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Terms in this set (586)
What is another term for the AP axial projection taken during a barium enema procedure?
A) Sims' position
B) Butterfly position
C) Chassard-Lapine position
D) Smith position
B
Which laxative is classified as a saline type?
A) Magnesium
citrate
B) Magnesium cyanide
C) Castor oil
D) Barium sulfate
A
Which of the following conditions may lead to an adynamic ileus?
A) Small bowel tumor
B) Scar tissue within the jejunum
C) Peritonitis
D) Stricture of ileum due to an inguinal hernia
C
Situation: An infant is brought to the ED with a
possible intussusception. Which of the following procedures may actually correct this condition?
A Small bowel enema
B Small bowel series
C Defecography
D Barium or air enema
D
Which part of the small intestine has the largest diameter?
Duodenum
In which abdominal quadrant is the duodenum located?
Right Upper
At what stage of respiration should the enema tip be inserted into the rectum?
1 During deep breaths
2 During shallow breaths
3 Suspended inspiration
4 Suspended expiration
4
True or False: During a colostomy barium enema, a double-contrast retention enema tip is used.
False
Which part of the small intestine has a feathery appearance when filled with barium?
Jejunum
A prolapse of the rectum may be diagnosed by a(n):
1 Single-contrast barium enema
2 Enteroclysis
3 Double-contrast barium enema
4 Evacuative proctography
4
Which part of the small intestine makes up three fifths of its entirety?
Ileum
Which of the following barium enema projections and/or positions provides the greatest amount of gonadal dosage to both male and female patients?
1 AP/PA
2 Lateral rectum
3 Left lateral decubitus
4 AP axial
2
Which of the following positions best demonstrates
the left colic flexure?
1 LPO
2 Left lateral decubitus
3 Left lateral
4 LAO
4
Which specific aspect of the large intestine must be demonstrated during evacuative proctography?
1 Sigmoid colon
2 Haustra
3 Anorectal angle
4 Rectal ligament
3
The recommended water temperature for a barium sulfate mixture used for most barium enema procedures is:
85 to 90 °F
The average time to scan the large intestine during a computed tomography colonography is:
10 minutes
Why is oral contrast media sometimes given during computed tomography colonography?
1 To determine if a fistula is present
2 To mark or "tag" possible fecal
matter
3 To demonstrate possible diverticula
4 To prevent spasm of the large intestine
2
Which portion of the small bowel is characterized by a feathery appearance?
Jejunum
True or False: The circular staircase, or herringbone pattern, is a common radiographic sign for a mechanical ileus.
True
During the initial enema tip insertion, the tip is aimed:
Toward the umbilicus
Prior to having a small bowel series, the patient should remain NPO for:
8 hours
Situation: During a double-contrast BE procedure the radiologist suspects a polyp in the descending colon. Which position would best demonstrate this?
Right Lateral Decubitus
The approximate uncoiled length (in feet) of the small intestine is:
20-23
The most distal portion of the colon is the:
Sigmoid
Which of the following pathologic conditions is best demonstrated with
evacuative proctography?
1 Intussusception
2 Volvulus
3 Rectal prolapse
4 Diverticulosis
3
The correct order of the segments of the colon, beginning with the cecum, is:
Ascending, hepatic flexure, transverse, splenic flexure, descending, sigmoid
Which part of the colon has the greatest amount of potential movement?
Transverse
During a single-contrast barium enema, the radiologist detects a possible defect within the right colic flexure. Which of the following projections and/or positions best demonstrates this region of the colon?
LPO
True or False: Evacuative proctography is most commonly performed on geriatric patients.
False
True or False: For an average adult, the amount of barium ingested is one 16-ounce cup for a small bowel only series.
False
Which of the following conditions may produce the "cobblestone" or "string" sign?
1 Whipple disease
2 Regional enteritis (Crohn's disease)
3 Giardiasis
4 Ileus
2
Situation: A patient comes to radiology for a double-contrast barium enema. The patient cannot lie on her side during the study. Which of the following projections could replace the lateral rectum projection?
1 AP axial
2 LPO axial projection
3 Ventral decubitus
4 Dorsal decubitus
3
A twisting of a portion of the intestine
upon its own mesentery is termed:
1 Intussusception
2 Diverticulosis
3 Volvulus
4 Hirschsprung disease
3
The "tapered," or "corkscrew," radiographic sign is often seen with:
1 diverticulosis.
2 neoplasm.
3 volvulus.
4 intussusception.
3
Which one of the following imaging modalities and/or procedures
is very effective in detecting the Meckel diverticulum?
1 CT
2 Double-contrast barium enema
3 Sonography
4 Nuclear medicine
4
The term describing a double-contrast small bowel procedure is:
1 two-stage small bowel procedure.
2 diagnostic intubation.
3 enteroclysis.
4 None of the above
3
What is the recommended kV range for an iodinated, water-soluble barium enema study?
80-90 kvp
Which radiographic sign is frequently seen with adenocarcinoma of the large intestine?
1 "Sail" sign
2 Diverticula
3 "Napkin ring" or "apple core" sign
4 Thickened mucosa
3
Which sections of the large intestine will most likely be
filled with air with the patient in the prone position during a double-contrast barium enema?
1 Ascending colon, descending colon, and rectum
2 Transverse and sigmoid colon
3 Rectum only
4 Right and left colic flexure and sigmoid colon
1
The average length of time (in hours) it takes barium sulfate to reach the ileocecal valve after entering the stomach is:
2-3
Which imaging modality can demonstrate abscesses in the retroperitoneum?
1 MRI
2 Nuclear medicine
3 Sonography
4 Conventional radiography
1
Why is the PA rather than the AP recommended for a small bowel series?
1 Less gonadal dose for female patients
2 More comfortable for patient
3 Places small intestine closer to film
4 Better separation of
loops of small intestine
4
A telescoping, or invagination, of one part of the intestine into another is termed:
1 diverticulosis.
2 volvulus.
3 intussusception.
4 colitis.
3
True or False: Overhead, radiographic projections are often not taken when using digital fluoroscopy.
True
True or False: The height of the enema bag should not exceed 36 inches (91 cm) above the radiographic table at the beginning of the study.
True
A properly positioned LAO for the large intestine will demonstrate the:
1 Right colic flexure and ascending colon
2 Right colic flexure and descending colon
3 Left colic flexure and ascending colon
4 Left colic flexure
and descending colon
4
Which of the following is classified as an irritant laxative?
1 Magnesium citrate
2 Magnesium sulfate
3 Castor oil
4 None of the above
3
Situation: A radiograph of an AP barium enema projection reveals poor visualization of the sigmoid due to excessive superimposition of the sigmoid colon
and rectum. How can this area be better visualized on the repeat exposure?
1 Angle the CR 30° to 40° cephalad with AP projection.
2 Increase kV.
3 Take PA projection with the patient in the left lateral decubitus position.
4 Take PA projection with a 30° to 40°cephalad CR angle.
1
Which part of the small intestine is the shortest?
Duodenum
Which of the following statements is not true in regard to a pediatric small bowel series?
1 The transit time for barium through the small intestine is longer than that of an adult.
2 Barium sulfate is the contrast medium of choice.
3 The small bowel series should be scheduled early in the morning.
4 A gonadal shield often cannot be used during the later stages of the study.
1
Which
of the following conditions would contraindicate the use of a cathartic before a barium enema?
1 Colitis
2 Diverticulosis
3 Obstruction
4 Diverticulitis
3
Situation: A patient comes to radiology for a barium enema. He has a possible fistula extending from the rectum to the urinary bladder. Which one of the following projections and/or positions would best demonstrate the fistula?
1 Lateral
rectum position
2 AP erect projection
3 LPO axial projection
4 LPO and RPO positions
...
True or False: The sigmoid colon and upper rectum are infraperitoneal structures.
False
How much CR angulation is required for the AP axial projection?
30° to 40°
Adenocarcinoma:
1) Is also known as megacolon
2) May have an apple core appearance on a radiograph
3) May result in bowel obstruction
A) 2 only
B) 1 and 2 only
C) 1 and 3 only
D) 2 and 3 only
D
Which of the following structures is NOT considered part of the colon?
A. Transverse colon
B. Right & left colic flexures
C. Rectum
D. All of the above are
part of the colon
Rectum
Which part of the large intestine is located between the rectum and the descending colon?
A. Cecum
B. Splenic flexure
C. Hepatic flexure
D. sigmoid colon
Sigmoid colon
The ascending colon and upper rectum are intraperitoneal structures
A. true
B. false
False
The "tapered" or "corkscrew" radiographic sign is often seen with:
A. Diverticulosis
B. Neoplasm
C. Volvulus
D. Intussusception
Volvulus
At what stage of respiration should the enema tip be inserted into the rectum?
A. During deep breaths
B. During shallow breaths
C. Suspend inspiration
D. Suspend expiration
Suspend expiration
During a double-contrast BE, the radiologist suspects a polyp in the ascending colon. Which position would best demonstrate this?
A. 45 degrees erect PA projection
B. Left lateral decubitis
C. Right lateral decubitis
D. Supine for AP projection
Left lateral decubitis
A patient comes to radiology for a BE. He has a possible fistula extending
from the rectum to the urinary bladder. Which one of the following projections and/or positions would best demonstrate the fistula?
A. Lateral rectum position
B. AP erect projection
C. LPO axial projection
D. LPO & RPO position
Lateral rectum position
A patient comes to radiology with possible diverticulosis. Which of the following studies is most diagnostic for detecting this condition?
A.
Single contrast BE
B. Double contrast BE
C. Evacuative proctogram
D. Small bowel series
Double contrast BE
Which of the following is a severe inflammation of the colon and rectum with loss mucosal lining?
A. Diverticula
B. Ulcerative colitis
C. Enteritis
D. Adynamic ileus
Ulcerative colitis
During a
single contrast BE, the radiologist detects a possible defect within the left colic flexure. Which of the following projections and/or positions best demonstrates this region of the colon?
A. LPO
B. AP axial
C. RAO
D. LAO
LAO
While attempting to insert an enema tip into the rectum, the technologist experiences resistance. What should be the next step taken by the technologist?
A. Retry the
insertion using more lubrication
B. Ask the patient to try to insert it him/herself
C. Have the radiologist insert it using fluoroscopic guidance
D. Cancel the procedure
Have the radiologist insert it using fluoroscopic guidance
What is the classification of barium sulfate as a contrast media?
A. Radiopaque
B. Radiolucent
C. Isodense
D. Negative contrast media
Radiopaque
What is a potential risk associated with the use of water-soluble contrast agents, especially for geriatric patients?
A. Bowel obstruction
B. Cardiac arrest
C. Dehydration
D. Shock
Dehydration
Which of the following conditions is characterized by pouch-like herniations oft he colonic wall?
A. Diverticula
B. Polyps
C. Pyloric stenosis
D. Ulcerative
colitis
Diverticula
What part of the small intestine has the largest diameter?
A. duodenum
B. ileum
C. jejunum
D. cecum
Duodenum
The opening between the small intestine and the large intestine is called the:
A. Ampulla of Vater
B. Greater duodenal papilla
C. Ileocecal valve
D. Pyloric valve
Ileocecal valve
The CR angulation for the AP axial projection of the large intestine is:
A. 10-20 degrees caudad
B. 30-40 degrees caudad
C. 10-20 degrees cephalic
D. 30-40 degrees cephalic
30-40 degrees cephalic
How far is the enema tip inserted into the rectum for a colon examination?
A. No more than 2"
B. No more than
3"
C. No more than 4"
D. No more than 5"
No more than 4"
The ascending portion of the colon joins the transverse colon at the:
A. Left colic (splenic) flexure
B. Right colic (hepatic) flexure
C. Sigmoid colon
D. duodenojejunal flexure
Right colic (hepatic) flexure
An enlarged rectal vein is called a:
A.
hemorrhoid
B. Haustrum
C. Diverticulum
D. Hiatal hernia
Hemorrhoid
Which of the following liquids is NOT appropriate for patients on a liquid diet in preparation
for a colon examination?
A. Juice
B. Jell-O
C. Chocolate milk
D. Sweet tea
Chocolate milk
Which sections of the large intestine will most likely
be filled with barium with the patient in the prone position during a double-contrast BE
A. rectum only
B. right and left colic flexure and sigmoid colon
C. ascending colon, descending colon, and rectum
D. transverse and sigmoid colon
Transverse and sigmoid colon
Which of the following describes a bowel obstruction caused by immobility of the bowel:
A. diverticula
B. adynamic ileus
C.
pyloric stenosis
D. ulcerative colitis
Adynamic ileus
Which of the following BE projections and/or positions provides the greatest amount of gonadal dosage to both male and female patients
A. AP/PA
B. Left lateral decubitus
C. Lateral rectum
D. Left posterior oblique
Lateral rectum
Which of the following
procedures best demonstrates a rectocele?
A. Double-contrast BE
B. Single contrast BE
C. Evacuative proctography
D. Enteroclysis
Evacuative proctography
Patients who require priority scheduling for studies that require fasting are: emergencies, infants & small children, diabetic patients, and geriatric patients
A. true
B. false
True
Which radiographic sign is frequently seen with intussusception?
A. "napkin ring" or "apple-core" sign
B. Thickened mucosa
C. "Mushroom-shaped" dialation
D. "Beak" sign
Mushroom shaped dialation
Why is the PA rather than the AP projection recommended for a small bowel series?
A. less gonadal dose for female patients
B. more confortable for patients
C. better
seperation of loops of small intestine
D. places small intestine closer to the IR
Better separation of loops of small intestine
How long is the small bowel?
15-18 ft
How long is the large intestine?
5 ft
Characteristics of the Duodenum
Shortest/Widest/Most fixed portion
Quadrants of the Duodenum
RUQ/LUQ
Is appendicitis more common in men or women?
1.5% more common in men
What are the four parts of the colon?
1. ascending
colon
2. transverse colon
3. descending colon
4. sigmoid colon
What level does the rectum start?
S3
most common tumors of the small bowel
carcinoid tumors
What is the ideal kV range for a double contrast barium enema?
90-100 kv
What modality is the best in detecting Meckel's diverticulum?
Nuc Med
What type of enema tip should be used for a barium enema on an infant?
10 Fr, flexible silicon catheter
What is the term for the three bands of muscle that pull the large intestine into pouches?
Taenia coli
The tip of the catheter is advanced to the _______ during an enteroclysis.
duodenojejunal junction (ligament of Treitz)
What projection would best demonstrate a fistula extending from the rectum to the urinary bladder?
lateral rectum
During a double contrast barium enema, the radiologist suspects a polyp in the descending colon. Which position would best demonstrate this?
Right lateral decubitus
A patient comes into radiology for a single contrast barium enema. The patient cannot lie on their side during the study. Which projection could replace the lateral rectum?
Ventral decubitus
A twisting of the intestine on its own mesentery is termed:
Volvulus
A radiograph of an AP barium projection reveals poor visualization of the sigmoid due to excessive superimposition of the sigmoid colon and rectum. How can this area be better visualized on the repeat exposure?
Angle the CR 30-40 degrees cephalic with AP
Central ray for a one hour small bowel radiograph
at the iliac crest
Why is it important for the technologist to review the patient's chart and inform the radiologist before beginning the barium enema examination if a biopsy was performed as a part of a prior sigmoidoscopy or colonoscopy procedure?
The biopsy of the colon may weaken that portion of the colon, which would lead to perforation
What is the highest/most superior portion of the large intestine?
left colic flexure
Rotation for abdominal oblique projections
35-45 degrees
CR RAO/LAO
CR perp @ 1 inch lateral from medial to side up from table
RAO: Anatomy demonstrated
Right colic flexure/sigmoid/ascending colon seen without superimposition
Right ilium is foreshortened
Right colic flexure seen in profile
LAO: Anatomy demonstrated
Left colic flexure/descending colon seen without superimposition
left ilium foreshortened
left colic flexure seen in
profile
RPO/LPO CR
CR perp at iliac crest about 1 inch lateral to elevated side
Lateral rectum CR
CR perp at level of ASIS
Colitis
inflammation of the colon
Appears in radiographs with thickening of mucosal wall and loss of haustral
markings
Exam: single or dbl contrast BE
Ulcerative colitis
chronic inflammation of the colon with presence of ulcers
Appearance: Cobblestone/Stovepipe appearance
Exam: single/dbl contrast BE
Intussusception
telescoping of the intestines
Appearance: mushroom shaped dialation
Exam: single/dbl contrast
BE
neoplasm
Abnormal growth
Appearance: narrowness or tapering of lumen/napkin ring/apple core
Exam: dbl contrast BE or CT Colonography
Polyps
Barium filled saclike inward projections
Exam: dbl contrast BE; CT Colonography
Volvulus
twisting
of the intestine on itself
Appearance: corkscrew appearance
Exam: single contrast BE
Which imaging modality can demonstrate abscesses in the retroperitoneum?
MRI
While attempting to insert an enema tip into the rectum, the technologist experiences resistance. What should be the next step taken by the technologist?
Have the radiologist insert it using fluoroscopic guidance
Why is oral contrast media sometimes given during computed tomography colonography?
To mark or "tag" possible fecal matter
T/F Rectal retention enema tips should be fully inflated by the technologist before beginning a barium enema
False
T/F The enteroclysis procedure is indicated for patients with regional enteritis
false
The types of digestive movement characteristic of the large intestine include:
1.) Rhythmic Segmentation
2.) Haustral Churning
3.) Mass Peristalsis
4.) Defecation
2,3,4
T/F Ultrasound, with graded compression, can be used in diagnosing acute appendicitis.
true
Plicae circulares
mucosal folds which increase the surface area in the small bowel to aid in absorption of nutrients
T/F The terms large intestine and colon are synonymous
false
The sternal extremity is the __________ end of the clavicle
medial
Difference between male and female clavicle
female is shorter and less curved
What is the anterior surface of the scapula called?
Costal surface
Structures of the proximal humerus
greater and less tubercle, intertubercular sulcus, anatomical and surgical neck, head
Where is the sub scapular fossa located?
Within the anterior surface of the scapula
Where is the deltoid tuberosity located?
anterolateral surface of the humeral insertion
The scapulohumeral has a _____ type of movement
Ball and Socket
The internal rotation of the humerus will result in a _______ position of the proximal humerus
Lateral
Positioning : The internal projection of the shoulder and proximal humerus is created by..
Placing back of affected palm against the thigh
A medial CR angle of 25-30 degrees is required for the ________ projection
Lawrence/Transaxillary/InfSup Axial shoulder
How is a possible Hill-Sachs defect best demonstrated?
Inferior Superior Axial Shoulder with exaggerated external rotation of affected arm
What does the Grashey method demonstrate?
Open glenoid fossa in profile
What ionization chambers for the AEC should be used for a tangential projection for the intertubercular groove?
AEC should not be used, it is tabletop
What type of breathing technique should be used for AP scapula?
Orthostatic breathing
What is the CR for a trans thoracic proximal humerus projection?
Level of the surgical neck
The lateral scapula projection requires the patient to be rotated ____ degrees towards the IR for a PA position.
45-60 degrees
What projection demonstrates the Lesser tubercle in profile?
AP shoulder with internal rotation
The internal AP shoulder projection demonstrates the _______________ in profile medially
Lesser tubercle
The __________ rotation AP shoulder projection demonstrates the greater tubercle profiled laterally
external
How should weights be places for the AC joint weight bearing studies?
attached to the wrists
What is the garth method used for?
Apical Oblique trauma for possible fx
What projection does the anterior and posterior rims of the glenoid cavity need to be superimposed?
AP Oblique/Grashey
If the anterior and posterior rims of the glenoid cavity are not superimposed... what should the radiographer to do correct this?
Increase rotation of the thorax
How much clavicle should be included on an AP/AP axial projection
Acromial end to sternal end
What projection of the scapula should the vertebral and axillary borders be superimposed?
Scapular Y Lateral
What projection should be performed to demonstrate a subscromial spur?
PA scapular Y lateral with 10-15 degree caudal angle
What is the SID for an AC joint projection?
72 inches
What dislocation of the shoulder occurs more frequently?
Anterior
What projection best demonstrates a Bankart lesion?
Grashey
What does the Neer method demonstrate?
coracoacromial arch
When a patient presents with osteoarthritis or osteoporosis, what should happen to your exposure factors?
Decrease
When performing an AP axial projection of the clavicle on an asthenic patient, What should your angulation be?
30 degrees cranial
CR for AC joints
1 inch above the jugular notch
Subacromial spurring is a common radiographic sign of ???
Impingment syndrome of the shoulder
What projection should be utilized to demonstrate the intertubercular groove?
Tangential/Fisk
Where does shoulder radiography produce a significant dose to?
Breast and thyroid
What should the radiographer do when a patient cannot raise their unaffected arm over their head for a transthoracic projection?
Angle CR 10-15 degrees cephalad
What positioning rotation should be performed for a patient that presents with a proximal fx of the humerus?
AP and transthoracic lateral
What AC projection requires a 15 degree cephalic angle?
Alexander
What is the Alexander method projection performed for?
Possible AC joint dislocation
What AP projection of the shoulder are the epicondyles located 45 degrees to the IR?
Neutral
What AP projection of the shoulder is the greater tubercle located anterior and the lesser tubercle is medial (in profile)?
Internal
What is the CR for an AP shoulder?
1 inch inferior to coracoid process
What three parts make the Y in a Scapular Y?
Acromion process, coracoid process, inferior angle
How can you tell the difference between a Scapular Y and Lateral scapula?
Lateral Scapula= arm over chest
What is the CR for an AP scapula?
2 inches inferior to coracoid process, 2 inches medial to axillary border
What is the CR for the Lawrence method?
25-30 degrees to Axilla
What type of movement is are the AC and SC joints?
Plane/gliding
What is another term for the mid area of the costal surface of the scapula?
Subscapular fossa
What projection of the shoulder is the lesser tubercle profiled medially?
Internal rotation
What projection is the greater tubercle profiled laterally?
External rotation
What is the main pathology that is being looked at for the inter tubercular groove projections?
Calcium deposits
What is the CR for a supine inter tubercular groove projection?
CR 15-20 degree posterior to humerus
CR for scapular Y lateral
Cr proximal to humerus, 2 inches below top of shoulder
True or false: The Hill-Sachs defect is a fracture of the articular surface of the glenoid cavity.
False
Which rotation of the humerus will result in a lateral position of the proximal humerus?
1. Internal rotation (epicondyles perpendicular to image receptor)
2. Neutral rotation (epicondyles 45° to the image receptor)
3. External rotation (epicondyles parallel to the image receptor)
4. None of the above
Internal rotation (epicondyles perpendicular to image receptor)
A
patient enters the ED with a possible bony defect of the midwing area of the scapula. The patient is able to stand and move the upper limb freely. In addition to the routine AP scapula projection with the arm abducted, which of the following would best demonstrate the involved area?
1. Take an AP apical oblique projection of the shoulder.
2. Take a transthoracic lateral projection of the shoulder region.
3. Correct Have the patient reach across the chest and grasp the opposite shoulder
for a lateral scapula projection.
4. Have the patient drop the affected arm behind him or her and take a lateral scapula projection.
Have the patient drop the affected arm behind him or her and take a lateral scapula projection.
A patient enters the ED with multiple injuries. The physician is concerned about a dislocation of the left proximal humerus. The patient is unable to stand. Which of the following
routines is advisable to best demonstrate this condition?
1. AP shoulder and inferosuperior axial projection
2. AP shoulder and 35° to 45° AP oblique (Grashey method)
3. AP shoulder and Neer projection
4. Correct AP shoulder and recumbent AP oblique (scapular Y) projection
Correct AP shoulder and recumbent AP oblique (scapular Y) projection
True or false: The affected arm should not be abducted for an AP scapula projection.
False
Where is the CR centered for a transthoracic lateral projection for proximal humerus?
1. 1 inch (2.5 cm) inferior to the acromion
2. Level of the greater tubercle
3. Level of surgical neck
4. Midaxilla
Level of surgical neck
A radiograph of a transthoracic lateral projection reveals
that it is difficult to visualize the proximal humerus due to the ribs and lung markings. The following analog exposure factors were used: 75 kV, 30 mAs, 40-inch (102 cm) SID, grid, and suspended respiration. Which of the following changes will improve the visibility of the proximal humerus?
1. Make the exposure on second inspiration.
2. Use a compression band to prevent patient movement.
3. Use a 72-inch (183-cm) SID.
4. Use an orthostatic (breathing) technique.
Use an orthostatic (breathing) technique.
The anterior surface of the scapula is referred to as the:
1. scapular surface.
2. dorsal surface.
3. supraspinous and infraspinous fossa.
4. costal surface.
Costal surface
Which of the following shoulder positions is considered a trauma projection (can be performed safely for a possible fracture
or dislocation of the proximal humerus)?
1. AP apical oblique axial (Garth method) projection
2. Inferosuperior axial (Clements modification) projection
3. AP projection-internal rotation
4. None of the above
AP apical oblique axial (Garth method) projection
Which of the following AP shoulder projections demonstrates the greater tubercle in profile medially?
1. External rotation
2. Internal
rotation
3. Neutral rotation
4. None of these
None of these
A patient enters the ED with a midshaft humeral fracture. The AP projection taken on the cart demonstrates another fracture near the surgical neck of the humerus. The patient is unable to stand or rotate the humerus because of the extent of the trauma. What other projection should be taken for this patient?
1. Scapular Y lateral-AP oblique
projection
2. Apical oblique projection
3. Horizontal beam transthoracic lateral projection for humerus
4. Rotational lateral projection for humerus
Horizontal beam transthoracic lateral projection for humerus
Which of the following AP shoulder projections demonstrates the lesser tubercle in profile medially?
1. External rotation
2. Internal rotation
3. Neutral rotation
4. None of the
above
Internal rotation
A patient enters the ED with a possible AC joint separation. The patient is paraplegic; therefore, the study cannot be done erect. Which of the following routines would be performed to diagnose this condition?
1. Non-weight-bearing and weight-bearing types of projections performed with the patient recumbent by pulling down on the shoulders
2. Recumbent AP and AP axial projection of
the clavicles to include AC joints
3. AP projections of shoulders with external and internal rotation performed recumbent
4. AP and AP apical oblique projection of the shoulder performed recumbent
Non-weight-bearing and weight-bearing types of projections performed with the patient recumbent by pulling down on the shoulders
Which AP projection of the shoulder and proximal humerus is created by placing the
affected palm of the hand facing inward toward the thigh?
1. Internal rotation
2. Neutral rotation
3. External rotation
4. AP axial
Neutral rotation
Which of the following projections can be performed using an orthostatic (breathing) technique?
1. Scapular Y lateral projection
2. Inferosuperior axiolateral projection
3. AP clavicle
4. AP scapula
AP scapula
Which alternative landmark can be palpated if unable to locate the coracoid process for the shoulder projection for the obese shoulder?
1. Inferior angle of scapula
2. Greater tubercle of humerus
3. AC joint
4. Lesser tubercle of humerus
AC joint
A radiograph of an AP axial projection of the clavicle demonstrates that the clavicle is within the
midaspect of the lung apices. What should the technologist do to correct this error?
1. Do nothing; this is an acceptable AP axial clavicle projection.
2. Increase the caudad CR angle during repeat exposure.
3. Increase the cephalic CR angle during repeat exposure.
4. Make the exposure upon complete inspiration.
Increase the cephalic CR angle during repeat exposure.
True or False: All of the joints of the shoulder girdle are diarthrodial.
True
True or False: A radiograph of the inferosuperior axial projection (Lawrence method) demonstrates the acromion process of the shoulder to be located most superiorly (anteriorly).
False
What medial central ray (CR) angle is required for the inferosuperior axial shoulder (Lawrence
method)?
1. 5° to 10°
2. 40° to 45°
3. 25° to 30°
4. 10° to 15°
25° to 30°
Which of the following best demonstrates the coracoacromial arch?
1. Neer method
2. West Point method
3. Fisk method
4. Garth method
Neer method
Where is the CR centered for the bilateral acromioclavicular (AC) joint projection on
a single 35 x 43 cm (14 x 17 inch) image receptor?
1/ At the affected AC joint
2. 1 inch (2.5 cm) above the jugular notch
3. At the level of the thyroid cartilage
4. At the sternal angle
1 inch (2.5 cm) above the jugular notch
How much CR angulation is required for an asthenic patient for an AP axial projection of the clavicle?
1. 15°
2. 30°
3. 45°
4. No CR angulation should be used for
this projection.
30°
Which projection of the shoulder requires that the patient be rotated 45° to 60° toward the IR from a PA position?
1. Inferosuperior axiolateral projection
2. AP oblique projection
3. Lateral scapula projection
4. None of these
Lateral scapula projection
Another term for osteoarthritis is:
1.
rheumatoid arthritis.
2. bursitis.
3. degenerative joint disease.
4. osteoporosis.
degenerative joint disease
Which of the following joints is considered to have a ball and socket (spheroidal) type of movement?
1. Acromioclavicular joints
2. Sternoclavicular joints
3. Bicipital joint
4. Scapulohumeral joint
Scapulohumeral joint
A patient enters the ED with multiple injuries including a possible fracture of the left proximal humerus. Which positioning rotation should be performed to determine the extent of the humerus injury?
1. AP neutral shoulder rotation and carefully rotated internally proximal humerus
2. AP shoulder as is; show radiograph to the ED physician before attempting a rotational lateral projection
3. AP and horizontal beam transthoracic lateral shoulder projection
4. AP
and apical oblique shoulder without any arm rotation
AP and horizontal beam transthoracic lateral shoulder projection
True or false: Sonography is effective in the dynamic evaluation of the shoulder joint.
True
True or false: For AC joint weight-bearing studies, patients should not be asked to hold on to the weights with their hands; rather, the weights should be attached to the wrists.
True
A radiograph of an AP clavicle reveals that the sternal extremity is partially collimated off. What should the technologist do?
1. Repeat the AP projection and correct collimation.
2. Make sure the sternal extremity is included on the AP axial projection.
3. Only repeat it if the patient's pain/symptoms involve the sternal
extremity.
4. Ask the radiologist whether he or she wants the projection repeated.
Repeat the AP projection and correct collimation.
True or false: A posterior dislocation of the shoulder occurs more frequently than an anterior dislocation.
False
Which of the following modalities best demonstrates shoulder joint pathology
such as rotator cuff tears using dynamic evaluation techniques during joint movements?
1. Ultrasound
2. Magnetic resonance imaging (MRI)
3. Computed tomography (CT)
4. Arthrography
Ultrsound
Which of the following shoulder projections best demonstrates the glenoid cavity in profile?
1. Grashey method
2. Clements modification
3. Garth method
4. AP shoulder, neutral rotation
Grashey method
What is the name of the large fossa found within the anterior surface of the scapula?
1. Supraspinous fossa
2. Infraspinous fossa
3. Subscapular fossa
4. Glenoid fossa
Subscapular fossa
A radiograph for an AP projection with external rotation of the proximal humerus reveals that the greater tubercle is profiled
laterally. What should be changed to improve this image for a repeat exposure?
1. Rotate epicondyles so they are perpendicular to the image receptor.
2. Move the patient obliquely 10° to 15° toward the affected side.
3. Rotate the arm to place palm of the patient's hand against the thigh.
4. Positioning is acceptable; do not repeat it.
Positioning is acceptable; do not repeat it.
Which of the
following structures is not part of the proximal humerus?
1. Lesser tubercle
2. Glenoid process
3. Intertubercular sulcus
4. Anatomic neck
Glenoid process
True or False: For an AP oblique (Grashey method) projection of the shoulder, the CR is centered to the acromion.
False
The AP humerus requires that the humeral
epicondyles are _____ to the IR.
1. set at a 45° angle
2. parallel
3. perpendicular
4. slightly oblique
Parallel
How much CR angulation should be used for a PA oblique (scapular Y) projection?
1. No CR angle is required.
2. 10° to 15°
3. 20° to 30°
4. 35° to 45°
No CR angle is required.
A patient comes to
radiology for treatment of an arthritic condition of the right shoulder. The radiologist orders AP internal/external rotation projections and an inferosuperior axial projection of the scapulohumeral joint. However, the patient cannot abduct the arm for this projection. Which other projection will best demonstrate the scapulohumeral joint space?
1. AP oblique (Grashey method)
2. Scapular Y lateral
3. Transthoracic lateral
4. AP projection-neutral rotation
AP oblique (Grashey method)
True or false: The use of a grid during shoulder radiography will result in higher patient dose over nongrid procedures.
True
A patient comes to the emergency department (ED) with a possible right AC joint separation. Right clavicle and AC joint examinations are ordered. The clavicle is taken first, and a small linear fracture of the
midshaft of the clavicle is discovered. What should the technologist do in this situation?
1. Perform the weight-bearing phase as ordered.
2. Reduce the amount of weight that would normally be given to the patient and perform the weight-bearing study.
3. Consult with the ED physician before continuing with the AC joint study.
4. Slowly give the patient more weight to hold until he begins to complain and then complete the AC joint study.
Consult with the ED physician before continuing with the AC joint study
What is a possible radiographic sign for impingement syndrome of the shoulder?
1. Calcified tendons
2. Fluid-filled joint space
3. Fracture of the glenoid rim
4. Bone spurring in acromiohumeral space
Bone spurring in acromiohumeral space
What is the common term for idiopathic chronic
adhesive capsulitis?
1. Bankart lesion
2. Tendinitis
3. Bursitis
4. Frozen shoulder
Frozen shoulder
Where is the CR centered for the AP oblique (Grashey method) position for the glenoid cavity?
1. Acromion
2. 2 inches (5 cm) medial and inferior to the superolateral border of shoulder
3. Coracoid process
4. 1 inch (2.5 cm) superior to the coracoid process
2 inches (5 cm) medial and inferior to the superolateral border of shoulder
What type of compensating filter is recommended for an AP shoulder projection?
1. Wedge
2. Correct Boomerang
3. Trough
4. Gradient
Boomerang
Which term describes the medial end of the clavicle?
1. Acromial extremity
2. Acromion
3. Correct Sternal extremity
4. Acromial
tuberosity
Sternal extremity
A radiograph of a PA oblique (scapular Y) lateral position reveals that the scapula is slightly rotated (the vertebral and axillary borders are not superimposed). The axillary border of the scapula is determined to be more lateral compared with the vertebral border. Which of the following modifications should be made for the repeat exposure?
1. Decrease rotation of thorax.
2.
Decrease CR angle.
3. Increase rotation of thorax.
4. Abduct the arm more and flex it at the elbow.
Decrease rotation of thorax
True or false: An orthostatic (breathing) technique can be performed for the AP projection of the scapula.
True
A patient enters the ED with a dislocated shoulder. The technologist attempts to
position the patient into the transthoracic lateral projection, but the patient is unable to raise the unaffected arm over his head completely. What can the technologist do to compensate for the patient's inability to raise his arm completely?
1. Perform the Grashey method instead.
2. Use a breathing technique.
3. Increase kV to penetrate through both shoulders.
4. Angle the CR 10° to 15° cephalad.
Use a breathing technique.
True or False: The female clavicle is usually shorter and less curved than that of the male.
True
What is the name of the insertion point for the deltoid muscle located on the anterolateral surface of the humerus?
1. Surgical neck
2. Deltoid protuberance
3. Correct Deltoid tuberosity
4. Intertubercular sulcus
Deltoid tuberosity
True or false? The recommended SID for AP AC joint study is 72 inches (~183cm).
True
A radiograph of an AP oblique (Grashey method) projection for the glenoid cavity reveals that the anterior and posterior rims of the glenoid process are not superimposed. Which of the following modifications should produce a more acceptable image?
1. Angle CR 5° to
10° caudad.
2. Angle CR 5° to 10° cephalad.
3. Increase rotation of the body toward the IR.
4. Abduct the arm slightly.
Increase rotation of the body toward the IR.
A referring physician suspects that a subacromial spur may be the cause for a patient's shoulder impingement. She asks the technologist for a projection that would best demonstrate any possible spurs in the suprasinatus outlet. Which of the
following projections would accomplish this objective?
1. Tangential projection with 10° to 15° caudad angle
2. Tangential projection with 10° to 15° cephalad angle
3. AP oblique shoulder with 45° caudad angle
4. AP shoulder with 10° to 15° caudad angle
Tangential projection with 10° to 15° caudad angle
What additional maneuver must be added to the inferosuperior axial shoulder (Lawrence method)
projection to best demonstrate a possible Hill-Sachs defect?
1. Increase medial CR angulation.
2. Angle the CR 10° to 15° downward or posteriorly in addition to the medial angle.
3. Correct Perform exaggerated external rotation of the affected upper limb.
4. Increase abduction of the affected upper limb.
Perform exaggerated external rotation of the affected upper limb.
Which view and projection of
the proximal humerus is represented in the figure?
1. External rotation, anteroposterior (AP) projection
2. Neutral rotation, AP projection
3. Internal rotation, AP projection
4. External rotation, lateral projection
External rotation, anteroposterior (AP) projection
CR Bilateral AP Frog Leg
CR 3 inches inferior to level of ASIS
CR Axial Outlet Projection
males- 20-35 degrees towards head
females- 30-45 degrees towards head
1-2 inches distal to greater trochanter
CR Axial inlet projection
CR 40 degrees caudal at level of ASIS
Metastatic carcinoma
Malignancy spread to bone via the circulatory, lymphatic systems, or direct invasion
ankylosing spondylitis
a form of rheumatoid arthritis that produces calcifications of the longitudinal ligament of spinal column
When patient presents with osteoarthritis, how should your technique move?
Should be lowered
Pelvic ring fractures
fx resulting from severe blow to one side of pelvis
What projection should be performed with a patient that presents with a pelvic ring fx?
inlet and outlet projections
Depression on the head of femur where a ligament attaches the head into the acetabulum
fovea capitis
How do you get a true AP on hip projections
Turn leg in 15-20 degrees
Function of the obturator foramen
passage for nerves and blood vessels for the lower leg
True/False pelvis
true- birth canal
false-ilium and wings
metastatic cancer
What disease does this patient present with?
What is a natural landmark for the femoral neck?
Inguinal crease
Sacroiliac joint classification/mobility type
synovial/amphiarthroidal
hip joint classification/mobility type
synovial/diarthroidal
symphysis pubis joint classification/joint type
cartilaginous/limited
Union of acetabulum joint classification/joint type
cartilaginous/synarthroidal
How do you position a patient to get the lesser trochanters of the femur in profile?
Heels together, toes apart
What is the largest bone of the pelvic girdle?
Ilium
What bony landmark is located posterior to the acetabulum?
Ischial tuberosity
T/F... The "false pelvis" forms the birth canal in the females
false
Which body landmark should not be visible on a correctly positioned non trauma AP pelvis?
Lesser trochanters
How much rotation of the toes is there on an AP distal femur projection?
5 degrees internally
How much do you flex the knee for a lateral projection of femur?
45 degrees
What is the first projection when dealing with a trauma hip/femur?
AP pelvis
How much do you rotate limbs internally for a trauma AP pelvis/hip?
None. You do not rotate limbs until you are sure there are not fractures
What is another name for the "frog leg" AP projection?
Wiggins
How much should you abduct the leg for the frog leg projection and why?
20-30 degrees for less distortion of the femoral neck
How does the greater trochanter appear in the frog leg projection?
greater trochanter is superimposed over the femoral neck
What are the other names of the AP axial outlet projection?
Taylor method & Uptilt
How should the CR be angled for an axial outlet projection of a male?
20-35 degrees towards head
1-2 inches distal to trochanter
How should the CR be angled for an axial outlet projection of a female?
30 to 45 degrees towards head
1-2 inches distal to trochanter
How is the pelvis going to present in an AP axial outlet projection?
pubic and ischial bones are elongated and magnified
How is the pelvis going to present in an AP axial inlet projection?
sigmoid colon straightened, ischial spines demonstrated
Legg-Clave-Perthes disease usually involves:
Males between 5-10 Years of age
-flattened head of femur and appears fragmented due to poor blood supply
to minimize distortion of the femoral neck for an AP bilateral frog-leg projection, the lower limbs should be abducted:
20-30 degrees
What projection is best suited for the patient with limited movement of both lower limbs to demonstrate a lateral perspective of the proximal femur?
Clements-nakayama method
How is the cassette aligned for an axiolateral (Danelius-Miller method) projection?
Parallel to femoral neck
important joints of the lower limb
hip joint
sacroiliac joint
symphysis pubis
4 parts of the femur
head
neck
greater trochanter
lesser trochanter
angle of the femur neck to shaft on average adult
125 degrees
what is the degree of the longitudinal plane of the femur on an average adult?
10 degrees from vertical
angle of the femur head and neck in relation to the body?
15-20 degrees
why is the the angle of the femur head important?
since the head is projected more anteriorly, to gain a true AP projection the lower legs must be rotated 15-20 internally to place the femoral neck parallel to the IR
what connects the vertebral column and the lower limbs?
pelvis
4 bones of the pelvis
ilium
ischium
coccyx
pubis
innominate bones
ilium, ischium, pubis
lumbosacral joint
L5-S1
where the sacrum articulates superiorly with the fifth lumbar vertebra
sacroiliac joints
where the right and left iliac bones articulate posteriorly with the sacrum
3 divisions of the hip bones
ilium, ischium, pubis
The 2 important positioning landmarks of the ilium?
ASIS
Iliac crest
What is the ischium divided into?
body and ramus
largest foramen in the body
obturator foramen
what bones make of the acetabulum?
ilium
ischium
pubis
what bones make up the obuturator foreman?
ilium
ischium
greater (false) pelvis
above pelvic brim
lesser (true) pelvis
Below pelvic brim
what does the true pelvis form?
birth canal
inlet of true pelvis
outlet of true pelvis
female vs male pelvis
Female: wider, 80-85 degree pubis arch
Male: narrow, deeper 50-60 pubis arch
Female pelvis X-ray
Male pelvis X-ray
classification of sacroiliac joint?
synovial /ampiarthrodial
AP Hip (Unilateral)
CR 4 inches from ASIS, 2 inches medial (perpendicular to femoral neck)
-leg internally rotted 15-20 degrees
What should be in profile for an AP Hip projection?
greater trochanter, femoral neck
-lesser trochanter not seen
Axiolateral Inferosuperior Projection-Trauma
Danelius-Miller Method
Dani-Miller
CR perpendicular to femoral neck (mid femur)
IR perpendicular to CR
Internally rotate leg 15-20 if possible
Grid
Cross table, horizontal beam
Modified Cleaves Method-Hip & Proximal Femur
Unilateral Frog-leg Projection (Mediolateral)
Frog-leg
CR 4in down from ASIS, 2 in medial (into crease)
Leg abducted 45 degrees
what projection would you use if affected hip can not be moved and a lateral view is needed for a fracture?
Danelius-Miller
-Axiolateral Inferosuperior
what projection would you use to get a lateral view of the hip joint for a non-traumatic injury?
Modified cleaves method
-Unilateral Frog-leg Projection
Modified Axiolateral Inferiorsuperior-Possible trauma
Clements-Nakayama Method
Clements-Nakayama
Patient supine with affected side near edge of table. Legs fully extended, neutral position
IR 2in below level of table
IR angled 15 degrees (perpendicular to CR)
Grid
CR centered to femoral neck
CR angled 15-20 posteriorly
what projection would you use for a possible hip fracture when the patient has liminted movement?
Modified Axiolateral Inferiorsuperior
-Clements-Nakayama
AP Pelvis (Bilateral Hips)
CR 2 in below ASIS, centered in middle
internally rotate legs 15-20 degrees
-lesser trochanter not visible
-light field above iliac crest
AP Bilateral Frog-Leg Projection-Pelvis
Modified Cleaves Method
What projection would you use to look for dysplasis of the hip (congenital hip dislocation)?
Ap bilateral frog-leg
bilateral frog-leg
CR centered 3 in below ASIS, middle
top of IR at level of iliac crest
both knees flexed 90 degrees
abduct
legs 40-45 from vertical
AP Axial Inlet Projection
Staunig method
what projection is used to look for posterior displacement of the pelvis? (inward/outward rotation of anterior pelvis)
AP axial inlet
Inlet pelvis
Patient supine
CR level of
ASIS, centered in the middle
CR angled 40 degrees caudal
AP Axial Outlet Projection
Taylor Method
what projection is used to view the bilateral pubis and ischium?
Taylor method- outlet pelvis
Outlet pelvis
Patient supine
CR centered 1-2 in
distal to greater trochanters
CR angled cephalic 20-35 (males) 30-45 (females)
why do you have to angle more for females on an AP outlet projection of the pelvis?
the pubic arch on females is greater than males
posterior oblique projection-pelvis (acetabulum)
Judet Method
Judet method
Patient semisupine
-affected side UP or DOWN
-patient 45 degree oblique (use sponge)
if affected side is down
CR 2in distal 2 in medial from down ASIS
if affected side is up
CR 2 in distal to ASIS
imaginary plane that divides the pelvic region into the greater and lesser pelvis?
pelvic brim
hip joint classification
snyovial
diaarthrodial
ball & socket
sacroiliac joint classification
synovial
ampiarthrodial
limited
symphysis pubis classification
cartilaginous
ampiarthrodial
limited
Acetabulum classification
cartilaginous
synarthrodial
non-movable
what is an indicator of hip fracture?
external rotation of the foot
if hip trauma is suspected what should you do before rotating the patient?
take AP pelvis
-dont move until cleared by doctor
what must be included on an AP and lateral femur?
knee and hip joint
if the left iliac wing appears elongated on an AP pelvis image what positioning error has occurred?
left side is rotated toward the IR
what degree are the femurs abducted for a bilateral frog leg projection?
40-45
what is the angle of the CR for a female AP axial-outlet (Taylor Method) projection?
30-45
what best demonstrates anterior pelvic bone fractures?
posterior oblique pelvis (Judet method)
how much is the body obliqued for Judet Method?
45 degrees
how do you angle the CR for Clements-Nakayama Method?
15-20 posterior for horizontal
what projection would you use to assess trauma to pubic and ischial structures?
Taylor method
what projection demonstrates anterior and posterior rims of the acetabulum and ilioischial and iliopubic columns?
Judet method
what degree of hip abduction is used on the unilateral frog leg?
20-30 from vertical
if the lesser trochaters are clearly seen on an AP pelvis what is the positioning error?
feet need rotated 15-20 degrees internally
on an AP pelvis the right iliac wing is forshortened, what is the error?
patient is in an LPO position, right side is further from the IR
Ankylosing Spondylitis
Begins with fusion of SI joints and follows with extensive calcification of anterior longitudinal ligament of spinal coloumn.
End result is a radiographic characteristic called "bamboo spine"
males mostly affected.
Avulsion (evulsion) Fractures of the Pelvis
difficult to diagnose if not imaged properly.
lower kv (75-85kvp) needed to detect on AP pelvis.
usually occurs in adolescent athletes
Chondrosarcoma
A malignant tumor of the cartilage
usually occurs in pelvis and long bones of men 45+
may be removed surgically if not responsive to radiation or chemotherapy.
Developmental Dysplasia of the Hip (DDH)
aka congenital dislocation of the hip (CDH)
caused by conditions present at birth and may require frequent hip radiographs.
Legg-Calve-Perthes Disease
most common type of aseptic or ischemic necrosis.
lesions usually involve 1 hip (head or neck of femur)
usually ocurs in boy 5-10yrs.
limp is usually first clinical sign
presents radiographically as a flattened femoral head (may appear fragmented)
Metastatic Carcinoma
malignancy spread to bone by the circulatory of lymphatic system.
metastatic tumors are more common than primary malignancies.
most commonly presents in red bone marrow sites such as spine, skull, ribs, pelvis, and femora
Osteoarthritis (Degenerative Joint Disease DJD)
normal part of aging process.
most common and first evident in weight bearing joints such as the hips.
joint cartilage and adjacent bone degenerate, causing pain and stiffness. new growths of bone and cartilage are evident (osteophytes)
Pelvic Ring Fractures
the nature of a closed ring pelvis is such that, a severe blow or trauma to one side of pelvis can result in a fracture site opposite the side of trauma, requiring a radiographic visualization of entire pelvis.
Proximal Femur (Hip) Fractures
most common in geriatric patients w/ osteoporosis or avascular necrosis (loss of blood circulation causing cell death)
leads to weakening or collapse of weight bearing joints such as the hip and occur w/ only minimal trauma.
Slipped Capital Femoral Epiphysis (SCFE)
occurs during rapid growth, typical of 10-16 year olds where minor trauma can precipitate development. epiphysis appears shorter and the epiphyseal plate wider w/ smaller margins
Sacroiliac joint classification
synovial
mobility-
amph
movement- limited
Symphysis pubis classification
cartilaginous
mobility- amph
movement- limited
Union of acetabulum classification
cartilaginous
mobility- synarthrodial
movement- nonmovable
Hip joint classification
Synovial
mobility-
diarthrodial
movement- ball and socket
Movements of the hip joint
flexion/extension
abduction/adduction
medial/lateral rotation
circumduction
CR AP Pelvis
CR perp midway between ASIS and the symph pubis. About two inches inferior to level of ASIS
AP Bilateral Frog Leg Pelvis (Modified Cleaves) CR
CR Perp at 3 inches below level of ASIS
AP Bilateral Frog Leg Pelvis Positioning
Flex knees 90 degrees and abduct femora 40-45 from vertical
(20-30 degrees abduction provides least foreshortening in femoral necks but foreshortening in proximal femora)
AP Axial Outlet Projection: Taylor Method CR
CR angled 20-35 degrees cephalic for males
CR angled 30-45 degrees for females
@ 1-2 inches distal to greater trochanters/symphasis pubis
AP Axial Inlet Projection CR
CR angled 40 degrees caudal @ level of ASIS
What are they looking at on an AP Axial Inlet Projection?
Ischial spines
PA Axial Oblique Projection (teufel) CR and position
Patient PA in 35-40 anterior oblique (looking at downside anatomy)
CR 12 degrees cephalad @ 1 inch superior to level of greater trochanter
AP Unilateral Hip CR
CR @ femoral neck, about 1-2 inches medial and 3-4 inches distal to ASIS
TRAUMA axiolateral inferosuperior projection: Danelius miller
CR @ perpendictular to femoral neck and IR
(T or F) An AP pelvis projection using 90 kV and 8 mAs results in less patient dose than a projection using 80 kV and 12 mAs ( for both males and females)
true
A radiograph of an AP pelvis projection reveals that the lesser trochanters are readily demonstrated on the medial side of the proximal femurs. The patient is ambulatory but has a history of early osteoarthritis in both hips. Which positioning modification needs to be made to prevent this positioning error?
Rotate the lower limbs 15-20 degrees internally to place the proximal femurs in a true AP position
What does KUB stand for?
kidneys, ureters, bladder
What allows kidneys to be seen on an xray?
The fat capsules surrounding them
Difference between 2 way and 3 way abdomen?
3 way includes a chest X-ray to look for free air under the diaphragm
when is a small bowel study complete?
When contrast reaches the Ileocecal valve
Abdominal muscle locates near lumbar vertebral column
Psoas major muscle
Reasons to do an acute abdominal series
1. peritoneal air
2. ascites
3. mass
How long is the small bowel?
15-18 ft
parts of the small intestine in descending order
1. duodenum
2. jejunum
3. ileum
What quadrant is the liver located in?
RUQ (right upper quadrant)
What is cholelithiasis?
stones in the gallbladder
Liver in relation to the peritoneal cavity
Intraperitoneal
Gallbladder in relation to the peritoneal cavity
intraperitoneal
Spleen in relation to the peritoneal cavity
intraperitoneal
stomach in relation to the peritoneal cavity
intraperitoneal
jejunum in relation to the peritoneal cavity
intraperitoneal
ileum in relation to the peritoneal cavity
intraperitoneal
Cecum in relation to the peritoneal cavity
intraperitoneal
transverse colon in relation to the peritoneal cavity
intraperitoneal
sigmoid colon in relation to the peritoneal cavity
intraperitoneal
Where is the CR located for a left lateral decubitus abdomen?
2 inches above the iliac crest
which projection would best demonstrate an umbilical hernia?
lateral
kV range for a KUB of an adult
80 kVp at 40 mAs
How should a KUB prone or supine be evaluated for rotation?
Rotation of the iliac crests
How should the radiographer correct the centering for an image of the supine abdomen that reveals the obturator foramen has been cut?
Cr is too high, bring the bottom of the IR to the level of the greater trochanter
What is the difference between a PA and AP abdomen?
Iliac wings are flipped
Three clinical indications for an acute abdominal series
bowel obstructions, ascites, pnemoperitoneum, chrones disease, volvulus, paralytic ileus
An image of an AP abdomen demonstrates elongation of the right iliac wing, how should this be corrected?
Patient Is rotated too much
Which projection will best demonstrate an abdominal aortic aneurysm?
Dorsal decubitus
What is the most common abdominal radiograph?
AP supine often called the KUB (kidneys, ureters, and bladder)
Plain radiographs are taken without the use of what?
contrast
Acute abdominal series may show what?
bowel obstruction
perforations involving:
free
intraperitoneal air
excessive fluid in abdomen
intra-abdominal mass
air outside the digestive tract
intraperitoneal air
how many radiographs are taken on an acute abdominal series?
2 or 3
What 3 muscles are the most important in abdominal radiography
diaphragm, and 2 Psoas majors
What 2 muscles should be faintly visible on an abdominal radiograph?
The lateral borders of the 2 Psoas majors
What are the accessory organs for the digestive system?
Liver, Gallbladder, and Pancreas
Where is the esophagus located?
Mediastinum of the thoracic cavity
What are the tree digestive organs within the abdominal cavity?
Stomach, small intestines, and large intestines
What is the expandable reservoir for swallowed food and fluids?
Stomach
What is the entire digestive system called?
Gastrointestinal (GI) tract
Where does the GI tract start?
Stomach
What are the 3 parts of the small intestine?
Duodenum, Jejunum, and Ileum
How long is the small intestine?
4.5-5.5 m (15-18 feet)
What is the first portion of the small intestine?
Duodenum
What is the shortest but widest of the three segments of the small intestine?
Duodenum
What is the proximal portion of the duodenum called?
Duodenal bulb or cap
What ducts empty into the Duodenum?
Liver, gallbladder, and pancreas
What is the first 2/5 after the Duodenum called?
Jejunum
What are the distal 3/5 of the small intestine called?
Ileum
What connects the Ileum to the large intestine?
Ileocecal valve
Should you see air filling the entire stomach or small intestine on a healthy adult?
No
What quadrant does the large intestine begin in?
right lower quadrant (RLQ)
What is the portion of the large intestine below the ileocecal valve called?
Cecum
What is attached to the posteromedial aspect of the cecum?
Appendix (vermiform appendix)
What is the vertical portion of the large intestine above the Cecum?
Ascending colon
What quadrant is the Ascending colon in?
right lower quadrant (RLQ)
What joins the ascending colon and and transverse colon?
Right colic (hepatic) flexure
What joins the transverse colon and the descending colon?
Left colic (splenic) flexure
What is the S-shaped section of the descending colon called?
Sigmoid colon
What quadrant is the Sigmoid colon in?
Lower left quadrant LLQ
What is the final 15 cm of the large intestine called?
Rectum
The rectum ends at the what?
Anus
What is the sphincter muscle at the terminal opening of the large intestine?
Anus
Is the location of the large intestine the same in a hypersthenic type and a hyposthenic type?
No
Where would the transverse colon be on a hypersthenic type?
high in the abdomen
Where would the transverse colon be on a hyposthenic type?
low in the abdomen
The spleen is part what system?
Lymphatic
Is the spleen located posterior or anterior in the abdominal cavity?
posterior
Where is the spleen located?
posterior and to the left of the stomach in the left upper quadrant (LUQ)
If enlarged can the spleen be seen on a plain abdominal radiograph?
Yes, faintly
Where is the pancreas located?
posterior to the stomach and near the posterior abdominal wall, between the duodenum and the spleen
How long is the pancreas?
about 12.5 cm (6 inches)
What is the "romance of the abdomen"
where the head of the pancreas sits in the curve of the C shape of the duodenum
Is the pancreas part of the endocrine or exocrine secretion system?
Both, endocrine because it secretes insulin into the bloodstream to control blood sugar levels, and exocrine because it secretes digestive juices into the duodenum.
Is the lumen of the digestive tract considered internal or external?
External
What is the largest solid organ in the body?
Liver
What quadrant is the liver located in?
Right upper quadrant (RUQ)
Where does the liver store its bile?
Gallbladder
What is the pear-shaped sac located below the liver called?
Gallbladder
Is the gallbladder seen without contrast normally?
No
What are the structures of the Urinary system?
2 kidneys, 2 ureters, urinary bladder, and urethra
What connects the kidneys to the urinary bladder?
ureters
Where is the urinary bladder located?
above and behind the symphysis pubis
What are the glands that sit superomedial on the kidneys?
Suprarenal (adrenal) glands
Where are the kidneys located?
On each side of the lumbar vertebral column
Which kidney sits a bit lower and why?
The right, because of the large liver
What is the function of the kidneys?
To filter waste materials and excess water from the blood
What is the radiographic examination of the urinary system performed with IV contrast medium called?
Intravenous Urogram (IVU)
What is the large serous, double-walled sac like membrane called?
Peritoneum
What are the 2 types of peritoneum called?
Parietal peritoneum, and the Visceral peritoneum
What is the outermost peritoneum that covers that adheres to the cavity wall?
Parietal peritoneum
What is the peritoneum that covers the organ called?
Visceral peritoneum
What is the space or cavity between the parietal and visceral portion of the peritoneum called?
Peritoneal cavity
An abnormal accumulation of the serous fluid in the peritoneal cavity is called what?
ascites
If organs are only partially covered by the visceral peritoneum and are closely attached to the posterior abdominal wall they called what?
Retroperitoneal
A double fold of peritoneum that loosely connects the small intestine to the posterior abdominal wall
Mesentery
A specific type of double fold peritoneum that extends from the stomach to another organ
Omentum
extends superiorly from the lesser curvature of the stomach to portions of the liver
Lesser omentum
connects the transverse colon to the greater curvature of the stomach inferiorly
Greater omentum
drapes down over the small bowel then folds back on itself to form an apron along the anterior abdominal wall
Greater omentum
Peritoneum that attaches the colon to the posterior abdominal wall
Mesocolon
What are the four forms of mesocolon?
Ascending, descending, transverse, and sigmoid or pelvic
The major portion of the peritoneal cavity
Greater sac or peritoneal cavity
A smaller portion of peritoneal cavity, located posterior to the stomach
Lesser sac or omentum bursa
Structures closely attached to the posterior abdominal wall
Retroperitoneal
Are retroperitoneal structures less mobile?
Yes
What structures are retroperitoneal?
Kidneys
Ureters
Adrenal glands
Pancreas
C loop of duodenum
Ascending and Descending Colon
Upper rectum
Major abdominal blood vessels (Aorta and inferior vena cava)
Organs located under or beneath the peritoneum
Lower rectum, urinary bladder and reproductive organs
Organs within the abdominal cavity that are partially or completely covered by some type of visceral peritoneum that are not infra or retro peritoneal
Liver
Gallbladder
Spleen
Stomach
Jejunum
Ileum
Cecum
Transverse
Colon
Sigmoid Colon
Tor F The lower aspect of the peritoneum is a closed sac and ends above the urinary bladder, separating the reproductive organs in the male?
True
Tor F the lower aspect of the peritoneum is a closed sac in the female?
False, In females, the uterus, uterine tubes, and ovaries pass directly into the peritoneal cavity
What level would the horizontal or transverse plane be for the four abdominal quadrants?
Level of the umbilicus around L4 or L5, Iliac crest on a female
Where is the vertical plane located for the four abdominal quadrants?
Midsagittal plane, passing through the umbilicus and symphysis pubis
What anatomy can be found in the RUQ of the abdomen?
Liver
Gallbladder
Right colic (hepatic) flexure
Duodenum
Head of pancreas
Right kidney
Right suprarenal gland
What anatomy can be found in the LUQ of the abdomen?
Spleen
Stomach
Left colic (splenic) flexure
Tail of the pancreas
Left kidney
Left suprarenal
gland
What anatomy can be found in the RLQ of the abdomen?
Ascending colon
Appendix (vermiform)
Cecum
2/3 of Ileum
Ileocecal valve
What anatomy can be found in the LLQ of the abdomen?
Descending colon
Sigmoid colon
2/3 of Jejunum
How many regions are in the abdomen?
9
What are the 2 vertical planes of the 9 regions called?
Right and left lateral planes
What are the two transverse/horizontal planes called?
Transpyloric and transtubercular planes
What level is the transpyloric plane located?
L1
What level is the transtubercular plane located?
L5
Where are the right and left lateral planes of the abdominal regions located?
between the midsagittal plane and each anterior superior iliac spine (ASIS)
What is region A called?
Right hypochondriac
What is region B called?
Epigastric
What is region C called?
Left hypochondriac
What is region D called?
Right lateral (lumbar)
What is region E called?
Umbilical
What is region F called?
Left lateral (lumbar)
What is region G called?
Right inguinal (iliac)
What is region H called?
Pubic (hypogastric)
What is region I called?
Left inguinal (iliac)
What system is used for locations of anatomy by radiographers most the quadrant system or region system?
The quadrant system
What are topographic landmarks?
bony landmarks that are easily palpated and used for locating organs not visible from the exterior
How many landmarks are used for the abdomen?
7
What landmark is atT9-T10, superior margin of the abdomen
Xiphoid process
What landmark is at L2-L3 and is used to locate upper abdominal organs, such as the gallbladder and stomach?
Inferior costal margin
What landmark is at L4-L5, and at the level of the midabdomen
Iliac crest
What landmark is found anteriorly and inferiorly from the iliac crest, and is used for positioning the pelvic and vertebral structures?
Anterior superior iliac spine (ASIS)
What landmark is used instead of the symphysis pubis to locate the inferior margin of the abdomen
Greater trochanter
What landmark corresponds to the inferior margin of the abdomen but may be embarrassing for you to touch
Pubis symphysis
What landmark is used to locate the lower margin of the abdomen when in the prone position, it is 1-4 cm or 1.5 inches lower than the symphysis pubis?
Ischial tuberosity
what breathing technique should we give for abdominal exams?
Full expiration
should we use gonadal shield on all patients?
only males
What exposure factors do we use for abdominal exams?
70-80 kVp at 40 DIR
Abnormal accumulation of fluid in the peritoneal cavity of the abdomen
Ascites
Free air or gas in the peritoneal cavity
Pneumoperitoneum
Complete or nearly complete blockage of the flow of intestinal contents
Dynamic or mechanical bowel obstruction
most common cause of mechanically based obstruction
Fibrous adhesions
chronic inflammation o f the intestinal wall resulting in bowel obstruction in some patients
Crohn's disease
telescoping of a section of bowel into another loop, creating an obstruction
Intussusception
twisting of a loop of intestine, creating an obstruction
Volvulus
nonmechanical bowel obstruction (adynamic)
Ileus
chronic inflammation of the colon
Ulcerative colitis
What does a routine KUB exam consist of
AP supine
What does a routine Acute abdomen exam consist of
AP supine, AP erect, and PA chest erect
Where do you center for an AP supine KUB
Center of IR to level of iliac crest(L4-L5)
Where do you center for a PA prone abdomen
Center of IR to level of iliac crest
Where do you place IR on a Lateral Decubitus?
Top of IR at armpit region or Center of IR 2 inches above level of iliac crest
Where do you center for an erect Abdomen?
Top of IR at the level of the axilla, Center of IR 2 inches above iliac crest
Where do you center for a dorsal decubitus?
Center of IR 2 inches above iliac crest
Where do you center for a Lateral abdomen?
Center IR at level of iliac crest (L4-L5)
What specific clinical indications are we concerned with in an acute abdominal series 3 view
Ileus: (non mech. small bowel ovstruction)
Ascites: (abnormal fluid accumulation)
Perforated hollow viscus :(free intraperitoneal air)
Intra abdominal mass
postoperative abdominal surgery
how long should a patient be upright or decubitus to demonstrate potential intraperitoneal air?
5 minutes
How do you not there is no rotation on a lateral position exam?
superimposition of posterior ribs, and iliac wings
What structure should always be included on an abdominal radiograph?
Diaphragm
What structures should be seen on a KUB/
outline of liver, spleen, kidneys, and air filled stomach and bowel segments and the arch of the symphysis pubis for bladder region MUST include symphysis Pubis
CR of AP knee
1/2 inch distal to apex of patella
Cr of lat knee
1/2 distal to medial condyle
The adductor tubercle is the slightly raised area located on the posterior aspect of the ____________.
Medial condyle of the femur
The popliteal region is located __________.
Behind the knee
What serves as a pivot to increase the leverage of the quad femoris muscle?
Patella
What are bursae?
Fluid filled sacs that lubricate and surround the joints
What type of joint is the patellofemoral joint?
Synovial/saddle
What type of joint is the femoraltibial joint?
Bicondylar
What is the medical term for Runner's knee?
chondromalacia patallae
What is the medical term for Ricketts?
Osteomalacia
Ewing's sarcoma
malignant growth found in the shaft of long bones
"onion peel" look
What method of the knee requires the use of a special IR holding device?
Merchant method
Why is a PA projection of the patella preferred to an AP projection
OID, patella is closer to IR
For AP bilateral upright knees, how much do you rotate legs?
3-5 degrees internally
How much should the CR be angled for AP bilateral knees on a thin patient?
5-10 degrees caudal
How much should the CR be angled for AP bilateral knees for a normal sized patient?
Perpendicular to IR
When will the Rosenburg projection of the knee be ordered?
Cartilage damage and degenerative diseases
How is patient positioned for the Rosenburg method?
Patient erect
Anterior portion of knee touching Bucky with knees flexed 45 degrees
How is the CR positioned for the Rosenburg projection of the knee?
CR angled 10 degrees towards feet (caudal), at midpoint between knee joints, 1/2 inch below apex of the patella
How should a patient be positioned for the Camp-Coventry projection?
Patient prone, flex knee 40-50 degrees
How should the tube be angled for the Camp coventry projection of the knee?
Tube should be parallel to lower leg, CR directed to knee joint
How should a patient be positioned for the kneeling Holmblad projection?
patient on all fours, CR towards knee crease, have patient lean forward 20-30 degrees
How should patient be positioned for the straddling table holmblad projection?
patient with knee on chair while leaning on X-ray table, CR at knee crease, have patient lean forward 20-30 degrees
How should patient be positioned for the Beclere method?
patient supine, knee flexed 40-45 degrees, CR perp to lower leg (40-45), 1/2 inch distal to apex of patella
Difference between lateral knee and lateral patella
no angulation, collimation,knee flexed 5-10 degrees
What patella projection requires a special holding device?
Merchant method
CR of Merchant method
30 degrees from horizontal plane (to femur), mid way between patella
Patient position for hughston method
Patient prone, knee flexed up 50-60 degrees, can use sheet to hold leg
CR of Hughston method
CR angled 45 degree towards head into patella joint
Settegast CR
midway between patellofemoral joint, 15-20 degrees from lower leg
If a patient presents with Osgood-Schlatters disease, what would the routine knee examination consist of?
AP and Lat projection of affected knee
The articular facets of the proximal tibia are also referred to as the
Tibial plateau
The articular facets slope ___* posteriorly
a. 25
b. 45
c. 35
d. 10-15
d
Why must the central ray be angles 5-7* cephalad for a lateral knee position?
because the medical condyle extends lower than lateral condyle of femur
The slightly raised area located on the posterolateral aspect of the medial femoral condyle is called the ______.
adductor tubercle
For which large muscle does the patella serve as a pivot to increase the leverage?
quadriceps femoris muscle
The crescent-shaped fibocartilage disks that act as shock absorbers in the knee joint are called
medial and lateral menisci
Gout
Inherited type of arthritis that commonly affects males; uric deposits in joint spaces
What is the recommended central ray angulation for an AP projection of the knee for a patient with thick thighs and buttocks (measuring greater than 24 cm)
3-5* cephalad
Where is the central ray centered for an AP projection of the knee?
1/2 inch distal to apex of patella
Which basic projection of a knee best demonstrates the proximal fibula free of superimposition?
AP 45 degree medial oblique
For the AP oblique projection of the knee, the ___ rotation best visualizes the lateral condyle of the tibia and the head and neck of the fibula
medial
What is the recommended central ray placement for a lateral knee position on a tall, slender male patient with a narrow pelvis (without support of the lower leg)?
5 degrees ceph
How much flexion is recommended for a lateral projection of the knee?
20-30
What is the best modality to examine ligament injuries to the knee?
MRI
SITUATION: A projection is performed for the patellofemoral joint w/ the patient supine and the knee flexed 40. The CR is angled 30 caudad from horizontal. The cassette is resting on the lower legs supported by a special device. Which method is being described?
Merchant
SITUATION: A radiograph of the knee reveals the joint spaces are not equally open & the proximal fibula is superimposed over the tibia. What positioning error lead to this?
lateral rotation of lower limb
What type of CR angulation & how much flexion is required for PA axial weight-bearing projection (Rosenberg)?
CR- 10 degrees
flexion-45
Osteogenic sarcoma xray presentation
sunburst pattern look
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