Imaging Procedures

Question 1

All the following structures are associated with the posterior femur except:

A. popliteal surface

B. intercondyloid fossa

C. intertrochanteric line

D. linea aspera

Answer 1

intertrochanteric line

EXPLANATION: The femur is the longest and strongest bone in the body. The femoral shaft is bowed slightly anteriorly and presents a long, narrow ridge posteriorly called the linea aspera. The distal femur is associated with two large condyles; the deep depression separating them posteriorly is the intercondyloid fossa (Figure 2–49). Just superior to the large condyles are the smaller medial and lateral epicondyles. The posterior distal femoral surface presents the popliteal surface, whereas the distal anterior surface presents the patellar surface. Proximally, the femur presents a head, neck, and greater and lesser trochanters. The intertrochanteric crest is a prominent ridge of bone between the trochanters posteriorly; anteriorly the intertrochanteric line is seen. The femoral head presents a roughened prominence, the fovea capitis femoris—ligaments attached here secure the femoral head to the acetabulum. (Tortora and Derrickson, 11th ed., p. 249)

Question 2

Which of the following bones participate(s) in the formation of the obturator foramen?

1. Ilium
2. Ischium
3. Pubis

Answer 2

2 and 3 only

EXPLANATION: The obturator foramen is a large oval foramen below each acetabulum and is formed by the ischium and pubis. The acetabulum is the bony socket that receives the head of the femur to form the hip joint. The upper two-fifths of the acetabulum is formed by the ilium, the lower anterior one-fifth is formed by the pubis, and the lower posterior two-fifths is formed by the ischium. Thus, the acetabulum is formed by all three of the bones that form the pelvis—the ilium, the ischium, and the pubis. (Frank, Long, and Smith, 11th ed., vol. 1, p. 335)

Question 3

Which of the following is the preferred scheduling sequence?

A. Lower GI series, abdomen ultrasound, upper GI series

B. Abdomen ultrasound, lower GI series, upper GI series

C. Abdomen ultrasound, upper GI series, lower GI series

D. Upper GI series, lower GI series, abdomen ultrasound

Answer 3

Abdomen ultrasound, lower GI series, upper GI series

EXPLANATION: Diagnostic imaging examinations must be scheduled appropriately. Retained barium sulfate contrast medium can obscure necessary anatomic details in x-ray or ultrasound studies that are scheduled later. Therefore, the ultrasound examination should come first, followed by the lower GI series (BE), and finally the upper GI series. Retained barium from the lower GI series probably will not obscure upper GI structures. (Torres et al., 6th ed., pp. 233–234)

Question 4

At what level do the carotid arteries bifurcate?

Answer 4

C4

EXPLANATION: The common carotid arteries function to supply oxygenated blood to the head and neck. Major branches of the common carotid arteries (internal carotids) function to supply the anterior brain, whereas the posterior brain is supplied by the vertebral arteries (branches of the subclavian). The carotid arteries bifurcate into internal and external carotid arteries at the level of C4. The foramen magnum and pharynx are superior to the level of bifurcation, and the larynx is inferior to the level of bifurcation. (Frank, Long, and Smith, 11th ed., vol. 3, p. 55)

Question 5

The primary center of ossification in long bones is the

Answer 5

diaphysis.

EXPLANATION: Long bones are composed of a shaft, or diaphysis, and two extremities. The diaphysis is referred to as the primary ossification center. In the growing bone, the cartilaginous epiphyseal plate (located at the extremities of long bones) is gradually replaced by bone. For this reason, the epiphyses are referred to as the secondary ossification centers. The ossified growth area of long bones is the metaphysis. Apophysis refers to vertebral joints formed by articulation of superjacent articular facets. (Bontrager, p 9)

Question 6

The apophyseal articulations of the thoracic spine are demonstrated with the

Answer 6

coronal plane 70° to the IR.

EXPLANATION: The thoracic apophyseal joints are demonstrated by placing the patient in an oblique position with the coronal plane 70° to the IR (MSP 20° to the IR). This may be accomplished by first placing the patient lateral, then obliquing the patient 20° “off lateral.” The apophyseal joints closest to the IR are demonstrated in the PA oblique, and those remote from the IR in the AP oblique. Comparable detail is obtained using either method, because the OID is about the same. (Ballinger & Frank, vol 1, p 327)

Question 7

Which of the following is (are) true regarding radiographic examination of the acromioclavicular joints?

1. The procedure is performed in the erect position.
2. Use of weights can improve demonstration of the joints.
3. The procedure should be avoided if dislocation or separation is suspected.

Answer 7

1 and 2 only

EXPLANATION: Evaluation of the acromioclavicular joints requires bilateral AP or PA erect projections with and without the use of weights. Weights are used to emphasize the minute changes within a joint caused by separation or dislocation. Weights should be anchored from the patient’s wrists rather than held in the patient’s hands because this encourages tightening of the shoulder muscles and obliteration of any small separation. (Frank, Long, and Smith, 11th ed., vol. 1, p. 202)

Question 8

The junction of the sagittal and coronal sutures is the

Answer 8

bregma

EXPLANATION: The skull has two major parts: the cranium, which is composed of 8 bones and houses the brain, and the 14 irregularly shaped facial bones (Figure 2–52). The inner and outer compact tables of the cranial skull are separated by cancellous tissue called diploe. The internal table has a number of branching meningeal grooves and larger sulci that house blood vessels. The bones of the skull are separated by immovable (synarthrotic) joints called sutures. The major sutures of the cranium are the sagittal, which separates the parietal bones; the coronal, which separates the frontal and parietal bones; the lambdoidal, which separates the parietal and occipital bones; and the squammosal, which separates the temporal and parietal bones. The sagittal and coronal sutures meet at the bregma, which corresponds to the fetal anterior fontanel. The sagittal and lambdoidal sutures meet posteriorly at the lambda, which corresponds to the fetal posterior fontanel. The parietal, frontal, and sphenoid bones meet at the pterion, the location of the anterolateral fontanel. The highest point of the skull is called the vertex. (Frank, Long, and Smith, 11th ed., vol. 2, pp. 278–279)

Question 9

Below-diaphragm ribs are better demonstrated when

Answer 9

the patient is in the recumbent position.

EXPLANATION: The ribs below the diaphragm are best demonstrated with the diaphragm elevated. This is accomplished by placing the patient in a recumbent position and by taking the exposure at the end of exhalation. Conversely, the ribs above the diaphragm are best demonstrated with the diaphragm depressed. Placing the patient in the erect position and taking the exposure at the end of deep inspiration accomplishes this. (Frank, Long, and Smith, 11th ed., vol. 1, p. 490)

Question 10

To make a patient as comfortable as possible during a single-contrast barium enema (BE), the radiographer should

1. instruct the patient to relax the abdominal muscles to prevent intra-abdominal pressure
2. instruct the patient to concentrate on breathing deeply to reduce colonic spasm
3. prepare a warm barium suspension (98–105°F) to aid in retention

Answer 10

1 and 2 only

EXPLANATION: To reduce anxiety prior to the examination, the radiographer should give the patient a full explanation of the enema procedure. This explanation should include keeping the anal sphincter tightly contracted, relaxing the abdominal muscles, and deep breathing. The barium suspension should be either just below body temperature (at 85–90°F) to prevent injury and bowel irritation or cold (at 41°F) to produce less colonic irritation and to stimulate contraction of the anal sphincter. (Bontrager and Lampignano, 6th ed., p. 503)

Question 11

Which of the following equipment is necessary for ERCP?

1. A fluoroscopic unit with imaging device and tilt-table capabilities
2. A fiberoptic endoscope
3. Polyethylene catheters

Answer 11

1, 2, and 3

EXPLANATION: A fluoroscopic unit with spot device and tilt table should be used for endoscopic retrograde pancreatography. The Trendelenburg position is sometimes necessary to fill the interhepatic ducts, and a semierect position may be necessary to fill the lower end of the common bile duct. Also necessary are a fiberoptic endoscope for locating the hepatopancreatic ampulla and polyethylene catheters for the introduction of contrast medium. (Frank, Long, and Smith, 11th ed., vol. 2, p. 116)

Question 12

Which of the following may be used to evaluate the glenohumeral joint?

1. Scapular Y projection
2. Inferosuperior axial
3. Transthoracic lateral

Answer 12

1, 2, and EXPLANATION: The scapular Y projection is an oblique projection of the shoulder and is used to demonstrate anterior or posterior shoulder dislocation. The inferosuperior axial projection may be used to evaluate the glenohumeral joint when the patient is able to abduct the arm. The transthoracic lateral projection is used to evaluate the glenohumeral joint and upper humerus when the patient is unable to abduct the arm. (Frank, Long, and Smith, vol. 1, 11th ed., p. 189)
3

Question 13

Important considerations for radiographic examinations of traumatic injuries to the upper extremity include

1. the joint closest to the injured site should be supported during movement of the limb.
2. both joints must be included in long bone studies.
3. two views, at 90 degrees to each other, are required.

Answer 13

2 and 3 only

EXPLANATION: All traumatic injuries require the radiographer to be particularly alert and observant. Patient status must be observed and monitored continually. The radiographer must speak calmly to the patient, explaining the procedure even if the patient appears unconscious or unresponsive. In the case of an injured limb, both joints must be supported if any movement is required. Both joints also must be included when examining long bones. The injured limb need not be placed in exact AP and lateral positions, but any two views of the part at right angles to each other must be obtained. (Frank, Long, and Smith, 11th ed., vol. 2, pp. 32–33)

Question 14

The AP oblique projection (medial rotation) of the elbow demonstrates which of the following?

1. Radial head free of superimposition
2. Olecranon process within the olecranon fossa
3. Coronoid process free of superimposition

Answer 14

2 and 3 only

EXPLANATION: The AP oblique projection (medial rotation) of the elbow superimposes the radial head and neck on the proximal ulna. It demonstrates the olecranon process within the olecranon fossa, and it projects the coronoid process free of superimposition. The radial head is projected free of superimposition in the AP oblique projection (lateral rotation) of the elbow. (Saia, p 10)

Question 15

Which of the following examinations involves the introduction of a radiopaque contrast medium through a uterine cannula?

Answer 15

Hysterosalpingogram

EXPLANATION: Hysterosalpingography involves the introduction of a radiopaque contrast medium through a uterine cannula into the uterus and uterine (Fallopian) tubes. This examination is often performed to document patency of the uterine tubes in cases of infertility. A retrograde pyelogram requires cystoscopy and involves introduction of contrast medium through the vesicoureteral orifices and into the renal collecting system. A voiding cystourethrogram also requires cystoscopy and involves filling the bladder with contrast medium and documenting the voiding mechanism. A myelogram is performed to investigate the spinal canal. (Frank, Long, and Smith, 11th ed., vol. 2, p. 262)

Question 16

The AP projection of the coccyx requires that the CR be directed

1. 15 degrees cephalad
2. 2 inches superior to the pubic symphysis
3. to a level midway between the ASIS and pubic symphysis

Answer 16

2 only

EXPLANATION: The AP projection of the coccyx requires the CR to be directed 10 degrees caudally and centered 2 inches superior to the pubic symphysis. The AP projection of the sacrum requires a 15-degree cephalad angle centered at a point midway between the pubic symphysis and the ASIS. (Bontrager and Lampignano, 6th ed., p. 344)

Question 17

Valid evaluation criteria for a lateral projection of the forearm requires that

1. the epicondyles be parallel to the IR.
2. the radius and ulna be superimposed distally.
3. the radial tuberosity should face anteriorly.

Answer 17

2 and 3 only

EXPLANATION: To accurately position a lateral forearm, the elbow must form a 90-degree angle with the humeral epicondyles perpendicular to the IR and superimposed. The radius and ulna are superimposed distally. Proximally, the coronoid process and radial head are superimposed, and the radial head faces anteriorly. Failure of the elbow to form a 90-degree angle or the hand to be lateral results in a less than satisfactory lateral projection of the forearm. (Frank, Long, and Smith, 11th ed., vol. 1, p. 142)

Question 18

During an upper gastrointestinal (GI) examination, a stomach of average shape demonstrates a barium-filled fundus and double contrast of the pylorus and duodenal bulb. The position used is most likely

Answer 18

LPO

EXPLANATION: With the body in the AP recumbent position (or LPO position), barium flows easily into the fundus of the stomach (from the more distal portions of the stomach), displacing/drawing the stomach somewhat superiorly. The fundus, then, is filled with barium, whereas the air that had been in the fundus is now displaced into the gastric body, pylorus, and duodenum, illustrating them in double contrast. Double-contrast delineation of these structures allows us to see through the stomach to the retrogastric areas and structures. The RAO position demonstrates a barium-filled pylorus and duodenum. Anterior and posterior aspects of the stomach are visualized in the lateral position; medial and lateral aspects of the stomach are visualized in the AP projection. (Frank, Long, and Smith, 11th ed., vol. 2, p. 142)

Question 19

During lower-limb venography, tourniquets are applied above the knee and ankle to

1. suppress filling of the superficial veins.
2. coerce filling of the deep veins.
3. fill the anterior tibial vein.

Answer 19

1 and 2 only

EXPLANATION: During lower-limb venography, tourniquets are applied above the knee and ankle to suppress filling of the more superficial veins and coerce filling of the deep veins. The anterior tibial vein may be blocked when tourniquets are used. The patient is positioned so that the table is tilted with the head up to slow the transit time of the contrast medium, in order that images may be obtained of the entire lower-limb and pelvic area. (Ballinger & Frank, vol 2, p 542)

Question 20

The innominate bone is located in the

Answer 20

pelvis.

EXPLANATION: The two innominate bones (os coxae) make up the pelvis. Each innominate bone is made three bones: ilium, ischium, and pubis. These three bones contribute to form the formation of the acetabulum. When the interior of the acetabulum is viewed, the ilium comprises its upper two-thirds, the ischium comprises its lower posterior two-thirds, and the pubis comprises the lower anterior one-third of the acetabulum. (Bontrager and Lampignano, 6th ed., p. 263)

Question 21

Which of the following may be used to evaluate the glenohumeral joint?

1. Scapular Y projection
2. Inferosuperior axial
3. Transthoracic lateral

Answer 21

1, 2, and 3

EXPLANATION: The scapular Y projection is an oblique projection of the shoulder that is used to demonstrate anterior or posterior shoulder dislocation. The inferosuperior axial projection may be used to evaluate the glenohumeral joint when the patient is able to abduct the arm. The transthoracic lateral projection is used to evaluate the glenohumeral joint and upper humerus when the patient is unable to abduct the arm. (Frank, Long, and Smith, 11th ed., vol. 1, p. 189)

Question 22

In which of the following projections is the talofibular joint best demonstrated?

Answer 22

Medial oblique

EXPLANATION: The AP projection demonstrates superimposition of the distal fibula on the talus; the joint space is not well seen. The 15- to 20-degree medial oblique position shows the entire mortise joint; the talofibular joint is well visualized, as well as the talotibial joint. There is considerable superimposition of the talus and fibula in the lateral and lateral oblique projections. (Frank, Long, and Smith, 11th ed., vol. 1, p. 291)

Question 23

Which of the following skull positions will demonstrate the cranial base, sphenoidal sinuses, atlas, and odontoid process?

Answer 23

Submentovertical (SMV)

EXPLANATION: The SMV projection is made with the patient’s head resting on the vertex and the CR directed perpendicular to the IOML. This position may be used as part of a sinus survey to demonstrate the sphenoidal sinuses or as a view of the cranial base for the basal foramina (especially the foramina ovale and spinosum). It also demonstrates the bony part of the auditory (eustachian) tubes. AP or PA axial projections are used frequently to demonstrate the occipital region or evaluate the sellar region. A lateral projection is usually part of a routine skull evaluation. The parietoacanthal projection is the single best position to demonstrate facial bones. (Frank, Long, and Smith, 11th ed., vol. 2, p. 324)

Question 24

Which of the following positions will demonstrate the lumbosacral apophyseal articulation?

Answer 24

30-degree RPO

EXPLANATION: The articular facets (apophyseal joints) of the L5-S1 articulation form a 30-degree angle with the MSP; they are, therefore, well demonstrated in a 30-degree oblique position. The 45-degree oblique position demonstrates the apophyseal joints of L1–4. (Frank, Long, and Smith, 11th ed., vol. 1, p. 432)

Question 25

The uppermost portion of the iliac crest is at approximately the same level as the

Answer 25

fourth lumbar vertebra

EXPLANATION: Surface landmarks, prominences, and depressions are very useful to the radiographer in locating anatomic structures that are not visible externally. The costal margin is at about the same level as L3. The umbilicus is at approximately the same level as the L3–4 interspace. The xiphoid tip is at about the same level as T10. The fourth lumbar vertebra is at approximately the same level as the iliac crest. (Frank, Long, and Smith, 11th ed., vol. 1, p. 63)

Question 26

During chest radiography, the act of inspiration

1. elevates the diaphragm
2. raises the ribs
3. depresses the abdominal viscera

Answer 26

2 and 3 only

EXPLANATION: With inspiration, the diaphragm moves inferiorly and depresses the abdominal viscera. The ribs and sternum are elevated. As the ribs are elevated, their angle is decreased. Radiographic density can vary considerably in appearance depending on the phase of respiration during which the exposure is made. (Bontrager and Lampignano, 6th ed., p. 84)

Question 27

To demonstrate the pulmonary apices with the patient in the AP position, the

Answer 27

central ray is directed 15° to 20° cephalad.

EXPLANATION: When the shoulders are relaxed, the clavicles are usually carried below the pulmonary apices. To examine the portions of the lungs lying behind the clavicles, the central ray is directed cephalad 15° to 20° to project the clavicles above the apices when the patient is examined in the AP position. (Ballinger & Frank, vol 1, p 472)

Question 28

Which of the following statements regarding myelography is (are) correct?

1. Spinal puncture may be performed in the prone or flexed lateral position.
2. Contrast medium distribution is regulated through x-ray tube angulation.
3. The patient’s neck must be in extension during Trendelenburg positions.

Answer 28

1 and 3 only

EXPLANATION: Myelography is radiologic examination of the structures within the spinal canal. Opaque contrast medium is usually used. Following injection, the contrast medium is distributed to the vertebral region of interest by gravity; the table is angled Trendelenburg for visualization of the cervical region and in the Fowler position for visualization of the thoracic and lumbar regions. Although the table is Trendelenburg, care must be taken that the patient’s neck is kept in acute extension to compress the cisterna magna and keep contrast medium from traveling into the ventricles of the brain. (Bontrager and Lampignano, 6th ed., p. 763)

Question 29

Which of the following is (are) valid criteria for a lateral projection of the forearm?

1. The radius and ulna should be superimposed proximally and distally.
2. The coronoid process and radial head should be superimposed.
3. The radial tuberosity should face anteriorly.

Answer 29

2 and 3 only

EXPLANATION: To accurately position a lateral forearm, the elbow must form a 90° angle with the humeral epicondyles superimposed. The radius and ulna are superimposed only distally. Proximally, the coronoid process and radial head are superimposed, and the radial head faces anteriorly. Failure of the elbow to form a 90° angle or the hand to be lateral results in a less than satisfactory lateral projection of the forearm. (Saia, p 95)

Question 30

Which of the following is (are) accurate positioning or evaluation criteria for an AP projection of the normal knee?
Femorotibial interspaces equal bilaterally.
Patella superimposed on distal tibia.
CR enters 1/2 in. distal to base of patella.

Answer 30

1 only

EXPLANATION: In the AP projection of the normal knee, the space between the tibial plateau and the femoral condyles is equal bilaterally. It is, therefore, important that there be no pelvic rotation that could change the appearance of an otherwise normal relationship. The AP projection of the knee superimposes the patella and femur. The CR should enter at the knee joint, located 1/2 in. distal to the patellar apex. (Frank, Long, and Smith, 11th ed., vol. 1, p. 302)

Question 31

Which of the following articulates with the base of the first metatarsal?

Answer 31

First cuneiform

EXPLANATION: The base of the first metatarsal articulates with the first (medial) cuneiform. The base of the second metatarsal articulates with the second (intermediate) cuneiform; the third base of the metatarsal articulates with the third (lateral) cuneiform. The bases of the fourth and fifth metatarsals articulate with the cuboid. The navicular articulates with the first and second cuneiforms anteriorly and the talus posteriorly. (Bontrager, p 198)

Question 32

Which of the following positions would best demonstrate the left apophyseal articulations of the lumbar vertebrae?

Answer 32

LPO

EXPLANATION: The posterior oblique positions (LPO, RPO) of the lumbar vertebrae demonstrate the apophyseal articulations closer to the image receptor. The left apophyseal articulations are demonstrated in the LPO position, while the right apophyseal articulations are demonstrated in the RPO position. The lateral position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes. (Saia, p 131)

Question 33

Which of the following bony landmarks is in the same transverse plane as the symphysis pubis?

Answer 33

Prominence of the greater trochanter

EXPLANATION: The most prominent part of the greater trochanter is at the same level as the pubic symphysis—both are valuable positioning landmarks. The ASIS is in the same transverse plane as S2. The ASIS and the pubic symphysis are the bony landmarks used to locate the hip joint, which is located midway between the two points. (Bontrager and Lampignano, 6th ed., p. 38)

Question 34

To demonstrate esophageal varices, the patient must be examined in

Answer 34

the recumbent position

EXPLANATION: Esophageal varices are tortuous dilatations of the esophageal veins. They are much less pronounced in the erect position and always must be examined with the patient recumbent. The recumbent position affords more complete filling of the veins because blood flows against gravity. (Frank, Long, and Smith, 11th ed., vol. 2, p. 138)

Question 35

The right anterior oblique of the cervical spine requires which of the following combinations of tube angle and direction?

Answer 35

15° to 20° caudad

EXPLANATION: The cervical intervertebral foramina lie 45° to the midsagittal plane (MSP) and 15° to 20° to a transverse plane. When the posterior oblique position (LPO, RPO) is used, the central ray is directed 15° to 20° cephalad and the cervical intervertebral foramina demonstrated are those farther from the image recorder. There is therefore some magnification of the foramina (because of the OID). In the anterior oblique position (LAO, RAO), the central ray is directed 15° to 20° caudad, and the foramina disclosed are those closer to the image recorder. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 404-406)

Question 36

In the 15° medial oblique projection of the ankle, the

1. tibiofibular joint is visualized.
2. talotibial joint is visualized.
3. malleoli demonstrated in profile.

Answer 36

2 and 3 only

EXPLANATION: The medial oblique projection of the ankle can be performed either as a 15° to 20° oblique or as a 45° oblique. The 15° to 20° oblique demonstrates the ankle mortise, that is, the articulations between the talus, tibia, and fibula. The 45° oblique opens the distal tibiofibular joint. In all three cases, it is often recommended that the plantar surface be vertical. (Bontrager and Lampignano 7th ed p. 236)

Question 37

Which of the following shoulder projections can be used to evaluate the lesser tubercle in profile?

Answer 37

Internal rotation position

EXPLANATION: The internal rotation position places the humeral epicondyles perpendicular to the IR, the humerus in a true lateral position, and the lesser tubercle in profile. The external rotation position places the humeral epicondyles parallel to the IR, the humerus in a true AP position, and the greater tubercle in profile. The neutral position is used often for the evaluation of calcium deposits in the shoulder joint. (Frank, Long, and Smith, 11th ed., vol. 1, p. 178)

Question 38

The thoracic apophyseal joints are demonstrated with the

Answer 38

midsagittal plane 20 degrees to the IR.

EXPLANATION: The thoracic apophyseal joints are demonstrated in an oblique position with the coronal plane 70 degrees to the IR (MSP 20 degrees to the IR). This may be accomplished by first placing the patient lateral and then obliquing the patient 20 degrees “off lateral.” The apophyseal joints closest to the IR are demonstrated in the PA oblique projection and those remote from the IR in the AP oblique projection. Comparable detail is obtained using either method because the OID is about the same. The thoracic intervertebral foramina are demonstrated in the lateral projection. This places the MSP of the patient parallel to the IR, and the coronal plane perpendicular to the IR. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 421–423)

Question 39

The esophagus commences at about the level of

Answer 39

C6.

EXPLANATION: The esophagus is a musculomembranous tube commencing at about the level of the cricoid cartilage, that is, C5–6. It is located posterior to the larynx and trachea and extends to about the level of T11, where it joins with the proximal stomach. (Bontrager and Lampignano, 6th ed., p. 447)

Question 40

In the lateral projection of the scapula, the

1. vertebral and axillary borders are superimposed.
2. acromion and coracoid processes are superimposed.
3. inferior angle is superimposed on the ribs.

Answer 40

1 only

EXPLANATION: A lateral projection of the scapula superimposes its medial and lateral borders (vertebral and axillary, respectively). The coracoid and acromion processes should be readily identified separately (not superimposed) in the lateral projection. The entire scapula should be free of superimposition with the ribs. The erect position is probably the most comfortable position for a patient with scapular pain. (Frank, Long, and Smith, 11th ed., vol. 1, p. 214)

Question 41

Which type of articulation is evaluated in arthrography?

Answer 41

Diarthrodial

EXPLANATION: Diarthrodial joints are freely movable joints that distinctively contain a joint capsule. Contrast medium is injected into this joint capsule to demonstrate the menisci, articular cartilage, bursae, and ligaments of the joint under investigation. Synarthrodial joints are immovable joints composed of either cartilage or fibrous connective tissue. Amphiarthrodial joints allow only slight movement. (Frank, Long, and Smith, 11th ed., vol. 1, p. 73)

Question 42

When evaluating a PA axial projection of the skull with a 15-degree caudal angle, the radiographer should see

1. petrous pyramids in the lower third of the orbits
2. equal distance from the lateral border of the skull to the lateral rim of the orbit bilaterally
3. symmetrical petrous pyramids

Answer 42

1, 2, and 3

EXPLANATION: A PA axial projection of the skull with a 15-degree caudad angle will show the petrous pyramids in the lower third of the orbits. If no angulation is used, the petrous pyramids will fill the orbits. Either PA projection should demonstrate symmetrical petrous pyramids and an equal distance from the lateral border of the skull to the lateral border of the orbit on both sides. This determines that there is no rotation of the skull. (Frank, Long, and Smith, 11th ed., vol. 2, p. 314)

Question 43

The contraction and expansion of arterial walls in accordance with forceful contraction and relaxation of the heart are called

Answer 43

pulse

EXPLANATION: Since the heart contracts and relaxes while functioning to pump blood from the heart, arteries that are large and those that are in closest proximity to the heart will feel the effect of the heart’s forceful contractions in their walls. The arterial walls pulsate in unison with the heart’s contractions. This movement may be detected with the fingers in various parts of the body and is referred to as the pulse. (Tortora and Derrickson, 11th ed., p. 754)

Question 44

Which of the following projections of the ankle would best demonstrate the mortise?

Answer 44

Medial oblique 15 to 20 degrees

EXPLANATION: The 15-degree medial oblique projection is used to demonstrate the ankle mortise (joint). Although the joint is well demonstrated in the 15-degree medial oblique projection, there is some superimposition of the distal tibia and fibula, and greater obliquity is required to separate the bones. To best demonstrate the distal tibiofibular articulation, a 45-degree medial oblique projection of the ankle is required. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 289–290)

Question 45

In the anterior oblique position of the cervical spine, the CR should be directed

Answer 45

15 degrees caudad to C4

EXPLANATION: The anterior oblique positions (LAO and RAO) of the cervical spine require a 15-degree caudal angulation and demonstrate the intervertebral foramina closest to the IR. The posterior oblique positions (LPO and RPO) require that the CR be directed cephalad 15 degrees to C4. The posterior oblique positions demonstrate the intervertebral foramina farther away from the IR. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 404–406)

Question 46

An AP oblique (lateral rotation) of the elbow demonstrates which of the following?

1. Radial head free of superimposition
2. Capitulum of the humerus
3. Olecranon process within the olecranon fossa

Answer 46

1 and 2 only

EXPLANATION: The radial head and neck are projected free of superimposition in the AP oblique projection (lateral rotation) of the elbow. The humeral capitulum is also well demonstrated in this external oblique position. The AP oblique projection (medial rotation) of the elbow superimposes the radial head and neck on the proximal ulna. It demonstrates the olecranon process within the olecranon fossa, and it projects the coronoid process free of superimposition. (Bontrager and Lampignano, 6th ed., p. 171)

Question 47

The term varus refers to

Answer 47

turned inward

EXPLANATION: The term varus refers to bent or turned inward. In genu varus, the tibia or femur turns inward causing bowlegged deformity; in talipes varus, the foot turns inward (clubfoot deformity). The term valgus refers to a part turned/deformed outward—as in hallux valgus and talipes valgus. Hallux valgus is angulation of the great toe away from the midline; talipes valgus is a foot deformity with the heel turned outward—a component of clubfoot. (Bontrager and Lampignano, 6th ed., p. 26)

Question 48

Which of the following conditions is often the result of ureteral obstruction or stricture?

Answer 48

Hydronephrosis

EXPLANATION: Hydronephrosis is a collection of urine in the renal pelvis owing to obstructed outflow, such as from a stricture or obstruction. If the obstruction occurs at the level of the bladder or along the course of the ureter, it will be accompanied by the condition of hydroureter above the level of obstruction. These conditions may be demonstrated during IVU. The term pyelonephrosis refers to some condition of the renal pelvis. Nephroptosis refers to drooping or downward displacement of the kidneys. This may be demonstrated using the erect position during IVU. Cystourethritis is inflammation of the bladder and urethra. (Taber, p. 1022)

Question 49

Blood is returned to the left atrium, from the lungs, via the

Answer 49

pulmonary veins.

EXPLANATION: Deoxygenated blood is collected by the superior and inferior vena cava and emptied into the right atrium.
Pulmonary circulation conveys deoxygenated blood from the right ventricle, through the pulmonary semilunar valve, into the pulmonary artery (the only artery that carries deoxygenated blood), and into the lungs where the blood becomes oxygenated. The oxygenated blood from the lungs is carried via the four pulmonary veins (the only veins that carry oxygenated blood) and emptied into the left atrium. (Tortora, 11th ed, p 792)

Question 50

All the following positions are used frequently to demonstrate the sternoclavicular articulations except

A. weight-bearing
B. RAO
C. LAO
D. PA

Answer 50

weight-bearing

EXPLANATION: Sternoclavicular articulations may be examined with the patient PA, either bilaterally with the patient’s head resting on the chin or unilaterally with the patient’s head turned toward the side being examined. The sternoclavicular articulations also may be examined in the oblique position, with either the patient rotated slightly or the CR angled slightly medialward. Weight-bearing positions are used frequently for evaluation of acromioclavicular joints. (Frank, Long, and Smith, 11th ed., vol. 1, p. 480)

Question 51

The floor of the cranium includes all the following bones except

A. the temporal bones
B. the occipital bone
C. the ethmoid bone
D. the sphenoid bone

Answer 51

the occipital bone

EXPLANATION: The skull is divided into two parts—the cranial bones and the facial bones. There are eight cranial bones. Four of them comprise the calvarium—the frontal, the two parietals, and the occipital. The bones that comprise the floor of the cranium are the two temporals, the ethmoid, and the sphenoid. (Bontrager and Lampignano, 7th ed., p. 372)

Question 52

Pacemaker electrodes can be introduced through a vein in the chest or upper extremity, from where they are advanced to the

Answer 52

right ventricle

EXPLANATION: Pacemakers are electromechanical devices that help to regulate the heart rate. They consist of a pulse generator connected to a lead that has an electrode at its tip. The lead is introduced under fluoroscopic guidance into the subclavian vein, then moved to the right atrium, and finally positioned at the apex of the right ventricle. (Bontrager and Lampignano, 6th ed., p. 647)

Question 53

The advantages of digital subtraction angiography over film angiography include

1. greater sensitivity to contrast medium
2. immediately available images
3. increased resolution

Answer 53

1 and 2 only

EXPLANATION: Superimposition of bony details frequently makes angiographic demonstration of blood vessels less than optimal. The method used to remove these superimposed bony details is called subtraction. Digital subtraction angiography (DSA) accomplishes this through a computer. The advantages of DSA over film angiography include greater sensitivity to contrast medium, immediate availability of images, and lower total cost. Although DSA applications are increasing, film angiography may be preferred in cases in which resolution is critical. (Frank, Long, and Smith, 11th ed., vol. 3, p. 28)

Question 54

Which of the following is (are) located on the proximal aspect of the humerus?

1. Intertubercular groove
2. Capitulum
3. Coronoid fossa

Answer 54

1 only

EXPLANATION: The intertubercular (bicipital) groove is located on the proximal humerus, distal to the head, between the greater and lesser tubercles. The distal humerus articulates with the radius and ulna to form the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, which articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar notch of the ulna. Just proximal to the capitulum and the trochlea are the lateral and medial epicondyles; the medial is more prominent and palpable. The coronoid fossa is found on the anterior distal humerus and functions to accommodate the coronoid process with the elbow in flexion. (Tortora and Derrickson, 11th ed., p. 325)

Question 55

Which of the following articulates with the base of the fifth metatarsal?

Answer 55

Cuboid

EXPLANATION: The bones of the foot include the seven tarsal bones, five metatarsal bones, and 14 phalanges. The calcaneus (os calsis) serves as the attachment for the Achilles tendon and articulates anteriorly with the cuboid bone.

Articulating anteriorly with the navicular are the three cuneiform bones: medial/first, intermediate/second, and lateral/third. The navicular articulates laterally with the cuboid. The bases of the fourth and fifth metatarsals articulate with the cuboid. The fifth (most lateral) metatarsal projects laterally and presents a large tuberosity at its base making it very susceptible to fracture. (Tortora, 11th ed, p 250)