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CCI RCS Adult Echo study materials
CCI RCS Adult Echo study resources

CCI RCS Adult Echo practice questions

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Question 1Cardiac Anatomy and Physiology

Which ventricular wall is normally the thickest in the adult heart?

  1. Left ventricular free wall Correct answer.
  2. Right ventricular free wall
  3. Left atrial wall
  4. Right atrial wall

Explanation

Wall thickness parallels the pressure load a chamber must overcome. The left ventricle ejects against systemic pressure (roughly 120 mmHg), so its free wall normally measures about 6-10 mm, whereas the right ventricle works against much lower pulmonary pressures and measures about 3-5 mm. Atrial walls are thin because they only fill the ventricles.

Question 2Cardiac Anatomy and Physiology

In a normal heart, the aortic valve consists of how many cusps?

  1. Four
  2. One
  3. Three Correct answer.
  4. Two

Explanation

The normal aortic valve is tricuspid, with right, left, and non-coronary cusps. A two-cusp valve represents a congenital bicuspid aortic valve, which is the most common congenital cardiac anomaly. Four-cusp and single-cusp valves are rare malformations.

Question 3Cardiac Anatomy and Physiology

Which valve separates the right atrium from the right ventricle?

  1. Tricuspid valve Correct answer.
  2. Pulmonary valve
  3. Aortic valve
  4. Mitral valve

Explanation

The tricuspid valve guards the right atrioventricular orifice and normally has three leaflets. The mitral valve occupies the left atrioventricular orifice, while the aortic and pulmonary valves are semilunar valves guarding the ventricular outflow tracts.

Question 4Cardiac Anatomy and Physiology

Which cardiac chamber lies most posteriorly in the chest?

  1. Left atrium Correct answer.
  2. Left ventricle
  3. Right ventricle
  4. Right atrium

Explanation

The left atrium forms the posterior surface of the heart and lies directly anterior to the esophagus and descending thoracic aorta. This posterior position explains why transesophageal echocardiography images the left atrium at the top of the sector and why the left atrium is the chamber closest to the probe.

Question 5Cardiac Anatomy and Physiology

Which structures connect the mitral valve leaflets to the papillary muscles?

  1. Chordae tendineae Correct answer.
  2. Trabeculae carneae
  3. Fossa ovalis
  4. Moderator band

Explanation

The chordae tendineae are fibrous strands that tether the leaflet edges to the papillary muscle tips. This tethering prevents leaflet prolapse into the atrium during ventricular systole. Trabeculae carneae are muscular ridges, the moderator band is a right ventricular structure, and the fossa ovalis is an atrial septal remnant.

Question 6Cardiac Anatomy and Physiology

The pericardial cavity is the space between which two layers?

  1. Visceral and parietal pericardium Correct answer.
  2. The myocardium and the endocardium
  3. The epicardium and the myocardium
  4. The fibrous pericardium and the sternum

Explanation

The serous pericardium has a visceral layer adherent to the heart (epicardium) and a parietal layer lining the fibrous sac. The potential space between these two serous layers is the pericardial cavity, which normally contains a small amount of lubricating fluid. Accumulation of fluid in this space produces a pericardial effusion.

Question 7Cardiac Anatomy and Physiology

Which chamber forms the apex of the heart?

  1. Left ventricle Correct answer.
  2. Left atrium
  3. Right atrium
  4. Right ventricle

Explanation

The left ventricle extends inferiorly and to the left to form the cardiac apex, which is the point of maximal impulse in most patients. Because the apex is formed by the left ventricle, apical imaging windows interrogate left ventricular and mitral valve pathology.

Question 8Cardiac Anatomy and Physiology

What is the usual normal range for left ventricular ejection fraction measured by echocardiography?

  1. 40-50%
  2. 55-70% Correct answer.
  3. 15-30%
  4. 30-40%

Explanation

Ejection fraction is the fraction of end-diastolic volume ejected per beat, normally about 55-70% in adults. Values of 50% or below generally indicate some degree of systolic dysfunction, and values below 40% indicate moderately to severely reduced function. Values under 30% represent severe impairment.

Question 9Cardiac Anatomy and Physiology

In most individuals, which artery supplies the anterior two-thirds of the interventricular septum?

  1. Right coronary artery
  2. Left main coronary artery
  3. Left anterior descending Correct answer.
  4. Circumflex artery

Explanation

Septal perforator branches of the left anterior descending artery supply the anterior two-thirds of the septum, while the posterior descending artery supplies the remaining posterior third. Occlusion of the LAD therefore produces anterior and anteroseptal infarction. The left main is the parent vessel that bifurcates into the LAD and circumflex.

Question 10Cardiac Anatomy and Physiology

The moderator band, or septomarginal trabecula, is a normal finding in which chamber?

  1. Left atrium
  2. Right ventricle Correct answer.
  3. Right atrium
  4. Left ventricle

Explanation

The moderator band is a muscular bridge extending from the interventricular septum to the anterior papillary muscle of the right ventricle. It conducts part of the right bundle branch and helps prevent overdistension of the right ventricle. Its presence is a reliable marker of right ventricular identity on echocardiography.

Question 11Cardiac Anatomy and Physiology

Which structure is the remnant of the fetal foramen ovale?

  1. Coronary sinus
  2. Crista terminalis
  3. Sinus of Valsalva
  4. Fossa ovalis Correct answer.

Explanation

After birth the septum primum and septum secundum fuse, leaving the fossa ovalis as a shallow depression in the atrial septum. Incomplete fusion produces a patent foramen ovale, which can allow right-to-left shunting. The crista terminalis and coronary sinus are separate right atrial landmarks.

Question 12Cardiac Anatomy and Physiology

The coronary sinus lies within which groove on the heart?

  1. Anterior atrioventricular groove
  2. Anterior interventricular groove
  3. Posterior interventricular groove
  4. Posterior atrioventricular groove Correct answer.

Explanation

The coronary sinus runs in the posterior portion of the left atrioventricular groove before emptying into the right atrium near the inferior vena cava. Because of this location it is imaged in the posteromedial region of the mitral annulus on apical and parasternal views. The interventricular grooves carry the LAD and posterior descending arteries.

Question 13Cardiac Anatomy and Physiology

What is the primary function of the fibrous skeleton of the heart?

  1. Anchor valves and electrically separate atria from ventricles Correct answer.
  2. Generate the force that ejects blood into the great arteries
  3. Carry electrical impulses from the atria to the ventricles
  4. Provide a smooth lining that reduces intracardiac friction

Explanation

The fibrous skeleton is dense connective tissue forming the valve annuli; it anchors the leaflets and provides the only electrical insulation between atria and ventricles except at the bundle of His. This arrangement ensures that atrial impulses reach the ventricles only through the conduction system. Force generation is a property of myocardium, not the fibrous skeleton.

Question 14Cardiac Anatomy and Physiology

Within normal physiologic limits, an increase in left ventricular end-diastolic volume produces which effect?

  1. Decreased myocardial oxygen demand
  2. Increased stroke volume Correct answer.
  3. Decreased stroke volume
  4. Increased heart rate

Explanation

The Frank-Starling mechanism states that greater diastolic stretch of myocardial fibers increases the force of contraction and therefore stroke volume. This relationship holds within physiologic limits, beyond which overstretch reduces efficiency. Heart rate is governed primarily by autonomic tone rather than preload.

Question 15Cardiac Anatomy and Physiology

Cardiac output is calculated as which of the following?

  1. Stroke volume multiplied by heart rate Correct answer.
  2. Stroke volume multiplied by systemic vascular resistance
  3. Mean arterial pressure divided by heart rate
  4. Heart rate divided by stroke volume

Explanation

Cardiac output is the volume of blood ejected per minute, equal to the product of stroke volume and heart rate. For example, 70 mL per beat at 70 beats per minute gives about 4.9 L/min. Systemic vascular resistance relates to pressure, not directly to output in this formula.

Question 16Cardiac Anatomy and Physiology

Which structure is a normal point of attachment for the mitral valve chordae?

  1. Aortic valve cusps
  2. Left ventricular papillary muscles Correct answer.
  3. Interventricular septum
  4. Left atrial appendage

Explanation

Mitral chordae arise from the anterolateral and posteromedial papillary muscles and insert on the leaflet margins. Contraction of these muscles during systole tightens the chordae and prevents leaflet prolapse. Attachment to any atrial or aortic structure would be abnormal.

Question 17Cardiac Anatomy and Physiology

Which statement correctly describes isovolumic contraction?

  1. All valves are open and volume is changing
  2. The mitral valve is open and the aortic valve is closed
  3. The aortic valve is open and the mitral valve is closed
  4. All valves are closed and volume is constant Correct answer.

Explanation

Isovolumic contraction begins at mitral closure and ends at aortic opening, so both the mitral and aortic valves are closed while ventricular pressure rises. Because no valve is open, ventricular volume does not change during this phase. Ejection begins only when left ventricular pressure exceeds aortic pressure.

Question 18Cardiac Anatomy and Physiology

Where is the sinoatrial node normally located?

  1. In the membranous interventricular septum
  2. At the SVC-right atrial junction Correct answer.
  3. At the apex of the left ventricle
  4. Near the coronary sinus ostium

Explanation

The sinoatrial node lies at the junction of the superior vena cava and the right atrium, near the crest of the right atrial appendage. It is the dominant pacemaker because its spontaneous depolarization rate is the fastest in the conduction system. The atrioventricular node lies near the coronary sinus ostium and the bundle of His penetrates the membranous septum.

Question 19Cardiac Anatomy and Physiology

How many pulmonary veins normally drain into the left atrium?

  1. Three
  2. Two
  3. Four Correct answer.
  4. Six

Explanation

There are normally four pulmonary veins, two from each lung, entering the posterior wall of the left atrium. Variant anatomy with a common left trunk or additional right-sided veins is common and matters for atrial fibrillation ablation planning. The left atrium has no other venous tributaries of significance.

Question 20Cardiac Anatomy and Physiology

Where are the sinuses of Valsalva located?

  1. In the right atrial wall
  2. In the mitral annulus
  3. In the aortic root Correct answer.
  4. In the pulmonary trunk

Explanation

The sinuses of Valsalva are the three outpouchings of the aortic root located just above each aortic cusp. The coronary arteries originate from the right and left coronary sinuses, while the non-coronary sinus gives rise to no vessel. Dilatation or rupture of these sinuses is an important echocardiographic finding.

Question 21Cardiac Anatomy and Physiology

Which structure is continuous with the anterior mitral leaflet and separates the left atrium from the left ventricular outflow tract?

  1. Membranous septum
  2. Coumadin ridge
  3. Coronary sinus
  4. Aortomitral continuity Correct answer.

Explanation

The aortomitral continuity is the fibrous tissue joining the anterior mitral leaflet to the aortic root, forming the posterior boundary of the left ventricular outflow tract. It is the site where abscesses from aortic valve endocarditis can extend into the mitral apparatus. The membranous septum lies between the right and left ventricular outflow tracts.

Question 22Cardiac Anatomy and Physiology

In approximately what percentage of adults does the posterior descending artery arise from the right coronary artery?

  1. About 5%
  2. About 15%
  3. About 50%
  4. About 85% Correct answer.

Explanation

Right coronary dominance, in which the posterior descending artery arises from the right coronary artery, occurs in roughly 85% of people. Left dominance accounts for about 8-10%, and codominance for the remainder. Dominance is defined by which artery supplies the posterior descending branch, not by overall vessel size.

Question 23Cardiac Anatomy and Physiology

Which statement best describes normal left ventricular systolic torsion?

  1. The apex rotates clockwise in systole
  2. The apex rotates counterclockwise in systole Correct answer.
  3. Apex and base rotate in the same direction
  4. The base rotates counterclockwise in systole

Explanation

During systole the left ventricular apex rotates counterclockwise (viewed from the apex) while the base rotates clockwise, producing a wringing motion that aids ejection. This opposite rotation results from the helical orientation of subendocardial and subepicardial fibers. Loss of torsion is an early marker of myocardial dysfunction.

Question 24Cardiac Anatomy and Physiology

The membranous interventricular septum is clinically important because it:

  1. Gives rise to the moderator band in the right ventricle
  2. Forms the posterior floor of the coronary sinus
  3. Is the usual site of ventricular septal defects Correct answer.
  4. Contains the sinoatrial node pacemaker cells

Explanation

The membranous septum is the thin, fibrous portion of the interventricular septum and is the most common location for ventricular septal defects. It also transmits the bundle of His, so defects or surgical repair here risk conduction disturbance. The muscular septum makes up the remainder of the partition.

Question 25Cardiac Anatomy and Physiology

The transverse pericardial sinus passes between which structures?

  1. Between the great arteries and the pulmonary veins Correct answer.
  2. Between the right and left ventricular chambers
  3. Between the right atrium and the diaphragm
  4. Between the visceral and parietal pericardial layers

Explanation

The transverse sinus is the pericardial recess that runs behind the ascending aorta and pulmonary trunk and in front of the superior vena cava and left atrium, allowing access to the great vessels during surgery. It is distinct from the oblique sinus, which lies behind the left atrium. Both are parts of the normal pericardial cavity.

Question 26Cardiac Anatomy and Physiology

Which of the following is the approximate normal mitral valve orifice area in an adult?

  1. 4.0 to 6.0 cm² Correct answer.
  2. 2.0 to 3.0 cm²
  3. 7.0 to 9.0 cm²
  4. 1.0 to 1.5 cm²

Explanation

The normal adult mitral orifice measures roughly 4 to 6 cm², which allows unimpeded flow from the left atrium during diastole. Orifice areas of about 2 cm² or less indicate significant stenosis, and areas near 1 cm² correspond to severe stenosis. Planimetry and pressure half-time are used echocardiographically to estimate this area.

Question 27Cardiac Anatomy and Physiology

The left main coronary artery most commonly bifurcates into which pair of vessels?

  1. The left anterior descending and the right coronary arteries
  2. The left anterior descending and the posterior descending arteries
  3. The left anterior descending and the circumflex arteries Correct answer.
  4. The circumflex and the right coronary arteries

Explanation

The left main coronary artery normally divides into the left anterior descending artery, which runs in the anterior interventricular groove, and the circumflex artery, which courses in the left atrioventricular groove. The posterior descending artery usually arises from the right coronary artery, and the right coronary artery has its own separate ostium from the aorta.

Question 28Cardiac Anatomy and Physiology

The early-diastolic transmitral E wave primarily reflects which of the following?

  1. Ventricular systole
  2. Atrial contraction
  3. Isovolumic relaxation
  4. Rapid passive filling of the left ventricle Correct answer.

Explanation

The E wave is produced by the rapid passive filling phase that follows mitral valve opening, driven by the atrioventricular pressure gradient. It occurs after isovolumic relaxation is complete and before atrial systole, which generates the late A wave. Its peak velocity is influenced by relaxation, preload, and left atrial pressure.

Question 29Cardiac Anatomy and Physiology

In a patient with long-standing untreated systemic hypertension, which pattern of left ventricular remodeling is most characteristic?

  1. Isolated left atrial dilatation with normal ventricular geometry
  2. Concentric hypertrophy with increased wall thickness Correct answer.
  3. Right ventricular hypertrophy with septal flattening
  4. Eccentric hypertrophy with cavity dilatation

Explanation

Chronic pressure overload, as in systemic hypertension or aortic stenosis, stimulates sarcomeres to add in parallel, raising wall thickness while cavity size stays normal or small. This concentric pattern normalizes systolic wall stress according to the Laplace relationship. Volume overload, by contrast, produces the eccentric pattern with chamber dilatation.

Question 30Cardiac Anatomy and Physiology

Which statement best describes normal right ventricular geometry and systolic function?

  1. It is a thick-walled cone that shortens predominantly in the circumferential axis
  2. It is crescent-shaped and shortens predominantly in the longitudinal axis Correct answer.
  3. It ejects against systemic-level pressures under normal resting conditions
  4. Its free wall generates most of the stroke volume through radial thickening

Explanation

The right ventricle is a thin-walled, crescent-shaped chamber wrapped around the left ventricle, with myofibers arranged so that longitudinal shortening of the tricuspid annulus and free wall dominates ejection. Its low-resistance pulmonary circuit means it normally operates at roughly one-quarter of systemic pressure. This geometry explains why tricuspid annular plane systolic excursion and fractional area change are used to assess its function.

Question 31Ultrasound Physics and Instrumentation

What is the average propagation speed of ultrasound in soft tissue?

  1. 1,450 m/s
  2. 4,080 m/s
  3. 1,540 m/s Correct answer.
  4. 330 m/s

Explanation

Soft tissue averages about 1,540 m/s, and this is the value assumed by scanners when converting echo travel time into depth and when solving the Doppler equation. Fat is slower, bone is much faster, and air is the slowest of the common media.

Question 32Ultrasound Physics and Instrumentation

The piezoelectric effect in a diagnostic transducer is best described as which process?

  1. Reflection of sound at an acoustic impedance boundary
  2. Absorption of acoustic energy by the backing block
  3. Progressive attenuation of sound within the crystal element
  4. Conversion of electrical to mechanical energy Correct answer.

Explanation

Piezoelectric materials deform when a voltage is applied and generate a voltage when deformed, so the same crystal can transmit and receive. This two-way energy conversion is the basis of all diagnostic transducers.

Question 33Ultrasound Physics and Instrumentation

Which transducer frequency range is typically selected for adult transthoracic echocardiography?

  1. 1.0 to 2.0 MHz
  2. 5.0 to 7.5 MHz
  3. 7.0 to 12.0 MHz
  4. 2.5 to 3.5 MHz Correct answer.

Explanation

Adult echo requires penetration to 15-20 cm, which favors a lower frequency in the 2.5-3.5 MHz range. Higher frequencies improve resolution but cannot penetrate the adult chest adequately.

Question 34Ultrasound Physics and Instrumentation

The 2D gain control affects the displayed image by producing:

  1. near-field amplification only
  2. far-field amplification only
  3. increased transmitted acoustic power
  4. uniform amplification of all echoes Correct answer.

Explanation

Receiver gain amplifies all returning echoes equally, brightening or darkening the whole image without altering the acoustic output. Depth-dependent compensation is handled separately by time-gain compensation controls.

Question 35Ultrasound Physics and Instrumentation

Aliasing occurs when the Doppler shift frequency exceeds which value?

  1. The transmitted frequency
  2. The spatial pulse length
  3. The Nyquist limit Correct answer.
  4. The wall filter cutoff

Explanation

The Nyquist limit equals half the pulse repetition frequency, and a Doppler shift above that limit cannot be sampled correctly. The result is wrap-around of the spectral display to the opposite channel.

Question 36Ultrasound Physics and Instrumentation

If imaging depth is increased while all other settings remain unchanged, the frame rate will:

  1. Increase
  2. Remain the same
  3. Decrease Correct answer.
  4. Become erratic

Explanation

Frame rate equals the pulse repetition frequency divided by the number of lines per frame. Greater depth lengthens the round-trip time for each pulse, lowering the pulse repetition frequency and therefore the frame rate.

Question 37Ultrasound Physics and Instrumentation

Which zoom function can improve the spatial resolution of the displayed image?

  1. Digital magnification of a stored loop
  2. Panning the field of view
  3. Read zoom on a frozen image
  4. Write zoom during acquisition Correct answer.

Explanation

Write zoom (acquisition zoom) rescans a smaller region of interest using the same number of scan lines, so line density and resolution actually increase. Read zoom only enlarges pixels that were already acquired.

Question 38Ultrasound Physics and Instrumentation

Adjusting the compression control changes which image property?

  1. Frame rate of the display
  2. Doppler Nyquist limit
  3. Transmitted acoustic power
  4. Dynamic range of displayed echoes Correct answer.

Explanation

Compression maps the received range of echo amplitudes onto the display range, so it alters gray-scale assignment and apparent contrast. It is a post-processing function and does not change acoustic output or sampling.

Question 39Ultrasound Physics and Instrumentation

Axial resolution is primarily determined by which factor?

  1. Doppler packet size
  2. Beam width at the focus
  3. Line density of the scan
  4. Spatial pulse length Correct answer.

Explanation

Axial resolution equals half the spatial pulse length, so a shorter pulse separates reflectors that lie close together along the beam. Higher frequency and effective damping both shorten the pulse.

Question 40Ultrasound Physics and Instrumentation

Lateral resolution is best at which location in the ultrasound field?

  1. At the focal zone Correct answer.
  2. Immediately at the transducer face
  3. In the far field beyond the focus
  4. At the maximum imaging depth

Explanation

Lateral resolution is determined by beam width, which is narrowest at the focal zone. Moving the focus to the depth of interest is how the sonographer optimizes lateral detail in that region.

Question 41Ultrasound Physics and Instrumentation

A pulsed Doppler system operating at a pulse repetition frequency of 6,000 Hz has a Nyquist limit of:

  1. 2,000 Hz
  2. 3,000 Hz Correct answer.
  3. 12,000 Hz
  4. 1,500 Hz

Explanation

The Nyquist limit is half the pulse repetition frequency, so 6,000 Hz divided by two gives 3,000 Hz. Doppler shifts above this value will alias.

Question 42Ultrasound Physics and Instrumentation

The main purpose of the matching layer on a transducer face is to:

  1. damp crystal ringing after excitation
  2. improve sound transmission into tissue Correct answer.
  3. focus the beam at the focal zone
  4. protect the crystal from electrical noise

Explanation

The matching layer has an impedance between that of the crystal and soft tissue and is a quarter wavelength thick, which reduces reflection at the face and increases transmitted energy.

Question 43Ultrasound Physics and Instrumentation

In pulsed Doppler, increasing the sample volume depth tends to produce aliasing because:

  1. the available pulse repetition frequency is lower Correct answer.
  2. the interrogation angle becomes larger
  3. the wall filter cutoff rises
  4. the transmitted frequency increases

Explanation

Pulses must travel to the gate and back before the next pulse is sent, so deeper gates force a longer pulse repetition period and a lower pulse repetition frequency. A lower pulse repetition frequency means a lower Nyquist limit and greater likelihood of aliasing.

Question 44Ultrasound Physics and Instrumentation

For the most accurate Doppler velocity measurement, the interrogation angle should be:

  1. between 70 and 80 degrees
  2. 60 degrees or less Correct answer.
  3. any angle, provided gain is optimized
  4. 90 degrees

Explanation

The Doppler equation contains the cosine of the angle, so the estimate degrades as the angle approaches 90 degrees, where the shift falls to zero. Keeping the angle at 60 degrees or less limits the error to an acceptable range.

Question 45Ultrasound Physics and Instrumentation

Continuous-wave Doppler can measure very high velocities because it:

  1. has no range gating and cannot alias Correct answer.
  2. applies a low wall filter setting
  3. transmits at a higher frequency
  4. uses a high pulse repetition frequency

Explanation

Continuous-wave Doppler transmits and receives simultaneously along the entire beam, so there is no sampling rate to violate and no aliasing. The trade-off is that the origin of the signal along the beam cannot be determined.

Question 46Ultrasound Physics and Instrumentation

Tissue harmonic imaging improves image quality mainly because the received signal:

  1. is generated only in the near field
  2. is unaffected by attenuation
  3. occurs at twice the transmit frequency Correct answer.
  4. has higher amplitude than the fundamental

Explanation

Harmonics are generated as the transmitted beam propagates through tissue and are received at twice the transmitted frequency. The harmonic beam is narrower with weaker side lobes, which reduces clutter and improves lateral resolution.

Question 47Ultrasound Physics and Instrumentation

The mechanical index displayed on the screen provides an estimate of which risk?

  1. Fetal hearing damage
  2. Cumulative operator dose
  3. Cavitation Correct answer.
  4. Thermal injury to bone

Explanation

The mechanical index reflects peak rarefactional pressure relative to frequency and is an indicator of nonthermal, cavitation-related bioeffects. Thermal risk is instead reflected by the thermal index.

Question 48Ultrasound Physics and Instrumentation

Multiple equally spaced echoes appearing behind a strong reflector such as a pacing wire are caused by:

  1. shadowing
  2. refraction
  3. enhancement
  4. reverberation Correct answer.

Explanation

Reverberation occurs when sound bounces repeatedly between two strong reflectors or between a reflector and the transducer, producing a series of echoes equally spaced in depth. The first echo is real and the later ones are artifacts.

Question 49Ultrasound Physics and Instrumentation

A densely calcified valve leaflet typically produces which artifact behind it?

  1. Acoustic shadowing Correct answer.
  2. Speed error
  3. Posterior enhancement
  4. Mirror image

Explanation

Calcification attenuates and reflects sound strongly, so echoes returning from behind it are weak and a dark shadow appears. Shadowing is the classic signature of a highly attenuating structure.

Question 50Ultrasound Physics and Instrumentation

Decreasing the displayed dynamic range of a 2D image will:

  1. increase image contrast Correct answer.
  2. lower the frame rate
  3. raise the Nyquist limit
  4. increase the number of gray shades

Explanation

Reducing displayed dynamic range assigns a smaller spread of echo amplitudes to the full gray scale, which steepens the mapping and makes the image look more contrasty. More gray shades are displayed when the dynamic range is widened.