Merryl Fulmer Procedures Flashcards
(167 cards)
1
Q
The difference in degrees between the OML and IOML is:
A
7 degrees
2
Q
The difference in degrees between the GML and OML is:
A
8 degrees
3
Q
What is this image:
A
AP Townes View of the Skull
Demonstrates the dorsum selli and posterior clinoid processes portrayed in the shadow of the foramen magnum
Occipital Bone
Symmetrical Petrous Ridges
4
Q
Which sinuses are demonstrated on an AP Townes:
A
NONE
5
Q
What image is this?
A
PA Skull
Petrous Ridges Fill the orbit
CR is perpendicular
6
Q
The PA skull shows what sinuses?
A
the frontal sinuses
7
Q
A
PA Axial (Caldwell) Skull
8
Q
A
Submentovertical
IOML Parallel to the IR
MSP perpendicular
CR perpendicular to the IOML
Sphenoid sinuses, ethmoid sinuses
OML- 30 degrees caudal
IOML- 37 degrees caudal
9
Q
the spongy cancellous bone separating the inner and outer layers of the cortical bone of the skull
A
Diploe
10
Q
A
Waters Method
Demonstrate maxillary sinuses
Done Erect with horizontal beam
MML perpendicular
OML 37 degrees
Petrous ridges below the floor of the maxillary sinuses
11
Q
A
Modified Waters
Petrous ridges in the lower 1/3 of the sinus
OML 55 degrees
chin down
best demonstrates the floor of the orbits
If the patient is having an MRI
12
Q
A
Cervical Vertebrae
holes in 6 of the 7 transverse process
holes are called transverse foramen
C1-C6 have a hole
vertebral artery go up to the brain
C7 does not have a hole
Hole in the vertebrae: vertebral foramen
13
Q
A
AP Cervical Spine, demonstrates C3, C4
Do not see C1 or C2 on the AP C-Spine because the purpose of C1-C3 is the open mouth
14
Q
A
C1- lateral masses of C1
C2- has the dense that fits up into the area of C1
Upper oclusal plane and the mastoid tip perpendicular
15
Q
A
Lateral Cervical Spine
We should be seeing T1
“Ask the patient to take in a deep breath and blow the air out” act of expiration drops the shoulders down
Lateral cervical spine shows the: zygopophyseal joints NOT Intervertebral foramina.
Spine has a lordotic curvature
CR perpendicular
16
Q
A
LPO- right intervertebral foramina
RPO- left intervertebral foramina
45 degree oblique
angle 15-20 cephalic
RAO-
LAO
15-20 caudad
17
Q
A
Flexion (look at feet) of the cervical spine
18
Q
Is this cervical, thoracic, or lumbar?
A
Thoracic Vertebrae (facets attach to the ribs)
19
Q
Which vertebrae?
A
Thoracic Vertebrae
20
Q
A
Lateral Thoracic Spine
Seeing Intervertebral Foramina
21
Q
A
Scoliosis Study
Breast Shields, gonad shield
Scoliosis- lateral curvature of the spine
PA because of breast exposure
22
Q
A
overexposed lumbar spine
hard to see the transverse processes
SI joints- angle cephalic 30-35 degrees to see them better
If patient is in LPO and centered 1 inch medial to ASIS- demonstrates SI Joint
23
Q
What vertebrae?
A
Lumbar
24
Q
Failure of the lamina to unite posteriorly:
A
spina bifida
25
3?
6?
4?
2?
5?
Spinous Process
Body
Superior Articulating Process
Inferior Articulating Process
Transverse Process
26
What position- structures shown?
Oblique Lumbar Spine
Scotty Dogs
27
I.
II.
III.
V.
IV.
IV. neck, pars interarticularis
V- eye, pedical
III. Transverse Process, nose
II. body, lamina
I. ear, superior articular process
foot- inferior articulating process
28
Which is which and which angle?
Sacrum, 15 degree cephalic angle
also do a lateral do both sacrum and coccyx on one exposure
*ask the patient to use the bathroom
29
Which is which and which angle?
Coccyx
*ask the patient to use bathroom
10 degrees caudad
also do a lateral do both sacrum and coccyx on one exposure
30
A radiographic examination of the spinal canal
Myelography
31
The type of injection into the spinal canal is called:
intrathecal
32
The level the injection for a myelography and location of the needle:
L3-L4
location of needle: subarachnoid space cerebrospinal fluid is produced
33
Which one is male and which female?
Left male (acute angle less than 90 degrees)
Right female (angle of pubic bone more than 90 degrees obtuse)
34
Male
35
Right Hip
See the greater trochanter
Do not see the lesser trochanter, rotate the leg 15 degrees inward
Head of the femur sits into the socket called the acetabulum
Top part of acetabulum: iliem
Hole- obterater foramen, made up of pubic and ichium
36
What is the largest foramen in the body?
Obturator Foramen
37
Hysterosalpingograms
girls only
see the entire fallopian tube before it empties out.
If the contrast is spilling out: ducts are patent (good)
done for fertility issues
38
For right posterior rib pain
AP
RPO
39
Right anterior rib pain:
PA
LAO
40
What is the purpose of doing an oblique of the rib?
to see the axillary part of the rib, it brings the rib parallel to the IR.
41
Diaphragm Up or Down
Inspiration or Expiration
Inspiration
Diaphragm moves down
42
Diaphragm Up or Down
Inspiration or Expiration
Expiration
Diaphragm moves down
43
Three reasons why we do inspiration and expiration?
rule out foreign bodies
demonstrate excursion or movement of the diaphragm
44
Why do we do chest x-rays erect?
to allow the diaphragm to move down further
45
Presence of the liver
arrow- sternoclavicular joint, test rotation on a PA chest
46
Left- erect
Right- recumbent
47
left- PA
right- AP
reduce heart magnification (PA)
48
10 pairs of good posterior ribs on a chest x-ray.
male
49
What is wrong with this image?
Done erect
Air fluid levels present
50
What is wrong with this
Person has the heart on the wrong side
Situs Inversus
51
Describe the flow of the heart:
deoxygenated blood enters the heart by way of the superior vena cava and inferior vena cava, the right atrium pumps forcing the blood into the tricuspid valve into the right ventricle, the right ventricle pumps and pushes the blood through the pulmonary valve which is headed towards the lungs, at the lungs you breathe in and out to get the deoxygenated blood to the oxygenated blood, the cells in the lungs by the four pulmonary veins, the veins take the blood through the mitral (bicuspid valve)
The pulmonary artery is the only artery that takes deoxygenated blood
Viens take blood toward the heart
Arterys take blood away from the heart
52
Study, Position, Breathing
Sternum
RAO Sternum
Shallow breathing over a time of three seconds
Long time and low mA
Orthostatic Breathing
53
Why do you do an RAO sternum? If you cant do one what is the other position?
Superimpose the sternum over the heart shadow
LPO
54
What type of breathing for soft tissue neck?
slow inhalation
55
Left- PA abdomen (ala go in)
Right- AP abdomen (ala come out)
56
What study is this?
Upper GI and small bowel
57
What study is this?
IVU
IV urogram
58
What study is this? Position?
Upper GI
Prone (air in fundus)
59
Study and position?
Prone
Small bowel study
60
Study and What demonstrating?
Right Lateral Upper GI
Retrogastric Space
61
Left: polyps (hang down into the lumen of the bowel)
Right: Diverticula (outpouched)
62
What is the purpose of the galbladder?
store bile
63
Label
64
Where is bile produced?
by the liver
65
What is the purpose of bile?
emulsify or breakdown fat
66
ERCP
Endoscopic retrograde cholangiopancreatography
67
Antegrade flow of contrast medium through superficial vein in arm and absorbed in the kidney
IVU (Functional Study)
68
Retrograde flow into the bladder through urethral catheter driven by gravity
Retrograde cystography (structural study)
69
Retrograde flow into bladder through urethral catheter, followed by withdrawl of catheter for imaging during voiding
Voiding Cystourethrography
70
Retrograde injection through brodney clamp or special catheter
Retrograde Urethrography (male)
71
Where do we find Bowans Capsule?
At the Glomerolus
72
Intravenous Urogram (Pyelogram)
73
Retrograde Urogram (Pyelogram)
74
30 degrees LPO
shows the right kidney
left ureter
75
Venipuncture Procedure, Apply the tourniquet:
8-10 cm above the site
3-4 inches above the kidney
76
1. PA Abdomen
2. PA Abdomen Erect
3. PA Abdomen
77
1. PA Abdomen (Hypo/Asthenic Patient)
2. Small bowel
3. IVU IV urogram
*done on expiration
78
What is the best position for the Esophagus?
RAO Esophagus
Esophagus between the vertebrae and the heart
79
Dysphagia
Difficulty Swallowing
80
Dysphasia
Difficulty Speaking
81
Barrette's Esophagus
Stricture or "streaked" appearance of distal Esophagus
82
Achalasia
Stricture or narrowing of esophagus
83
Esophageal Varicies
Narrowing or "worm like" appearance of esophagus
84
zenker diverticulum
Endless recess or cavity in proximal esophagus
85
Meckel Diverticulum
86
Hypertrophic Pyloric Stenosis
Distention of stomach owing to obstruction of pylorus
Vomiting
First noticed in babies
87
Hiatial Hernia
Gastric bubble or protruding aspect of stomach above diaphragm or Schatzki Ring
88
Projectile Vomitting in babies
Hypertrophic Pyloric Stenoisis
89
What study is this?
Upper GI
Patient is Prone, Air in fundus
PA stomach
90
What positition?
The best position for the esophagus.
Removes the esophagus from superimposition and places it between the heart and thoracic spine
91
What study? What position?
RAO Oblique
Upper GI
There is barium in the duodenal bulb and pyloric canal
Air in fundus
92
Right Lateral
Stomach
Shows retrogastric space
93
Chrohn's Disease
Segmants of the lumen narrowed and irregular "cobble stone appearance and "string sign" common
94
Small Bowel Obstruction
Illeus
Mechanical Tumor
95
Feathery Appearance
Jejunum
96
Double Contrast Enema
Barium and Air
Decubitus (Right Lateral Decubitus)
97
Decubitus
Left Lateral Decubitus
Double Contrast Enema
Mucosa lined with barium
98
Upper GI (seeing the stomach)
PA
Air in the fundus
99
Stomach
Hypersthenic Patient
Small Bowel Series
100
Double Contrast Enema
Air in the transverse colon (more anterior)
Supine because there is air in the transverse colon
101
Ventral Decubitus
Air in the rectum
If it is a double contrast study BE: do a right lateral decubitus, left lateral decubitus, ventral decubitus
Single contrast study: Decubitus is not required
102
How do you localize the hip joint?
Feel for the ASIS and Symphysis pubis bisect halfway go down an 1.5 inches at the head of the femur, go down 2 inches your'e at the neck of the femur.
3-5 cm medial
8-10 cm distal
Female patient this is.
103
Cross Table Horizontal Lateral Hip
Danielles Miller Method
-Center to the grid
-do not center, get grid cut off
-raise the patient up
104
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
A. Liver (lower portion of right lobe)
B. Galbladder
C. Small Intestine
D. Spleen
E. Left Kidney
F. Left renal cortex
G. Abdominal Aorta*
H. Right psoas muscle
I. Right ureter
J. Right kidney
The way you view is from below at the end of the table looking up.
105
Voiding Cystourethrogram
RPO of bladder male
Using a brodney clamp*
106
IVU radiograph, demonstrates kidney, ureters, and bladder
contrast absorbed by kidney in collecting system on its way down
Supine
107
Benign prostatic hyperplasis (BPH)
Elevated or indented bladder floor
IVU
108
Inflammation of bladder
Cystitis
109
Staghorn Calculus
110
The Bowmans capsule would be found:
Kidney
111
The functioning unit of the kidney:
nephron
112
What position?
Left lateral rectum
Show rectum on single contrast study
113
Show rectum on double contrast study
Ventral Decubitus
114
Why do you do this?
obliques on an enema open up flextures
Obiques you do when the patient is supine:
RPO and or an LPOx
RPO- left flexture open up
LPO- right flexture open up
115
For a small bowel series what cells would you use?
all three
116
Left Lateral Decubitus
Double contrast study
117
Sims position
Position you are in to insert the enema tip
118
Image intensifier
Lead drapes- 2.5 equivalent
119
Cecal Volvulus
Twisting of the bowel
Only way to correct it is surgery
Beak sign
120
Virtual CT colonoscopy
They still have to go to the GI doctor to get this removed
121
Neoplasm colon cancer with "apple core"
Classic sign of cancer of large intestine
122
Double contrast study pointing to outpouches
Diverticulosis
123
ERCP
Endoscopic Retrograde colangiopancreatography
124
What are some reasons a person may need a BE?
colitis (inflammation of the large intestine)
125
Intravenous Urogram (Pyelogram)
126
Seeing the structure of the collecting system
Retrograde Urogram (Pyelogram)
127
Retrograde Urography
Performed in surgery
Contrast media delivered retrograde through catheter
Lithotomy Position
128
IVU- Posterior Obliques
RPO- left kidney parallel to the IR, right ureter
70-80 kVp for iodine
129
Where do you place the tourniquet for a Venipuncture Procedure?
8-10 cm above the site
130
A?
B?
C?
D?
E?
F?
G?
Minor calyx
Major calyx
Renal Pelvis
Uretopelvic Junction
Proximal Ureter
Distal Ureter
Urinary Bladder
131
The centering for a hand:
3rd metacarpophalangeal joint
132
How many phalanges in the hand?
14
133
3rd metacarpal phalangeal joint
3rd MCP joint
this is a child because we see the epiphysis
134
Secondary center of ossification
Epiphysis
135
Gaynor Hart Position
Tangential Carpal Canal
*know the anatomy
136
1.
2.
3.
4.
5.
6.
1. 1st Metacarpal
2. Greater Multangular or Trapezium
3. Navicular or Scaphoid
4. Hamulus of Hamate
5. Pisiform
6. 5th metacarpal
Gaynor Hart Method
Tangential Carpal Tunnel
137
A.
B.
C.
A. AP elbow (do not see coronoid process in profile) (the head of the radius is superimposed) (Epicondyles are parallel)
B. Pronated Hand, Internal Rotation 45 degrees (Epicondyles 45 degrees)
C. Ap External Position 45 degrees (head of the radius not superimposed) (Epicondyles are 45 degrees
138
Lateral Elbow (Epicondyles perpendicular to IR)
Fat Pads
*Evidence of Fat Pads there is a fracture*
139
What do you do if they patient can not fully extend their arm?
Do two AP
One with humorous parallel to IR
One with the radius and ulna parallel to the IR
CR is perpendicular*
140
How do you get obliques of an elbow if the patient can not extend their arm?
Coyles Method
Pronate the hand
141
Coyles method of the elbow
Oblique of the elbow
Pronate the hand*
45 degree angle both away and toward the elbow
1st image- 90 degrees
2nd image- 80 degrees
Radial head- 90 degrees
Coronoid process- 80 degrees
142
AP internal shoulder
Greater tuberosity in profile
Epicondyles are parallel to the IR
3. coracoid process
143
Inferosuperior axial (Lawrance)
CR directed at the surgical neck
144
Transthoracic lateral shoulder
Breathing technique to blur out the ribs
145
Four positions that you can do orthostatic breathing on:
RAO sternum
Transthoracic lateral
AP scapula
Lateral T-spine
146
What study?
Y-View for scapula
RAO
Effected side against the IR
147
AC Joints
Get both on one IR
Done with weights and without weights to see if there is a ligament tear.
*Weights are draped around the wrist
148
Avulsion Fracture
Chipped fracture
149
attaches muscle to bone
Tendon
150
Attaches bone to bone
Ligament
151
AP Tib Fib
4. Tibia
10. Fibula (lateral to the Tibia) Posterior by 15 degrees
152
Medial Oblique (open up distal tibia fibular joint space)
153
Mortise Ankle
15-20 degrees internally rotated
154
What is this?
AP ankle
2. medial mallioulus
5. lateral mallioulus
155
Where do you center?
the base of the third metatarsal
we have 5 metatarsals
we have 7 tarsals
156
the medial femoral condyle is bigger than the femoral lateral condyle of the knee
Medial femoral condyle is further from the IR than the lateral condyle
angle cephalic on a lateral knee 5-7 degrees
157
30-35 degrees
The base of the fifth metatarsal is the most frequently fractured tarsal bone (Jones Fracture)
158
A. Tangential
159
Camp Coventry (PA- axial intercondyloid fossa)
160
Settegast (tangential patella)
161
A. pattella (Houston)
B. patella (Settegast)
C. patella (Settegast)
162
Intercondyloid fossa
Camp Coventry
163
Patella
Houston
164
Patella
Settegast
165
Bad
Lateral condyle and medial condyle not superimposed
5-7 degrees cephalic angle* NEEDS
166
Adductor Tubercle
167
