Jerica's Radiology Final Flashcards

1
Q

The function of the collimator on the x-ray machine includes all of the following except:

reduces the radiation and therefore the volume of irriadiated tissue
reduces the size of the xray beam
reduces the amount of soft radiation

A

reduces the amount of soft radiation

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2
Q

The purpose of a filter in the tubehead is to:

A

filter the long wavelength radiation

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3
Q

The term for the type of switch on the x-ray machine for actually exposing the film to radiation is called a “dead man” switch because:

A

The radiation is terminated if pressure is not kept on the switch at all times

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4
Q

Electrons are created at the filament of the cathode when the filament is heated to incandescence. This process is known as:

A

thermionic emission

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5
Q

Which of these is classified as a semicritcal object?

tube head support arm
film holder
lead apron
treatment chair

A

film holder

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6
Q

All of the following are form of energy except:

light
heat
xradiation
water

A

water

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7
Q

What is the maximum number of electron shells an atom can have?

A

7

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8
Q

Excessive exposure to radiation is reduced by all of the following except:

holding the film in the patient’s mouth
restricting the size of the x-ray beam
safer x-ray machines with shielding
using fast film

A

holding the film in the patient’s mouth

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9
Q

All of the following should be covered with an impervious prior to radiographic procedures except one. Which one is this exception?

PID
exposure switch
treatment chair
film holding device

A

film holding device

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10
Q

All of the following statements about x rays are true except:

travel at the speed of light
travel in convergent lines
have no mass
are invisible

A

travel in convergent lines

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11
Q

The speed of wave

A

velocity

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12
Q

The majority of x rays produced by dental x ray machines are formed by:

A

bremsstrahlung radiation

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13
Q

The greatest exposure to ionizing radiation to the population comes from:

A

background radiation

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14
Q

Which of the following should be used when opening film packets without plastic barrier envelopes?

treatment gloves
over gloves
clean, dry hands
an air-filled glass tube

A

treatment gloves

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15
Q

All of the following conditions must exist for x rays to be produced except:

a target capable of stopping the electrons
a source of free electrons
high voltage to impart speed to the electrons
an air filled glass tube

A

an air filled glass tube

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16
Q

Ordinary household current in the United States is:

A

110-v and 60-cycle AC

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17
Q

Dental x ray machines contain all of the following components except:

automatic processing unit
tube head
extension arm
control panel

A

automatic processing unit

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18
Q

Dental radiographic film has been especially adapted for dental use in all of the following except:

film size
diagnostic clearness
emulsion
film speed

A

diagnostic clearness

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19
Q

The tube head performs all of the following functions except:

prevents overheating of the xray tube
protects the x ray tube from accidental damage
allows non primary beam x rays to escape to prevent pressure build up
incresease the safety of the x ray machine by grounding high voltage components

A

allows non primary beam x rays to escape to prevent pressure build up

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20
Q

All of the following points about the dental x ray machine are correct except:

the x ray tube contains a target capable of stopping the electrons
the control panel may be integrated with the x ray machine tube head supportthe positive anode and the negative cathode are sealed within the x ray tube
the exposure button should be on the end of a three foot timer cord

A

the exposure button should be on the end of a three foot timer cord

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21
Q

The intensity of the x ray beam is affected by all of the following except:

exposure time
kilovoltage
target size
millamperage

A

target size

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22
Q

The PID which most reduces the amount of radiation is the:

A

rectangular

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23
Q

External aiming devices are used in dental x rays because they:

A

allow for more reducible radiograph

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24
Q

The MPD or Maximum Permissable Dose for radiation workers is:

A

one REM per year

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25
How many transformers are used in a dental x ray machine?
3
26
How many electrical circuits are used in a dental x ray machine?
2
27
MAD is figured as the operators age minus 18 times:
5
28
Federal government regulation of the manufacture and installation of dental x ray machines occurred in what year?
1974
29
Greatest sensitivity to radiation
F speed
30
Actively dividing cells are more sensitive to radiation than more slowly dividing cells. The more specialized the cell the less sensitive the cell is to radiation. This theory of cell susceptability is known as:
Law of B and T
31
All of the following is true regarding ionization except: ionization is the gain or loss of electrons ionization is the formation of ion pairs ionizing radiation is any radiation that causes ion pairs ionizing particulates are never naturally occuring
ionizing particulates are never naturally occuring
32
When pure energy causes electrons to fly off in all directions until it uses up all the energy and dissipates or disappears occuring approximately 30% of the time, it is known as:
photoelectric effect
33
The Systeme Internationale (SI) units of measure are:
Coulombs per kilogram, grays, sieverts
34
The term radiopaque refers to the portion of the processed image that is:
white
35
A somatic effect occurs after radiation exposure when:
the biologic change occurs in the individual but not the offspring
36
What metal is used for the focusing cup of the cathode?
molybdenum
37
The electrical pressure sometimes known as the potential difference between two electrical charges is known as:
voltage
38
Acute radiation syndrome ARS symptoms include erythema, nausea, vomitting, diarrhea, hemorrhage, and hair loss. ARS is a particular concern for dental office workers since multiplex ray machines may be present. True or False statements?
the first statement is true and the second is false
39
True or False Equipment Standards that keep the amount of radiation low includes collimation, filtration, and the use of PID's
True
40
True or False the shorter the PID the less the radiation
False
41
True or False F film is not routinely used because it is slower than E film
False
42
True or False Long term exposure to radiation can cause statistical increases in the incidence of cancer, increases in birth defects in children, and decreases in genetic mutations
False
43
True or False We always use a lead apron with a thyroid collar for all dental types of radiographs
False
44
The anode is the negative portion of the tube
False
45
True or False Radioresistant occurs when dividing and the radio station becomes static due to resistant radio waves
False
46
True or False The best quality radiograph is achieved with a longer scale which provides a low contrast radiograph
False
47
True or False The two accepted theories of how radiation damages biologic tissures are the Direct and Indirect theories
True
48
According to the Law of B and T, red blood cells are more sensitive to radiation than heart cells
True
49
Benefits most from a vertical bitewing radiograph rather than horizontal bitewing radiograph
Age 25 years, permanent dentition, severe gingival inflammation, generalized probe readings of 5-8mm
50
With positive vertical angulation, the PID is pointing such thatthe x ray beam will be directed:
Down
51
The coin test may be used to determine:
safelight adequacy
52
A step wedge can be used to test all of the following except one: x ray unit output exposure timer mA setting processing chemistry
processing chemistry
53
Which of the following is false when generalizations as an aid to film mounting? maxillary anterior teeth are wider than mandibular anterior teeth mandibular molars have two roots while maxillary have three most roots curve mesially the occlusal plane curves upward in a smile appearance
most roots curve mesially is false
54
All of the following are advantages of film mounting except one? minimizes misdiagnosis reduces the chance for film damage eliminates the need for duplicate radiographs aids in charting and documentation
eliminates the need for duplicate radiographs
55
The purpose of the lead foil sheet in the film packet is:
to protect the film from backscatter radiation
56
Standard size film
Size 2
57
The speed of a film is determined by the size of the silver halide crystals in the emulsion which means?
the larger the crystals, the faster is the film speed
58
A breakdown of chemicals in the processing solution that results from exposure to air is termed:
Oxidation
59
Unopened boxes of radiographic film should not be stored in the darkroom because:
chemical fumes from processing solutions may fog the film
60
All of the following factors affect the life of the processing solutions except: ``` number of films processed care in preparation of solutions type of safelight filter used age of solutions proper care and maintenance of the automatic processor ```
type of safelight filter used
61
Which of the following are not advantages of the paralleling technique? increased accuracy simplicity of use ease of film placement in all circumstances ease of duplication
ease of film placement in all circumstances
62
Which of the following definitions is correct? parallel-always seperated by the same distance intersecting-to cut through right angle-formed by two parallel lines central ray-central portion of the x ray beam
right angle formed by two parallel lines
63
Reticulation occurs when:
developer/fixer temperature differences are too great
64
Which of the following is the correct vertical angulation used with the bitewing technique? -10 degrees 0 degrees +10 degrees varies per patient
+10 degrees
65
The ALARA concept states that every dose of radiation produces some kind of damage and:
should be kept to the minimum necessary for diagnoses
66
Which of the following describes the primary use of the bitewing radiographic technique? examination of the apical areas of the teeth examination of the apical and interproximal areas of the teeth examination of the interproximal area of the teeth and the alveolar crest level examination of only alveolar crest level
examination of interproximal area of teeth and the alveolar crest level
67
Which of the these films will the dentist most likely prescribe for evaluation of a specific tooth and its surrounding structures? bitewing periapical occlusal panoramic
periapical
68
Overlapped interproximal spaces results from an error made in:
horizontal angulation
69
When using the bisecting technique, which of these errors results from inadequate vertical angulation? (that is the conehead almost straight) elongation foreshortening cone cut overlapping
elongation
70
When utilizing the bisecting technique, the film is placed: parallel to the teeth as close as possible to the teeth as close as possible to the bisector line parallel to the bisector line
as close as possible to the teeth
71
Which utilizing the paralleing technique, the film is place: parallel to the tooth as close as possible to the tooth as close as possible to the bisector parallel to the bisector
parallel to the tooth
72
A herringbone pattern appears across one end of light film. This indicates:
film was placed in backwards in the film holder
73
Unequal distribution of the arches results from an error made in:
vertical angulation
74
Modification of technique may be required because of: large tori shallow palate patient's health all of the above
all of the above
75
The point of entry of the x-ray beam for canines is: tip of nose ala of the nose below the pupil of the eye outer canthus of the eye
ala of the nose
76
When the PID is tipped upward the angulation is: zero degrees parallel to the patient positive negative
negative
77
Another name for interproximal radiographs is: periapicals bitewings occlusals panoramics
bitewings
78
____ film is longer and more narrow, but only one film needs to be taken for bitewings ``` 0 1 2 3 4 ```
3
79
Failure to push the aiming ring in next to cheek before exposing the film results in a radiograph that is:
too light
80
Distortion results when: the film is not parallel to the teeth thus causing the wrong angle for the x-ray beam x-ray beam is perpendicular to the object and film using a short object film distance using a small focal spot
the film is not parallel to the teeth thus causing the wrong angle for the x ray beam
81
Dense objects (such as amalgams) absorb the passage of x rays and therefore appear radiolucent on the radiographic image. True or False?
The first statement is true and the second is false
82
Film fog in the darkroom may be caused by: ``` flurescent lighting afterglow crack in safelight filter prolonged exposure to the safelight any of the above none of the above ```
any of the above
83
The safelight should be no less than ___ from the work area 2 feet 4 feet 6 feet 8 feet
4 feet
84
When mounting a film the dot should: bubble up bubble down-depression be to the top be to the right side
bubble up
85
The purpose of the developer is:
to react with silver crystals activated by the x rays within the latent image
86
The purpose of the fixer is to:
to remove unreacted silver crystals from the image
87
Dental radiographic film has been especially adapted for dental use in all of the following except:
diagnostic clearness
88
An exhausted developing solution will result in a film that is: too light too dark high contrast fogged
too light
89
Replenisher is added to the developing solution to compensate for: oxidation loss of volume loss of solution strength all of the above
all of the above
90
The basic constituents of the developer solution are: reducing agent, activator, preservative, restrainer reducing agent, acidifer, preservative, restrainer clearing agent, activator, preservative, restrainer clearing agent, preservative, hardener, acidifer
reducing agent, activator, preservative, restrainer
91
The emulsion on dental film is composed of all the following except: gelatin crystals silver halide fluoride salts
fluoride salts
92
In manual processing, the optium temperature for the developer is:
68 degrees F
93
Film can be processed outside of a darkroom by using: a dark light proof cloth placed over the hands and film while loading a specialized light resistant film a processor with film unwrapping capability a processor equipped with a daylight loader
a processor equipped with a daylight loader
94
The steps in manually processing film in order are:
developing, rinsing, fixing, washing, drying
95
The purpose of processing is to do all of the following except: brings the latent image to a visible state to take as many radiographs as the insurance company allows preserve the visible image on a permanent record have a legal proof of a condition or lack of condition
to take as many radiographs as the insurance company allows
96
ALARA
as low as reasonably achievable
97
Test 2: Look at bonus #2
Snap aray
98
Duplicators use a: very small 2mA of radiation to the very sensitive duplicator film built in ultraviolet light and timer panoramic film that is sent through the processor on slow none of the above
built in ultraviolet light and timer
99
The bisecting technique uses the ____ casting rules
shadow casting
100
The bisecting technique uses the ____ casting rules
shadow casting
101
When exposing a mandibular periapical radiograph on a patient with a large mandibular tori, where should the film packet be placed?
behind the tori
102
A molar periapical radiograph that is undiagnostic due to overlapped interproximal areas is the result of incorrect:
horizontal angulation
103
Foreshortening or elongation errors are a result of:
vertical angulation
104
A mandibular molar periapical radiograph that did not image the entire second molar results from an error made in which of the following: packet placement vertical angulation horizontal angulation centering the x ray beam
packet placement
105
Radiographs that are too dark result from all of the following except: ``` developer is too hot processing time was too long the developer chemical mix was overactive the film was exposed twice the film was placed in the fixer first ```
The film was placed in the fixer first
106
Which of the following would result in a blank or clear film when processed? non exposure to x rays extending the developing time white light exposure inside the packet overexposure
non exposure to x rays
107
The follwing must be disclosed to the pateint beofre obtaining informed consent: the purpose of the procedure and who will perform it the potential benefits of receiving the procedure the possible risks in having the procedure as well as not having it all of the above
all of the above
108
Incomplete disclosure to the patient before obtaining his or her informed consent may: validate the consent serve as partial consent invalidate the consent none of above
invalidate the consent
109
The ability to share in the patient's emotions and feelings is called:
empathy
110
A substance that inhibits the growth of bacteria:
antiseptic
111
A complete absence of pathogens, or disease causing microorganisms:
asepsis
112
A microorganism capable of causing diease is an:
pathogen
113
The use of a physical or chemical procedure to destroy all pathogens, including the highly resistant bacterial and mycotic spores:
sterilize
114
The use of a chemical or physical procedure to inhibit or destroy pathogens with the exception of baterial and mycotic (fungal) spores:
disinfect
115
The disinfectant that is a chemical germicide labeled as hospital grade that can not destroy spores, TB, or nonlipid virus is:
low level
116
Film holding devices are classified as:
semi-critical objects
117
A dark image may occur because of all of the following except: the aiming ring is not pushed in next to the face before exposure the developer is too concentrated the film is left in the developer too long the developer is too hot
the aiming ring is not pushed in next to the face before exposure
118
A film processed under ideal conditions and used to compare subsequent radiographic images as:
reference film
119
Processing errors can cause all of the following except: cone cuts dark spots brown stains reticulation
cone cuts
120
Test 3- 21
nasal sinus
121
Test 3- 22
sinus
122
Test 3- 23
overlapping
123
Test 3- 24
inverted y
124
Which of the following would appear radiopaque on a radiograph? incisive foramen median palatine suture mental foramen mylohyoid ridge
mylohyoid ridge
125
Test 3- 26
genial tubercles
126
Test 3- 27
a mandibular central periapical
127
Test 3- 28
processing error
128
Test 3- 29
left premolar bite wing
129
Test 3- 30
film placement error
130
All of the following would be likely to appear on a maxillary anterior radiograph except: maxillary tuberosity nasal septum incisive foramen lateral fossa
maxillary tuberosity
131
Which of the following would appear radiolucent on a radiograph? maxillary sinus anterior nasal spine genial tubercles mental ridge
maxillary sinus
132
The ability to recognize errors made when taking dental radiographs will help the oral health care professional to: keep patient radiation exposure to a minimum provide optimal oral health care for the patient properly diagnose oral conditions avoid retake of radiographs not continue to reproduce the same error all of the above
all of the above
133
Which of the following dental materials would appear the most radiolucent in a radiograph? dental amalgam acrylic partial metallic crown implant
acrylic partial
134
All of the following may resemble caries radiographically except: abrasion cervical burnout composite restorations amalgam restorations
amalgam restorations
135
Near the apex of the mandibular second premolars
mental foramen
136
The densities seen on the daily radiograph appear lighter than the densities seen on the reference radiograph. This result indicates: ``` the developer is too weak the developer is too concentrated the developer is too cold either a or c either b or c ```
either a or c
137
On BW radiographs, not being able to see the maxillary crestal bone may be caused by:
incorrect vertical angulation
138
Radiographic evidence of a bone fracture appears as a radiolucent line that may resemble:
nutrient canal
139
Which of the following would be best for imaging a generalized (all over) periodontal status? select periapical radiographs exposed utilizing the bisecting technique select periapical radiographs exposed utilizing the paralleling technique posterior horizontal bitewing radiographs series of vertical bitewing radiographs
series of vertical bitewing radiographs
140
Which of the following would be best for imaging a generalized (all over) periodontal status? select periapical radiographs exposed utilizing the bisecting technique select periapical radiographs exposed utilizing the paralleling technique posterior horizontal bitewing radiographs series of vertical bitewing radiographs
series of vertical bitewing radiographs
141
Radiographs may help to locate all of the following predisposing factors except one. Which one is this exception? calculus occlusal trauma amalgam overhang deep gingival pocket
deep gingival pocket
142
Which of the following terms describes bone loss that occurs in a plane parallel to the cementoenamel junction of adjacent teeth? irregular vertical horizontal periapical
horizontal
143
Which of the following appears radiographically as a radiolucent notch that is less than half-way through the enamel? incipient proximal caries moderate proximal caries advanced proximal caries severe proximal caries
incipient proximal caries
144
Which level of caries appears radiographically as a radiolucent double triangle that is less than half way through the dentin toward the pulp?
advanced proximal caries
145
All of the following mimic caries radiographically except one. Which one is the exception? composite restoration stainless steel crowns cervical burnout mach banding
stainless steel crowns
146
Which of the following appears radiographically as an ill defined saucer shaped radiolucency below the CEJ? proximal caries occlusal caries cemental caries buccal/lingual caries
cemental caries
147
A round or oval radiolucent shape that appears superimposed over the pulp chamber of the tooth may be: interproximal caries occlusal caries cemental caries buccal/lingual caries
buccal/lingual caries
148
Which of the following describes the primary use of the bitewing radiograph? examination of the apical areas of the teeth examination of the apical and interproximal areas of teeth examination of the interproximal areas of the teeth examination of the pulp chambers of the teeth
interproximal areas of the teeth
149
What is the correct vertical angulation used with the bitewing technique?
+10 degrees
150
Mineralized plaque seen opposite the salivary ducts is
dental calculus
151
A diligent search for recurrent caries should be made when radiographs detect: open margins on restorations interproximal restoration overhangs restorations which appear to end short of the preparation margins all of the above
all of the above
152
When placing a size 4 film for an occlusal radiograph, the dot should be placed toward the: mesial distal anterior posterior
anterior
153
The least reliable method of localization is the: definitive-evaluation right angle method tube shift method none of the above
definitive evaluation method
154
All of the following are indications for exposing a panoramic radiograph except: caries detection location of an impaction evaluation of eruption imaging a lesion that is larger than normal film size
caries detection
155
The horseshoe shaped zone of sharpness where an object would be imaged in a panoramic machine is known as the: ghost image cassette drum focal trough intensifying screen
focal trough
156
Distinct pixels, arranged numerically to from a radiographic image is known as a/an:
digital image
157
All of the following may be necessary to produce a digital radiograph except: ``` computer scanner film x ray machine special software ```
film
158
Which of the following types of sensors requires a processing step where the sensor must be read by a laser device? CCD CMOS PSP
PSP
159
Defined as the ability to distinguish between closely spaced objects?
spatial resolution
160
Which of the following infection control methods is required for an intraoral digital sensor? disinfect and cover with a plastic barrier ultrasonic with detergent and dry heat sterilization wash with soap and water and cover with a plastic barrier disinfect and autoclave dispose and get a new one for each patient
Disinfect and cover with a plastic barrier
161
All of the following are considered advantages of digital imaging compared to film except: less radiation less time to produce an image no need for a darkroom initial cost for set up is less
initial cost for set up is less
162
Which of the following will a mandibular cross-sectional occlusal radiograph best image? cleft palate fractured mandible large periapical cyst sublingual swelling
sublingual swelling
163
All of the following are reasons for exposing occlusal radiographs except: ``` locating foreign bodies for use with special needs patients or children examining sinus borders evaluating perio disease revealing sialoliths ```
evaluating perio disease
164
You will see an exaggerated smile on a panoramic film where the patients head is:
tilted chin down
165
Which describes a use of panoramic film? dianosis of caries evaluation of perio disease evaluation of impacted molars evaluation of periapical disease
evaluation of impacted molars
166
Rare earth intensifying screens are recommended in a panoramic radiography because: rare earth screens emit blue light rare earth screens provide a more diagnostic image rare earth screens require less x ray exposure for the patient the images convert faster in automatic processes
rare earth screens require less x ray exposure for the patient
167
The imaginary line that passes from the bottom of the eye socket through the top of the ear canal is termed the:
frankfort plane
168
You will see a frown on a panoramic film where the patient's head is:
tilted chin up
169
You will see the anterior teeth appear skinny and out of focus on a panoramic film where the patient's head is:
the anterior teeth are positioned anterior to the focal trough
170
You will the anterior teeth appear fat and out of focus on a panoramic film where the patient's head is:
the anterior teeth are positioned posterior to the focal trough
171
Radiopaque artifact seen on a panoramic film that is produced when a radiodense object is penetrated twice by the x ray beam: exaggerated smile reverse smile ghost image densosity
ghost image
172
SLOB
Same Lingual Opposite Buccal
173
A dark shadow obscuring the apices of the maxillary anterior teeth in a panorex is most likely caused by which of the following: ``` lead apron in the way facial jewelry not removed chin not rested on chin rest tongue is not resting against palate patient is not occluded on bite guide/cotton roll ```
tongue is not resting against palate
174
Which of the following will a mandibular cross-sectional occlusal radiograph best image? large periapical cyst fractured mandible cleft lip sublingual swelling
sublingual swelling
175
Periodontal bone changes imaged on radiographs include all of the following except: amount of bone loss pattern of bone loss distribution of bone loss current active status of bone loss
current active status of bone loss
176
Where should the embossed dot be positioned when placing an occlusal film packet intraorally?
toward the anterior
177
All of the following should be done to prepare the patient for occlusal radiographs except: explain the procedure prepare the film holder perform a cursory oral inspection ask the patient to remove eyeglasses
prepare the film holder
178
All of the following are true regarding occlusal radiographs except: to detect incipient, interproximal caries to locate soft tissue calcifications to assist in evaluation fractures to reveal supernumerary teeth
to detect incipient, interproximal caries
179
All of the following statements regarding pixels are correct except one. Which one is the exception? the number and size of pixels determines the spatial resolution of an image the more pixels in an image, the higher the resolution and the sharper the image a pixel with a stored number of 0 would be pure white when the number of pixels is low, the image appears to have jagged edges
a pixel with a stored number of 0 would be pure white
180
All of the following statements regarding charge-coupled device sensors are correct except one. Which one is this exception? contains 640 x 480 individual pixels also used in fax machines and video cameras most widely used image receptor in dental digital imaging first developed in the 1990s
first developed in the 1990s
181
All of the following statements regarding intensifying screens are correct except on. Which one is the exception? are sensitive to white light exposure transfer x ray energy into visible light work in pairs receive less radiation to produce an image
are sensitive to white light exposure
182
Which of the following statements regarding intensifying screens is correct? calcium tungstate crystals produce a latent image on the film with less radiation exposure than rare earth screens larger crystals produce an image with greater resolution than smaller crystals the larger the crystal size, the more radiation required to produce an image the thicker the emulsion, the faster the speed of the screen
the thicker the emulsion, the faster the speed of the screen
183
All of the following statements regarding principles of panoramic radiology are correct except one. Which one is the exception? the x ray beam is directed toward the stationary cassette the rotational center is the functional focus of the projection the patient stands or is seated in a stationary position the radiation beam passes through the patient towards the cassette
the x ray beam is directed toward the stationary cassette
184
What teeth should be imaged on a maxillary premolar periapical radiograph
distal portion of the canine, first pre molar, second pre molar, first molar, mesial portion of the second molar
185
All of the following are goals of the dental radiographer except: reducing the radiation dose used during an exposure professional conduct presenting confidence to gain patient acceptance increasing the demand for dental x rays
increasing the demand for dental x rays
186
All of the following may be protected with a plastic barrier to maintain infection control during the radiographic procedure except: film packet film holder exposure button PID and tube head
film holder
187
Which of the following would be the best method for preventing a gag reflex? apply a topical anesthetic use salt on the tip of the tongue provide instructions confidently rinse with an antiseptic mouth rinse
provide instructions confidently
188
Which of the following projections is most likely to intiate a gag reflex? premoler bitewing molar bitewing mandibular canine periapical maxillary molar periapical
maxillary molar periapical
189
The method of show- tell -do is beneficial in all of the following situations except: visually impaired patients children hyperactive individuals patients with a different cultural background and language
visually impaired patients