POS registry prep 2.0 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 makes up 2/5 of the small bowel?
3/5 of the small bowel?
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 is the ileocecal valve?
Connection between ileum and cecum
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 consists in the urinary system?
2 kidneys
2 ureters
1 urethra
1 bladder
2 suprarenal adrenal glands
what is the kvp for AP erect abdomen?
70-80 kVp
what is the omentum?
Double fold peritoneum extending from stomach to another organ
what is the peritoneum?
what is the visceral peritoneum? parietal?
double walled membrane enclosing the abdominal organs
inner layer
outer layer
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
what is volvulus?
twisting of loop of intestine creating an obstruction
what is ascites?
accumulation of fluid in peritoneal
what is pneumoperitoneum?
free air or gas in peritoneal cavity
what is intussusception?
Most common with?
Can cause?
Telescoping of bowel onto itself
More common in children
Necrosis in 48 hrs
what are the four divisions of the respiratory system?
pharynx, trachea, bronchi, & lungs
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 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)
where does the diaphragm move during expiration? Inspiration?
moves upward
moves downward
in a PA chest x-ray, the mid-sagittal plane is ___ to the x-ray and mid-coronal plane is ____
perpendicular
parallel
what pathologies can be seen on expiration chest x-ray?
pneumothorax & COPD
what is kyphosis?
hump-back curvature
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 happens to technique for suspected hemothorax?
Pneumothorax?
increase
decrease
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 is atelectasis?
collapse of a portion of the lung
(pneumothorax or pleural effusion)
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
why does the right hemi-diaphragm sit higher than the left?
presence of the liver
what is pleurisy?
inflammation of the pleura
what is pleura effusion?
accumulation of fluid in the pleural cavity
what is the compression of the median nerve referred to as?
carpal tunnel syndrome
how many phalanges are there?
14
what do this phalange articulate with proximally?
first:
second:
third:
fourth:
fifth:
trapezium
trapezoid
capitate
hamate
what are the four proximal carpals?
four distal?
scaphoid, lunate, triquetrum, pisiform
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
lateral fx is best displayed in what view?
AP fx best displayed in?
AP
Lateral
For a lateral view of the second digit what side do we place against the IR? why?
lateral side
reduced OID
what position is the arm in a 90-degree flexion?
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 the hook of the hamate (hamulus)?
Gaynor-hart method
25-30 degrees to the long axis of the hand + 1” distal to the third MCP
what view best shows arthritis in the hand?
carpal tunnel?
ball-catcher
Gaynor-hart method
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 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 osteoporosis?
osteopetrosis?
decrease in bone density, decrease technique
hereditary disease resulting in abnormal dense bone, increase technique
what is the name of the process located on the proximal anterior ulna?
coronoid process
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
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
how are the elbow epicondyles to the IR for these projections?
AP:
LAT:
OBL:
parallel
perpendicular to IR
obliqued
what view do you see the fat pads on?
what are the fat pads name?
lateral elbow
anterior, posterior, & supinator fat pad
in a trauma instance what view could replace an AP elbow?
2 projections
forearm parallel + humerus parallel, 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
Fracture of wrist causing posterior radial displacement is called this?
Colles fracture
Located on distal, lateral end of the humerus?
Capitulum
The lateral elbow projection best demonstrates this anatomy free of superimposition?
Olecranon process
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)
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”
Criteria for lateral foot:
Patient Supine
Mediolateral projection
CR is at medial cuneiform (level of base of third metatarsal)
SID 40”
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 (& lateral)
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
(talotibial)
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 weight bearing 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?
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 (excessive blood in joint) that may be hereditary
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)
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
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
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 lumbar 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
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
What is the thickest/densest part of the cranium?
petrous portion of the temporal bone
pyramid shaped
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?
Where is the pituitary gland?
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)
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?
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
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?
fibrous 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?
What is chewing called?
deglutition
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
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?
eft 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
why do we prefer PA over AP for small bowel studies?
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
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 hangman’s fx?
fx occurs in pedicles of C2 or with/without displacement of C2/C3
what is spiral fracture?
bone is twisted apart & fx spirals around the long axis
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
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 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
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?
What are the functions of the kidneys?
What is an essential component of the kidney?
nephrons
What is anuria?
complete cessation of urinary secretion by the kidneys
(kidneys producing none-little urine due to a blockage)
What calyx’s form the renal pelvis?
major & minor
We must verify ____ ____ for patients with _____ before resuming metformin?
kidney function
diabetes
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 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?
pigg-o-stat
erect abdomen + chest
At what age can pediatrics understand simple commands?
2-3 years old
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 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 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 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 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
What are the six categories of child abuse?
neglect
physical abuse
sexual abuse
psychological maltreatment
medical neglect
other
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
