image analysis

Question 1

for ribs AP and PA projections above the diaphragm what should be seen? (expiration)

Answer 1

scapula off the lung fields by placing back of hands on the hips, rotating the elbows and shoulders anteriorly (AP)
scapula off the lungs fields by abducting and internally rotating patients arms forcing the shoulders to rotate anteriorly (PA)
-chin is elevated
-9th posterior ribs are demonstrated above the diaphragm indicating full lung aeration (upright 10ribs)
-7th posterior rib in the center of the exposure of the affected side

Question 2

for ribs AP and PA projections below the diapharm what should be seen? (inspiration)

Answer 2

• 8-12 posterior ribs below the diapharm
• 10th posterior rib in the center of the exposure
• part of the thoracic & lumbar vertebral column

Question 3

for a hyperstenic patient with a short wide throax where should the centering be placed for ribs below the diapharm

Answer 3

slightly higher place the IR 5cm above the iliac crest

Question 4

if the ribs below the diapharm only show 3 posterior ribs below the diapharm what happened?

Answer 4

the image was exposed after the patient had taken a deep breathe.
to fix: show more posterior ribs below the diapharm and the image is exposed after the patient exhales

Question 5

when the posterior ribs are affected how is the image taken

Answer 5

in AP to place the posterior ribs closer to the IR with the 7th rib in the middle of the exposure field

Question 6

what should AP Axial C-spine look like

Answer 6

spinous processes aligned down the center
open intervertebral disk spaces 
vertebral bodies without distoration
c4 in the center
see C4-C7

Question 7

how can you detect rotation on the AP Axial C-spine

Answer 7

if the side of the patient is positioned closer to the table or upright IR its the side toward which the mandible is rotated and also side that is demonstrated

Question 8

if the patient has a large lordotic curve…..

Answer 8

the vertebral bodies slant upward anteriorly to posteriorly

Question 9

why do we angle for the cspine?

Answer 9

so the angle is in the same direction oas the slope of the vertebral bodies to open the intervertebral disk spaces

Question 10

if the patient is in a upright position then the cervical vertebrae show?

Answer 10

more lordotic curve than if supine (more straight in the supine position)

Question 11

if the patient is very kyphotic there will be

Answer 11

excessive lordotic curvature and you will need to increase the degree of central ray angulation

Question 12

if on a cspine the spinous processes are not aligned in the middle and pedicles are not symmetrical, the mandible is rotated towards the patients left side and the medial end of the left clavicle shows no vertebral column superimposition what happened

Answer 12

the patient was rotated toward the left side LPO position
- rotate the patient towards the right side until the shoulders are at equal distances and turn the patients head toward the right side till mandible angles and mastoid tips are at equal distances

Question 13

what is the criteria for AP open mouth?

Answer 13

atlas is symmetrical, lateral masses at equal distances from the dens, spinous process in the middle, upper incisors and base of skull seen superior to the dens and atlantoaxial jt, dens in the center

Question 14

most patients in a c-collar for a ap open mouth need

Answer 14

10 degree caudal angle, CR is parallel with the IOML

Question 15

to project the upper incisors superiorly you need

Answer 15

5 degree cephalic angle

Question 16

for a ap open mouth the dens is superimposed over the posterior occipital bone. the upper incisors are demonstrated approx. 1.5” superior to the base of the skull so the patient s head was not accurately positioned how can you fix

Answer 16

tuck the chin toward the chest until the line of the upper occulsal plane and the base of skull are aligned perpendicular to the IR. so tuck in the chin 2cm

Question 17

for a ap open mouth the upper incisors are superimposed over the dens. the base of skull is 1.25cm superior to the upper incisors and 0.6cm superior to the dens so the upper occlusal plane was positioned inferior to the base of the skull how can you fix

Answer 17

elevate the upper jaw until the upper occulsal plane and the base of the skull is aligned perpendicular to the IR

Question 18

for lateral c-spine what is the criteria

Answer 18

see the prevertebral fat stripe

see spinous processes, left and right zygopopyseal jts , c4 in the center, see the c7 & T1 intervertebral jt space

Question 19

for a lateral c-spine the vertebral body of c7 is not demonstrated in its entirety and the superior body of t1 is not demonstrated so the shoulders were not adequately depressed so how would you fix

Answer 19

have the patient hold weights on each arm to depress the shoulders if the patient cannot then do the swimmers projection

Question 20

how should the patient be positioned for a cspine obliques?

Answer 20

done AP or PA

• see 2nd-7th intervertebral foramina open
• open intervertebral disk spaces
• see down to the c7-t1 intervertebral disk space

Question 21

if for the c-spine oblqiues if the pedicles appear forshortened and the intervertebral foramina are peanuts what happened

Answer 21

rotated not enough

Question 22

if for the cspine oblqiues the one side of the pedicles are partially foreshortened but the other side is aligned with the midline of the vertebral bodies what happened

Answer 22

rotated more than 45degrees

Question 23

for a lateral t-spine T8-T12 intervertebral disk spaces are obscured and the vertebral bodies area distorted the veretebral column was not parallel with the table how would you fix

Answer 23

place a sponge under the iliac crest to make the column parallel or angle cepahlad until the column is perpendicular to the t spine (3-5)

Question 24

ap lumbar spine T12 to L3 intervertebral disk spaces are closed and the lumbar bodies are distorted. the ischial spines are demonstrated without pelvic brim superimposition so there was a lordotic curvature in the spine how to fix

Answer 24

flex the hips and knees until the lower back is placed against the table

Question 25

for a lateral lumbar spine the posterior surfaces of the 1st through 4th vertebral bodies and the posterior ribs are demonstrated one anterior to the other, the posterior ribs demonstrate greater mag and were positioned posteriorly how can you fix

Answer 25

rotate the side positioned farther from the IR anteriorly until the posterior ribs are superimposed

Question 26

for a lateral lumbar spine l4-l5 and l5-s1 intervertebral disl spaces are closed and the 3rd through 5th vertebral bodies are distorted so the lumbar vertebral column was not aligned parallel with the IR how would you fix it

Answer 26

place a sponge under the lateral surface just superior to the iliac crest to the align the column parallel with the table

Question 27

for a ap coccyx the pubic symphysis is superimposed over the coccyx and the 2nd through 3rd coccygeal vertebrae are foreshortened so the CR was not angled caudally how can you fix it

Answer 27

angle the CR 10 caudad to project the pubic symphysis off

Question 28

for a PA chest the manubrium is at the level of the 5th t spine and more than 1” of apices superior to the clavicles so the upper midcoronal place was tilted anteriorly how can you fix

Answer 28

move the patients upper thorax posteriorly until the midcoronal plane is vertical

Question 29

for a PA chest the manubrium is at the level of 2nd t spine and less than 1” of apices above superior the clavicles. the upper MCP was tilted away from the IR

Answer 29

move the patients upper throax twd the IR until the MCP is vertical

Question 30

for a lateral chest the right and left posterior ribs are separated by more than 0.5” indicating that the chest was rotated and the gastric bubble is not seen but the superior heart shadow is extending beyond the sternum and into the anterior lung the left lung, the left throax is rotated anterior and the right thorax is rotated posteriorly

Answer 30

position right throax anteriorly half the distance between the posterior ribs about 1”

Question 31

for the lateral chest the right and left posterior ribs are more than a 0.5 inch space so the chest is rotated the superior heart shadow does not extend beyond the sternum and the gastric air bubble is posterior the lung so the right lung is anterior to the sternum and left lung posterior the right throax was rotated anterior and left posterior

Answer 31

postiotion the right throax posterior

Question 32

for an abdomen the sacrum is not aligned with the pubic symphysis and is closer to the left and the distance of the spinous processes is less on the right indicating the patient was rotated toward the right side how should you fix

Answer 32

rotate the patient to the left side until the shoulder and ASIS are at equal distances

Question 32

for an abdomen the sacrum is not aligned with the pubic symphysis and is closer to the left and the distance of the spinous processes is less on the right indicating the patient was rotated toward the right side how should you fix

Answer 32

rotate the patient to the left side until the shoulder and ASIS are at equal distances

Question 33

the vertebral column is deviated laterally at the level of the 2nd thru 4th Lspiine and the sacrum is centered within the inlet of the pelvis indicating scoliosis how to fix

Answer 33

nothing is needed

Question 33

the vertebral column is deviated laterally at the level of the 2nd thru 4th Lspiine and the sacrum is centered within the inlet of the pelvis indicating scoliosis how to fix

Answer 33

nothing is needed

Question 34

upright abdomen and the domes of the diapharm are not included and the CR was centered to inferiorly how can you fix

Answer 34

center the CR and IR 5cm superiorly from the crest

Question 34

upright abdomen and the domes of the diapharm are not included and the CR was centered to inferiorly how can you fix

Answer 34

center the CR and IR 5cm superiorly from the crest

Question 35

the pubic symphysis is not included on the image and the centering was to superiorly

Answer 35

center higher

Question 35

the pubic symphysis is not included on the image and the centering was to superiorly

Answer 35

center higher