organization and quality.

It is important to note that this competency assessment differs significantly from traditional
academic or employment examinations. Hence, this information booklet has been created to
address the informational needs of both examinees and teaching faculty regarding the Ethiopian
Health Professionals’ Licensure Examination. Additionally, it aims to facilitate the assessment
process, while promoting transparency and ensuring the sustainability of the program.

The preparation of this guideline involved the collaboration of esteemed experts from various
higher education institutions, the Ministry of Health, JHPIEGO-Ethiopia, Amref/HWIP, Health
Professionals’ Associations, and the Ministry of Education. Their invaluable contributions are
acknowledged with sincere gratitude, alongside appreciation for the Ministry of Health staff for
their unwavering commitment and hard work throughout the project.

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Acknowledgements

This Information Booklet for Ethiopian Health Professional’s Licensure Examinations is a

contribution from several educators, researchers, students and concerned individuals with a
genuine interest to propel Ethiopia’s medical and health sciences education forward.

The Ministry of Health is grateful for the contribution of many individuals and institutions in
realizing this endeavor. Among these are Professional Associations, Student Association, Higher
Education Institutions (both public and private), JHPIEGO-Ethiopia, AMREF/HWIP, MOE
(Ethernet), UNFPA, AAU-IER and all HHRIPR LEOs staff.

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Acronyms and Abbreviations

EHPLE Ethiopian Health Professionals Licensing Examination

ETA Educational and Training Authority

HEIs Higher Education Institutions

HHrIPR-LEO Health and Health-related Institutions and Professionals Regulatory Lead Executive
Office

HSTP-II Health Sector Transformational Plan-II

MCQ Multiple Choice Question

MoH Ministry of Health

WHO World Health Organization

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Purpose of the Information Booklet

The Ethiopian Health Professionals’ Licensure Examination (EHPLE) Information
Booklet serves as a comprehensive guide for those individuals seeking information
about the exam. It typically outlines basic information for candidate registration,
exam development and administration processes and procedures, result notification,
and the licensing process. It also includes information on the exam framework, i.e.,
the exam domain, sub-domain, content, process, and task, with sample exam items
specific to each profession.
The publication of this Booklet is crucial for the following reasons:

 Clarity and guidance: It provides clear information about the exam by

ensuring candidates understand the necessary information to prepare them.
 Accessibility: It serves as a readily accessible resource for individuals
pursuing to take the exam, consolidating essential information in one
document and facilitating easy access to necessary details. It also helps other
stakeholders who might be interested in such resources.
 Transparency: It promotes transparency in the examination process and
fosters trust among stakeholders about the exam.
In summary, the publication of this Booklet is essential for creating a transparent,
standardized, and accessible framework that guides candidates through the EHPLE
process.

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Contents
Message From the State Minister, Ministry of Health -Ethiopia ................................................................... i
Acknowledgements ....................................................................................................................................... ii
Acronyms and Abbreviations ...................................................................................................................... iii
Definition of terms ....................................................................................................................................... vi
1. Introduction ........................................................................................................................................... 1
1.1. Background ................................................................................................................................... 1
1.2. The Rationale of EHPLE .............................................................................................................. 1
2. Key processes of EHPLE ...................................................................................................................... 2
2.1. Registration of candidates ............................................................................................................. 2
2.2. Task Analysis ................................................................................................................................ 3
2.3. Exam Blueprint ............................................................................................................................. 3
2.4. Item Development ......................................................................................................................... 3
2.5. Item Review .................................................................................................................................. 3
2.6. Standard setting method ................................................................................................................ 4
2.7. Exam Administration .................................................................................................................... 4
2.8. Scoring and post exam analysis .................................................................................................... 5
2.9. Result notification and appeal management ................................................................................. 5
2.10. Licensing ................................................................................................................................... 5
3. Exam Framework .................................................................................................................................. 6
Sample questions .......................................................................................................................................... 9
Sample Reference ....................................................................................................................................... 17
List of contributors...................................................................................................................................... 18
Contact Us................................................................................................................................................... 19

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Definition of terms
 Domain: a broad category or area of knowledge or skills of a profession
 Sub-domain: a subset of a broader domain that focuses on knowledge or skills related to the
overarching domain
 Content: a more specific subcategory, which is a breakdown of the sub-domain
 Task: the responsibility, knowledge, skill, and attitude of a junior undergraduate professional
in an actual work environment
 Process: a systematic sequence of steps or actions designed to achieve a specific outcome
 Learning outcome: a clear and measurable statement that describes what the examinee is
expected to know or be able to do
 Relative emphasis: the proportional importance or weight assigned to different content areas
or categories within the assessment
 Item: a particular multiple-choice question
 Item developer: a subject matter expert responsible for writing test items or questions that
make up the examination
 Item reviewer: a subject matter expert responsible for reviewing and refining the test items
or questions that make up the examination
 Standard setting: a process of determining a cut-off point or passing score for an exam
 Item difficulty index: a statistical measure that indicates the proportion of examinees who
answered a particular test item correctly
 Discrimination index: a statistical measure that evaluates how well a particular test item
differentiates between high-performing and low-performing examinees
 Admission paper: a printout paper generated by the system after completing registration that
contains the examinee's photo, QR code, and necessary information

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1. Introduction
1.1. Background
Competency assessment is one of the strategies for controlling the standard of healthcare services
provided in healthcare facilities. The World Health Organization (WHO) recommends all
healthcare professionals to have necessary competencies. In Ethiopia, the Health Sector
Transformational Plan-II (HSTP-II) states competency assessment of all graduates before joining
the health workforce as one of the strategic initiatives.

The Ministry of Health (MoH) launched the Ethiopian Health Professionals Licensing
Examination (EHPLE) for undergraduates in 2019. The Health and Health-related Institutions and
Professionals Regulatory Lead Executive Office (HHrIPR-LEO) of the Ministry of Health was
given a mission to implement the Ministry’s objective to achieve competency-related goals. It has
the responsibility to ensure that the EHPLE meets technical, professional, and legal standards, and
to protect the health, safety, and welfare of the public by assessing candidates’ abilities to practice
competently.

Currently, the exam is given for 13 health professions (Medicine, Nursing, Public Health,
Pharmacy, Medical Laboratory Science, Anesthesia, Midwifery, Dental Medicine, Medical
Radiology Technology, Environmental Health, Psychiatric Nursing, Pediatric and Child Health
Nursing, and Emergency and Critical Care Nursing). Since its introduction until February 2024, a
total of 166293 examinees took the exam in 14 rounds.

1.2. The Rationale of EHPLE

One of the critical functions of the MoH is to guarantee the efficiency, quality, and equity of
healthcare delivery and to protect the public from any undesirable consequences in healthcare
delivery practices. As professionals’ competence is a significant determinant of the quality of
health, evaluation of health professionals’ competence has now been given due attention. The
licensing examination for health professionals serves as a crucial step to ensure that individuals
entering the field meet specific competency standards. The sole aim of the competency assessment
is to safeguard public health by verifying that health professionals have the minimal basic
knowledge, attitude, and skill required to provide safe and effective care.

Licensing exams act as a preventive measure, ensuring that only competent professionals join the
health workforce, which, in turn, contributes to reducing the occurrence of medical errors and
enhancing overall patient safety. By setting standards through examinations, regulatory bodies
strive to minimize the risk of medical errors caused by incompetence.

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2. Key processes of EHPLE

EHPLE involves several key processes to ensure the quality and reliability of the examination.

2.1. Registration of candidates

EHPLE has a mandatory online registration system for both new and repeat candidates, which can
be found at www.hple.moh.gov.et

Please note these important notes during registration.

New Test Takers:
 The list of eligible candidates from governmental and private Higher
Education Institutions (HEIs) will be sent from Ministry of Education (MoE)
to MoH and uploaded to the online registration system by MoH.
 Once the name of the candidate is uploaded to the system and registration has
opened for the current exam round, the candidate must register at
www.hple.moh.gov.et by uploading the necessary documents listed below.
 a scanned original or temporary degree
 a scanned government-issued ID, passport, driving license, or any
other legal ID
 a passport-size photo of the candidate
 For international candidates:
o Equivalence document from ETA
o Completing an externship attachment according to assignment
by the regulatory body
o Externship attachment completion letter

Repeat Test Takers:

 Since the information about re-exam candidates already exists in the system,
the candidate should register by directly going to www.hple.moh.gov.et.
There is no need for re-exam candidates to upload their documents.

Both new and repeat candidates:

 After completing the registration, the candidate must download and print the
admission paper by logging into his/her account using his/her email address
and password
 The candidate can change the exam center by logging into his/her account
only during the registration period
 Once an examinee has selected his/her exam center during the registration
period, an application for center change will not be allowed

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2.2. Task Analysis

The first step of exam development involves conducting a comprehensive task analysis study,
which identifies the tasks, knowledge, skills, and abilities required from a junior undergraduate
professional in the specific profession. The analysis is typically done through surveys, interviews,
or observations of practitioners in the actual work environment, as well as through the Delphi
method with subject matter experts.

2.3. Exam Blueprint

Based on the task analysis findings, a test blueprint is created that outlines the content areas to be
covered in the examination and the weight or emphasis given to each area. This ensures that the
exam reflects the key competencies and knowledge needed for competent practice in that specific
profession. Blueprint or test specification is the matrix or chart that shows the number and type of
test questions represented across the topics in the content area, consistent with the learning
outcome and relative weight of the test given to each content area. The blueprint also identifies the
percentage weighting of cognitive dimensions as the level of competence tested in each knowledge
domain.
Key components of a blueprint are:
 Domain
 Sub-domain
 Content
 Task
 Process
 Learning outcome
 Assessment methods
 Assessment tools/instrument (test format)
 Relative emphasis (in percentage)

2.4. Item Development

The items are developed following specific guidelines to ensure clarity, relevance, and fairness.
Subject matter experts with experience in the field are selected from HEIs to develop test questions
(items) that align with the test blueprint. The exam questions will focus mainly on “knows how”
according to the competency level of the Miller's pyramid. The items are produced in a secure
location on designated computers that are free from internet connectivity. The items are scenario-
based and constructed with stem, lead-in, and four options/alternatives. All items will have a
single-best-answer type of Multiple Choice Question (MCQ) that addresses the learning outcome
defined in each content area. Standard text books, updated guidelines, and standards are used as
reference materials.

2.5. Item Review

Once developed, the items undergo a rigorous review process by item reviewers. The main purpose
of the exam review process is to evaluate content relevance, technical accuracy, clarity, and
sensitivity related to culture and religion. More experienced subject matter experts as well as
psychometric experts will do the review to ensure the items meet psychometric standards. Subject
matter experts shall review the items to confirm that they are accurate, clearly stated, and correctly

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keyed using the checklist. Psychometric experts shall reviews the items to ensure that they are not
technically flawed. They also work on editorial review to check grammar, punctuation, and
spelling errors. This helps ensure the reliability and validity of the items.

2.6. Standard setting method

The standard setting or cut-off point of the EHPLE is determined using the Modified-Angoff
method, which is one of the most widely used and legally defensible standard setting approaches
to set a cut-off point for high-stake competency examinations.
The method involves a panel of subject matter experts who evaluate each test question and then
estimate the probability that a minimally competent examinee would answer each test item
correctly. The average of the experts’ predictions for a test question becomes its predicted
difficulty. The average of the predicted difficulty values across all items on a test is the
recommended cut-off point. This point indicates the minimum level of knowledge and skill
required to pass.

2.7. Exam Administration

The EHPLE is administered following established protocols and guidelines. Proper test
administration procedures, appropriate security measures, and appropriate consideration for test-
takers who need special support will be applied during exam administration at exam centers. The
exam is administered in selected HEIs nationally, where candidates can choose based on their
convenience at the time of registration. The exam schedule will be posted ahead of time on the
MOH website and official Facebook page. Examinees who have a valid admission paper are
eligible to sit for the exam. The mode of exam administration is computer-based testing.

CAUTIONS

 Candidates are allowed

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 Candidates are NOT allowed

2.8. Scoring and post exam analysis

Once the exam is completed, the scoring process begins. The exam scoring process involves
computerized scoring using software.
Post-exam analysis is the process of analyzing examinees’ responses to individual test items in
order to assess the quality of the items and the exam as a whole. This phase helps to identify any
poorly performing items that may need revision or removal from the exam. The item difficulty
index, discrimination index, and reliability coefficient are elements of exam analysis.

2.9. Result notification and appeal management

After scoring and analysis, individual score reports are generated and provided to examinees
through the website www.hple.moh.gov.et. After result notification, examinees can submit their
appeal through phone or email within 10 working days after result notification.

2.10. Licensing
The list of examinees who passed the exam will be sent to regional and city administration
regulatory bodies. A license is obtained from the regional/zonal health bodies where he/she
permanently lives.
Requirements for professional licensing are:
 Passing the EHPLE
 Original or temporary degree
 Educational documents (10th and 12th certificates)
 Medical certificate
 Government issued ID
 Additional prerequisites based on the requirements of regional regulatory
bodies

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3. Exam Framework
The key broader professional roles, also known as domains or main knowledge areas serve as a
building framework for the licensing examination content for Medical Radiology Technology
professionals. The domains are further divided into discrete professional attributes that constitute
sub-units (also referred to as sub-domains) defining the professional identity of Medical Radiology
Technology professionals. Tasks specifying the performance level of each sub-domain serve as
the final characteristic of the professional duties on which the licensing exam focuses.

The contents of the licensing examination are presented below, structured into key roles (domains),
sub-units (sub-domains), and tasks. The examination emphasis for each domain and sub-domain,
out of the total 100% questions, is indicated in brackets.

Key professional roles/ domains

 Patient Care (78%)
 Scholar (7%)
 Professionalism (5.0%)
 Leadership and management (6.0%)
 Health promotion and disease prevention (4.0%)

Key role/ domain 1: Patient Care (78%)

Description: This domain encompasses the professional role of medical radiology technologists
in the provision of high-quality, safe, and patient-centered medical radiology service for diverse
groups of patients. The provision of up-to-date, ethical, and resource-efficient radiologic services
requires the application of integrated knowledge of biomedical, clinical, social, and behavioral
sciences within their scope of practice. As patient care providers, medical radiology technologists
shall possess applied knowledge of patient positioning, selection of appropriate technical factors
and equipment to produce optimum diagnostic images, performing appropriate diagnostic
imaging, and interpretation of medical radiologic images within their scope of practice and with
an understanding of the limits of their expertise. To demonstrate competence in this domain,
candidate shall apply an integrated knowledge in the following sub-units/sub-domains:
 X-ray (26.5%)
 Special procedures (4.5 %)
 Ultrasound (22.5%)
 Computed Tomography/ CT scan (11%)
 Magnetic Resonance Imaging/ (9.5%)
 Quality assurance and safety (4%)

Key role/ domain 2: Scholar (7.0%)

Description: This domain encompasses the professional roles of medical radiology technologists
in generating and utilizing scientific data to improve the health and well-being of the community
and broaden their scientific knowledge within the healthcare system and community setting.
Providing this service requires the application of integrated knowledge in research methods,
measurements of health and disease, biostatistics, epidemiology, clinical audit, evidence-based
practice, and research ethics. To demonstrate competence in this domain, candidates must possess

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applied knowledge in planning, problem identification, data collection, analysis, interpretation,

report writing, and dissemination of research findings.

Key role/ domain 3: Professionalism (5.0%)

Description: This domain encompasses the professional commitment of medical radiology
technologists to promoting the health and well-being of individuals and society through adhering
to ethical standards, maintaining personal integrity, and upholding high standards of competence
in all areas of practice. To exhibit competence in this domain, candidates must possess applied
knowledge of ethical principles, medico-legal practices, effective communication, accountability
to the profession and society, maintenance of professional excellence and personal health,
continuous professional development and professional values such as, integrity, honesty, altruism,
and humility, motivated, compassionate, and respectful care.

Key role/ domain 4: Leadership and management (6.0%)

Description: This domain encompasses the professional roles of medical radiology technologists
in envisioning a high-quality healthcare system through self-awareness, active participation in
healthcare team development and leadership, and managing health systems. Providing this service
requires the application of integrated knowledge in continuous quality improvement, effective
health system leadership, management, and healthcare ethics. To demonstrate competence in this
domain candidate shall possess applied knowledge to plan, organize, staff, lead, execute, monitor,
and control healthcare resources and activities.

Key role/ domain 5: Health promotion and disease prevention (4.0%)

Description: This domain encompasses the professional roles of medical radiology technologists
in enhancing the health and well-being of patients, communities, and the larger populations they
serve through health advocacy, disease prevention, health promotion, health protection, and the
promotion of health equity. Providing this service takes an integrated understanding of
determinants of health, health informatics, epidemiology, communicable disease control, and
health education.

Table Exam Content For Medical Radiology Technology Profession

Domain 1: Patient Care
Sub-domain Tasks
Prepare X-ray machine
Perform Upper limb X-ray
Perform Lower Limb X-ray
X-RAY Perform Vertebral X-ray
Perform Abdominal X-ray
perform Skull and Facial X-ray
Perform Thorax X-ray
Prepare flouroscopic machine and patients
SPECIAL PROCEDURES Perform the IVU, HSG, and Cystourethrography (cysto,urethro)
Perform barium studies (swallow, meal and enema)
Perform abdominal ultrasound
ULTRA-SOUND Perform pelvis ultrasound
Perform obstetrics ultrasound
CT-SCAN Prepare CT machine and patients

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Perform head and neck CT examinations (brain, PNS, TMJ, Orbit)

Perform spine CT (Cervical, Thoracic, LS)
Perform thorax (Chest, HRCT)
Perform abdominal, pelvis and CT urography
Perform MSK (lower and upper extremity) CT scan
Perform CT angiography
Prepare MRI machine and patients
Perform head and neck MRI examination
Perform MSK MRI (Humerus, shoulder, Arm, Hand and Wrist, hip, thigh, leg, knee,
ankle and foot)
MRI
Perform spine MRI examination (cervical, thoracic and lumbar LS)
Perform thorax and abdominal MRI
Perform pelvic MRI
Perform MR angiography
Perform radiological equipment acceptance test
QUALITY ASSURANCE
Perform preventive and corrective maintenance
AND SAFETY
Apply magnetic and radiation safety

Domain 2: Leadership and Management

Tasks
Apply principles and functions of management and leadership
Develop strategic and operational plan
Apply resource management principles
Develop and cascade program monitoring and evaluation

Domain 3: Health promotion and disease prevention

Tasks
Apply health promotions principle
Select health education theory/model suitable for medical radiological services
Provide health education related to medical radiological services

Domain 4: Professionalism
Tasks
Adhere to legal and ethical principles pertaining to MRT practice
Establish and maintain a motivated and compassionate care along with a collaborative working relationship with
clients, client families, the MRT team, and other working colleagues
Produce and maintain accurate documentation of activities, procedures and results

Domain 5: Scholar
Tasks
Assess community health status to ascertain determinants of health
Develop research proposal
Collect data for quantitative study
Analyze and interpret research findings

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Sample questions
1. A radiology technologist sets imaging protocol for a 17-year-old young patient who is referred
to an MRI department for Magnetic Resonance Urography (MRU) examination.

What is the most appropriate protocol the technologist should use during MRU scanning?
(A) 3D T1 post-contrast with MPR and MIP images
(B) Long TE scans producing heavy T1 weighting
(C) Short TE scans producing heavy T2 weighting
(D) 3D T2 imaging with thick slices

Answer Key: The answer is A

Explanation: The use of a 3D T1 post-contrast image with multi-planar reformat and maximum
intensity projection is the most appropriate protocol for this MRU examination as it provides a
better spatial resolution. On the other hand, long echo-time scans producing heavy T2 weighting
images allow better visualization of renal pathologies, but not long echo-time scans producing
heavy T1 weighting images (Option B). Short echo-time scans are not sufficient to visualize fluid
distribution in the urinary tract (Option C) and 3D T2 imaging with thick slice gaps (Option D)
may miss small pathologies and have low resolution in the scanning process.

2. A 55-year-old male patient comes to a radiology department with a request paper for
Intravenous Urography (IVU) procedure. A radiology technologist appoints the patient for the
next day after giving instructions.

What is the most important patient preparation that has to be taken place at home?
(A) Emptying the bladder
(B) Psychological readiness
(C) NPO for 5 hours prior to examination
(D) Drinking more water prior to examination

Answer Key: The answer is D

Explanation: In order to prepare the patient for an IVU procedure, the patient cannot take food 5
hours prior to the examination. This is needed to clear gas from the bowel that may obscure
suspected pathology and to avoid artifacts. On the other hand, though psychological preparation
(Option A) is desirable, it is not effective in clearing the bowel. Equally, drinking water only
distends the stomach (Option B) which is not important in this case and emptying the bladder
(Option C) is not effective in clearing the bowel additionally this procedure does not increase urine
secretion.

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3. A patient comes to a radiology department for a Para-nasal sinus /PNS/ x-ray examination. A
radiology technologist on duty positions the patient and takes a PNS Waters view.

What is the most anterior anatomical landmark to position the patient??

(A) Inion (B) Nasion (C) Gonion (D) Acanthion

Answer Key: The answer is D

Explanation: The proper anatomical landmark for this case is the Acanthion (Option D) which is
the midline junction of the upper lip and nose as the projection would position the patient facing
the upright Bucky in contact with the chin and nose. Using the Achantion as an exit point displays
the sinuses and allows the petrous ridge to appear below the maxillary sinus. On the other hand,
using the Inion (Option A) and Gonion (Option C) distorts the orbitomeatal line angle needed for
this projection. In the same vein, using the Nasion (Option B) does not produce the proper Water’s
view but instead displays PA Cladwell projection.

4. A 45-year-old patient comes to a radiology department for knee joint x-ray. A radiologic
technologist puts the patient in prone position by adjusting the leg parallel with the long axis
of table and flexing the joint slightly more than 90 degrees. The radiographic image shows the
patella which is projected anterior to the distal femur.

What is the most likely patient positioning applied by the radiologic technologist in this case?
(A) Lateral view (C) Posterio-anterior view
(B) Skyline view (D) Antero-posterior view

Answer Key: The answer is B

Explanation: The positioning described in the above case is typical of Skyline view (Option B),
which can demonstrate the patella projected anterior to the distal femur. The lateral view (Option
A) demonstrates the patella clear of the femur on the side not anteriorly. The postio-anterior view
(Option C) helps in bringing the patella in close proximity to the cassette and demonstrates the
patella more clearly, but it is not able to demonstrate the patella anterior to the distal femur. The
antero-posterior view (Option D) shows the patella centralized and superimposed over the femur.

5. A 45-year-old female patient comes to a radiology room for pelvic ultrasound examination.
She has a clinical history of menorrhagia, irregular mensus and pelvic pain. Ultrasound image
shows a well-demarcated, round and hypoechoic lesion within the normal homogeneous
myometrial echopatterns.

What is the most likely diagnosis for this case?

(A) Adenomyosis (B) Hyperplasia (C) Myoma (D) Polyp

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Answer Key: The answer is C

Explanation: In the above scenario, the patient’s signs and symptoms are highly suggestive of
uterine mass. The results of the ultrasound, a well-demarcated, round and hypoechoic lesion within
the normal homogeneous myometrial echopatterns, also indicates the sonographic features of
Myoma (Option C). Moreover, Myomas are common benign lesions, present in more than 30% of
woman aged 40-60 years of age. Adenomyosis(Option A) is not an answer because the most
specific ultrasound signs of adenomyosis are subendometrial echogenic linear striations, a globular
configuration to the uterus and myometrial cysts. Hyperplasia (Option B) has ultrasound features
of persistent thickening over 10mm. It can also contain tiny cystic spaces. Polyp (Option D) has
ultrasound feature of a focal area of echogenic endometrial thickening.

6. A radiology technologist on duty is preparing a CT-scan machine for examination in the early
morning. While performing short tube conditioning using phantom to warm up the tube, the
radiology technologist identifies ring artifact on the resultant images. To resolve the artifact
and proceed the examination, he has planned to take interventional management.

What is the most appropriate initial interventional management that has to be taken by the
radiology technologist?
(A) Decrease scan time (C) Increase KVP settings
(B) Adjust pitch settings (D) Recalibrate the scanner

Answer key: The answer is D

Explanation: One of the major roles of the radiology technologist in the CT-scan room is to warm
up the machine before doing any examination. This is to identify artifacts, keep machine safety
and to produce high quality images. In this scenario, the technologist identified ring artifact. Ring
artifacts appear on the CT images as a ring centered on the rotational axis with third generation
scanners. These artifacts are caused by imperfect detector elements which are either faulty or
simply out of calibration. There are interventional managements taken when artifacts occur. The
most appropriate initial interventional management to eliminate ring artifact is recalibrating the
scanner (Option D). If the rings persist after recalibrating the scanner, the problem must be reported
to a service engineer for repair. Decreasing the scan time (Option A) is not preferred since it helps
to manage motion effect but not ring artifact. Adjust pitch setting (Option B) will help to manage
aliasing effect and spiral interpolation artifacts. Increase KVP setting (Option C) will help to
eliminate beam-hardening artifact and metallic streaks.

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7. A 60-year-old patient comes to a radiology department for intravenous urography examination.

A radiologic technologist has positioned the patient to take a preliminary image after properly
preparing the patient.

What is the most appropriate positioning in the above case?

(A) PA, erect (C) 30° anterior obliques
(B) AP, supine (D) 30° posterior obliques

Answer key: The answer is B

Explanation: Proper positioning of the patient during radiographic procedures is mandatory to
enhance the diagnostic value of the procedure. The preliminary image should be taken prior to the
administration of contrast agent for the procedure. This image is evaluated for preparation of the
patient, proper exposure factor selection, patient positioning and centering. In the above case, the
radiologic technologist positioned the patient for obtaining the preliminary image. AP, supine
(Option B) is the most appropriate positioning technique during preliminary image. PA erect
(Option A) is not a preferred positioning since intravenous urography procedure is performed in
supine position. Moreover, 30° anterior oblique (Option C) cannot be used for intravenous
urography procedure. As well, 30° posterior oblique (Option D) is used in the sequences after
contrast agent administration; it is not used in the preliminary image.

8. A radiologic technologist has designed a successive health education and promotion

interventions to improve radiation protection utilization during x-ray examinations. The first
intervention focuses on improvement of knowledge and skills regarding type and application
of radiation protection materials. The second intervention is designed to avail all necessary
radiation protection materials while the third intervention is devised to increase the
contribution made by senior leaders and professionals in utilizing radiation protection
materials.

Which principles of health education is applied by the technologist?

(A) The hierarchical principle (C) Principle of educational diagnosis
(B) Principle of cumulative learning (D) The known to unknown principle

Answer Key: The answer is A

Explanation: The interventions that the radiology technologist has made are to improve radiation
protection utilization has showed sequences of measures to influence the behavior of the senior
leaders and professionals who are working in the department of radiology. The first measure taken
is to address predisposing factors by narrowing the knowledge and skill gaps on application of the
radiation protection materials. The second measure taken is accessing the necessary materials.
Finally, reinforcing measure was taken by means of applying the obtained knowledge and skill of
radiation protection using availed materials. Thus, the principle applied by the radiology

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technologist for the improvement of the radiation safety indicates hierarchical principle (Option
A).

9. A 58-year-old female patient presents with a chronic lower back pain. Lumbar x-ray shows
decreased bone density, exaggerated width of disc space and biconcave vertebrae.

What is the most likely diagnosis for the patient’s problem?

(A) Infection (C) Osteoporosis
(B) Metastasis (D) Paget’s Disease

Answer Key: The answer is C

Explanation: In this scenario, the patient’s age indicates that she is in the post- menopausal period.
Her chronic back pain related with the x-ray features: i.e., decreased bone density, exaggerated
width of disc space and biconcave vertebrae, indicate typical appearance of osteoporosis of the
vertebrae (Option C). Infection (Option A), metastasis (Option B) and Paget’s disease (Option D)
all increase the radiographic density of the vertebral body.

10. A radiologic technologist has performed an MRI coil quality control test. The technologist
has used a phantom to measure the maximum and mean signal to noise ratio of the coil.

What is the most likely MRI coil function test that has been done in this case?
(A) Head coil test (C) Surface coil test
(B) Body coil test (D) Volume coil test

Answer Key: The answer is C

Explanation: Radiofrequency coils are devices used in MRI to transmit and receive radiofrequency
pulse during MRI scanning. Quality control tests are preformed regularly to check the functionality
and uniformity of these coils. Measurement of the maximum and mean signal to noise ratio are used
to test the surface coils quality (Option C). Head coil (Option A) and body coil (Option B) are the
types of volume coil (Option D) and the quality control test needed for these coils are Measurements
of Image uniformity, Signal to noise ratio and percent signal ghosting.

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11. A radiologic technologist has noticed a gestational sac while he has been scanning a 25-year-
old female patient, who comes for abdomino-pelvic ultrasound. The ultrasound machine of
curvilinear transducer with frequency ranging from 2.5MHz to 5MHz has been used during
scanning. The radiologic technologist wants to assess the gestational sac for presence of yolk
sac and embryo, and to measure takes the true gestational sac diameter.

What is the next most appropriate technique that the technologist should use?
(A) Changing the frequency to 5MHz (C) Changing the frequency to 2.5MHz
(B) Changing the frequency to 3.5MHz (D) Changing the frequency to 7.5 MHz

Answer Key: The answer is D

Explanation: The probe frequency indicates the penetration capability and image resolution of
the ultrasound. The high frequency ultrasound has low penetration capability and high image
resolution. In this case, the technologist wants to assess the presence of yolk sac, embryo and
gestational sac measurement which are the signs of early pregnancy that need high image
resolution. Therefore, to achieve this, the curvilinear probe frequency has to be changed to 5 MHz
(Option D). A frequency of 2.5MHz (Option A) and a frequency of 3.5MHz (Option B) are used
for deep organs and not for early pregnancy. What is more, 7.5 MHz (Option C) is not applicable
in the curvilinear probe because they are used in linear probe to scan superficial organs.

12. A 47-year-old obese patient with complaints of severe steady ache in the right upper quadrant,
which begins suddenly and occurs after fatty meals and lasts for several hours, comes for
abdominal ultrasound. A radiologic technologist on duty has identified a hyperechogenic
intraluminal structure which is gravity-dependent and casts a posterior acoustic shadow within
gallbladder.

What is the most likely diagnosis of this patient?

(A) Cholelithiasis (C) Adenomyomatosis
(B) Cholesterolosis (D) Choledocholithiasis

Answer Key: The answer is D

Explanation: In this scenario, the patient’s severe right upper quadrate pain after fatty meals
suggested gallbladder, liver and pancreas pathologies. While performing abdominal ultrasound
scanning, the technologist has identified a hyperechogenic and movable structure with posterior
acoustic shadow within the gallbladder lumen which is the ultrasound feature of Cholelithiasis
(Option D). Choledocholelithias (Option A) is a stone that also has posterior acoustic shadow;
however, it is located in the common bile duct. Adenomyomatosis (Option B) is a non-
inflammatory process which has thickened GB wall with Rokitansky-Aschoff sinus.
Cholesterolosis (Option C), is known as strawberry gallbladder, is the presence of multiple tiny
nodules on the surface of the gallbladder mucosal lining resulting from the build-up of lipids.

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13. A patient, who has a colostomy bag, comes to an MRI center for pelvic MR examination with
his family member. The patient and his family member are cooperative and follow instruction
of the radiographers. When radiographers asked to expose the patient’s private body part, they
altogether said, “we are here to get your service, and we feel health professionals are like our
family member and thrive for our full recovery.”

What type of family and patient behavior is exhibited in this scenario that would help the family
to cope-up the situation?
(A) Tolerance
(B) Adaptation
(C) Rationalization
(D) Taking initiative to build relationship

Answer Key: The answer is C

Explanation: Adaptation, rationalization and taking of further action to build relationship are
among commonly mentioned patient and family related factors of respectful care. In
rationalization, patient and family rationalize health professionals act towards betterment of health
and good health outcome and cooperate fully. In the scenario, the patient rationalizes the bodily
exposure is part of professional act and not complains about it. Therefore, C is the answer for the
question.

14. A Head of radiology department has planned to develop performance indicators for controlling
a new project. The project is required performance indicators which will be collected daily and
regularly to describe the change in performance, to identify problems, and to take immediate
corrective actions.

What is the most appropriate performance indicator that the Head should develop to gather
information for this purpose?
(A) Evaluation (C) Inspection
(B) Monitoring (D) Supervision

Answer Key: The answer is A

Explanation: Monitoring is conducted continuously since it is the main activity of different
programs and projects. It involves continuous data collection, analysis, interpretation and
utilization to answer project related questions. Monitoring is a day-to-day, or continuous follow-
up of an ongoing activities. It is can be done through observation of workers and materials,
discussion with workers, supervisors and beneficiaries, and review of reports or statistical data.
Furthermore, monitoring is one of the tools for evaluation.

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15. A medical radiologic technologist measured the amount of scatter radiation (mSv) from
different X-ray examinations. The data were asymmetric with high variability.

What is the most appropriate measure of central tendency and dispersion for this scenario?
(A) Mean and SD (C) Median and SD
(B) Mean and IQR (D) Median and IQR

Answer Key: The answer is D

Explanation: Median is one measure of central tendency that divides the dataset into two equal
parts which cannot be affected by the outliers. Interquartile range (IQR) is also the measure of
dispersion/variability of the dataset in the middle 50 percent, and it is not affected by the outliers.
In the above scenario, the medical radiologic technologist observed an asymmetric X-ray
examination result, which means it has an outlier value. Thus, in this scenario median and IQR are
the best measure of central tendency and dispersion respectively. The other mean and SD are
highly affected by the outlier measure of central tendency and dispersion respectively.

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Sample Reference
 Elmaoglu, M. (2011). MRI Handbook: MR Physics, Patient Positioning, and Protocols. Yeni
Yüzyıl University.
 Kenneth L. Bontrager & John Lampignano (2011). Radiological Anatomy and Positioning: An
Integrated Approach. Lippincott Williams & Wilkins.
 Author. (1998). Radiographic Anatomy and Positioning: An Integrated Approach. Stamford.
 Allan, P. L. (2011). Clinical Ultrasound (3rd ed.). Churchill Livingstone
 Romans, L. E. (2011). Computed Tomography for Technologists. Lippincott Williams &
Wilkins.
 Chapman, S. (2002). A Guide to Radiological Procedure (4th ed.). Saunders Ltd.
 Palmer, P. E. S. (Ed.). (1995). Manual of Diagnostic Ultrasound. World Health Organization.
 Bates, J. (2011). Abdominal Ultrasound: How, Why and When (3rd ed.). Churchill Livingstone
 Price, R., & Allison, J. (2015). Magnetic Resonance Imaging Quality Control Manual.
American College of Radiology.
 WHO. (1995). Manual of Diagnostic Ultrasound (P.E.S Palmer, Ed.).
 Daniel, W. W. (2022). Principles of Biostatistics (8th ed.). Chapman & Hall.
 Meshesha, B. (2008). Health Education Handout: For Health, Medical & Family Science Students.
Hawassa University. (p. 9).
 Jirra, C., Feleke, A., & Mitike, G. (Year). Health Planning and Management: For Health Extension
Trainees in Ethiopia (p. 99).
 Peter J. Lloyd (2001). Quality Assurance Workbook for Radiographers and Radiology Technology.
World Health Organization.
 Author. (2017). CT Quality Assurance Manual. American College of Radiology.
 Barbara S. Hertzberg & William D. Middleton. (2015). The Requisites Ultrasound (3rd ed.). Elsevier.
 Daniel, W. W. (1998). Biostatistics: A Foundation for Analysis in the Health Sciences (6th ed.). Wiley
International Edition.

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List of contributors

Mr. Endalkachew Tsedal MoH/ HHRIPR LEO

Dr. Meron Yakob MoH/ HHRIPR Exam Development and Administration Desk Lead
Ermias G/Yohannes MoH/ HHRIPR
Bethelhem Buzuayehu MoH/ HHRIPR
Dr. Wudasie Teshome MoH/ HHRIPR
Dr. Melese Achamo MoH/ HHRIPR
Tsedale Tafesse MoH/ HHRIPR
Mekonnen Desie MoH/ HHRIPR
Abera Bezabih MoH/ HHRIPR
Fikadie Dagnaw MoH/ HHRIPR
Lemeneh Wondimu MoH/ HHRIPR
Melkamu Gereme MoH/ HHRIPR
Tadele Asefa MoH/ HHRIPR
Nibretie Chalachew MoH/ HHRIPR
Demeke Getu MoH/ HHRIPR
Mebrat Tadesse MoH/ HHRIPR
Neway H/Michael MoH/ HHRIPR
Mebrahtu Tarekegn MoH/ HHRIPR
Milkoman Ayele MoH/ HHRIPR
Bethelhem Shikabew MoH/ HHRIPR
Amanuel Tesfay MoH/ HHRIPR
Dr. Alemseged Agmassie Jhpiego/HWIP
Dr. Yohannes Molla Jhpiego/HWIP
Bekalu Assamnew AMREF HWIP project
Dr. Equlinet Misganaw AMREF HWIP project

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Dr Belay Hagos AAU- IER

Dr Birhanu Abera AAU- IER
Dr Girma Lema AAU- IER
Dr Daneal Desta AAU- IER
Dr Firdisa jebessa AAU- IER
Dr Wessenu Yimam AAU- IER
Dr. Abdnasir Ahmed AAU- IER
Tamirat Tekilu Ethiopian Health Students Association
Alemayehu Nigussie Addis Ababa University
Blein Mulugeta Addis Ababa University
Wondimu Getye Addis Ababa University
Wassie Negash Debre Birhan University

Sisay Shunie Debre Birhan University

Agezegn Asegeid Wachemo University

Contact Us
Ministry of Health – Ethiopia
Street Address: - 1234 Sudan Street, Addis Ababa – Ethiopia
Telephone: +251-118275936
Hotline service: - 952
Website: https://www.moh.gov.et

EHPLE Information Booklet 2024

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