Mock 2 Flashcards
what are the radiography significant abdominal muscles?
Diaphragm (Umbrella-shaped
Separates thoracic & abdominal cavities)
Psoas (Lateral to vertebral column
Visible on abdominal radiograph)
what are the three accessory organs for digestion?
Liver
Gallbladder
Pancreas
what are the three segments of the small intestine?
Duodenum
Jejunum
Ileum
what is the duodenum?
1st segment of small intestine
Shortest & widest diameter
“C” loop appearance
what is the duodenal bulb or cap?
Proximal portion of duodenum
what makes up 2/5 of the small bowel?
3/5 of the small bowel?
Jejunum
Ileum
what is the ileocecal valve?
Connection between ileum and cecum
what consists in the urinary system?
2 kidneys
2 ureters
1 urethra
1 bladder
2 suprarenal adrenal glands
what is the peritoneum?
what is the visceral peritoneum? parietal?
double walled membrane enclosing the abdominal organs
inner layer
outer layer
what is the omentum?
Double fold peritoneum extending from stomach to another organ
what is the lesser Omentum?
Greater Omentum?
Extends superiorly from lesser curvature of stomach to portions of liver
Connects transverse colon to greater curvature of stomach inferiorly
where is the location for these:
Xiphoid process
Inferior costal margin
Iliac crest
Vertebra Prominens
Jugular notch
Mid-thorax
Larynx
T9 - T10
L2 - L3
L4 - L5
C7
T2/T3
T7
C3 to C6
what is the acute abdomen series?
AP supine abdomen
AP erect abdomen
PA erect chest
what is the kvp for AP erect abdomen?
70-80 kVp
what is the CR for erect AP abdomen?
2” superior to iliac crest
what is ileus?
Inability of intestine (bowel) to contract normally & move waste out
Paralysis of movement to the bowel
what is ascites?
accumulation of fluid in peritoneal
what is pneumoperitoneum?
free air or gas in peritoneal cavity
what is volvulus?
twisting of loop of intestine creating an obstruction
what is intussusception?
Most common with?
Can cause?
Telescoping of bowel onto itself
More common in children
Necrosis in 48 hrs
what is Crohn’s disease?
What does it cause?
Who does it affect mostly?
Chronic inflammation of small bowel
causing fistulas between loops of small bowl
affects young adults
what are the four divisions of the respiratory system?
pharynx, trachea, bronchi, & lungs
what is anterior trachea or esophagus?
trachea is anterior to the esophagus
what device is used for pediatric imaging
Pigg-O-Statt
What are these body types?
Sthenic:
hypersthenic:
hyposthenic:
asthenic:
average physique (50%)
wide physique (5%)
skinny (35%)
sickly/ill (10%
why do we perform chest x-ray at 72”?
reduces distortion (magnification) and increases image resolution
what situs inversus?
heart is on the right side of the body
what is hemothorax?
blood accumulation in the pleural space
what is pneumothorax?
air accumulation in the pleura space
what is emphysema?
lungs lose elasticity and become long in dimension
(become radiolucent, reduce technique)
what is kyphosis?
hump-back curvature
what pathologies can be seen on expiration chest x-ray?
pneumothorax & COPD
in a PA chest x-ray, the mid-sagittal plane is ___ to the x-ray and mid-coronal plane is ____
perpendicular
parallel
where does the diaphragm move during expiration? Inspiration?
moves upward
moves downward
what is the kVp range for a cxr?
110-125 kvp
how many ribs need to be present on a CXR to be diagnostic?
10 ribs
where is the base of the lung located?
apex?
most inferior portion
underneath the clavicles
what is the CR for a CXR?
T7 (mid-thorax)
AP: 3-4 inches inferior to jugular notch
PA: 7-8 inches inferior to C7
what happens to technique for suspected hemothorax?
Pnemothorax?
increase
decrease
what are the 3 parts of the sternum?
manubrium
body
xiphoid process
what is the outer layer of the pleural space called?
inner?
parietal
visceral
what is pleurisy?
inflammation of the pleura
why does the right hemi-diaphragm sit higher than the left?
presence of the liver
what is atelectasis?
collapse of a portion of the lung
(pneumothorax or pleural effusion)
what is pleura effusion?
accumulation of fluid in the pleural cavity
how many phalanges are there?
14
what is the compression of the median nerve referred to as?
carpal tunnel syndrome
what are the four proximal carpals?
four distal?
scaphoid, lunate, triquetrum, pisiform
trapezium, trapezoid, capitate, hamate
what do this phalange articulate with proximally?
first:
second:
third:
fourth:
fifth:
trapezium
trapezoid
capitate
hamate
what articulates with the radius distally?
scaphoid & lunate
The capitulum is part of what bone?
distal humerus
(Lateral side)
What elbow view causes ulna + radius cross over?
internal elbow
(also PA forearm)
What kind of joint is proximal/distal radioulnar?
elbow?
humeroulnar?
humeroradial?
pivot (trochoidal) joint
hinge (ginglymus)
what kind of joints are the interphalangeal joints?
What joint is Metacarpophalangeal? (MCP)
What joint is Carpometacarpal (CMC)? 2-5 CMC?
hinge (ginglymus)
Condyloid (ellipsoidal)
1st digit is Saddle (Sellar) joint
2-5 digits are plane (gliding) joints
what kind of joint is the radiocarpal joint?
ellipsoid (condyloid) joint
what position is the arm in a 90-degree flexion?
lateral
For a lateral view of the second digit what side do we place against the IR? why?
lateral side
reduced OID
lateral fx is best displayed in what view?
AP fx best displayed in?
AP
Lateral
what view of the elbow shows the olecranon process free of superimposition?
Coronoid process?
radial head?
how do we remeber this?
lateral (elbow)
internal oblique
external oblique
ICER (internal=coronoid, external=radial head+capitulum)
what is the view that shows the scaphoid best?
ulnar deviation + 15 degree toward the wrist
what view best shows arthritis in the hand?
carpal tunnel?
ball-catcher
Gaynor-hart method
what view best shows the hook of the hamate (hamulus)?
what is the CR?
Gaynor-hart method
25-30 degrees to the long axis of the hand + 1” distal to the third MCP
what is a colles fx?
what is a smiths fx?
radius & ulna go anterior + distal radius go posterior
radius & ulna go posterior + distal radius goes anterior
what is a Barton’s fx?
what is a Bennett’s fx?
Boxer’s fx?
fx of posterior lip of distal radius (styloid process)
fx at base of first metacarpal
fx at fifth metacarpal (from fights)
what is osteoporosis?
osteopetrosis?
decrease in bone density, decrease technique
hereditary disease resulting in abnormal dense bone, increase technique
what is the CR for elbow views?
forearm?
hand views (PA, OBL, LAT)?
digits?
wrist views (PA, OBL, LAT)
mid-elbow
mid-forearm
3rd MCP, 2nd MCP
PIP joint
mid carpals
what is the name of the process located on the posterior + superior ulna?
when is it best seen?
olecranon process
lateral
what is the name of the fossa located on the posterior distal humerus?
olecranon fossa
what is the name of the process located on the proximal anterior ulna?
coronoid process
how are the elbow epicondyles to the IR for these projections?
AP:
LAT:
Internal/external:
parallel
perpendicular to IR
obliqued
in a trauma instance what view could replace an AP elbow?
2 projections
forearm parallel + humerus parallel, CR mid elbow
what view do you see the fat pads on?
what are the fat pads name?
lateral elbow
anterior, posterior, & supinator fat pad
which Coyle view shows the radial head?
coronoid process?
90 degree arm flexion + 45 degree toward shoulder CR mid-elbow
80 degree arm flexion + 45 degrees away from the head CR mid-elbow
what is the name of the view for the AP thumb projection?
how is it positioned?
what does this rule out?
Roberts view
hand supinated + 15 degrees toward the CMC joint
Bennetts fx
The lateral elbow projection best demonstrates this anatomy free of superimposition?
Olecranon process
Located on distal, lateral end of the humerus?
Capitulum
Fracture of wrist causing posterior radial displacement is called this?
Colles fracture
Ulnar deviation best demonstrates this anatomy?
Scaphoid
Trochlear notch is on this anatomy?
Ulna
This joint is considered freely moveable?
limited movement?
immoveable?
Diarthrodial
Amphiarthrodial
Synarthrodial
For a lateral projection of the humerus how are the epicondyles to the IR? hand placement?
for AP?
perpendicular + pronated
parallel + supinated
What does the acromioclavicular joint articulate with?
What does the sternoclavicular joint articulate with?
What is the medial extremity?
What is the lateral extremity?
Clavicle & acromion
clavicle & sternum
Sternal extremity
Acromial extremity
Deep grove between the two tubercles?
Intertubercular groove
(Bicipital groove)
What does the sternal extremity articulate with?
Manubrium
What are the 3 borders of the scapula?
Superior border, Axillary (lateral) border, & vertebral (medial) border
What are the angles of the scapula?
Superior angle & inferior angle
How many fossa’s on the scapula?
What are the names?
4
Supraspinous fossa (superior, posterior)
Infraspinous fossa (inferior, posterior)
Subscapular fossa (ventral/anterior)
Glenoid fossa (lateral, anterior)
On the Y view of the shoulder, what is shown on the scapula?
Coracoid process (right side)
Acromion (left side)
Inferior angle
Spine of scapula
Body of scapula
What kind of joint is the scapulohumeral (glenohumeral) joint?
AC and SC joints are what type?
what type of joint?
Ball or socket
plane or gliding
freely-moveable/ diarthrodial
What rotation best shows the greater tubercle? how is the hand rotation? how are the epicondyles?
What rotation best shows the lesser tubercle? how is the hand rotation? how are the epicondyles?
External rotation + supination + parallel
Internal rotation + pronation + perpendicular
What is the CR for AP humerus?
What is the CR for Lateral humerus?
What is the CR for Internal Shoulder?
What is the CR for a transthoracic lateral?
mid-humerus
1 inch inferior to coracoid process
surgical neck
What is the CR for Grashey?
35-45 degree LPO/RPO patient oblique
2 inches inferior 2 inches medially from supralateral border of shoulder
What is the CR for a Y shoulder view?
Neer view?
patient rotated 45-60 degrees toward affected side (LAO/RAO)
48” SID
10 x 12 portrait
CR is mid-scapula
10-15 degrees caudad
What is the CR for an Axillary shoulder?
(Superiorinferior)
Scapulohumeral joint
CR for AP Clavicle:
CR for AP axial clavicle:
AP: mid-clavicle
AP-axial: 15-30 degrees cephalic
(25-30 degrees asthenic)
(15-20 for hypersthenic)
CR for AC joints:
1 inch above jugular notch, mid-point AC joints
72 Inch SID
2 views (one with weights, one without)
Why or when do we do the neutral rotation?
What imaging is useful for shoulder joints and rotator cuff tears?
In trauma cases when the patient is unable to rotate
Ultrasound
What is the Hill-Sachs defect?
A compression fx of the humeral head
What is idiopathic chronic adhesive capsulitis?
Frozen shoulder
Caused by chronic inflammation around the shoulder joint
Pain and limited movement
What is osteoarthritis?
Degenerative joint disease
Non-inflammatory
Gradual deterioration
Most common arthritis and normal due to age
What a rotator cuff injury?
Acute or chronic trauma injury to the rotator cuff muscles:
Tere’s minor
Supraspinatus
Infraspinatus
Subcapularis
What is a shoulder dislocation?
Removal of humeral head from glenoid cavity
95% of dislocations are anterior
what is the kvp range for hand, elbow, & shoulder?
50, 60, 70 kVp
What is the CR for Internal Shoulder?
hand pronated
CR 1 inch inferior to coracoid
SID 48”
70 KVP
shows lesser tubercle
INT markers
What position is the greater tubercle superimposed over the humeral head?
Internal rotation
When performing the west point projection this is free of superimposition?
Coracoid process
the scapular notch is located on what part of the scapula?
Superior border
Why do we add weights to the AC joint projection?
to separate the joint spaces
(weight add stress and allow the shoulders to “naturally” fall)
You would use this CR on a asthenic patient when performing an Axial Clavicle exam?
25-30 degrees
(15-20 degrees for larger “hyperstenic” patients)
What is the CR for a transthoracic lateral projection?
surgical neck
(on the humerus in profile)
Where do the medial and lateral borders of the scapula meet?
at the inferior angle
Medial aspect of the clavicle is called?
Sternal extremity (end)
What is the dislocation of the radial head called?
Nurse maid’s jerked elbow/
Pulled elbow
The scapula is required to be in this position for the Neer method?
scapula needs to be lateral
perpendicular to IR
What is the flattened triangular part on the scapula?
Acromion
What is the name of the larger depression on the anterior surface of the scapula?
subscapular fossa
What type of fractures force the splinted pieces through the skin?
Open or compound fx
This is the only bony articulation between the upper extremity and the torso:
Sternoclavicular joint (SC joint)
Another name for the lateral border of the scapula:
Axillary border
In an AP humerus, is the humerus flexed or extended?
What is the rotation of the AP humerus?
extended
external rotation
what consists in the shoulder girdle?
Clavicle
Scapula
NOT HUMERUS
your patient is in a 45-degree posterior oblique position with the affected side closest to the IR. The humeral epicondyles are parallel to the image receptor. CR is 2 inches inferior and 2 inches medial to the supralateral border of the shoulder. Which view would this be?
Grashey
(hint is the CR and epicondyles)
(T/F) we use a breathing technique for transthoracic lateral projection
True
(ALWAYS)
When were X-rays discovered?
by who?
Who discovered fluoroscopy?
November 8, 1895
Wilhelm Conrad Roentgen
Thomas Edison
ALARA stands for?
Largest source of radiation for average human?
As
Low
As
Reasonably
Achievable
(Refers to occupational exposure)
Radon gas
Scientific approach is _________
Self-correcting - it will always change
Unit prefix for hundredths:
Unit prefix for millions:
Unit prefix for thousandths:
Unit prefix for millionths:
Unit prefix for thousands:
centi = c
mega = M
milli = m
micro = Mu
kilo = k
2 types of Mechanical Energy?
what is the law of conservation of energy?
Potential energy & Kinetic energy
Energy can’t be created/destroyed
Energy can only be transformed
what types of energy are these?
Potential Energy:
Conduction heat:
Kinetic Energy:
Convection heat:
Radiation heat:
99% of X-ray tube interactions are ____ interactions
Energy of position
Direct contact
Energy of motion
Mixing of hot & cold molecules
Transfer
Heat
what is the main reason for the use of technique charts?
how do we determine technique?
Consistency
Tissue density (Body part density muscle, air, fat)
Tissue thickness (Measurement of body part thickness)
what are these and where are they located?
proton:
neutron:
electron:
Positively charged particle located in nucleus
No charge particle located in nucleus
Negatively charged particle orbiting nucleus & creating orbital layers
what are atomic shells?
what 2 rules are associated with shells?
Letters: K - Q
Principle Quantum Numbers: 1 - 7
2n^2 rule & Octet rule
what is a nucleon?
what is an Alpha particle?
what is a beta particle?
Protons & neutrons
2 protons & 2 neutrons
20x more damaging than X-rays
(Due to the size)
Breakdown of neutron into positive neutron (now a proton) & high-speed negative electron
what is the z number?
what is the 2n^2 rule?
what is the octet rule?
Number of protons in (elements) nucleus
maximum number of electrons allowed in a shell
outermost shell can never hold more than 8 electrons
what is a mixture?
aka?
what is a molecule?
what is an isotope?
2+ substances not chemically bonded
aka Suspension
2+ atoms chemically bonded together
atom w/ unusual number of neutrons
(Not necessarily radioactive)
what is an ionic bond?
Positive & negative ions attracted to each other electrically
Super strong bond
what is a covalent bond?
Bonding of 2 atoms w/odd number of electrons
2 atoms share “extra” electrons in figure 8 pattern
Much weaker than ionic bond
what is the radioactive state?
what is the ground state?
Nucleus is unstable & spends too much energy holding itself together
most stable configuration of nucleons
(correct number of neutrons to stabilize atom)
what are gamma rays?
what is natural about these?
energy released from unstable nucleus w/o change to atomic structure
naturally occurring X-rays
what are two ways an electron can be removed creating an ion?
Incident electron
Incident x-ray
Outer shell electron gives off its energy in the form of _____
X-ray
what is wavelength?
what is measured in?
distance between two like points on wave
(measured in Angstroms)
Angstrom = 10^ -10 m
what is velocity?
how fast energy of wave moves from one point to another
what is amplitude?
maximum displacement of media from its equilibrium
(strength of the wave, not its energy)
what is tungsten’s symbol?
what is its z number?
what is its K shell quantum number & binding energy?
L shell?
M shell?
W (wolfram)
74
#1 & binding energy of 69 kV
#2 & binding energy of 12 kV
#3 & binding energy of 3 kV
what is the electromagnetic formula?
c (speed of light) = frequency x wavelength
what is frequency?
what is this measured in?
number of cycles passing through a fixed second
hertz
Frequency & wavelength have ___ proportional relationship
inverse
what is velocity equaled too?
velocity= frequency x wavelength
Energy is directly proportional to ___
X-rays have ___ nature
frequency
dual
light photons and physical properties
Radiopaque:
Radiolucent:
Very few X-rays pass thru
X-rays can pass easily thru
Strength of attraction/repulsion of poles follows the ___ law
Magnetic fields are strongest near the ___
Magnetic field - unit of measurement
Inverse square law
poles
Gauss (G) - roughly strength of earth’s magnetic field at the poles
Typical strength of MRI machine
1 Tesla (T) equals ___ gauss
2 Teslas (T)
10,000
Static electricity is generally caused by electrification by ___
To minimize static, humidity should be above ___
friction
40%
Electromotive Force (EMF)
Force created by any electric potential difference
Electrodynamics - Semiconductors
Electrical current flow in certain conditions
Electrodynamics - Conductors
Electrical current flow in most conditions
Current flow & electron flow are in ___ directions
opposite
Electrodynamics - Current
Flow of loosely-bound outer shell electrons
Electrodynamics - Insulators
No electrical current flow
Current - unit of measurement
1 Coulomb per second is equal to ___
Ampere / Amp
1 Coulomb per second
1 ampere
Ohm’s Law:
Formula
V = I x R
Voltage = Current x Resistance
Parallel circuit
Each component is connected to power source independently
Failure of one component only breaks circuit to that component, not the others
Resistance affected by:
Length, Diameter, Material of conductor
Series circuit:
Each component of circuit is connected to each other
Failure of one component breaks the circuit
Electrical power is the rate
RATE at which electrical power is used
what is resistance?
Force preventing electrons from moving thru circuit
what is the unit of measurement for electrical power?
Watt (W)
At frequency of 60 Hertz, each cycle lasts for ___
How many hertz in a second?
1/60th second
60
what is alternating current?
Oscillation of current back & forth
How many pulses in a hertz?
2
3 ways to generate alternating current
1.Move conductor back & forth thru magnetic field - most common
2. Move magnetic field back & forth near conductor
3. Alternate the strength of magnetic field
Step-down transformer, volt & amp goes:
Voltage goes down
Amperage goes up
How many pulses in a second?
120
Step-up transformer
voltage & amperage
Voltage goes up
Amperage goes down
True/False
Induction only works with Alternating Current
True
Autotransformer
Uses concept of self-induction to slightly change voltage in a circuit
What is the Typical incoming line voltage to the high voltage circuit?
220 volts
Autotransformer:
makes adjustments to voltage before it is stepped-up
on low-voltage side of the high voltage circuit for safety
What is part B in the x-ray machine?
Autotransformer
What is part A in the X-ray machine?
Main power switch
&
circuit breaker
Typical incoming line voltage is 220V
Autotransformer (step?):
B
adjusts voltage before stepping up
What is part C in the x-ray machine?
Exposure switch
&
exposure timer
initiates exposure and terminates 1 of 3 ways:
Manual timer
mAs Timer
Automatic exposure control (AEC)
What is part D in the x-ray machine?
kVp Meter
measures the Kvp
(parallel circuit)
What is part E in the Xray machine?
Step-up transformer
turn ratio 500:1 to 1000:1
What is part F in the x-ray machine?
mA meter
Measures the amount of mA
(series circuit)
What is part H in the x-ray machine?
x-ray tube
thermionic emission- cathode (-)
x-ray production- anode (+)
What is part G in the x-ray machine?
Rectification bridge
(changes alternate to direct current)
What is part I in the x-ray machine?
Rotor switch
anode spin at 3400 RPM
heats up the filament
boils off electrons from filament due to high amps and high resistance
What is part J in the Xray machine?
mA selection
(resistors)
What is part K in the x-ray machine?
Step Down Transformer
ratio 1:44
up to 5 amps
xray tube
Cathode:
Thermionic emission:
negative side of the x-ray tube
Thermionic emission
“BOILING OFF” electrons from filament due to high amperage and high resistance
Half wave/self-rectified circuits
60 pulses a second
100% voltage ripple
30% average Kvp
single-phase/ full wave rectified
120 pulses a second
100% voltage ripple
30% average Kvp
3 phase/ 6-pulse generators
360 pulses per second
14% voltage ripple
91% average Kvp
3-phase/ 12-pulse generators
720 pulses per second
4% voltage ripple
97% average Kvp
high frequency generators
greater than 500 pulses
per second 500<
1% voltage ripple
100% average kvp
hz is altered from 60 to 500-25,000 HZ
How many filaments in x-ray tube?
2 filaments
small= 1 cm
large: 1.5-2 cm
What does focal spot do?
Small?
Large?
smaller focal spot creates sharper images
large focal spot better for high heat x-rays (L-spine)
what is heat units for?
to measure how much heat the anode can withstand
(a unit of measurement for anode heat capacity)
Thermionic emission occurs in the:
What is thermionic emission?
Cathode
“boils off” electrons from the filament due to high current flow and high resistance
Focusing cup:
What is its charge?
Negative charge
prevents electrons from rushing away by surrounding the filament (negative focusing cup narrows the electrons due to the law of attraction)
focal spot (in anode) is _% of filament?
5%
(0.5mm-1mm)
Focal spot for hands/feet x-rays:
Small focal spot
1cm
What is space charge?
electron cloud forms around the filament when the rotor button is pushed
mAs directly controls the number:
of x-rays that exit the tube
Doubling mAs will:
double the amount of x-rays created
Target:
A part of what?
Made of what?
area of the anode disk that is struck by the electrons
made of tungsten and rhenium z=75
focal spot for lateral lumbar:
large focal spot
1.5cm to 2cm
Anode is what kind of charge:
positive side of the x-rays tube
Xray production
What is struck by electrons in the x-ray tube?
the target in the anode (anode disk)
very durable to high amounts of heat
Rotor:
A part of what?
Anode
Connects the shaft and spins when influenced by the stator (induction)
What is arcing?
vaporized tungsten coats the inside of the tube
type of short circuit:
1. cracks the glass
2. eliminates vacuum
3. burns out the filament
Main cause of x-ray tube failure?
arcing
What is a way we can protect the x-ray tube?
(3)
1 warm up procedures to prevent thermal shock (hot water on cold glass=crack)
2 avoid excessive rotoring
3 calculate the heat units to prevent overheating of the anode
What is the anode cooling chart purpose?
how long will it take for the anode to cool before making another exposure
What is the purpose for a tube rating chart?
to ensure that a technique will not exceed the heat capacity of an x-ray tube
HU (heat units) formula:
1.4 (constant/ don’t forget)
x
kVp
x
mA
x
s (seconds)
heat interactions:
99.5% of interactions at 60 Kv
99% of interactions at 100 kv
bremsstrahlung is responsible for the:
vast majority of x-rays
stream of electrons:
How fast?
using the voltages in x-ray electrons can accelerate at 1/2 the speed of light in just one inch
Bremsstrahlung:
“braking radiation”
interactions with the nucleus
Characteristic:
projectile electron from CATHODE interacts with INNER shell electron
it can be ejected
In Bremsstrahlung what is the average kv exiting?
(The avg kv after filtration is 1/3 of kvp setting)
the average KV exiting the x-ray tube after filtration is about 1/3 of the kVp setting
Any _____ can fill the vacancy in an inner shell electron, including ____ _______ outside the atom in characteristic
Electrons
Free electrons
Characteristic cascade:
Inner shell electrons are replaced in sequence (k by L,L by M, M by N,N by O).
MULTIPLE x-rays are created
What are the steps of characteristic?
1 electron interacts with inner shell electron
2 outer shell electron will drop down to fill the vacancy (L to K)
3 The strength of the x-ray is equal to the difference between the two shell electrons
Filtration removes what kind of x-rays?
adding more filtration will:
Filtration removes weak x-rays
&
adding more filtration will remove even more weak ones
Increasing the average kvp
The result of characteristic cascade is x-rays at _____ _________
Specific energies
K shell- 57, 66, 68, 69 KV
L shell- 9,11,12 KV
(T/F)
when the Bremsstrahlung spectrum and characteristic spectrum are combined we have a complete graph of all the x-rays leaving the x-ray tube
True
What are factors that affect the x-ray emission spectrum?
1 Target material (mammography)
2 Milliampere-seconds (mAs)
3 added filtration
4 Kilovoltage-peak (kVp)
5 generator type
(3 are of these are most common/ I think 2,3,4)
Increasing the kVp will move:
the x-ray emission spectrum to the right due to the increase energy from x-rays
When we filtrate more x-rays what happens to the average KV?
What is this known as?
the average KV will go up
this is known as “hardening” the x-ray beam
How do generator type play a role in x-ray emission spectrum?
most importantly the average kvp
Changes the pulses, voltage
ripple, average kvp
(high frequency, single phase, etc)
Average KV after exiting the x-ray tube after:
filtration is about 1/3 of the kVp setting
Hardening the x-ray beam:
adding more filtration for weak x-rays
thus increasing the average kVp
At the bridge current:
can flow
(T/F)
free electrons outside of the atom can fill the vacancy of the inner shell?
True
ANY electron
what are these societies?
JRCERT
ARRT
ISRRT
ASRT
AAPA
ACR
Accreditation agency for radiography programs
Certification body for radiography
International Society
Society for Radiologic Technologists
Society for Medical Physicists
American college of radiography
what are accreditation agencies?
what is it for radiology?
ensure education programs meet standards
JRCERT
Which modalities do NOT use ionizing radiation?
MRI
Sonography
what are professional societies?
what is this for radiology?
Voluntary organizations that inform, represent & lead members
ASRT
what are certification bodies?
what is this for radiology?
Accreditation agency for radiography programs
ARRT
what is MQSA?
What is OSHA?
Mammography Quality Standards Act - regulates mammography services on federal level
Occupational Safety & Health Administration
Regulates workplace federally
Minimum of ___ views on all radiographs
2
what is the preferred imaging modality for pediatric patients?
sonography
patients that come to radiology are at low or high levels of the Maslow’s hierarchy?
low
what is the patient interaction for pediatrics?
what is the patient interaction for adolescents?
modesty (important)
get them involved
speak to them as an adult
For history taking, what are the two types of data?
what are they?
subjective data (feelings/attitudes)
objective data (measurable/physiologic)
wheel-chair transfers should occur with w/c at a ____ angle to the ____
45 degree
table
where is the center gravity located?
at the level of the second sacral segment
what are the 4 principles of lifting?
communication
patient does most work
hold patient close
watch for orthostatic hypotension (faint after standing to quickly)
what are the steps for a w/c transfer?
lock stretcher
get patient involved
use slider board
three people needed for assisted transfer
what is the goal of immobilization techniques?
to reduce motion
what are the rules for trauma applications?
initial images should include the device
device can only be removed after receiving permission
what is the main rule with restraints?
do not remove restraint without authorization
do not restrain without permission
what is the average temperature for these?
Oral:
axillary (armpit):
tympanic:
temporal (head):
rectal:
98.6 degrees
97.6 degrees
97.6 degrees
100 degrees
99.6 degrees
what is the range for hyperthermia?
hypothermia?
Higher than 99.5 degrees
Below 97.7 degrees
what is the average adult respiratory rate?
child?
12 to 20 breaths per minute
20 to 30 breaths per minute
what are the pulse rates for adults?
child?
60 to 100 bpm
70 to 120 bpm
what is tachypnea?
bradypnea?
Fast breathing rate
Slow breathing rate
what is tachycardia?
what is bradycardia?
Fast pulse rate
Slow pulse rate
what is the normal oxygen saturation for pulse oximeter?
95-100%
what is the normal range for blood pressure
120/80 systolic/diastolic
what is hypotension?
hypertension?
Below normal blood pressure
Above normal blood pressure
Oxygen is considered a ______
what is the color of the oxygen flowmeter?
drug
Green
what is a central line?
what are the most common insertion sites?
catheter inserted into large vein
subclavian vein preferred also internal jugular & femoral vein
what is bacteria?
classified:
diseases associated with bacteria?
single celled organism reside in host as colony
by shape
strep throat & food poisoning
Infection Control - chain of infection
Pathogen
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
what is a pathogen?
Bacteria
Virus
Fungi
Parasite
Reservoir - 5 examples
People
Animals
Soil
Food
Water
Portal of Exit - 3 examples
Coughing/sneezing
Bodily secretions
Feces
Mode of Transmission - 3 examples
Direct contact
Indirect contact
Vectors
Portal of Entry - 4 places
Mouth
Nose
Eyes
Cuts in skin
what is a susceptible host?
Elderly
Infants
Immunocompromised
ANYONE!
what is a virus?
what are some common pathologies associated?
microscopic organism that infect animals/ people
cant reproduce w/o host or live long outside a living cell
flu, colds, COVID
what is fungi?
common pathologies?
single celled or complex multicellular organism (small number of fungi cause disease in animals)
athletes foot, ringworm, thrush
what are nosocomial infections?
what is the percentage that affects patients?
inpatient (hospital infections)
5% of all inpatient contract
what is a parasitic protozoa?
Classified by?
where do they live?
Neither plant nor animal but larger than bacteria
Classified by their movement
Live on or in other organisms at expense of host
what parasitic disease that causes most deaths globally?
Malaria
what types are these?
reservoir:
Portal of exit:
Direct Contact transmission:
Droplet transmission:
Blood-borne transmission:
Airborne transmission:
Vector transmission:
Fomite transmission:
Place for pathogen to thrive
Any route for pathogen to LEAVE reservoir
Person-to-person contact
Pathogen transferred thru air via droplet of body secretion (3-6 feet)
Pathogen transmitted directly thru blood
Pathogens smaller than 5 microns remain suspended in air long after person left area
Insects transport pathogen
Inanimate objects carry & spread disease
what are these?
Portal of entry:
Susceptible host - factors:
Any route that pathogen uses to enter host
age, health, medication usage
what is the PPE (personal protection equipment) donning?
removal?
gown, mask, goggles, then gloves
gloves, goggles, gown, then mask
what is the recommended hand-washing time?
hand rubbing?
40-60 seconds
20-30 seconds
what is surgical asepsis?
medical asepsis?
elimination of all micro-organisms in an area
reduce micro-organisms in area
what are the rules for a sterile field?
create field close to usage time
below table is unsterile
equipment must be covered with proper sterile covers
what are four common surgical procedures in radiology?
chest tube placement
dressing changes
tracheostomy
urinary catheterization
what are five common non-aseptic activities done in radiology?
nasogastric tubes (NG)
urinal use
bedpan use
enema
barium enema
what are the responsibilities of the tech in emergencies?
recognize an emergency
Preserve life
Avoid further harm
Get help
what are the four different types of shock?
hypovolemic (loss of blood or fluids)
Cardiogenic (Cardiac disorders (MI)
Neurogenic (spinal cord damage)
Vasogenic (anaphylaxis)
what should a technologist be alert for changes in patients
level of consciousness
Demeaner
Pain level
Respiration
Speech patterns
what are the four signs of stroke?
slurred speech
dizziness
loss of vision
one-side paralysis
what is the generic name for drugs?
name given to drug when commercially available
what is a drug’s chemical name?
identifies chemical structure of drug
what is a drugs trade name?
name given to drug by company
(brand name)
what are the classifications of these drugs?
antiarrhythmics:
Antidiabetic drugs:
Antihistamines:
Antiplatelets:
vasodilators:
adenosine
Metformin (Glucophage)
diphenhydramine (Benadryl)
aspirin
nitroglycerin
what is a mild drug reaction?
Anxiety
lightheadedness
nausea
vomiting
itching
what are the seven factors that influence drug action?
patient age
health status
time of day
emotional status
other drugs in the body
genetics (genetic variations)
disease state of the body (kidney/liver function)
what are severe drug reactions?
Bradycardia (<50 beats/min)
cardiac arrythmias
laryngeal swelling
convulsions
loss of consciousness
cardiac arrest
respiratory arrest
no detectable pulse
what are moderate drug reactions?
urticaria
bronchospasm
angioedema
hypotension
Tachycardia (<100 beats/min)
what are the methods of administration?
topical:
enteral:
parenteral:
application of drug directly on skin
Drug administration through digestive system (oral, sublingual, buccal, rectal)
administration usually from needles/syringes
(Intradermal, intramuscular, intravenous, subcutaneous)
what are the five types of drug administration?
right drug
right amount
right patient
right time
right route
what are the needle diameter and length?
diameter expressed in gauges from 14-28
(smaller # is bigger diameter)
Vary in length .25 inches to 5 inches
most common is 1-1.5 inches
at what angle do we insert the needle for a venipuncture procedure?
insert needle next to vein at 15–30-degree angle
what is infiltration?
what is extravasation?
medicine leaking into the soft tissue WITHOUT irritation
medicine leaking into the tissue WITH irritation
what are these common medical abbreviations?
C:
IM:
IV:
PO:
with
intramuscular
intravenously
by mouth
what are these common medical abbreviations?
S:
NPO:
SC:
Stat:
without
nothing by mouth
subcutaneously
immediately
what are positive contrast media?
how do they appear?
what are some examples?
Composed of higher atomic number elements
appears radiopaque on image
barium sulfate
water-soluble iodine contrast agents
what are negative contrast media?
how do they appear?
what are some examples?
composed of low atomic number elements
appears radiolucent on image
Examples: air/gas (CO2)
most adverse reactions to contrast result from the:
osmolality of the agent
what is a contraindication for barium sulfate?
what should we do following a barium study?
what does barium sulfate have a tendency to do?
suspected cases of Bowel Perforation
push fluids
flocculation
what are the contrast considerations?
renal function
metformin (Glucophage) should be discontinued for 48 hrs before and after the use of iodine contrast
two types of radiopharmaceutical contamination:
external- spilled on
Internal- ingested
ethical dilemmas occur when:
the correct choice is not clear and personal values may conflic
In medical imaging and radiation therapy professional ethics are primarily maintained by the ______ in its _________ which contains __ main sections
which are?
ARRT
Standard of ethics
2
Code of ethics & Rules of ethics
what is electronic medical record? (EMR)
medical records that are controlled by a single institution
a patient can see their EMR apon request
what are the code of ethics?
rule of ethics?
behaviors a professional should aspire to achieve
mandatory rules that outline how a professional should behave
what is the electronic health record? (HER)
medical records that are easily accessed by patient
multiple medical institutions
(patient portal)
what is the hospital information system? (HIS)
designed to share patient data:
scheduling
billing
assigns patient number
what is the radiology information system? (RIS)
manages patient scheduling, billing, and orders in RAD department
assigns accession number #
what is ICD-10-CM?
CPT-4?
reason for the visit translated into a code
codes used for specific diagnostic procedures and services
what patient information is protected? (9)
medical history
current medical conditions
prognosis
current treatment
financial information
birth date
social security number #
address
name
How is patient information protected?
administrative safeguards (security violations)
physical safeguards (doors)
technical safeguards (passwords)
organizational safeguards (training)
HIPPA is enforced by:
the US Department of Health and Human Services
Medical law
What are the types of law? (4)
constitutional (supreme law of the land)
legislative regulations that direct most of our days)
case (judge/jury)
contract (legal, ex: NDA)
10% of all medical negligence lawsuits originate from:
medical imaging
(mis-diagnosis)
torts:
(patient believes they have been wronged or injured and can sue)
patients can claim they have been wronged or sustained some injury (other than breach of contract) for which they can sue for damages
battery:
unlawful touching
can occur w/o injury
false imprisonment:
a patient is restrained against there will
Defamation:
two forms:
protected health information is released
could cause:
ridicule
scorn
contempt
Written & Slander
libel:
slander:
fraud:
written
spoken defamation
intentional misrepresentation of facts that cause harm to individual
breach of privacy:
sharing protected health information without consent
negligence:
failure to use proper-care as reasonably prudent person would use under the same circumstance
standard of care:
RT’s put themselves at legal risk if they perform an act outside the standard of care
Standard of care is defined by:
the ASRT practice standards
for medical imaging and radiation therapy
informed consent:
requires written consent for an invasive procedure
consent:
patients have the right to make informed decisions about their care
Res ipsa loquitur
(REGISTRY/EXAM QUESTION)
“the thing speaks for itself”
the only explanation for the injury is the medical procedure and staff
(REGISTRY/EXAM QUESTION)
Respondeat superior:
“the master speaks for the servant”
physician or institution is responsible
Patient bill of rights:
a list of patient rights developed by the American Hospital Association
What are water-soluble iodine contrast agents?
Ionic & non-ionic contrast media
What is the main difference between non-ionic and ionic contrast media?
Patient reactions
osmolarity/viscosity
Ions
non-ionic:
is better for patient reactions and ions don’t disassociate & low osmolarity/viscosity
How many bones in the foot?
What is the breakdown of these bones?
26 total
14 Phalanges
5 metatarsals
7 tarsals
TMT stands for?
is what?
Tarsometatarsal joint
joint located at in between the base of metatarsal and the tarsals
Sesamoid bones are?
small detached bones
The sesamoid bones in the foot location?
2 sesamoid bones name?
Which is medial, which is lateral?
plantar surface first metatarsal (head)
Tibial is medial sesamoid bone
Fibular is lateral sesamoid bone
Mnemonic for Tarsals?
Come (calcaneus)
To (talus)
Colorado (cuboid)
Next (Navicular)
3 Christmases (3 Cuneiforms)
What is the Sinus tarsi?
The space in between the calcaneus and talus articulation
Calcaneus articulates Distally with:
Medially:
What is the largest Tarsal bone?
Cuboid
Talus
Calcaneus
Deep depression between posterior and middle articular facets are:
Calcaneal sulcus
Plantar flexion:
Dorsiflexion:
posterior side of the foot (plantar side) is flexed downwards (tippy toes)
anterior side of the foot (dorsal side) is flexed upwards
What kind of joints are the Metatarsophalangeal joints?
ellipsoidal or condyloid (modified)
What kind of joints are the Tarsometatarsal joints:
What kind of joints are the Intertarsal joint:
(tarsals)
What kind of joints are the ankle joint:
What kind of joints are the knee joints:
AKA Femorotibial
plane or gliding
plane or gliding
Saddle or sellar
Bicondylar
What kind of joints are the proximal tibiofibular joint:
Distal tibiofibular
Classification:
Mobility type:
plane or gliding
Fibrous
Amphiarthrodial (slightly moveable)
syndesmosis Type
AP foot is what kind of projection?
Dorsoplantar (DP)
what is Gout?
form of arthritis
excessive blood in joints
Starts in first MTP
what are bone cysts?
bone lesions filled with clear fluid
common in pediatric patients in the knee
what is Osgood-Schlatter disease?
bone/cartilage inflammation of the anterior proximal tuberosity
common among boys 10-15
what is Paget disease?
disrupts new bone growth
very dense and soft bone
what is the Don Juan fx?
fx to the calcaneus resulting from blunt force trauma
Criteria for Oblique foot:
Patient supine
Rotate foot medially 30-40 degrees (2 fingers underneath)
CR base of 3rd metatarsal
SID 40”
55 kVp 2-5 mAs
Criteria for lateral foot:
Patient Supine
Mediolateral projection
CR is at medial cuneiform (level of base of third metatarsal)
SID 40”
55 kVp 2-5 mAs
Criteria for AP Toes:
Patient supine, knee flexed
10-15 degrees toward calcaneus/ (knee)
CR at MTP joint
40 SID
55 kvp 2-5 mAs
Criteria for oblique Toes:
Patient supine, knee flexed
30-45 degrees rotation (medially or lateral)
CR at the digits MTP
SID 40”
55 kVp 2-5 mAs
Criteria for lateral Toes:
position towards side with least amount of OID (medial or lateral side)
40” SID
CR at the IP joint for first digit
CR at the PIP joint for digits 2-5
Criteria for AP foot:
aka Dorsoplantar projection
Patient supine, knee flexed
angle 10 degrees toward heel (posteriorly)
(15 degrees for standing)
CR at BASE of third metatarsal
40” SID
55 kVp 2-5 mAs
Criteria for lateral foot:
Patient Supine
Mediolateral projection
CR is at medial cuneiform (level of base of third metatarsal)
SID 40”
55 kVp 2-5 mAs
Criteria for AP Mortise ankle:
patient supine
internally rotate about 15-20 degrees until intermalleolar is parallel to IR (Malleoli are even)
CR midway between malleoli
SID 40”
55 kVp 2-5 mAs
Criteria for AP ankle:
Patient supine
CR midpoint between malleoli
SID 40”
55 kVp 2-5 mAs
Criteria for lateral ankle:
Patient supine
Mediolateral projection
CR pointed at medial malleolus
SID 40”
55 kvp 2-5 mAs
How many degrees difference is there between the lateral and medial distal femur epicondyles?
5-7 degree difference
(this is why we angle 5-7 degrees cephalic for superimposition for lateral knee)
The fibula is considered to be more _____
posterior
Sustentaculum tali means:
Located?
support for the talus
medial proximal aspect of the calcaneus
Which bone in the foot is most often fractured?
what is the name of this fx?
base of fifth metatarsal
jones fx
What is the strongest and largest tarsal bone?
calcaneus
What is the superior part of the patella called?
The patella lies superior to the _____ ______
Base
distal femur
Patella surface is also known as the:
intercondylar sulcus
or
trochlear groove
For an AP stress study for an ankle, what would we not do to the foot?
Demonstrate a ligament tear
Rupture ligament
inversion/eversion
demonstrate a fracture of the tib fib
Not move the foot around due to the fracture of the Tibia and fibula
we would look at the ligaments
What is the difference between a mortise and an oblique ankle?
Mortise is rotated 15-20 degrees medially
Oblique ankle is rotated 45 degrees
Which rotation has the intermalleolar line parallel to the IR?
AP Mortise ankle
15-20 degree internal/medial rotation
Which Malleoli is superior?
Medial Malleoli
Which tarsal bone makes up the mortise?
Talus + tibia
What is the CR for axial calcaneus?
Is it Cephalic or Caudad?
40 degrees Cephalic to the long axis of the foot
CR is at base of third metatarsal
When you are positioning for a trauma lateral ankle what is necessary?
A. Ensure the plantar surface is in complete contact of the IR
B. Rotate the leg laterally so the leg is against the table
C. Ensure the plantar surface is perpendicular to the IR
D. Plantarflex the foot
C.
Ensure the plantar surface is perpendicular to the IR
When the patient is standing with the metatarsals of the foot in 90 degrees to the leg with a horizontal beam entering the lateral malleolus, which of the following of the weight-bearing projections?
Standing Lateromedial projection
(key: CR is entering in the lateral malleolus)
In the axial calcaneus the plantar surface of the foot should be ____ to the image receptor?
Perpendicular
The most posterior part of the calcaneus would be?
A. Sinus Tarsi
B. Tuberosity
C. Trochlear
D. Peritoneal
B. Tuberosity
How many views for the calcaneus?
What are the names?
2 views
Plantodorsal Axial Calcaneus
Lateral Calcaneus
When performing a lateral for the 2nd toe digit, what side should be closest to the Image receptor?
Why?
Medial side
To reduce OID
Where is the sustentaculum tali?
medial proximal calcaneus
What does the medial cuneiform articulate with distally?
First metatarsal
What does the metatarsal articulate with distally?
proximal phalanx
Medial oblique foot would show:
sinus tarsi free of superimposition
(also cuboid)
What do the heads of the metatarsal articulate with distally?
proximal phalanx
Where are the sesamoid bones located?
plantar surface of the first metatarsal
What is Pes planus?
Flat foot
What does the base of the metatarsal articulate with?
Tarsals
If we are looking at a lateral foot, all of these are correct except for?
A. We include at least one inch of the distal tibia fibula
B. we want to visualize the foot from digit to calcaneus
C. The cuboid is free of superimposition
D. The heads of the metatarsals are superimposed
C.
The cuboid is free of superimposition
(we only see the cuboid slightly free of superimposition in mediolateral)
Medial oblique shows the cuboid free of superimposition
If we are looking for a foreign body do we angle the central ray?
Why?
No.
An angle can distort the object and elongate it
T/F
*The image critique for an oblique foot with lateral rotation we want to see the sinus tarsi free of superimposition.
False
(medial oblique would show the sinus tarsi)
If the patients foot cannot be flat for an AP projection, what would we do?
What is the angle?
We would use a wedge
No angle for this
How many tarsal bones are in the foot?
7 tarsal bones
The lateral oblique foot best shows?
The base of the first metatarsal
In the AP projection of the ankle the:
1. Plantar surface is perpendicular to the IR
2. The Fibula projects more distally than the tibia
3. The calcaneus is well-visualized
1 & 2
AP ankle the plantar surface is ____ to the IR?
Perpendicular
Lateral foot the plantar surface is ____ to the IR?
How about standing?
Perpendicular supine
Parallel for standing
The second metatarsophalangeal joint is what kind of joint?
ellipsoid or condyloid
Synovial
Diarthrodial (freely moveable)
Which of the following joints is a fibrous syndesmosis Amphiarthodial (slightly moveable) joint?
A. Proximal interphalangeal
B. Talonavicular
C. Proximal tibiofibular
D. Distal Tibiofibular
D.
Distal Tibiofibular
When would you best see a medial displacement fracture?
(bone protruding towards medial side)
AP view
If there’s a posterior displacement, what view would best display that?
Lateral
What is the name of the fracture for the base of the fifth metatarsal?
Jones or nightstand fx
What joint is most affected by gout?
First MTP joint
Form of arthritis (execessive blood in joint) that may be hereditary
What is the Don Juan fx?
fx in the calcaneus
Osgood Slatter is?
inflammation of bone/cartilage of anterior proximal tibia (tibial tuberosity)
most common in boys 10-15
Inversion:
AKA?
Inward turning/bending of the ankle
aka Varus
Eversion:
AKA?
outward turning/bending of ankle
aka valgus
Dorsiflexion:
Dorsal/anterior surface of foot flexed upwards
Plantarflexion:
Posterior/Sole of foot is flexed downwards
(tippy toes)
Posterior foot name:
Plantar surface
Sole of foot
Anterior foot name:
Dorsum pedis (top of foot)
During most long bone exams, the part being radiographed should be _____ to the IR and ____ to the CR.
Parallel to IR
Perpendicular to CR
What is the superior portion of the foot called?
Dorsum Pedis
Is the dorsum pedis considered anterior or posterior part of the foot?
Anterior
How many degrees for a lateral knee?
5-7 degrees cephalic (mediolateral)
(T/F)
The lateral projection of the Tibia and Fibula the image should demonstrate some space in-between the Tibia and fibula.
True
(There should be some space in-between the tibia and fibula in lateral view)
The placement of the top border of the IR should extend at least ___ inches from the knee joint to avoid being projected off due to beam divergence:
A. 4 - 4 1/2 inches
B. 3 - 3 1/2 inches
C. 2 - 2 1/2 inches
D. 1 - 1 1/2 inches
D.
1 - 1 1/2 inches
What is the CR for AP foot?
What is the angle?
base of 3rd metatarsal
10 degrees posteriorly
Which views do we use for patella?
Inferosuperior
Hughston
Settegast
Merchant
(Mayo uses Merchant)
What views do we use for intercondylar fossa?
Rosenburg
(PA flexion- for tunnel view)
Which of the following tangential axial projections of the patella is the complete relaxation of the quadricep require for an accurate diagnosis?
1. Supine flexion 45 degrees (merchant)
2. Prone flexion 90 degrees (Settegast)
3. Prone flexion 55 degrees (hughston)
Supine flexion 45 degrees
(supine keyword, relaxes the Quads)
What is considered a shock absorber between the femoral condyle and the tibial articular casset?
Meniscus
If we are looking to see arthritic changes (arthritis) in the knee we want to see it:
1. recumbent
2. Erect
3. Merchant
AP erect
(we want weight bearing)
What knee oblique shows the proximal tibiofibular joint?
Internal/ medial oblique
(shows the head/neck of fibula free of superimposition)
which projections are performed with the tube face is angled and parallel to the flexed tibia?
A. Hughston
B. Merchant
C. Axial intercondylar fossa (BeClere)
D. Settegast
C. BeClere
When we are doing a lateral knee, what needs to be seen so we know the lateral is positioned correctly?
A. Patella is parallel to the IR
B. Femoral condyles are superimposed
C. Femoral condyles are perpendicular to the IR
D. The proximal tibiofibular articulation is open
B.
Femoral condyles are superimposed
What is proximal to the tibial plateau?
A. The tibia condyles
B. The tibial tuberosity
C. intercondylar fossa
C.
Intercondylar fossa
In a lateral projection of a normal knee:
1. The fibular head should be somewhat superimposed on the tibia
2. The patellofemoral joint should be visualized
3. The femoral condyles should be superimposed
1, 2 & 3
What is the CR for AP knees?
1/2” distal to the apex of the patella
These extra two bones underneath the first metatarsals?
Sesamoid bones
This is the name of the fossa on the distal posterior femur?
Intercondylar fossa
what is the saying for the sunrise view?
the merchant Houghton likes to watch the sunrise in Settegast
what is the saying for the intercondylar fossa? (PA flex)
To be Clere we have to go through the tunnel from camp Coventry to try some holmblad food
What kind of joints are the Tarsometatarsal joints:
plane or gliding
During a cervical myelogram what position do we placed the patient in for the best image
Prone
What type of articulation is primarily used for arthrograms?
Synovial but more specifically diarthrodial
What are the most frequent joints for an arthrogram?
What joints can’t be examined during an arthrogram?
shoulder and knee
(shoulder most likely)
Pubis Symphysis
(t/f)
Standard precautions must be followed for a T-Tube Cholangiogram placement
True
(sterile)
What kind of joint is an amphiarthrodial?
distal tibiofibular joint
(limited movement)
What is the insertion point for a myelogram LP?
L3-L4
subarachnoid space
What are the contraindications for an ERCP?
Mainly: pseudocyst of pancreas
Also Can be:
hypersensitivity to iodine contrast
infection to biliary system
elevated creatinine/BUN levels
What is the common reason for a myelogram?
to examine the spinal cord/nerve branch and find possible pathologies
What is the name of the scope for a ERCP?
duodenoscope
When it comes to slices what does more angle do?
What does less angle do?
What do small numbers mean?
What do the large numbers mean?
Increasing the angle will make thinner slices
less angle creates larger slices
How long does it take for contrast not to be radiographically detectable in a myelogram?
24 hours
Which of the following procedures may be performed during a post operative T tube cholangiogram?
A. remove gallbladder
B. remove a liver cyst
C. remove a biliary stone
D. remove the kidney
C. Biliary stone
(Gall stone)
when it comes to humerus injections, how do we want the arm rotated?
Why?
external rotation
to see the joint space (glenoid cavity)
What is the name for the ruler?
Bell-Thompson
HSG contraindications:
pregnancy
acute pelvic inflammatory disease
active uterine bleeding
(T/F)
bile is sterile.
False.
Outside of the standard precautions, bile is not sterile.
_______ the slice, the ______ it is.
Why?
For examining the kidney, we want _____ slices.
We want it to be ______.
Why?
Thinner, Blurrier
So we can see past the bone.
Thinner slices
Blurry (for the bones)
We want to see the kidney and thin slices make the bones blurrier
Where are we imaging in a long bone study?
Bell-Thompson ruler what joints are we looking at?
For upper?
For lower?
To examine the joint spaces
Ruler is for synovial diarthrodial joints
upper: shoulder, wrist, elbow
Lower: Hips, Knee, ankle
(T/F)
We can flex the knee when putting in contrast into the knee joint.
True.
the doctor manipulates the knee to see how the fluid flows in the capsule
(T/F)
Arthrogram should be a sterile procedure.
True
We need to prep the skin for the needle
Myelogram is for?
abnormality in spinal cord
spinal stenosis
map out for spinal chemo
What is a necessity during a cervical myelogram?
patient either prone/fowler with chin hyperextended to prevent contrast going to the brain
What does ERCP stand for?
What is it for?
endoscopic Retrograde Cholangiographic pancreatography
examine the biliary and pancreatic ducts
What is a hysterosalpingogram?
demonstrates uterus/fallopian tubes
How much do you oblique for Judet views?
What do you see on the upside of the Judet views?
What do you see on the downside Judet view?
45 degrees LPO/ RPO
posterior rim of the acetabulum & anterior iliopubic column
anterior rim of the acetabulum & posterior ilioschial column
How do we position for a downside Judet view?
patient supine
45 degree oblique LPO/RPO
2 inches inferior + 2 inches medial to downside ASIS
How do we position for an upside Judet view?
patient supine
45 degree oblique LPO/RPO
2 inches inferior to ASIS
What is the posterior portion of the hip?
What is the anterior portion of the hip?
what is the superior portion of the hip?
Ischium (itchy bum)
Pubis
Ilium
What view/rotation best shows the lesser trochanters in profile?
What view best shows the greater trochanter in profile?
external oblique/rotation
internal oblique/rotation
What view best shows a lateral fracture?
an anterior/posterior (AP) projection
Axial lateral horizontal beam projection of the hips (cross table) requires the image receptor to be placed:
1. parallel to the central ray
2. parallel to the long axis of the femoral neck
3. in contact with the lateral surface of the body
2 bc internal rotation makes the femoral neck parallel
3 bc we have patients lateral side closer to IR to reduce OID
cannot be no. 1 because the central ray is ALWAYS perpendicular to the image receptor
In a frog position the femoral neck is _____ to the image receptor
parallel
what part of the innominate bone makes up the obturator foramen?
Ischium
Pubis
(where the posterior and anterior meet to create the hole aka obturator foramen)
How much does the femur slant in?
5-15 degrees
What does the femur articulate with proximally?
acetabulum
When would we use the Nakayama method?
What does it replace?
Trauma views
it replaces our cross-table
What can we use for a cross table lateral projection to improve the quality of the image?
add filter & grid
What is the central ray for the AP pelvis?
2 inches inferior to ASIS
midway point between ASIS and Pubis symphysis
(15–20-degree internal rotation of affected leg)
What is the CR for inlet?
40 degrees caudad
CR ASIS
What is the CR for outlet? (Taylor method)
20-35 degrees cephalic for men
30-45 degrees cephalic for women
CR 1-2 inches inferior to pubis symphysis
where is the innominate bone located at?
also known as?
at the hips (left or right there are two)
ossa coxae
Where do you inject for a Myelogram (cervical)?
What is this called?
C1-C2
Subarachnoid space
Cisternal puncture
What is Lordosis?
increased concavity (lumbar)
exaggerated lumbar curvature
(swayback)
What is Scoliosis?
exaggerated lateral curvature of the spine
What is Kyphosis?
increased (exaggerated) convexity in the thoracic area
(humpback)
what is concave?
what is convex?
rounded inward or depressed surface like a cave
rounded outward or elevated surface
Cervical is what type of curve?
Thoracic is what type of curve?
lumbar is what type of curve?
sacrum (sacral) is what type of curve?
first compensatory curve (concave)
first primary curve (convex)
second compensatory curve (concave)
second primary curve (convex)
What makes up the zygapophyseal joint?
superior and inferior articular processes
What are primary curves?
convex curves
1st primary curve: thoracic
2nd primary curve: sacral
What are compensatory curves?
Concave curves
1st compensatory curve: cervical
2nd compensatory curve: lumbar
Where is the pedicle located?
What does it connect?
posterior to the body of the vertebrae
attaches body to vertebral arch
(terminate in the area of the transverse process)
Where are the laminae located?
What does it connect?
connects the transverse process to the spinous process
(posterior to transverse anterior to spinous)
In a cervical exam when would we see the zygapophyseal joints? (C2-C7)
true lateral
90 degrees to the midsagittal plane
When do we see the C1 & C2 Z joints?
In an AP open mouth
In a cervical exam when would we see the foramen?
45 degree oblique (15 cephalic AP)
How do we position for an open mouth?
upper incisors and base of skull lined up
When taking the Judd and Fuchs what are we looking for and what does it look like?
J: Dens sticking out in the hole of skull (foramen magna)
Book: Den’s and surrounding bony structures of the C1 ring
What is the name of the joint that articulates/connects the skull and the atlas?
Atlantooccipital joint
What is the purpose of the transverse foramen in the cervical spine?
For the nerve roots to connect to the brain
How many zygapophyseal joints do we see in a lateral (cervical)?
5 Z joints
(C1 & C2 are seen in AP open mouth)
(t/f)
During trauma we are doing a cross table lateral for a cervical spine we don’t see the anatomy demonstrated we would use a sandbag.
false
Sandbags would cause more harm then good
What skull line would we use to position for Judd and Fuchs?
MML
(Mentomeatal line)
What is the space called that we inject myelograms?
What level of the spine is this?
Subarachnoid space
Cervical: C1-C2
Lumbar: L3-L4
Which foramen is seen in PA cervical oblique? (RAO/LAO)
downside (closest to IR)
(marker is on side down)
Which foramen is seen in AP cervical oblique?
foramen farthest from IR (upside)
(marker on side up)
(RPO/LPO)
Which foramen is seen on LAO cervical oblique?
how is the projection?
how are the markers?
left foramen (downside)
PA projection
Mark side down, left side (cause that foramen is best demonstrated)
Which foramen is seen on RPO cervical oblique?
how is the projection?
how are the markers?
left foramen (upside so opposite)
AP projection
Marker on side up, left-side (bc that foramen is best shown)
Which foramen is seen on LPO cervical oblique?
how is the projection?
how are the markers?
Right foramen (upside)
AP projection
Marker on side up, right-side (bc that foramen is best shown)
Which foramen is seen on RAO cervical oblique?
how is the projection?
how are the markers?
right side (downside)
PA projection
Marker is side down, right-side (bc that foramen is best demonstrated)
What level is the vertebral prominence at?
What level is the jugular notch located at?
What level is the xiphoid tip located at?
What level is the thyroid cartilage located at? What level is the sternal angle located at?
What level is the EAM located at?
C7
T2-T3
T9-T10
C5 (varies between C4-C6)
T4-T5
1 inch above C1 (mastoid tip)
At what level is the mastoid tip located?
C1
(one inch inferior to EAM)
What is the Jefferson’s fx?
fx of C1 Ant & Post arches
from landing on feet/head abruptly
(AP open mouth best demonstrates this)
What is the clay shoveler’s fx?
avulsion fx of C6 to T1 from hyperextending neck
(best demonstrated in a lateral C spine)
What is a compression wedge fx?
collapse of T/L vertebral bodies from flexion
vertebral shapes like a wedge instead of a block
Scoliosis can be caused by:
Neuromuscular disorder
congenital (happens from birth)
idiopathic (just cause)
When do you see the zygapophyseal joints in a thoracic spine?
70-75 degree oblique from the midsagittal plane
When do you see the foramen in the thoracic spine
90 degrees to the midsagittal plane
(true lateral)
what helps form the intervertebral foramen?
inferior vertebral notch & superior vertebral notch
(t/f)
If the patient has a traumatic injury to their spine, its best to manipulate the tube rather than move the patient
true
Moving the patient in trauma situations can lead to more damage
What do you see in a PA cervical oblique?
AO or PO?
how is the positioning?
anterior oblique (AO)
15 degrees caudad
pedicles and foramina closest to IR
Mark side down
what do you see in an AP cervical oblique?
AO or PO?
how is the positioning?
posterior oblique (PO)
15 degrees cephalic
pedicles and foramina farthest from IR
Mark side up
What do you seen in the lateral cervical spine?
What do you seen in a lateral thoracic spine?
What do you see in a thoracic oblique spine?
what do you see in a cervical oblique spine?
zygapophyseal joints
intervertebral foramen
zygapophyseal joints (70-75 degree oblique)
intervertebral foramen (45 degree oblique)
What would we do for a functionality test of the spine? (stability)
flexion and extension
What is the nucleus pulposus?
What is the annulus fibrosis?
inner layer of disk
outer layer of disk
Where is the subarachnoid space?
L3-L4
LPO best demonstrates _____ lumbar Z joints.
Upside or downside?
left zygapophyseal joints
downside
RPO best demonstrates _____ lumbar Z joints.
Upside or downside?
right zygapophyseal joints
downside
The ear of the scotty dog is?
The eye of the scotty dog is?
The nose of the scotty dog is?
The feet of the scotty dog is?
The neck of the scotty dog is?
The body of the scotty dog is?
The tail of the scotty dog is the?
superior articular process
Pedicle
Transverse process
inferior articular process
Pars interarticularis
Laminae
Spinous process
What is an intrathecal procedure?
Administering drugs through the spinal canal
(Ex: MP with chemo)
What is the CR for Sacrum and coccyx?
What is the angle?
midway between pubis symphysis and ASIS or 2 inches inferior to ASIS
or 2 inches superior to pubis symphysis
(all mean the same thing)
15 cephalic for sacrum
10 caudad for coccyx
What do you see in a Myleogram?
1. posterior disk herniation
2. posttraumatic spinal cord swelling
3. internal disk legions
1 & 2
We can’t see the internal disk legions because the contrast goes up and down the spinal cord.
We can’t see because the “gusher” in the disc space.
What is the angle for a AP sacrum and coccyx?
PA?
15 cephalic for sacrum & 10 caudad for coccyx
PA: 15 caudad for sacrum & 10 cephalic for coccyx
When are Zygapophyseal joints seen for cervical?
When are the Zygapophyseal joints seen for thoracic?
when are the zygapophyseal joints seen for lumbar?
True Lateral (90 degrees)
70–75-degree oblique
45 degree oblique
If we are doing a lateral lumbar spine, what plane is perpendicular to the IR?
mid-coronal plane
What connects the arch for the spinous process to the transverse process?
What connects the vertebral body to the transverse process?
Laminae
pedicle
What is the pathology that involves the PARS?
What projection best shows this?
Spondylosis
Oblique lumbar
You are performing a 5 view lumbar the patient is complaining of lower back pain from an old sports injury. After the AP projection you roll the patient into a RPO position and make an exposure. The right transverse process projects from the front of the vertebral body and the pedicle is near the anterior aspect of the body in the image. What correction could we do?
More oblique
too AP (anterior) = under rotation
too lateral (posterior)= over rotation
What is Spondylosis?
a fx (defect) to the PARS interarticularis
(“Scottie dog wearing a collar”)
Most common at L4-L5
What is spondylolisthesis?
Best shown in?
forward slipping of one vertebrae
Originates from spondylosis
Common in L5-S1
“Slipped disc”
best shown in a lateral
When performing obliques if the pedicle appears to be too anterior what is the cause?
How do we fix it?
under rotated (too AP/anterior)
oblique the patient more
What is the angulation for AP Axial SI joints?
What is the CR?
30 degrees cephalic for men
35 degrees cephalic for women
midway between pubis symphysis and ASIS
What is the CR for lateral coccyx?
3-4 inches posterior to ASIS
2 Inches distal from ASIS
(no more than 4!)
What is the CR for the spot (L5-S1 lateral)?
1.5 inches inferior to crest
2 inches posterior to ASIS
5-8 degrees caudad
What is the CR for AP lumbar?
Lateral lumbar?
obliques?
flex Ext?
AP: Iliac crest (L4-L5)
Lateral: iliac crest (L4-L5)
Obliques: 2 inches medial and 1-2 inches superior to iliac crest + 45-degree PO rotations
Flex/Ext: iliac crest (L4-L5) + extension and flexion
What does flex/ext show?
what does side bending show?
posterior/anterior displacement
lateral displacement
If we are shooting an AP projection of the coccyx and the distal tip is superimposed over the pubis symphysis, we could correct this by?
throw more of a caudad angle
from 10 to 15 degrees
What is the CR for AP SI joints?
What is the obliques?
AP: 30 cephalic for men 35 cephalic for women + 2 inches below ASIS or 2 inches superior to Pubis symphysis
Obliques: 25–30-degree PO + 1 inch medial to UPSIDE ASIS
What is the CR for AP axial sacrum and coccyx?
Sacrum: 15 cephalic 2 inches superior to pubic symphysis
Coccyx: 10 degrees caudad 2 inches superior to symphysis
At what angle (oblique) does the SI joints open up at?
25-30 degrees oblique
At what angles do the zygapophyseal joints open up at?
45 degree oblique
What kind of joints are the Zygapophyseal joints?
What kind of joints are the intervertebral joints?
plane or gliding (synovial/diarthrodial)
slightly movable (Amphiarthrodial)
(cartilaginous/symphysis)
If we go from supine to prone what happens to the angle on spine?
changes from cephalic to caudad
(Vice versa)
What is the posterior end of the rib called?
What is the anterior end of the rib called?
vertebral end
sternal end
The first _____ pair of ribs connect directly to the sternum
The false ribs apply to ribs __ to ___
True ribs applies to the first ______ ribs
The last pair of ribs is referred to as:
Which ribs are these?
seven
8 through 12
seven
floating ribs & 11-12
The vertebral end of the rib has four parts:
head
neck
tubercle
angle
The head of the vertebral end of the rib connects to:
The tubercle of the vertebral end of the rib connects to the:
what is the name of this joint?
vertebral body
transverse process of the thoracic spine
costovertebral joint
Costotransverse ribs articulates between:
tubercle of the rib and the transverse process of the spine
Posterior pain is what rib projection?
Anterior pain is what rib projection?
AP
PA
Patient walks in the ER with anterior left upper pain what oblique would we use?
What is the projection?
RAO
PA projection
Patient walks in the ER with left lower posterior pain, what oblique best shows this?
What is the projection?
LPO
AP projection
Patient walks in the ER with right anterior pain what oblique would we use?
What is the projection?
LAO
PA
RAO best shows what axillary?
left axillary
LPO shows what axillary?
left axillary
RPO best shows what axillary?
right axillary
LAO best shows what axillary?
right axillary
If patient is in a RPO position, what pain are they experiencing?
If patient is in a LPO position what pain are they experiencing?
If patient is in a LAO position, what pain are they experiencing?
If patient is in a RAO position, what pain are they experiencing?
right posterior pain (AP = side down)
Left posterior pain (AP = side down)
right anterior pain (PA = Away)
left anterior pain (PA = Away)
What happens to the diaphragm on inspiration?
What happens to the diaphragm on expiration?
diaphragm moves down
diaphragm moves up
What pathologies can you see specifically from expiration x-rays?
pneumothorax
hemothorax
&
Pulmonary contusions
which of the following positions will best demonstrate the ribs of the left thorax?
RAO & LPO
What kind of joint is the sternoclavicular joint?
What kind of joint are the first to tenth costochondral joints?
what kind of joint is the first sternocostal joint?
what kind of joints are the second to seventh sternocostal joints?
what kind of joints are the sixth to ninth interchondral joints?
what kind of joints are the costotransverse joints? (1-10)
What kind of joints are the costovertebral joints? (1-12)
plane or gliding (diarthrodial)
synarthrodial (immoveable)
cartilaginous (immoveable)
plane or gliding (diarthrodial)
plane or gliding (diarthrodial)
plane or gliding (diarthrodial)
plane or gliding (diarthrodial)
The ___________ _____ is the only articulation between the shoulder girdle (upper extremity) and the bony thorax
sternoclavicular joint
How much do we oblique for Sternum?
What position do we oblique in?
What is the CR?
What is the SID?
What is the breathing technique?
15-20 RAO oblique (LPO if not possible)
CR mid sternum (1 inch from midline)
SID 40-48 inches
shallow breathing (expiration if not possible)
If a patient exhibits hemothorax on the right side and cannot stand what view could that best be shown in?
right lateral decubitus
(on expiration)
If the patient is able to stand what view best shows hemothorax in the right lung?
PA chest on expiration
Why are upper ribs best taken erect?
allows gravity to lower the diaphragm even more
Photoelectric effect strikes:
In photoelectric effect the x-ray photon ceases:
In Photoelectric absorption the electron absorbs all:
In photoelectric effect increased kVp leads to:
inner shell electron
to exist
the x-ray’s photon’s energy
decreased photoelectric absorption
(Beam is too fast/intense)
In Compton scatter the x-ray photon ceases:
to exist
photoelectric effect is _____ likely to occur when the _____ of the incident x-ray is slightly ______ than the binding energy of the orbital electron
more
energy
higher
In photoelectric effect the energy in excess of binding energy is given to:
the inner-shell electron
In photoelectric effect the inner shell electron ____ ups &:
In photoelectric effect increased atomic number leads to increased
speeds (excites)
leaves the atom
photoelectric absorption (attentuation)
(because more things to interact with)
In Compton scatter the electron absorbs:
all the incident x-rays energy
In Compton scatter _________ interacts (strikes) with an:
incident x-rays
outer shell electron
In Coherent when an incident x-ray interacts with an orbital electron it is:
Thompson
In Compton scatter some of the energy excess of binding energy is given to an:
outer shell electron
In Compton scatter outer shell electron speeds up and leaves:
what is this called?
the atom (recoil electron)
(Excess energy leaves as a scatter photon)
Attenuation can be affected by?
-Tissues thickness (every 4 cm = 50% xray beam attenuation)
-tissue atomic number (more z#= more attenuation)
-tissue density (most important ex: air vs muscle vs fat) muscle most dense/ air least dense
In Compton scatter remaining energy is ______ as a new x-ray and leaves the _____ in a random direction
reemitted
atom
Both the photoelectric effect and Compton scatter lead to
ionization
(the removal of an electron from orbit and net positive charge to the atom)
In coherent scatter the orbital electron reaches a temporary:
state of excitation
Attenuation is?
What different interactions result in attenuation?
Reduction in the number/intensity of x-rays reaching the IR (through scatter/absorption)
Photoelectric (absorption)
Coherent scatter (absorption)
Compton (both scatter & absorption)
mA is limited by what?
Focal spot size
Compton scatter is proportionally more likely:
at high kVp levels
(this is bc higher kVp levels have lower absorption rate but compton remains consistent at all levels)
In coherent scatter when an incident x-ray interacts with an entire atom is it called:
Rayleigh
In coherent scatter when the energy of the incident photon is ______ than the ________ no ________ occurs
less
binding energy
ionization
For each 4cm of tissue requires:
For every 4 cm of tissue how much x-ray beam attenuation is occuring?
doubling of mAs & kVp by:
15% kVp
100% mAs
- 50% x-ray beam attenuation
mAs is a measurement of what?
it is considered:
what is it not?
electron flow in a conductor
an electrical term
a unit of radiation output
mAs is the primary controller of:
intensity/quantity in the remnant beam
In coherent scatter the incident x-ray continues:
in a new direction
mAs math:
100 mA and .5 sec
50 mAs
In coherent scatter no _____ occurs
energy transfer
How do we reduce motion?
setting the shortest time while maintaining same mAs output
(Shorter time requires more mA)
To calculate the mAs we:
multiply mA x Time
Attenuation is absorption & scattering as a result of:
photoelectric effect
compton scatter
coherent scatter
mAs math:
300 mA and .2 sec
60 mAs
(300 x .2)
Radiologic time is measured in?
seconds
.25 secs or 250 ms or 1/4 second (all the same)
mAs math:
200 mA and .2 sec
40 mAs
Maintaining density:
150 mAs to 300 mAs
72 kVp to ___ ?
61.2 (reduced 15%, cuts exposure in half)’
mAs doubled
kVp needs to come down 15% to maintain
the small increase of 15% kvp will?
double the exposure to the image receptor
What is penumbra?
Is it good or bad?
blurry or unsharp edges of the shadow or image
bad
Doubling in mAs leads to:
doubling of intensity or quantity
Kilovoltage is the measurement of
electrical force
What does kVp control?
the quality of the x-ray beam
when the kvp increases 15% patient exposure increases by:
1/3
kVp math:
increase kVp 15% of 70 kvp:
decrease kVp 15% of 100 kVp:
80.5 (70 x 1.15)
85 (100 x .85)
kVp means?
kilo voltage peak (the highest value in electrical generator)
What does a higher kVp do?
increase the x-ray’s ability to penetrate through a particular tissue
OID stands for?
object image distance (patient distance from IR)
What is remnant radiation?
the part of the x-ray beam that has passed through the patient
(Leftovers from the primary beam)
SID stands for?
source to image distance (x-ray tube to IR)
What is preferred, optimal kVp or minimal kvp?
what is higher in kVp out of the 2?
optimal kVp
SOD stands for?
Source to object distance (x-ray tube to patient)
What is umbra?
is the ‘‘pure” shadow or image of uniform darkness
(crisp shadow line)
What is distortion?
misrepresentation of the size or shape of an object
As a radiographer do we want penumbra?
no, we want to minimize this
What is elongation?
the object appears to be longer than its actual size
How much of the primary beam becomes remnant radiation?
less than 1%
What is shape distortion?
What are the types?
the difference between the actual shape of the object and the shape of its projected image
(Difference between actual object shapes
& the image shape)
Elongation & foreshortening
What affects contrast?
kVp (low kvp = high contrast)
image receptor (grids)
computer algorithms (AEC)
patient factors (tissue density)
What is the relationship with SID and pneumbra & spatial resolution?
the greater the SID the smaller the pneumbra & higher the spatial resolution
what is foreshortening?
the object appears to be shorter than its actual size
How do we calculate the mag factor?
dividing SID/SOD
An object that measures 6 cm is radiographed using SID of 48 and OID of 4. How many centimeters will the object measure on the completed radiograph?
6.54cm
(48 (SID) - 4 (OID) = 44 SOD
48 (SID) / 44 (SOD)= 1.09
1.09 x 6 cm= 6.54cm
How can size distortion (magnification) be reduced?
decreasing OID or
increasing SID
What can contrast be referred to as?
which is?
gray scale
the number of different brightness levels in a x-ray
What is size distortion?
What is it also called?
misrepresentation of the size of the object
aka magnification
How can we reduce shape distortion?
properly aligning the:
tube
(Object) part
Image receptor
Mag Factor math:
SID= 72
SOD=66
1.09 mag factor
What is spatial resolution?
What is also referred to as?
the sharpness of the structural edges around the image
AKA detail, sharpness, or decreased pneumbra (OR LOW BLUR)
what affects spatial resolution? (5)
motion
focal spot size
distance (SID, SOD, OID)
patient factors (OID or motion)
angulation (elongation/foreshortening)
What is postprocessing?
adjustment of the image by a rad tech or rad at a workstation
What is noise?
undesirable image input that interferes with ability to visualize the x-ray
How is resolution (spatial resolution) measured?
using a line-pair test tool
(measured in line-pairs per millimeter or LP/mm)
What is contrast?
the difference between 2 adjacent brightness levels
What can be used to increase subject (patient) contrast?
barium & iodine
Low contrast =
high contrast =
long scale = low kVp (many greys)
short scale = high kVp(black & white)
What is SNR?
What should it always be greater than?
Signal to noise ratio
one
More kvp = ____ scatter
more volume = _____ scatter
more
more
(why collimation is key, and optimal kVp)
What is quantum mottle?
What is the opposite?
insufficient number of x-rays reaching the image receptor
scatter is too much x-rays reaching the image receptor
What causes quantum mottle?
What is usually the cause?
low mAs
low kVp
or difficult anatomy to penetrate
usually low technique, especially mAs
What is the rule regarding tissues thickness?
for every 4cm of tissue thickness 50% of x-ray beam is attenuated
Low contrast =
High contrast=
Long scale & low kvp
Short scale & high kVp
What is window level?
What is window width?
post-processing of image brightness
post-processing if image contrast
For digital systems, what is preferred quantum mottle or scatter?
Scatter
(the digital systems are very good at filtering out too much information)
What does high tissue atomic number mean for attenuation?
means more attenuation due to more interactions
(more electrons higher chance for photelectric absorption)
What does collimation do to radiologic contrast?
How?
Increases contrast
Decreases amount of area irradiated which thus reduces scatter
What does higher tissue density mean for attenuation?
more attenuation
(implants most, then bone, then muscle, then fat, and least dense is air)
more dense objects show up more dominantly on the x-ray
What is the collimator?
adjustable lead shutters
Who sets the standards for optimal contrast/brightness settings?
the radiologists
Collimation _____ patient dose by:
decreases
limiting the volume of tissue exposed to radiation
What is the aperture diaphragm?
fixed opening between the x-ray tube & collimator box
Light/radiation field can be off by:
+/- 2% of the SID
What is PBL?
What does it do?
What can you do to manipulate this?
positive beam limitation
automatic collimator (based on IR size)
override if the desired field size is smaller than the IR
What are the other beam limitations?
What are they?
aperture diaphragm: fixed opening between x-ray tube & collimator box)
Mask: lead sheet with an opening used to image specific anatomy of interest (skull x-ray with a hole cut through)
Scatter occurs commonly with:
large field sizes
increased tissue volume
What does scatter do to image receptor exposure?
scatter increases exposure to the IR
(also decreases contrast & increase noise ALL BAD)
What happens to scatter at higher kVp levels?
What happens to compton?
scatter is increased at higher kVp
Compton interactions proportionally increase at higher kVp levels
What does scatter do to noise?
how does scatter affect contrast?
what does scatter do to detail, magnification, or distortion?
scatter increases noise
scatter decreases contrast
scatter does not affect detail, magnification, or distortion
What is scatter also known as?
Secondary radiation
What affects detail?
focal spot size
penumbra
What do grids do?
affect scatter reaching the IR, not the PRODUCTION of scatter
What is the number one source for of occupational exposure?
scatter radiation
How do we calculate grid frequency?
number of lead strips per inch (100/inch)
How can we reduce scatter?
what is the most effective way to reduce scatter?
second most effective?
increase collimation (most effective way to control)
decrease part volume (compression) (second most effective way)
reduce kVp
grids (affects scatter reaching the IR, not PRODUCTION)
distance (SID < SOD< OID) (no effect on scatter production)
How are grids constructed?
alternating strips of lead & interspace material (AL most common but can also be plastic)
The effectiveness of the grids is measured by:
also know as?
the ratio of the height of the lead strips to the width of the interspace material
grid ratio
What is the purpose for grids?
What does it not affect?
restore subject contrast in an image
grids don’t affect the production of scatter radiation
What are focused grids?
Linear?
crosshatched?
grids that follow the divergent beam
run up and down (only can angle one way)
run up/down & side to side
Focused gridlines are directed to:
a convergence point (generally the focal spot)
Grids can be _____ _____ or ______ (different types of grids)
linear
crosshatched
focused
Grids are designed to be used
(need to be)
at a specific distance from the focal spot
What are the grid ratios?
no grid:
5:1
6:1
8:1
10:1
12:1
16:1
1
2
3
4
5
5
6
modern grids attenuate:
70-80% of scattered photons
Grids allow the ______ ______ to pass through ______ _______ and absorb ____ ______
primary beam
lead strips
scattered x-rays
Motion will?
blur the gridlines
Grids should be used:
part thickness greater than 10cm
kVp greater than 70
large field sizes
What type of grid errors are there?
what is the worst case scenario?
off-center
off-level
off- focus
upside down (worst outcome)
increasing kVp by 15% _____ image receptor exposure but only increases patient dose by _______
doubles
1/3 (kVp math will be on the test)
What does kVp affect?
the x-ray’s beam’s ability to penerate tissues
Grid math:
Old
500 mA
1 sec
12:1 Grid
New
50 mA
___ sec
6:1 grid math
Steps:
500 mA x.1= 50mA
12:1 grid (6) to 6:1 (3) (new/old)
3/5= .6
50 x .6= 30mA
30 mA/ 50 mA= .6
Exam: grid math
Old
100 mA
5 secs
1no Grid
New
____ mA
.25 sec
6:1 Grid
Steps:
100 mA x .5= 50 mA
no grid (1/old) to 6:1 (3/new)= 3/1 new/old
50 mA x 3= 150 mA
150 mA/.25 secs= 600 mA
How do generators affect penetration (x-ray technique)?
(generators affect technique by adjusting the kVp (penetration) of the created x-rays)
generators affect penetration by altering the average energy of created x-rays
What is total filtration?
what filtration is not apart of this?
added + inherent filtration
compensating filtration
two types of filtration:
inherent (built-in (x-ray tube glass, cooling oil, beryllium window)
added (usually aluminum but can be copper)
What exams are compensating filters used on?
x-table shoulder
x-table hip
swimmers c-spine
The primary purpose of beam filtration is?
(filtration)
to reduce patient exposure
what is the required filtration?
what kind of filtration is this?
2.5 mm Al/Eq (legally)
total filtration
What generator have an effective kVp equal to the set kVP?
Portables are the only generators that have an effective kVp equal to the set kVp
Increasing the kVp by 15%:
how much does patient dose increase?
doubles the number of x-ray photons that reach the image receptor
1/3
what does filtration do to the average kVp?
why?
increases the average kVp
bc of the removal of weak x-rays by filtration
What is compensating filtrations purpose?
to even out body parts that are inherently uneven
How is penetration measured?
half-value layers (HVL)
(QC stuff)
For postmortem how should our technique be adjusted:
in first 30 minutes
after 30 minutes
increased technique 35% in the first 30 minutes
increase technique 50% after the first 30 minutes increase technique
Compensating filtration is not considered to be apart of:
inherent or added filtration
what is hypersthenic?
what do we do to technique?
large body type, increased fatty tissue
increase kVp
What is sthenic?
a healthy average person
The caliper should:
measure along the central ray
What is hyposthenic?
what do we do to technique?
thin but healthy
reduce mAs
What is asthenic?
What do we do to technique?
thin and ill/old
reduce kVp
Technique for fiberglass casts:
Casts technique should:
Technique for dry casts:
Technique for wet casts:
no change to the technique
be increased for plaster casts
double the kVp (+15%)
triple the kVp (+15% kvp then +15% again)
What is the technique for iodine studies?
what about single contrast studies?
what about double contrast studies?
80 kVp minimum for iodine studies (urinary systems)
120 kvp for single contrast GI studies using barium
90-100 kVp for double contrast studies with air and barium
How are contrast agents appearing on an x-ray?
why?
contrast agents are easier to see on a radiograph due to their high atomic number (Z#)
What is the caliper?
device to measure a part thickness
(accurately)
How much change in a technique is required to demonstrate a noticeable difference in an x-ray?
35% change in technique is required to demonstrate a change to a radiographic
What should we expect in postmortem patient in regards to technique & anatomy?
increase technique
expect less air in the chest and increased fluids
what is the average abdomen thickness?
AP:
LAT:
AP: 22 cm
Lat: 30 cm
Contrast agents only affect:
image contrast
What is needed for contrast agents regarding technique?
increase technique to partially penetrate the contrast agent
(the introduction of contrast agent requires an increase in technique to partially penetrate the contrast agent)
soft tissue Additive diseases:
What do we increase?
Actinomycosis: 50% mAs
Ascites: 50-75% mAs
Carcinomas, fibrous: 50% mAs
Cirrhosis: 50% mAs
pulmonary edema: 50% mAs
hydrocephalus: 50-75% mAs
hydropneumothorax: 50% mAs
pleural effusion: 35% mAs
pneumonia: 50% mAs
Syphilis: 50% mAs
Tuberculosis, pulmonary: 50% mAs
mAs
for additive disease that have bony growth we increase:
kVp for bony growth in order to penetrate additional bony tissue
Destructive disease pathologies:
What is being done to technique?
aseptic necrosis: 8% kVp
blastomycosis: 8% kVp
bowel obstruction: 8% kVp
cancers, osteolytic: 8% kVp
emphysema: 8% kVp
ewing’s tumor: 8% kVp
exostosis: 8% kVp
Gout: 8% kVp
hodgkin’s disease: 8% kVp
hyperparathyroidism: 8% kVp
osteitis fibrosa cystica: 8% kVp
osteomalacia: 8% kVp
osteomyelitis: 8% kVp
osteoporosis: 8% kVp
pneumothorax: 8% kVp
rheumatoid arthritis: 8% kVp
Deceasing kVp
What is the typical anode angle?
15-17 degrees for diagnostic imaging
(typical anode angles for diagnostic imaging range from 15-17 degrees)
Additive diseases require:
an increase in technique due to increase fluid, soft tissue, & bony growth
for additive diseases with soft tissue, we need to increase:
mAs to maintain subject contrast for soft tissue disease
Destructive diseases require a decrease:
what should be reduced?
Why?
in technique due to increased air, fat, or bony destruction
kVp should be reduced as penetration is easier
Which side of the x-ray beam is the weakest?
why?
the intensity is weakest on the anode side of the x-ray beam
due to the beam being attenuated bc of the material of the anode
additive disease, bony growth:
acromegaly: 8-10 kVp
osteoarthritis (DJD) 8% kVp
osteochrondroma: 8% kVp
osteopetrosis: 8-12% kVp
pagets disease: 8% kVp
What creates a small effective focal spot?
thin electron beam (cathode) + small anode bevel (angle, anode)
(the combination of a thin electron beam (cathode) from the cathode and small anode bevel (angle) creates a small effective focal spot)
What and where is the effective focal spot?
also can be referred to as?
below the actual focal spot
projected focal spot
(the effective focal spot is the projected focal spot located directly below the actual focal spot)
What are the typical focal spot sizes (cathode)?
What are the typical effective focal spot sizes?
small focal spot: 1 cm
large focal spot: 1.5cm-2cm
small effective focal spot: 0.5-1mm
large effective focal spot: 1-2mm
Focal spot affects:
when would we use a large focal spot?
when would we use a small focal spot?
spatial resolution & heat capacity
the smaller the focal spot, the better the spatial resolution
large focal spots can be used when detail is not critical to reduce heat in the tube
(small+ better picture, large+ better for heat capacity)
What is the anode heel effect?
x-ray intensity from the long axis of anode to cathode side
(the variation in x-ray intensity along the long axis of the x-ray beam from anode to cathode)
How would an increase in SID affect IR exposure?
Decrease IR exposure
The anode-heel effect is more significant when using:
larger field sizes
shorter SID’s
What does an increase in SID primarily affect?
Size distortion - decrease
because of magnification
What factors does an increase in SID affect?
Size Distortion: Decrease (Primary controller)
IR Exposure: Decrease
Sharpness: Increase
How would an increase in OID affect IR exposure?
Decrease (Air Gap)
An increase in SID would do what to sharpness?
Increase
What does an increase in OID primarily affect?
Sharpness - decrease
Increased alignment does what to shape distortion?
Decrease
What affects shape distortion?
Alignment
What factors are affected by an increase in motion?
Subject contrast goes down
Noise (blur) goes up
Sharpness goes down
How would an increase in OID affect subject contrast?
Increase (Air Gap)
What primary factors are affected by an increase in SOD?
Sharpness increase
Size Distortion decreases
How would an increase in OID without air gap technique affect noise?
No effect on noise or contrast
How would an increase in OID with air gap technique affect noise?
Decrease (Scatter)
Increased OID with air gap leads to ______ exposure to the IR
Decreased because there is less scatter hitting the IR
Increased OID leads to ______ penumbra and ______ spatial resolution
Increase penumbra
Decreased spatial resolution (detail and sharpness)
What affects spatial resolution?
SID
Where is the SID measured from?
Focal Spot to image receptor
What is the inverse square law used for?
Used to determine intensity of new exposure (mGy or mSv)
Why is the measuring tape on the collimator cut?
Accounts for focal spot to collimator
What is the square law used for?
Used to maintain IR exposure
(old/new)
What is the relationship of SID/SOD/OID?
SID = SOD + OID
What is a primary result of increased OID? (1)
What else does it affect? (4)
Decreased sharpness
Also:
Decreased IR exposure (air gap)
Increased subject contrast (air gap)
Decreased noise (scatter)
Increased size distortion (magnification)
What is a primary factor of increased SOD? (2)
Increased sharpness & decrease size distortion (lower penumbra)
What is a primary result for increased SID? (1)
What is also affected? (2)
Decreased size distortion
Also:
decreased IR exposure (beam divergence)
Increased sharpness (less penumbra)
What is the result of increased motion? (3)
Decreased subject contrast
Increased noise (blur)
Decreased sharpness
What is a primary result of increased alignment?
Decreased shape distortion
Increased SID without adjustment. How does it affect?
IR exposure?
Detail?
Magnification?
IR exposure goes down (beam divergence)
Detail increases (lower penumbra)
Magnification decreases (increase SID decreases magnification)
Increased SID and adjusted technique to compensate. How does this affect:
IR exposure?
Detail?
Magnification?
IR exposure stays the same (technique has been adjusted)
Detail increases due to increase SID (technique plays no role in this)
Magnification decreases due to increased SID (technique plays no role)
(Only factor affected here is IR exposure & that has been compensated for)
Increased OID without any adjustments. How does this affect:
Contrast?
Noise?
Shape distortion?
What is the primary factor with increased OID?
Increased contrast (air gap technique)
Noise decreased (less scatter)
Shape distortion stays the same (shape distortion= elongation + foreshortening)
Decreased sharpness
What affects spatial resolution?
SID affects (more SID less OID)
Time not affected
KVP not affected
Why is the measuring tape on the collimator cut?
To account for the distance within the x-ray tube (focal spot to the collimator)
What are the relationships between OID/SOD/SID?
OID + SOD = SID
SID - OID = SOD
SID- SOD =OID
In regards to formulas of the square & inverse square law what does these signs represent?
E=
D=
n=
O=
E= exposure (mGy or mSv)
D = Distance (SID)
N= new
O= old
What is the SID measured from?
From the source (x-ray tube/anode focal spot) to the image receptor (distance)
What happens when AEC encounters metal?
Time
motion
patient exposure
IR exposure all increase.
Density settings of ____ are needed to see a visible change.
+2 (1=25%)
Modulation Transfer Function:
What is it?
what can happen?
A way physicists measure contrast resolution
When line pairs become too small their penumbrae merge and reduce contrast.
Backup time should be to ____% of anticipated time.
150%
Ex: Anticipated: 0.4 sec; Backup Time: 0.6 sec.
Where is the AEC detector located?
Between the patient and the image receptor and use ionization.
How many ionization chambers do most AEC Systems consist of
3 (the cells on the wall bucky)
The only thing AEC controls is:
time
What does the air-gap technique do?
increases size distortion (magnification)
improves contrast (decreasing scatter)
decreases detail (increased penumbra)
What’s the primary reason for technique charts?
To maintain consistency
Air Gap Technique is based on creating a gap by increasing the ___
OID
What is magnification?
Size distortion
how do we calculate the magnification factor?
SID/SOD
How do you find the objects actual size?
divide projected size/magnification factor
How would you find the size of an anatomy on a projected image?
multiply actual size x mag factor
Elongation is:
anatomy appearing longer than normal
(angle on tube or IR)
Foreshortening is:
part appears to be shorter than normal
(part is angled)
What causes shape distortion?
Misalignment of tube, image receptor, or part
We should always have a minimum of ____ views
2
What is Cieszynski’s Law?
angle 1/2 of the part’s angle to minimize distortion through elongation/foreshortening
Increase SID = ____ IR Exposure
why?
decreased
bc of beam divergence
Motion is generally caused by:
Patients
increased focal spot size will _____ sharpness
Decrease.
(It is the one and only controller?)
Off-centering is the same as:
why?
Angling
bc of the beam divergence
Increasing the OID will decrease:
A. Shape distortion.
B. Subject contrast.
C. Size distortion.
D. Sharpness.
D. Sharpness.
Increasing collimation will result in increased:
A. IR Exposure
B. Subject contrast
C. Noise
D. Spatial Resolution
B. Subject Contrast
The smaller the focal spot size, the ______ spatial resolution
Higher
Decreasing the focal spot size will result in:
A. Increase contrast.
B. Decrease contrast.
C. Increase sharpness.
D. Decrease sharpness.
C. Increased sharpness
Which one of the following pathologist would be MOST LIKELY to result in increased shape distortion?
A. Emphysema
B. Large bowel obstruction
C. Kyphosis
D. Cirrhosis
C. Kyphosis.
Reducing SID but adjusting mAs to compensate will result in decreased:
A. Subject contrast.
B. Sharpness.
C. Noise.
D. Size distortion.
B. Sharpness.
Decreasing kVp will result in:
A. Increased sharpness
B. Decreased sharpness
C. Increased IR Exposure
D. Decreased IR Exposure
D. Decreased IR EXPOSURE
Reducing mAs but adjusting kVp to compensate will result in decreased:
A. IR exposure
B. Size distortion
C. Subject contrast
D. Sharpness
C. Subject contrast.
A transthoracic humorous exam results in a radiograph that displays decreased subject contrast. If the image was repeated, which change would be MOST EFFECTIVE in improving subject contrast?
A. Increase mAs
B. Increase collimation
C. Decrease motion
D. Reduce kVp
B. Increase collimation
Where is the outer canthus located?
Where is the inner canthus located?
lateral junction of where the eyelids meet
inner eyelids meet near the nose
Where is the Gabella located?
smooth, raised triangle process superior to eyebrows & bridge of nose
Where is the nasion located?
at the junction of the two nasal bones & the frontal bone
Where is the acanthion located?
midline junction where the upper lip and nasal septum meet
What is the thickest/densest part of the cranium?
petrous portion of the temporal bone
pyramid shaped
Where is the gonion located?
lower posterior “angle” of the mandible
“jawline”
What is the pinna?
What is it also referred to as?
large flap of ear made of cartilage
aka auricle
What is the CR for Caldwell?
What is the angle?
What line is to the IR?
What does this best show?
CR exits nasion
Caudad 15 (30 exaggerated)
OML perpendicular to IR
Criteria:
petrous pyramid located in lower 1/3 (15)
petrous pyramid located IOM showing full orbit (30)
What is the difference between the lateral cranium and the lateral facial bones?
What is different in the anatomy?
What is the CR for both?
CR for Lat skull is 2 inches above EAM *
CR for Lat Facial is between outer canthus & EAM
Lat skull you can cut off the mandible *
Lateral sinus can cut off the posterior skull
(Positioning is RAO but cranium in lateral)
How do the Caldwell, exaggerated Caldwell, and PA skull look compared to each other?
15 degree caudad Caldwell puts petrous ridge in bottom 1/3 of orbit *
exaggerated Caldwell places petrous ridge completely out of the orbit *
PA skill has the petrous ridge completely in the orbit *
What is mesocephalic?
What is Brachycephalic?
What is dolichocephalic?
average shaped head shaped at an angle of 47 degrees
wide skull, greater than 47 (54)
skinny skull, less than 47 degrees from parietal tubercles
What bone houses the hearing organs?
Temporal bone
(Mastoid portion)
What does the occipital bone articulate with?
6 bones:
2 parietals
2 temporals
1 sphenoid
1 atlas (C1)
What does the parietal articulate with?
5 cranial bones:
1 frontal
1 occipital
1 temporal
1 sphenoid
1 (opposite parietal)
What does the temporal articulate with?
3 cranial bones:
1 parietal bone
1 occipital bone
1 sphenoid bone
What does the sphenoid articulate with?
all 7 of the cranial bones & 5 facial bones
acts as the anchor for the cranium
What does the ethmoid articulate with?
2 cranial bones & 11 facial bones
1 frontal bone
1 sphenoid bone
What does the frontal bone articulate with?
4 cranial bones:
2 parietals (L & R)
1 sphenoid
1 ethmoid
What is GML?
What is OML?
What is IOML?
What is AML?
What is LML?
What is MML?
What’s the degree difference between OML and IOML?
gabellomeatal line (GML)
Orbitomeatal line (OML)
infraorbitomeatal line (IOML)
Acanthiomeatal line (AML)
lips-meatal line (LML)
mentomeatal line (MML)
7 degree difference
What is GAL?
What is IPL?
Gabellaveolar line
Interpupillary line
What line is parallel or perpendicular in the SMV projection?
IOML is parallel to IR
GAL is perpendicular
How is the image receptor for the skull projections?
All are portrait except for lateral cranium
How many cranial bones are there?
What are the names?
8
1 frontal bone
2 parietal bones
2 temporal bones
1 ethmoid
1 sphenoid
1 occipital
How does Waters differ physically on an x-ray?
What line is the IR?
What is the CR?
What is best shown?
What is it also called?
Waters: MML perpendicular to IR
CR exits acanthion
best shows sinuses, nasal septum
Parietoacanthial
How does Haas differ physically on an x-ray?
What line is on the IR?
What is the angle?
What is the CR?
What’s is best shown?
What is magnified vs the Townes?
Also called?
Haas: OML perpendicular to IR,
CR exits 1 1/2 superior to nasion
25 cephalic
best shows dorsum sellae in foramen magnum,
Occipital bone is more magnified
PA axial
What is another name for Waters?
What is another name for Haas?
What is another name for Townes?
parietoacanthial projection: Waters
PA axial: Haas
AP axial: Townes
What bones make up the orbit?
3 cranial bones & 4 facial bones
C: frontal, sphenoid, & ethmoid
F: Maxilla, zygoma, lacrimal, palatine
What is the widest portion of the skull?
parietal tubercles (eminences)
What bone contains the sellae turcica?
What organ lies in the sellae turcica?
Sphenoid bone
Pituitary gland
Your patient comes to radiology for a study of the cranium and is unable to flex his head and neck to place the OML perpendicular to the IR for an AP axial projection (Townes). What should the technologist do to compensate for this without causing distortion?
increase the angle by 7 degrees caudad to match the IOML
(we don’t switch to Haas because PA projection would enlarge the occipital bone)
Where is the pituitary gland?
in the sellae turcica of the sphenoid bone
What bone is the cribriform plate & Crista galli located on? *
What lies anterior or posterior to each other?
ethmoid bone
Crista galli located anterior to cribriform plate
“Crista galli also known as rooster comb”
Where is the CR entering or exiting in the Caldwell projection?
CR is exiting the nasion
(15 caudad/ 30 caudad exaggerated)
Where is the CR entering or exiting in the Townes projection?
CR enters 2 1/2 inches above the Gabella
through the foramen magnum
exiting at the base of the occipital bone
Where is the CR entering or exiting in the exaggerated Caldwell projection?
CR is exiting the nasion
30 caudad
Where is the CR entering or exiting in the Haas projection?
CR exits 1 1/2 inches superior to nasion
Enters 1 1/2 below inion
25 degrees cephalic
Where is the Maxillary sinus located?
2 maxillary sinuses in both maxillae
(only sinus that correlates to facial bones)
What views are for cranium?
PA skull
Lateral skull
Caldwell + exaggerated Caldwell
Townes or Haas
What views are for facial bones/sinuses?
Lateral facial bones
Waters
Caldwell
How do sinus and cranium views differ?
no angle for sinus views (we want to see air fluid levels)
(sinus doesn’t need full skull, cranium doesn’t need mandible)
Where is the ethmoid sinus located?
lateral masses of the ethmoid bone
(anterior, middle, and posterior portions)
Where is the sphenoid sinus located?
body of Sphenoid bone, inferior to sellae turcica
Where is the frontal sinus located?
Frontal bone
(posterior to Gabella, rarely symmetric & mostly separated by a septum)
If we are shooting an AP axial (Townes) and in the picture the dorsum sellae is below the foramen magnum but the anterior arch of C1 is visible in the foramen. What error has taken place?
too much caudad angle
(almost becoming a tangential)
(dorsum sellae is supposed to be inside the foramen magnum, angling less will place it inside)
Should the orbital grooves be superimposed in the PA projection of the skull?
No
Only superimposed in a right lateral cranium
How many junctions are there?
What is the name of the anterior junction?
What is the name of the lateral junctions?
What is the name of the lateral posterior junctions?
What is the name of the posterior junctions?
6 junctions
(1) bregma junction
(2) Pterion junctions (L & R)
(2) asterion junctions (L & R)
(1) lambda junction
How many total sutures are there?
What is the name of the lateral sutures?
What is the name of the anterior suture?
What is the name of the posterior suture?
What is the name of the suture that goes down the midline of the cranium?
5 sutures
(2) squamous suture
coronal suture
lambdoidal suture
sagittal suture
What is best displayed in a Caldwell?
What is the name & difference with the alternative view?
Why would we want to shoot an alternative view?
petrous pyramids in lower 1/3 (15), or below the IOML in exaggerated (30)
Exaggerated Caldwell (15 to 30 caudad) places petrous pyramids completely out of orbit
to see the whole orbit
What is best shown in a Water’s projection?
What is the alternative view and when do we use this?
Open mouth (transoral) Water’s to show the sphenoid sinus (which shows the last and all 4 sinuses)
What is best shown in a Haas?
What is best shown in a Townes?
Haas & Townes: best shows dorsum sellae in the shadow of the foramen magnum, & occipital bone, petrous pyramids
(Haas enlarges the occipital bone, Townes enlarges the orbits)
What does the Haas do the x-ray?
What does the Townes do to the x-ray?
enlarge the occipital bone
enlarge the orbits
For the parietoacanthial projection, where does the CR exit?
Acanthion
(hint the name parietoacanthion)
For a modified parietoacanthial projection how many degrees does it place the OML to the IR?
55 degrees
(37 for regular waters)
What is the tragus?
external structure that acts as a shield to ear opening located anterior to EAM
What is the name of the two part articulation between the skull and the atlas?
atlanto-occipital joint
What are the two lateral oval convex processes located on each side of the ______?
Foramen magnum
A: Occipital condyles
What is a tripod fracture?
a blow to the cheek resulting in a fx to the zygoma in 3 places
How does the stomach lie in a hypersthenic patient?
What level is the stomach, pyloric portion, & duodenal bulb?
high & transverse
Stomach: T9-T12
Pyloric portion: T11-T12
Duodenal bulb: T11-T12
How does the stomach lie in a hyposthenic/asthenic patient?
What level is the stomach, pyloric portion, & duodenal bulb?
low & vertical (J shaped)
Pyloric portion: L3-L4
Duodenal bulb: L3-L4
What is bile?
made by the liver
breaks down fats
What is the CR for Upper GI RAO?
For sthenic?
Hyperstenic?
Asthenic?
40-70 degree RAO prone rotation
Sthenic: 45-55 oblique CR at L1 (duodenal bulb)
Hypersthenic: 70 degree oblique (2 inches superior to L1)
Asthenic: 40 degree oblique (2 inches inferior to L1)
(suspend respiration, expose on expiration)
What is the CR for Upper GI LPO?
Sthenic:
Hypersthenic:
Asthenic:
Expose on?
30-60 degree LPO supine rotation
Sthenic: 45 degree oblique at L1
Hypersthenic: 60 degree oblique 2 inches superior to L1
Asthenic: 30 degree oblique 2 inches inferior to L1
(suspend respiration, expose on expiration)
What is the CR for upper GI AP?
Sthenic:
Hypersthenic:
Asthenic:
Sthenic: at L1 45 LPO
Hypersthenic: 2 inches superior to L1 60 LPO
Asthenic: 2 inches inferior to L1 30 LPO
(suspend respiration, expose on expiration)
What is the CR for an AP/PA esophagogram?
expose on?
T5-T6
1 inches inferior to sternal angle or
3 inches inferior to jugular notch
(suspend respiration, expose on expiration)
What is the CR for LAO/RAO esophagogram?
35-40 degree AO prone oblique
CR: (LAO T5-T6) (RAO T6)
(2-3 inches inferior to jugular notch)
What does LAO esophagogram show?
What does RAO show?
LAO: esophagus is seen between hilar region & thoracic spine
RAO: Esophagus is seen between thoracic spine & heart
(entire esophagus is filled (or lined) with contrast)
What does angio mean?
What does Choles mean?
What does Cysto mean?
duct
relationship with bile
bag or sac
What is the stomach orientation?
Fundus (most posterior)
Body (anterior/inferior to fundus)
Pylorus (posterior/distal to body)
What is the order for all the ducts?
(know what it looks like on a picture)
Left & right hepatic (from liver)
Common Hepatic duct
cystic duct (duct into gallbladder)
Common bile duct
Pancreatic duct (duct of wirsung)
Duodenum (sphincter of Oddi)
What do you see in a lateral esophagogram?
What is the CR?
esophagus is seen between the thoracic spine and heart
T6 (2-3 inches inferior to jugular notch)
What do you see in LAO esophagogram?
What is the CR?
Esophagus is seen between the hilar region & the thoracic region
35-40 degree anterior oblique + T5-T6 (2-3 inches inferior to jugular notch)
What do you see in a AP/PA esophagogram?
What is the CR?
Esophagus superimposed over the spine
T5-T6 (1 inch inferior to sternal angle)
What is the sphincter of Oddi?
Also known as?
muscle fibers of the duct walls leading into the duodenum
hepatopancreatic sphincter
How do you oblique for an Upper GI study?
40-70 degree anterior oblique for RAO
30-60 degree posterior oblique for LPO
What is the ligament of Treitz?
Where is located?
Why is this important?
ibrous muscular band
superior to the duodenojejunal flexure
suspensory muscle of the duodenum
What is the kvp range for a double contrast exam?
90-100 kVp
What are the ionized contrasts?
What else can you use this for?
How does it taste & what is this an example of?
gastrogavin
omnipaque
visipeg
pre-surgical exams
bitter + water-soluble contrast
What is anterior & posterior when it comes to the trachea/esophagus?
trachea is anterior to the esophagus
Where is the gallbladder located?
What is its main purpose?
what are the 3 parts of the gallbladder?
how much bile can it hold?
inferior to liver
store bile, 2. concentrate bile (Hydrolysis: removal of water) (choleliths: gallstones), 3. contract
Fundus, Body, Neck
30-40 mL of bile
What is the kvp range for a single contrast exam?
What is the kVp range for water-soluble contrast studies?
110-125 kVp
(to increase visibility of barium-filled structures)
80-90 kVp
What do these mean?
Chole:
Cysto:
Angio:
Choledocho:
Cholangio:
Cholecyst:
Relationship with bile
Bag/sac
duct
Common bile duct
bile ducts
gallbladder
What do these terms mean?
Cholecystography:
Cholangiography:
Cholecystangiography:
Radiography of gallbladder
radiographic study of biliary ducts
radiography of both gallbladder & biliary ducts
In LPO how is the barium in the stomach?
Barium in the fundus
Air in the pylorus
In RAO how is the barium in the stomach?
Barium in the pylorus
Air in the fundus
Which oblique places air in the fundus?
RAO
What oblique puts the esophagus between the heart & thoracic spine?
RAO
What oblique places barium in the pylorus of the stomach?
RAO (has to be prone)
What oblique places the esophagus in between the hilar region & thoracic spine?
LAO
What view superimposes the esophagus over the spine?
AP or (PA)
Which oblique places barium in the fundus of the stomach?
LPO (has to be supine)
Which oblique places air in the in the pylorus of the stomach?
LPO (has to be supine)
What is chymes?
semifluid mass as a result of mixing (churning) of stomach contents & stomach fluids
Where is the duct or Wirsung?
Also known as?
Duct leading into the pancreas
Pancreatic duct
Which view of the stomach best displays the retrogastric space?
R lateral (upper GI) view
(lateral)
what is swallowing called?
deglutition
What is chewing called?
Mastication
Where does barium go if the patient is lying prone?
Where is the air?
barium in pylorus & air in the fundus
What is peristalsis?
involuntary muscle contractions
(wavelike movements that propel solid/semisolid structures)
Where is the barium going if the patient is lying supine?
Why?
Fundus
What is the epiglottis?
What does it do?
membrane-covered cartilage that moves down to cover the opening of the larynx during swallowing
How does the fundus lie in the stomach?
fundus is posterior
Barium is a:
colloidal suspension
(not a solution)
What is rugae?
where is the location?
internal lining of stomach thrown into numerus mucosal folds
(when the stomach is empty)
greater curvature
What helps food gets down the esophagus?
peristalsis
(gravity + involuntary movement)
What is the gastric canal?
Where is it located?
What is its function?
canal formed by rugae
along the lesser curvature
funnels fluids directly from the stomach’s body to the pylorus
Where is the cardiac antrum at?
distal portion of esophagus, that curves sharply into expanded portion of the esophagus
(right before the esophagogastric junction)
Where is the angular notch?
also known as:
ring like area that separate the body and pylorus region
incisura angularis
What is GERD?
gastroesophageal reflux disease
What is an accessory organ?
What is an example?
not a digestive organ but aids in digestion
salivary glands, pancreas, liver, & gallbladder
What is used to prevent scatter radiation in fluro?
Bucky slot shield
(lead drape shield, exposure patterns, lead aprons)
What is the 3 cardinal rules of radiation protection: (3)
Time
Shielding
Distance (most crucial)
What is the C loop of the duodenum?
What is inside of this area?
What is it referred to as?
The head of the pancreas
Called the romance of the abdomen (stomach)
What is the special name for having gallstones?
choleliths
(biliary calculi)
What is best shown in a RAO stomach?
barium in the pylorus
air in the fundus
What is a trichobezoar?
(cool/ scary thing)
Mass of ingested hair
What are the 3 parts of the pharynx?
Nasopharynx (nose area)
Oropharynx (mouth)
Laryngopharynx (throat area)
AP oblique that best demonstrates hepatic flexure + ascending colon?
What is the PA oblique?
What is the CR?
AP: LPO
PA: RAO
at crest
What is the AP oblique that best shows splenic flexure + descending colon?
PA oblique?
AP: RPO
PA: LAO
Which decubitus position best shows the air the splenic flexure + descending colon?
Why?
Right lateral decub
bc splenic flexure is on the left side of the body and to see air levels we need it to be side up
What decubitus position best shows the air in the posterior rectum?
What decubitus position best shows the air in the anterior rectum?
Why?
Ventral decubitus
Dorsal decubitus
bc air/fluid levels move depending on gravity. In prone position, air goes posterior and barium goes anterior
Where is the barium while the patient is PA?
Where is the air?
Why?
B: transverse & sigmoid colon
A: ascending & descending colon
Which decubitus position best shows the air the hepatic flexure + ascending colon?
Why?
left lateral decubitus
bc we want to see the air levels on the hepatic (right side) so we must have right side of the body up
Where is the barium when the patient is AP?
where is the air?
Why?
B: ascending & descending colon
A: transverse & sigmoid colon
bc of gravity and the ascending & descending colon are retroperitoneal
Splenic flexure is located on ___ side
Ascending colon is location on ___ side
Hepatic flexure is located on ____ side
descending colon is location on ____ side
left
right
right
left
Which aspect of the large intestine is the highest?
left colic flexure
What part of the large intestine is the widest?
What about the small intestine?
L: cecum
S: duodenum
How long should the patient NPO for a barium enema?
8 hours
What are the contraindications for a barium enema?
perforated hollow viscus & large bowel obstruction
When inserting the tip for a barium enema it must be on:
What position is best for a tipped insertion?
Where should you aim for when doing a barium enema insertion?
expiration (relaxes the abdominal muscles)
sims
Step 5
aim tip toward umbilicus approximately 1-1/2 inches (3-4 cm)
where is the CR for an initial small bowel study?
Where is the CR after 1-2 hours?
Initial: 2 inches above crest
1-2hr: at crest (bc barium has made its way from the stomach to bowel)
What does LPO best show?
Right hepatic flexure + ascending colon
compresses the small bowel to best show the loops
compresses the small bowel to best show the loops
What does ventral decubitus best display?
Air in the posterior portion of the rectum
What does LAO best show?
What is the CR?
Splenic flexure + descending colon
2 inches superior to crest + 1 inch to the right of MSP
What does RPO best display?
Splenic flexure + descending colon
What does right lateral best display?
Air in the splenic flexure + descending colon
(The side up)
What does left lateral decubitus best display?
air in the hepatic flexure + ascending colon + cecum
(air in side up)
What does RAO best display?
what is the CR?
how much oblique?
Hepatic flexure + ascending colon
CR at crest
35-45 oblique
What does lateral rectum best show?
what positions achieve this?
what the is the CR?
demonstrates polyps, strictures, & fistulas between rectum & bladder/uterus
left lateral rectum or Ventral decubitus
CR is at ASIS
What is the CR for AP axial & LPO oblique?
(butterfly)
What study is this for?
Do you angle the patient or the tube?
AP: supine + 30-40 cephalic + CR 2 inches inferior to ASIS
LPO: 30-40 LPO + 30-40 cephalic + 2 inches inferior & 2 inches medial to right ASIS
Barium enema
angle tube 30-40 cephalic
What is the difference between a PA and AP image?
right/left lateral?
PA: Barium in the transverse & sigmoid with air in the A & D colon
AP: Barium in the Ascending + descending with air in the Sigmoid + transverse
R lateral: Air in the splenic + descending barium in hepatic + ascending
L lateral: Air in the hepatic + ascending barium in the splenic + descending
which flexure is always higher?
splenic flexure
What is the CR for LPO/RAO ?
RAO: crest + 1 inch to the left of MSP
LPO: crest + 1 inch to elevated side from MSP
35-45 AO/PO oblique
The enema bag should not be higher than _____
24 inches above table (2 feet)
During small bowel studies how often should images be taken?
every 20-30 minutes
Which part of the small intestine makes up the 3/5’s?
which part makes up the 2/5’s?
ileum
& jejunum
What is subluxation?
what is an example of this?
a partial dislocation
nursemaids jerked elbow
What is apposition?
what are the types?
how fragmented ends of the bone make contact with each other
anatomic apposition (normal, end-to-end contact)
lack of apposition (distraction, end of fragments are alligned but don’t make contact with each other)
bayonet apposition (fx fragments overlap and shafts make contact but not the fx ends)
What is a contusion?
bruise injury
(possible avulsion fx)
What is a fracture?
a break or altering of the bone
What is a sprain?
forced wrenching/twisting of a joint (damages ligament without dislocation)
What is varus?
What is valgus?
What are the deformities?
valgus is away from the mid-line (medial)
Varus is toward from mid-line (lateral)
distal fragments are angled in these directions
What is a greenstick fracture?
What is a closed fx?
also known as?
fx is on one side only
fx with bone not though the skin (simple fx)
What is a complete fx?
what are the 3 types of fx?
fx is complete, broken into two pieces
transverse fx (transverse fx near the right angle to long axis)
oblique fx (fx passes through bone at oblique angle)
spiral fx (bone is twisted, fx spirals around long axis)
what is a smiths fx?
fx of the wrist with distal radius displaced anteriorly, with radius & ulna posteriorly
What is a comminuted fracture?
what are the types?
bone is splintered/crushed causing it to be in two or more fragments
segmental fx: (bone broken into 3 pieces, middle fragment fx at both ends)
butterfly fx: two fragments on each side of the main, wedged shape resemblance to butterfly)
splintered fx: splintered into thin sharp fragments
what is a colles fx?
distal radius is displaced posteriorly, with radius & ulna anteriorly
What is compound fracture?
also known as?
portion of bone (fx) is piercing through the skin
open fx
What is a stellate fx?
most commonly seen?
fx lines radiate from central point of injury that resembles a star-like pattern
(ex: most commonly seen in the patella, after knees hitting the dashboard in an accident)
What is a pott’s fx?
complete fx of distal tib/fib
(major injury to ankle + ligament damage)
(commonly seen in medial malleolus/distal tibia)
what is a boxer’s fx?
fx of distal 5th metacarpal
(fx comes from punching)
What is an impacted fx?
most common in?
one fragment is firmly driven into the other
(most common in femurs, humerus, & radius)
What is a jefferson fx?
aka?
how does this happen?
comminuted fx of anterior/posterior arches of C1
seen from landing on the head
(skull slams into the ring)
what is the minimum distance you should be away from exposing on portable x-ray?
6 feet
what is a hangman’s fx?
fx occurs in pedicles of C2 or with/without displacement of C2/C3
what is a compression fx?
vertebral fx from compression injury
(vertebral body collapses or compresses)
why do we prefer AP over PA view of the thumb?
for OID
What are the roles for the radiologic technologist?
radiation safety expert
(check for overuse of c-arm, failure to wear aprons, placement of hands in field)
if you are doing a horizontal beam in the OR, where should the surgeon stand?
near the image intensifier
(not near the x-ray tube for sterilization)
what is the CR for a portable chest?
AP: 3-4 inches inferior to jugular notch (T7)
3-5 caudad
CR perpendicular to the long axis of the sternum
If a patient has a dislocated shoulder, unable to sit erect or stand what view should we do to replace a lateral?
supine, transthoracic
(usually will have to break it up into a distal and proximal because of tissue)
What are the roles of the CST?
What does it stand for?
prepares with OR + supplying appropriate supplies and instruments
(prepping patient for surgery, connect surgical equipment, maintain a sterile field)
(t/f) When working in surgery we need to be confident about how to manipulate the factors & anatomy to make a “textbook” image
true
what is spiral fracture?
bone is twisted apart & fx spirals around the long axis
What are the roles for the scrub (scrub tech)?
prepares sterile field scrubs
gowns surgical team,
prepares/sterilizes instruments before procedure
CST or RN
when using fluro & boost fluro it is important to use:
Why?
How does image look?
intermittent fluro (pulse fluro)
bc less patient dose
less crisp
What does ORIF stand for?
What is it?
open reduction with internal fixation
fx site is exposed to a variety of screws, plates, & rods inserted to maintain alignment
What is the normal range for creatinine levels?
0.6 to 1.5 mg/dL
What is the average levels for BUN?
8-25mg per 100 ml
Metformin 48 hours before or after administration of iodinated contrast
Metformin 48 hours before or after administration of iodinated contrast
What is micturition?
the act of voiding or urination
What is incontinence?
involuntary passage (leakage) of urine through the urethra
(failure to control vesical and urethral sphincters)
What is retention?
inability to void: bladder unable to empty
(obstruction in the urethra or lack of sensation to urinate)
What exams/studies would you need to premedicate for?
What medications?
What are examples of procedures?
patients with history of hay fever, asthma, or food allergies
antihistamines (benadryl) + prednisone 12 or more hours prior to procedure
IVU
What position would you use for voiding cystograms?
What are the procedure steps?
What supplies do you need?
supine or erect (makes voiding easier) (women)
30 degree RPO (male, best shown)
What drugs would you use to reduce a reaction?
prednisone & Benadryl
What are mild reaction symptoms?
non allergic reactions:
anxiety
lightheadedness
nausea
vomiting
metallic taste (common side effect)
mild erythema
warm flush (common side effect)
itching
mid scattered hives
what is an IVU?
excretory urography
IV injection with contrast through superficial vein in arm
What is a retrograde urography study?
injection through ureteral catheter by urologist as a surgical procedure
What is a retrograde cystography?
contrast flowing to bladder through urethral catheter pushed by gravity
what is a voiding cystourethrography?
what is the positioning?
contrast flowing to from urethral catheter to bladder & withdrawal of catheter for voiding imaging
women: supine (lithotomy) or erect AP
men: 30 degree RPO
what is a retrograde urethrography study?
(RUG)
for males
retrograde injection through Brodney clamp or special catheter
What are moderate reaction symptoms?
true allergic reactions (anaphylactic):
urticaria
possible laryngeal swelling
bronchospasm
angioedema
hypotension
tachycardia >100 beats/min
bradycardia >60 beats/min
what are severe reaction symptoms?
vasovagal (life-threatening reaction):
hypotension (systolic <80)
bradycardia (<50 beats/min)
cardiac arrhythmias
laryngeal swelling
possible convulsions
cardiac arrest
respiratory arrest
no detectable pulse
What is an HSG?
What is it looking for?
contrast study of the uterus to assess the function
Which kidney sits lower than the other?
Why?
right sits more inferior to the left kidney
bc of the presence of the liver
What are the functions of the kidneys?
filter blood & remove waste through urine*
What are the reasons for using a uterus compression study?
Where do you place the compression device? (what level)
enhance filling of pelvicalyceal system/proximal ureters & allows renal collecting system to retain the contrast medium longer
(at ASIS) inflated paddles over outer pelvic brim
How do you position for an IVU?
What is the prep?
Scout: supine (AP) CR is iliac crest
5 min: Supine (AP) (KUB) CR is iliac crest
10-15 min: supine (AP +KUB) CR is iliac crest
20 min: 30 degree LPO/RPO (ureters away from spine) CR is iliac crest
postvoid: prone or erect AP (include bladder)
Prep:
light evening meal before procedure
bowel-cleansing laxative
NPO after midnight
enema on morning of exam
What is an essential component of the kidney?
nephrons
What is the positioning for the retrograde urography?
What is the prep?
30 degree RPO
special catheter inserted to distal urethra (contrast medium inserted by injection
What is a retrograde study?
What is an excretory study?
contrast through catheter (retro=backwards)
contrast through the vein (intravenous) (forward)
What organs make up the urinary system?
two kidneys
two ureters
one urinary bladder
one urethra
Where do the suprarenal glands lie in relation to the urinary system?
superior and medial to each kidney
(important glands of the endocrine system located in fatty capsule that surrounds each kidney)
What position do we need to place the patient in to get the kidneys parallel to the IR?
30 degree LPO/RPO
(30 LPO places right kidney parallel)
(30 RPO places left kidney parallel)
What is the name of the functional study of the bladder and urethra?
voiding cystourethrography (VCU)
When would we not use the uterus compression?
ureteric stones
abdominal mass
abdominal aortic aneurysm
recent abdominal surgery
severe abdominal pain
acute abdominal trauma
(pregnancy)?
what angle does the kidney sit to the midsagittal plane?
20 degrees from the midsagittal plane due to the psoas major muscles (vertical angle)
where should the tourniquet be placed in relation to the injection site?
3-4 inches above injection site
What is acute renal failure?
(Can’t filter waste from the blood)
inability of a kidney to excrete metabolites & inability to retain electrolytes (at normal plasma levels
& under normal conditions)
Three purposes for an IVU?
visualize portion of urinary system
assess function of kidneys
evaluate urinary system pathology
What is oliguria?
diminished amount of urine in relation to fluid intake
low urine output
(less than 400mL in 24 hr)
What is retention?
inability to void: bladder unable to empty
(due to obstruction in urethra or lack of sensation to urinate)
What is anuria?
complete cessation of urinary secretion by the kidneys
(kidneys producing none-little urine due to a blockage)
At what level does the kidney lie in an adult body??
Where in relation to the abdomen?
T11-T12 (between xiphoid process (T10) and iliac crest (L3-L4)
(Left kidney T11-T12)
(Bottom right is at L3)
retroperitoneal
What is the bladder capacity?
350ml-500ml
why do we premedicate for patients with allergies?
To prevent contrast reactions
Where are the kidneys located?
Midway between the xiphoid process and the iliac crest
What is the name of the leakage of contrast outside of the vessel and into surrounding tissue?
extravasation
This exam may be performed to demonstrate uterine position, uterine lesions, and uterine tubal obstruction?
HSG study
(hysterosalpinography)
What calyx’s form the renal pelvis?
major & minor
What drug combination is given to patients before an IVU to reduce the risk of a reaction?
prednisone + Benadryl
What type of contrast reaction affects the entire body or a specific organ system?
systemic reaction
What is the device used and positioned at the level of ASIS?
Uterine compression device
what type of contrast media dissociates into separate ions when injected?
ionic contrast media
What blood chemistry level should read 8-25 mg/100mL if in normal range?
BUN
Which of the following is not a reason to be pretreated before a contrast enema?
itching
We must verify ____ ____ for patients with _____ before resuming metformin?
kidney function
diabetes
The right kidney sits ____ to the left kidney due to the liver
inferior
for a male retrograde urethrogram the patient position should be?
30 degree RPO
Which study injects contrast through a catheter into the renal pelvis?
retrograde urethrogram (RUG)
What is the purpose for voiding a cystourethrogram?
to evaluate the patient’s ability to urinate
What position is best to see the ureters without obstruction?
RPO/ LPO
What is the name of the action urination?
micturition
Which two types of fractures are most commonly seen in victims of child abuse?
Bucket & Corner fx
What is necrotizing enterocolitis (NEC)?
condition causes the intestinal tissue to die
What is the life-threatening condition that occurs when the intestines fold into itself?
intussusception
What position of the abdomen is recommended for demonstrating the prevertebral region of the abdomen?
Dorsal Decubitus
what is atresia?
a medical condition where a body part that tubular in shape and either closed or doesn’t have a normal opening
What must you never do when using tape on a pediatric patient?
stick the adhesive side to the patient
(could have an undiagnosed allergy to adhesives)
what set of images would best demonstrate Croup?
AP + Lateral soft tissue neck
what is a weighted device used to assist in positioning?
sandbag
What is the primary technical factor to eliminate motion for pediatric patients?
shorten exposure time
What is pyloric stenosis?
rare condition affects the pylorus and muscular opening between the stomach and the small intestine in babies
For a patient with osteogenesis imperfecta how would you properly adjust your technique?
What is this?
decrease technique
a condition where bones easily break
What genetic disorder that causes bones to break easily?
osteogenesis imperfecta
What is the name of the flat radiolucent device with straps that assists with supine imaging?
Tam-em board
what is a common birth defect that causes one or both feet to turn inward and downward?
talipes equinovarus
What is the CR for a ped abdomen?
1” superior to umbilicus
What is the mummifying technique?
technique that helps to immobilize the child’s arms
(by wrapping patient up in a towel)
what is the rare birth defect that occurs when the nerves in the lower part of the intestine don’t develop properly?
Hirschsprung’s disease
which modality would help to diagnose congenital hip dislocations in newborns?
sonography (US)
what is the technical term for newborn?
neonate
what is the device used to image a child in upright/erect position?
What exams are these for?
pigg-o-stat
erect abdomen + chest
At what age can pediatrics understand simple commands?
2-3 years old
what position is performed to look at both hip joints in a lateral perspective?
bilateral frogs
(included as much as possible in one image
what exam or position is performed to determine if a child has stopped growing?
bone age survey
(one x-ray of the left hand)
what is a disorder of abnormal development resulting in dysplasia, subluxation, and possible subluxation of hip secondary to capsular laxity and mechanical instability?
DDH
(developmental dysplasia of the hip)
what is croup?
How is it diagnosed?
infection in the upper airway which becomes more narrow and making it hard to breathe
AP + Lat soft neck tissue
What is intussusception?
telescoping of the bowel causing life threatening folds in the stomach
What is RDS?
what exam would we perform for this?
respiratory distress syndrome
chest
What is the older term for child abuse?
What is the new & more acceptable term?
Battered child syndrome
suspected non- accidental trauma (SNAT)
What is osteogenesis imperfecta?
what happens to technique?
bones that easily break
decreases
What is RSV?
Respiratory syncytial virus
Common virus that affects most infants by age 2 & mimics symptoms of a cold
(Cough + running nose)
What is cystic fibrosis?
inherited disease which causes heavy mucus or clogging in the bronchi
hyperinflation of lungs from blocked airways
(shows up on x-rays as radiopaque & not obvious at birth but are more obvious later on)
What is the space between the primary and secondary growth center is called?
epiphyseal plate
what are the different abdomen positions?
why are these used?
Lat Decub + erect abdomen (to evaluate air-fluid levels)
Dorsal decub (to see pre-vertebral region of the abdomen)
Supine abdomen (regular KUB)
what demonstrates the pre-vertebral region of the abdomen?
dorsal decubitus
What are these?
SCA:
SNAT:
PIT:
BCS:
suspected child abuse
suspected non-accidental trauma
pediatric intentional trauma
battered child syndrome (old name)
what is the kVp range for PA + lateral chest x-rays?
70-80 kVp or 75 to 85 (D)
75-80 or 80-85 kVp (D)
what are the restraining devices used?
sandbag
pigg-o-stat
What aids motion in pediatric exams?
short exposure time
how are hip dislocations identified in newborns?
ultrasound (sonography)
What modality would we use to diagnose for ADHD & evaluate for suspected tumors?
MRI
what is the CR for KUB?
Chest?
1” above umbilicus
Mammillary line
if it is paired with other imaging complete in one exposure to reduce radiation exposure (ALARA)
if it is paired with other imaging complete in one exposure to reduce radiation exposure (ALARA)
what is a neonate?
technical term for newborns
What are Pigg-O-stats?
immobilization technique for erect abdomen & chest for infant up to age 5
What are the six categories of child abuse?
neglect
physical abuse
sexual abuse
psychological maltreatment
medical neglect
other
What is radiation protection for child?
what is optimal regarding exposures and imaging?
Gonadal shielding
if there are exams including wrist and forearm complete in one exam
(hip to ankle)
what is the CML fx?
what is another name for this?
classic metaphyseal lesion
fx along the metaphysis that results in tearing or avulsion fx
can be also called corner fracture
What positioning aid can we use for erect abdomens?
pigg-o-stat
Quality control is part of what kind of program?
Quality assurance
What is the purpose of the QC program?
To achieve the best image quality
What does the SMPTE pattern test for?
What does SMPTE stand for?
what does JND stand for?
the luminance response
Society of motion production and television engineers
Just-noticeable-difference
How do we calculate the repeat/reject rate?
What is the optimal number we like to stay within?
What is the primary cause of repeats on DR systems?
Divide total X-rays/ repeat
3-5%
patient positioning
What is a way to test the collimator alignment?
what is the tolerance?
A-penny test
2%
If we are testing the “hardness” of the x-ray beam what are we primarily looking at?
half-value layers
what is the tolerance for SID accuracy?
+/- 2% variance
what is the acceptable range of accuracy for collimator alignment test is?
we find this by using the:
+/- 2% variance
A-penny test
what is the tolerance range for Kvp variations?
5% variance
In Fluro units, what is the tolerance in one direction? (for collimation)
In total?
3% variance
4% variance total
what are the main components in quality control program?
Acceptance test (baseline for new machines)
Annual testing
Diagnose & documenting deviations
Which of the following tests of QC imaging can be performed visually by the radiographer?
what kind?
Uniformity issues
Artifacts
(Also can be uneven spatial resolution or dark noise)
If we are doing a repeat/reject analysis what is a good percent range to stay within?
3-5%
what is a primary reason we see repeats on digital exams?
patient positioning (motion will be on there, nit the primary)
what is the tolerance for timer accuracy?
5% variance
what kind of monitors do we mainly use?
what is the disadvantage?
what is the official name of this disadvantage?
LCD monitors
Limited viewing angle
VAD (viewing angle dependence)
what type of monitor or workstation is critical that the illuminance & contrast is set to a precise setting?
also known as?
Class 1 monitor
Diagnostic work station
What is illuminance?
What tool measures this?
the light that strikes the surface of an object
photometer
what is an example of a class 2 monitor?
what do we use these for?
technologist work station
Post processing & window leveling
What measures illuminance?
photometer
what is the least reliable exposure factor?
What is the tolerance?
MA-linearity
10% (from tube fatigue)
If we are using SMPTE test pattern and use the photometer and place it on the squares to measure the JND, what test are we performing?
luminance response test
if we are measuring resolution within an image what tool do we use?
Lines-pairs tool
What is the spatial resolution we should see on a monitor?
what about on the detector?
2.5 LP/mm
2.5 LP/mm
how often do we test aprons?
annually
What is the tolerance of these:
kVp accuracy:
Exposure reproducibility:
automatic exposure control:
collimator accuracy:
central ray accuracy:
SID accuracy:
Fluro collimation:
what is the Fluro exposure rate? Boost?
Exposure reproducibility?
5%
5%
10%
2%
1%
2%
3% one direction 4% total
10R 20R
5% of the average
What type are the radiation measurement units for radiation biology?
What are these units?
Systeme international SI
Grays, sieverts, and coulombs
What is exposure?
What units do we use to measure this?
Amount of radiation in the primary beam (x-ray tube output/air) (what’s in the air?)
Coulombs per kilogram (C/kg)
What is absorbed dose?
What is the unit of measurement for this?
Which also equals?
Energy per unit mass absorbed by an irradiated object
(What’s the radiation striking patient/healthcare worker)
Gray (Gy)
1 J/kg = 1 Gray
What is dose equivalent?
What is the unit we use for measurement?
Absorbed dose x radiation weighting factor
(What type of radiation is hitting us)
Sievert (SV)
what are the radiation weighting factors?
What are their values?
Gamma ray = 1
x-ray= 1
positron= 1
proton= 2
alpha particles= 20
What is effective dose?
What is the main thing that it accounts for?
what is the formula for this?
What is the unit for measuring this?
The sum of the equivalent doses for all irradiated tissues
Considers the type of radiation and the sensitivity of the tissues
Absorbed dose x radiation weighting factor x tissue weighting factor
Sieverts
What are these tissue weighting factor for these?
Gonads:
Red bone marrow:
Colon:
Liver (organs):
Skin:
0.20
0.12
0.12
0.05
0.01
What is Air KERMA?
What does this stand for?
What is the unit of measurement for this?
Kinetic energy of the air in the primary beam
Kinetic energy released in matter
Gray (Gy)
What is the dose area product?
How can this be measured?
Takes into account the area being irradiated
DAP meter
(More area radiated, more radiation)
(Increased collimation= less DAP)
(Decreased collimation = more DAP)
What is half-life?
Specific to:
Time required for radioactivity to reduce to half its original measurement
Isotope and constant
If we have 12 mGy with a 6-hour half-life, how much time will it take for the radiation to get to 6 mGy?
For 3 mGy?
6 hours
12 hours
For radiation with 24 mGy how much time will need to pass for us to reach 3 mGy with a 6 hour half life?
18 hours
What is the integral dose?
What is an example of this?
sum of a all absorbed doses in an exam
L-spine (AP + LAT + OBL)
What is the annual limit for natural radiation? Where does this radiation originate from?
What is the limit for manmade?
3 mSv & radon gas which is highest in tightly sealed structures such as granite/marble
3 mSv
What is an OSL or OSLD?
How is it released?
Optically stimulated luminescent dose (dosimeter)
released by light
What is a TLD?
How is it released?
Thermoluminescent dose (dosimeter)
By heat
What is a film badge?
What is the purpose of this?
A dosimeter with a small piece of film/ foil filter
For determining the type of radiation
(Ex: alpha particles)
What is a pocket or ion chamber?
What is an example of this?
Real-time dose readings using anode pin or plate
Pen or Geiger counters/ AEC (not for general use)
What is the occupational dose limit?
Where do we see most of this at?
50 mSv
Fluoroscopy
What is the radiation limit for the public?
1 mSv
What is the limit for the fetus?
0.5 mSv/month
what is the dose limit for the lens of the eye?
150 mSv
what is the radiation dose limit for everything else?
500 mSv
what does LET stand for?
what is it?
linear energy transfers
Amount of energy deposited in tissue per radiations travel
(How much energy is given off into the tissue)
What does high LET mean?
What is an example of this?
More concentrated which means more harmful to tissue
(like alpha particles)
What is an example of low LET?
What is an example of high LET?
Gamma ray (lowest) & x-ray (2nd lowest)
Alpha particles
What does RBE stand for?
What does it do?
Relative biological effectiveness
Compares different types of radiation
If one type of radiation can cause the same effect as the other with a lower amount (quantity) this type has?
A higher relative biological effectiveness (RBE)
what is radiation response curves?
What are the types of these?
Graph (ic) representation of the biological response to increasing doses of ionizing radiation
Linear or non-linear/ threshold or non threshold-hold
What is the most common CT scan done at a stoke center?
head CT (CT Brain Attack)
what does LD x/y stand for?
LD= lethal dose
x= percentage of population
y== number of days it is measured
(how much lethal dose and how many days it will take to kill the population, LD 50/30)
what are the orders for cell phases?
prophase
metaphase
anaphase
telophase
what is dose response?
linear non-threshold assumes that any dose of radiation can cause damage
most late effects follow this dose response
what is Dose rate?
what happens to effect if dose rate goes up?
how quickly a dose is delivered
dose rate goes up, effect increases
what is protraction?
if protraction goes up, what happens to effect?
how slowly a dose is delivered
protraction increases, effect decreases
what is the most radiosensitive phase of a cell?
what is the most radioresistant cell phase?
mitosis (division)
mid to late S phase (DNA replication)
what is the law of Bergonie & Tribondeau?
Like?
cells are more sensitive if they are more primitive & prolific (lymphocytes)
what is interphase cell death?
several hundred Gray can kill a cell before it can divide
what are somatic effects?
what two ways can this be measured in?
systemic effects of radiation to an individual
deterministic & stochastic
what is deterministic?
biological effects that can be directly related to the dose received
threshold dose
occurs after a large dose of radiation
can occur in fluroscopy
what is fractionation?
what happens to effect if fractionation increases?
delivering dose in discrete portions with a recovery period in between
fractionation increases effect deceases (90% repairable)
what are deterministic early effects?
later effects?
Erythema (2Gy), epilation, infertility
(hours/days/weeks 90% repairable)
cataracts, temporary sterility (100 mSv)
what are stochastic effects?
what type of effects?
randomly occurring biological effects of radiation
non-threshold
can happen in radiology (unlikely) probability increases with dose
late effect (cancer/ genetic abnormalities)
what are teratogenic effects?
What are the by products of this?
occurs en-utero to a developing embryo or fetus
Congenital abnormalities, skeletal defects, & leukemia
skeletal defects result during exposure at:
3rd week of gestation
A ___ ____ embryo is ____ ____more sensitive to radiation than an adult
10-day
10 times
how much of the skin exposure of the mother does the fetus receive?
1/3 (for abdomen)
Leukemia results from exposure during:
mid-to late fetal growth
Congenital abnormalities are likely caused by:
radiation (exposure) at 2-8 weeks
Genetic code consists of what?
a sequence of nitrogenous bases found in the DNA
how many pairs of chromosomes are there?
23 pairs
Transfer RNA (tRNA) is attached to a specific ___
amino acid
what is target theory?
certain molecules are critical to the survival of a cell
what is direct effects?
Example?
x-ray photon deactivates a target molecule
(x-ray photon directly damages a key gene of a chromosome)
(deactivation of a target molecule from an x-ray photon)
what is indirect effect?
What is most affected?
radiation ionizes water which in turn deactivates a target molecule
most damage caused by this effect (cytoplasm of the cell)
what is a free radical?
any uncharged atom with a single unpaired electron in its outermost shell
what can be the end result of hydrolysis (radiation) of water?
hydrogen peroxide
what is the oxygen effect?
What kind of hits?
tissue is more sensitive to radiation when irradiated in an oxygen rich environment
(indirect hits)
what is acute radiation syndrome?
“radiation sickness”
occurs after large doses of radiation over a short period of time
What are the 4 stages of acute radiation syndrome?
prodromal
latent
manifest illness
death
Prodromal:
side effects?
ARS within hours
nausea, vomiting, diarrhea, & fatigue
Latent:
symptoms?
1 week
no symptoms, false sense of recovery
manifest illness:
less than 1 week
syndrome effects
death:
instant or in some cases recovery with long-term effects/damage
what are the 3 main symptoms/syndromes?
hematopoietic
gastrointestinal
cerebrovascular
Hematopoietic syndrome:
range?
death?
effects?
who suffered early on?
1-10Gy
death in 6-8 weeks
decreased blood cells in bone marrow & body is susceptible to organ failure/infection
early radiologists suffered from leukemia
what are the gastrointestinal syndromes:
6-10 Gy
death in 4-10 days
damage to epithelial cells that line the GI tract (inability to absorb nutrients)
dehydration & severe diarrhea
what is the cerebrovascular syndrome?
range?
death?
effects?
50Gy+
death in hours to 3 days
fluid leaks into brain and intracranial pressure + central nervous system failure
what does LET stand for?
what is it?
linear energy transfer
the amount of energy deposited by radiation into a material per unit path or length
what is high LET?
high LET=
Example?
is low penetration (alpha particles) & high RBE
Alpha particles
what kind of LET has high penetration?
low LET
(Gamma & x-ray’s)
linear energy transfer of x-ray is low due to ___ ____
high penetration
low LET is associated with:
single strand DNA breaks
High LET=
Low LET=
Low penetration
High penetration
what is CPU?
central processing unit
coordinates all computer operations
what is the RAM?
random access memory
can be overwritten by the user and accessed very quickly
memory stored on a chip or disc
what is ROM?
read-only memory
memory that can’t be changed by user
(foundational programs)
what is BIOS?
basic input/output system
internal/primary ROM that directs the flow of information between CPU & peripherals
what is the motherboard?
houses CPU, RAM, ROM chips and connections for USB/audio
what is LAN?
Local area network
a network contained within a single building or business
what is WAN?
wide area network
extends to multiple businesses or geographical areas
what is teleradiology?
remote transmission of medical images via telephone wire or fiber cable outside a facility to a radiologists home or remote radiologist on the other side of the world
what is a bit?
how many bits become a byte?
small unit for binary numbers
8 bits
Bit units are used for:
binary numbers
convert this binary code: 110011
51
what is the smallest unit of a digital image?
pixel
the smaller the pixel:
the better the spatial resolution
in diagnostic imaging pixel size is limited by:
detector element size (DEL)
what is the field of view? (FOV)
the physical area of an image
what is the matrix?
15 x 15?
a pattern of pixels laid out in rows and columns
225
what is scanning?
what is sampling?
what is quantization?
creating a matrix
measuring the intensity
assigning a value
what is bit depth?
maximum range of pixel values that a computer can measure or store
what is a bit depth of 5?
32 shades of gray
(human eye can distinguish between 32 shades)
what is a bit depth of 8?
256 shades of gray
common for non-medical imaging
what is the bit depth 10?
1024 shades of gray
number of shade of gray in the remnant beam
what is dynamic range?
the range of shades of gray that a system can generate
(diagnostic is large)
what is window leveling?
adjusting the image brightness
increasing the window level decreases the brightness
decreasing the window level increases the brightness
what is window width?
adjusting the images contrast
increasing the width increases the shade of grey in the image (low contrast)
decreasing the width decreases the shade of greys in the image (high contrast)
what is the greatest benefit of digital imaging?
the ability to control contrast resolutions
what is the image matrix of these modalities?
Nuc med:
US:
MR:
CT:
x-ray:
Mammo:
64 x 64
128 x 128
512 x 512
512 x 512
1024 x 1024
3328 x 3328 (bit depth 14 & 27 MB file size)
what is preprocessing?
automatic cleaning up of the raw image before the initial image is visible to us (cleaned up by computer)
pre-processing makes ____
post-processing makes ____
corrections
refinements
what is flat field uniformity?
type of preprocessing that corrects for flaws in the electronics/optics of the image receptor system
what is the noise reduction for del drop-outs?
compensating for malfunctioning DEL’s by taking the surrounding 8 DELs and assigning a value to the malfunctioning one
what can happen to individual detector elements? (DELs)
can malfunctions and return no data
what is segmentation?
this occurs to what only?
error that occurs when the computer sees multiple images as a single image
CR (computed radiography) only
what is exposure field recognition?
error that occurs when the computer analyzes raw radiation outside the anatomy of interest
what is the histogram?
a bar graph created by counting the number of pixels (DELs) at each brightness level
how does a histogram visually appeal?
dark pixels to the right
white pixels to the left
what are the Smax & Smin?
Smax are the maximum pixel values that are used for analysis
Smin are the minium pixel values that are used for analysis
what are the different type of histogram analysis?
Type 1:
Type 2:
Type 3:
detects smax and removes the values to the right (that represent raw radiation) (gets rid of ultra black feeback)
assumes no raw radiation to the right of smax and identifies highest value as smax (abdomen) (assigns a smax)
detects Smin and removes values to the left that represent metal or prothesis (gets rid of ultra white)
what are the VOI?
value of interest
different value ranges within the histogram selected to highlight specific anatomy such as bone or soft tissue
what are the histogram process errors?
segmentation error
exposure field recognition error
unexpected objects in the data set (led apron, large prothesis, lead gloves, etc)
too little/ too much radiation
mispositioning
what is the primary thing that rescaling does?
affects brightness
what is rescaling?
the initial processing to make images appear “normal”
what is the goal of a lookup tables?
adjust input so that the image appears “normal”
what is spatial domain?
processing based on the location of a pixel in the overall matrix
what is intensity domain?
processing based on the greyscale value of an individual pixel
what is the frequency domain?
processing based on the size of an object
what does gradation processing primarily control?
contrast
what is data clipping?
a limited bit depth that can limit our ability to adjust the brightness or contrast as it will “clip” the ends of the processing curve
(we don’t want to data clip for our radiologist)
what is detail processing?
breaks down an image into a larger & smaller object based on how many pixels are used to create it
large objects have ____ ____ & ______ ______
small objects have _____ _____ & ____ _____
large waves & low frequency (large objects are not muted)
short waves & high frequency (small objects are not muted)
high pass filtering mutes:
low pass filtering mutes:
large objects
small objects
what is the rule?
low pass =
high pass=
low pass= low frequency= large objects
high pass= high frequency= small objects
what is edge enhancement?
mutes large objects and enhances smaller objects (including artifacts)
what is a kernel?
small matrix used to apply effects to a small section of an image or overall image
what is speed class?
how sensitive an imaging system is to radiation
increasing the speed (class) reduces:
increasing the speed (class) can increase:
patient dose
quantum mottle
what speed can modern CR & DR systems operate at?
without?
speed class of 400
the appearance of substantial quantum mottle
what do digital images lack?
why is this bad?
visual cues that can indicate correct technical factors
the exposure indicator is not ___
an actual exposure reading taken at the image receptor
(median point between Smin and Smax on the image histogram)
the standardized EI is based on _____ ______ to the image receptor and is measured in?
actual exposure
Micro-gray (siemens only)
what is the target EI? (EIT)
the ideal exposure to the image receptor for a particular projection
what is signal-to-noise- ratio? (SNR)
always greater than?
to produce the highest quality image, the signal should be as high as possible, and noise should be as low as possible
1
what is the deviation index?
indicator of how far away a technique was from ideal
If the index for deviation index were to change by +1 how much increased exposure is that?
and for -1?
25% increase in exposure for +1
20% decrease in exposure for -1
what happens if an x-ray results in -3.0?
automatic repeat as quantum mottle is likely
what is saturation?
what can be a result of this?
extreme overexposure (10x)
can overwhelm the digital detection system, causing a loss of data
what is alternative processing?
how can this affect a radiologist?
processing under incorrect anatomy
(processing a knee as a hand)
affect there ability to window or adjust the image data
what is dark masking?
darkens the collimated areas
what is the minimal spatial resolution when reviewing an image on a workstation?
6 LP/mm
what is the only controlling factor common to film and digital imaging?
distortion
(garbage in, garbage out)
