practice exam Flashcards
patient with prostate cancer recently fell and fractured his left distal femur. he is an inpatient receiving chemotherapy. his leg is in traction. mobile images of the fractured femur are requested. what is the most likely acquired pathology associated with the patients clinical information?
metastatic disease because prostate cancer commonly metastases to the bones
patient with prostate cancer recently fell and fractured his left distal femur. he is an inpatient receiving chemotherapy. his leg is in traction. mobile images of the fractured femur are requested. what steps are required of the technologist before entering the patients room of isolation?
both technologists are required to wear gown, cap, gloves, mask because the patient is immunocomprimised strict/reverse isolation is required
patient with prostate cancer recently fell and fractured his left distal femur. he is an inpatient receiving chemotherapy. his leg is in traction. mobile images of the fractured femur are requested. only an 80cm SID can be obtained for an AP projection because of the metal traction device. the exposure factors are 100cm SID would have been at 2mAs @ 65kv. what is the new mAs?
1.3mas
direct square law
patient with prostate cancer recently fell and fractured his left distal femur. he is an inpatient receiving chemotherapy. his leg is in traction. mobile images of the fractured femur are requested. for the lateral view using 100cm SID the cassette is positioned to include the knee joint and as much of the distal femur as possible. where would the technologist place the lower margin end of the cassette?
5cm distal to the knee joint because the diverging beam will project the knee distally, 5cm will ensure the inclusion of the joint on the image
mrs barton, 33 years old slipped and fell onto an outstretched hand. images of the wrist and scaphoid have been requested. what should be clearly seen on the images of the scaphoid views of the wrist?
soft tissue and bony trabeculae to visualize small fine fractures
mrs barton, 33 years old slipped and fell onto an outstretched hand. images of the wrist and scaphoid have been requested. the technologist uses separate 18 x 24cm CR imaging plates to record each of mrs bartons wrist images. what does this ensure for all the images that will be acquired?
they are displayed with comparable spatial resolution. using separate IRs will ensure that different and appropriate algorithms are applied to each individual image
mrs barton, 33 years old slipped and fell onto an outstretched hand. images of the wrist and scaphoid have been requested. department used a previous screen speed of 100 combination for extremity imaging. why is it necessary for the technologist to decrease technical factors for the use with CR?
CR is equivalent to 200-300 speed film screen imaging system.sensitivity of it is equal to that
mrs barton, 33 years old slipped and fell onto an outstretched hand. images of the wrist and scaphoid have been requested. when displayed on the CR monitor mrs bartons images appeared mottled, undiagnostic and need to be repeated. what should the tech do to improve the images?
increase mAs to increase the number of photons going to the IR
27 year old patient involved in a MVC arrives for xrays of skull, cspine, chest and pelvis. department uses film screen and the patient is on a spine board wearing a c collar and is conscious and alert. the horizontal beam lateral c spine image is to light across the entire image. what grid error caused the loss of density?
tilted grid because an off level grid misaligned results in an image with decrease in exposure across the entire image
27 year old patient involved in a MVC arrives for xrays of skull, cspine, chest and pelvis. department uses film screen and the patient is on a spine board wearing a c collar and is conscious and alert. exposure factors for a lateral cspine using a 8:1 grid was 85kv and 12mAs. the tech decides to use a non grid technique to repeat what should the new mas be?
3 going from grid to non grid the technical factors must decrease.
and you must figure out the math
27 year old patient involved in a MVC arrives for xrays of skull, cspine, chest and pelvis. department uses film screen and the patient is on a spine board wearing a c collar and is conscious and alert. AP chest is underexposed but has sufficient contrast. how should the tech alter the the Mas or kv to produce a minimal change in optical density
30% CHANGE IN mAs to show a visible change in optical density
27 year old patient involved in a MVC arrives for xrays of skull, cspine, chest and pelvis. department uses film screen and the patient is on a spine board wearing a c collar and is conscious and alert. the patients OML is extended 10 degrees from the perpendicular. what is the degree of angulation and direction of CR in order to obtain a 30 degree frontooccipital towne projection?
40 degrees caudad because a frontooccipital towne projection requires a 30 degree caudad angulation to the perpendicular OML so with a 10 degree extension of the OML a 40 degree caudad angle is needed.
27 year old patient involved in a MVC arrives for xrays of skull, cspine, chest and pelvis. department uses film screen and the patient is on a spine board wearing a c collar and is conscious and alert. what action by the technologist would be considered a breech of the patients right to confidentiality?
discussing the exam findings with the patients spouse
600mA, 100cmSID, 1.5mm focal spot
0.05sec, 5.0 OID, 35 x 43cm field size
70kv, 8:1 grid, CR system
what new set of technical factors will achieve the same exposure rate of intensity rate?
60kv, 300mas, 0.2sec
because of 15% decrease in kvp the mas will be doubled in order to maintain intensity
600mA, 100cmSID, 1.5mm focal spot
0.05sec, 5.0 OID, 35 x 43cm field size
70kv, 8:1 grid, CR system
what will be the affect of the field size adjusted to 10 x 10 cm
intensity is maintained and scatter production is decreased. intensity of the primary beam is controlled by mAs and kvp selected and scatter is reduced by reducing the field size
600mA, 100cmSID, 1.5mm focal spot
0.05sec, 5.0 OID, 35 x 43cm field size
70kv, 8:1 grid, CR system
what new parameters will minimize the affect of patient motion
900ma and 0.33sec
mAs is maintained while length of exposure is reduced which is necessary to reduce the affects of motion on the image
600mA, 100cmSID, 1.5mm focal spot
0.05sec, 5.0 OID, 35 x 43cm field size
70kv, 8:1 grid, CR system
what adjustment minimizes patient dose?
decreasing mA
hyperstenic patient is admitted for investigation of the GI tract. his doctor ordered a GI examination of, BE, and abdominal ultrasound. what is the proper sequence of exams for this patient
abdominal ultrasound, BE, upper GI
hyperstenic patient is admitted for investigation of the GI tract. his doctor ordered a GI examination of, BE, and abdominal ultrasound. following the BEwhat instructions should the technologist give the patient to prevent constipation
increase fluid intake
hyperstenic patient is admitted for investigation of the GI tract. his doctor ordered a GI examination of, BE, and abdominal ultrasound. the radiology resident seeks the technologists option because he is having trouble demonstrating the barium filled duodenal bulb free of superimposition so which view should be done
right lateral because shows the best view of the pyloric canal and duodenal bulb in patients with hyperstenic habitus
hyperstenic patient is admitted for investigation of the GI tract. his doctor ordered a GI examination of, BE, and abdominal ultrasound. the patients stomach is slow to empty during the upper GI exam. what recumbent position could stimulate gastric peristalsis?
RAO
technologist is preparing for a enhanced CT of the chest. the patient has a history of allergic response to IV contrast. what medication should be given prior to the exam
prednisone (deltasone), acting as a anti inflammatory preventing or reducing allergic response
technologist is preparing for a enhanced CT of the chest. the patient has a history of allergic response to IV contrast. what injection will optimize visulazation of contrast within the pulmonary vessels?
arterial contrast fills the pulmonary arteries during this phase giving optimal visualization because ww is wide enough to allow demonstration of all soft tissue including pulmonary vessels
technologist is preparing for a enhanced CT of the chest. the patient has a history of allergic response to IV contrast. what ww and wl would best visualize the sternum
+325 ww & +50 WL
technologist is preparing for a enhanced CT of the chest. the patient has a history of allergic response to IV contrast. when reviewing the patients images at what level will the tracheal bifurcation best be seen
T4T5 (carina)
request of a chest xray on a patient that is 25 years old. he is experiencing chest pain and SOB. upon viewing the image the technologist notices a absence of markings in the right lung. what should be done next
check with the doctor before letting the patient leave the department because a tension pnemothroax can quickly become life threatening and needs to be treated before circulatory collapse occurs
doing a mobile chest xray. when making the exposure what should the technologist do to protect themselves from scatter radiation
wear proper protective apparel
4 year old cooperative child gets wrist xrays. patient motion is seen on the PA image. how should the tech proceed for the repeat image
use a compression band to hold the childs arm in place.
what factor would be the most useful in visualizing both lung and mediastinum on the PA chest projection?
high kv to allow for long scale contrast to adequately penetrate the lungs and mediastinum
what patient history would require a increase in exposure factors for a mobile exam
ascites (increase of fluid in the abdominal cavity)
a patient is having a cerebral angiogram and during the procedure begins to cry. how should the tech respond to the patient
address her concerns before continuing with the exam
which joint is best demonstrated on the 15 degree internal oblique view of the ankle (medial rotation)
talo fibular
tech is preparing for enhanced ct of infants head, what factor is essential in calculating dosage
weight of infant so as to not impair renal function
with a CR system the recommended technical factors for an AP projection of the knee are 4mAs and 60kvp.how will image quality be affected if the tech uses 1mAs at 60kvp instead
increase image noise; lowering the mAs will reduce the signal to noise ratio by creating more image noise
29 year old female patient with a history of chronic back pain is scheduled for a xray exam of lumbar spine. during the interview the patient states that she may be pregnant what is the techs best response
consult with the physician for futher instructions they may not be aware of the possible pregnacy
what will obsure the odontoid process when the neck is hyperextended for an AP open mouth projection
base of occipital bone because its projected inferiorly
when working with patients with chest drainage systems what should the technologist do to ensure that the system continues to work properly?
keep the system below the level of the patients chest to allow drainage to occur
what pathology should the technologist anticipate when elderly frail female client with kyphoysis arrives in the DI department with a request of consultation for a tspine xray
osteoporosis- a metabolic bone disease resulting in demineralization of bone most commonly seen in post menopausal women. result of kyphosis is from a collapse in thoracic vertebrae
what is required for the correct use of AEC
the region of interest must be positioned over the detector cell.directly over the ionization chamber
if images taken with AEC are consistently to noisy what adjustment should be made until the unit can be serviced
INCREASE THE DENSITY CONTROL to overcome slowly changing calibration or sensitivity of AEC without additional patient dose
when viewing a PA chest what would indicate to the technologist that the patient may have received more radiation than necessary for the exam?
collimation not evident
why is personnel radiation dosimeter worn under the lead apron during fluro?
to detect whole body exposure
upper GI series has been requested on a patient with a possible perforated ulcer. which contrast should the tech select to prepare
water soluable iodine because it is readily absorbed in the peritoneal cavity
what varies directly with the intensity of the radiation emitted from the xray tube
tube current,(direct relationhip) atomic number of target material (as increase the intensity also increased)
what is most likely to cause the tube current (mA) to increase erractially and become uncontrollable
loss of vacuum in the tube insert which affects electron flow from cathode to anode
what aspect of digital image is affected by changing wl while maintaining the ww?
density is controlled by wl
ww (contrast)
what view of the elbow will demonstrate minimal compression of the fat pads
lateral
AP projection of the lumbar spine is taken on a large male patient using AEC @ 80kv. the image was blurred what would be the result of the tech repeating the image at 95kvp
mAs will be decreased because with a higher kvp AEC will compensate with a decrease in mAs to maintain beam intensity
what describes one disc slipping over another
spondiolithesis which results in spondylosis
what exam should be done if asked to rule out legge calfes perthe (osteochrondosis)
hip
when removing clothes from a hemiparais patient how is it done
by using the affected side first so their is less movement on that side
patient arrives for xray of the elbow. the elbow has dressing covering a deep wound. should the dressing be removed for the exam
no the wound needs to stay clean
how do you pour sterile betadine onto a sterile tray
check the label, discard the first few drops then pour into a container
what is the recommended cardio compression to ventilation when performing a 2 recuser CPR on adult
30:2
the technologist checks the dosimeter report and sees in the past year she has accumulated 2msv is this a concern
no because it is below the dose limit of radiation workers dose limit for the whole body for the year is 20
what is the rationale for a regular quality control measure cycle of of CR imaging plates
to remove background radiation and scatter
to ensure the validity of mA linearity test which test must be performed?
timer accuracy
under what circumstances would would radiography of the chest be appropriate
acute abdominal series to rule out chest pathology detecting free air under the diapharm
what is the dominant interaction of in soft tissue of the breast during mammo?
photo electric because of low energies and see attenuation differences
during a digital imaging exam what occurs if the ww setting is 100 and the wl is 0
numbers between +50 and -50 appear grey
what is the most common reason for performing a pre MRI shoulder arthrogram
rotator cuff tear
how should the patient be positioned for a upright lateral view of the chest
MSP vertical
tech must do a mobile abd series in the patients room during visting hours. how should the tech provide protection for the vistors
request the vistors to wait outside
what is essential when transporting a patient with a urinary drainage
keep it lower than the bladder to prevent back flow
patient develops epitaxis during the xray. what position provides proper care for the patient
sitting with head forward and the nostrils pinched to prevent swallowing of blood
what feature of the image will be affected by selecting the edge enhancement during a digital subtraction peripheral angiogram
visibility of small structures, good for fractures and high contrast objects
what structure is the most radiosensitive during the acanthioparietal projection of the facial bones
optic lens
patient with dementia arrives for an xray. she is uncooperative and disorientated what is the best rationale for use of immobilization techniques for this patient
to reduce the probability of repeat expsoures
an erect cspine series has just been completed when the patient feels faint and asks to lie on the table. the tech decides that the LAO must be repeated. what view would be acquired with the patient in the recumbent position
RPO to visualize the left intervertebral foramina
what infection control practices should the 2 techs follow when performing a mobile supine chest on an unconscious patient with blood soaked clothing
both techs wear gloves to position the patient then one removes the gloves to handle the equipment. once the patient is positioned one tech should remove their gloves and wash their hands before handling the equipment
what is the most important consideration for the tech to remember when transferring a patient with a possible cspine injury
maintain immobilization of the head and neck
what is the correct procedure to follow when the tech is inserting the rectal tip prior to a BE?
ask the patient to take slow deep breathes and insert the tip during exhalation because the abdominal muscles relax on exhalation
a patient has fallen from a stretcher and as a result of the siderails being left down. what is the legal term for this occurance
negligence because it is the omission of reasonable care that results in injury to a patient
what view would best demonstrate a suspected epiglottis on a 2 year old child
soft tissue lateral neck erect because it affects the soft tissue of the larynx and the patient needs to be supported in the upright position
a patient who is paraplegic requires xrays on the left femur. how should the tech provide assistance while moving him from the wheelchair to the table
enlist the help from another tech to lift the patients legs while the other tech lifts the torso to prevent injury to the patient and lifter
why dose the use of collimation reduce dose to the patient
because the area of useful beam is restricted
what is the most significant symptom of shock
tachycardia increase in heart rate, pallor, restlessness, respirations, hypotension and confusion
a patient for a postoperative hip arthroplasty patient requires a mobile pelvic exam. how should the tech properly prepare for the patient prior to the log roll
place the arms across the chest
tech in charge of quality control has been performing repeat analysis for the new DR room. during a 1 mth period this room had a total output of 5000 images and 260 repeats so what is the repeat rate
5 you do 260/5000
the number of repeat images divided by the total number of images multiplied by 100
while in the xray department the patient is rude and argumentative to the techs, at lunch in the cafeteria his family overhears the techs describing the patient as a homeless drug addict. what violation of the patients rights is this
slander- malicious verbal information
all enteries for procedures should include a
date and time
what is something that would be neglience
FAILURE TO CLEAN THE ROOM RIGHT AFTERA MRSA PATIENT , which puts other patients at risk
upon viewing a AP hip image taken to rule out osteoarthritis the tech notes that the femoral neck is foreshortened and the lesser trochanter is in profle what needs to be done to fix it
rotate the patients legs interally 15-20 degrees
what is the minimum shielding equalivancey for the hip exam
0.25 and should have 0.5 at 150 kvp
79 year old patient comes back for a repeat lateral lumbar spine xray. the tech reviews the previous exam and notes that on the lateral view of the L4-L5 and L5-S1 the intervertebral disc spaces are closed on the 3rd - 5th vertebral bodies are distorted. how can the tech ensure that the lateral repeat image is good
position a sponge under the patients waist to place the vertebral column parallel
tech has obtained routine lateral views for an elbow. the rad suspects a radial head fracture and requests an additional image how can it be seen
flex the elbow to 90 degrees with the hand pronated and the CR directed 45 degrees towards the shoulder to project the radial head anterior to the coronoid process
what kv should be used for a KUB for sthenic patient
70-80 to maximize subject contrast
86 years old patient brought to the hospital with a suspected hip fracture. she appears agitated and is worried about her dog being left alone. the tech feels the instructions are not being understood. how can the tech improve communication
speak slowly in a clear voice and ask the patient to respond to questions
what projection will show medial or lateral displacement of a fracture in the neck of the mandible
30 degree frontooccipital
a ct of a throax was requested to rule out medistinal pathology. to see the area the scan must include from apices to the level of what anatomical structure
diapharm
WBC are very sensitive to radiation a dose of
25 rads causes a drop
annual occupational dose is
5rads
neuroblas is one of the most
sensitive tissues to radiation
relative biological effect (RBE) ratio of dose of standard radiation necessary to produce a given effect to the dose of the
test radiation needed for the same effect
inherent infiltration general purpose is
0.5mm of AL
collimator 1.0mm of AL
to meet required total filtration of 2.5 mm if AL all manufactor inserts need additional
1.0ml of al equaivalent between the xray tube housing and the collimator
lead gloves need a minimum of
0.25mm thickness for fluro procedures @ 150kvp
acute whole body exposure of 2Gy (200rads) is
hemopeotic death so below 10gy is infection and electrolyte inbalance
biological effects are
somatic and genetic effects
pubic dose is
1/10th of the occupational dose
dose equivalent for the lens of the eye is
150msv for the year occupational for the public its 15msv/year
occupational dose for the skin, hands and feet
500msv/year
whole body dose limit
50msv/yr
dose equivalent for the fetus
0.5msv/mth
a controlled area (booth) should limit exposure to yearly whole body exposure
5rem per year (50msv/year) 10rem/wk
minimial patient tube distance for fixed fluro units is
38cm for mobile 30cm
skin erythema
deterministic effect with a threshold of 2gy (200rads)
gonadal significant dose
20mRads
a femur will benefit from anode heel effect more than foot because this effect is
more prouncecd with larger films and shorter SID
effective focal spot is smaller
at the anode end
focal spot blur smaller at the
anode side
for magnification purposes small focal spot
should used less than 0.3mm
relative speed
mas and rs2
maintain density
mas & distance
penumbra
OID/SOD/FSS
primary factor affecting the brightness of fluro image is the
size or composition of the part
ABC is maintained by
adjusting kvp and mas
tube warm up should be done using
70-80kvp and ma smaller than 200 for 1-2s
when AEC is used for kvp higher than 50 xray exposure must be terminated
after 6s or 600 mas is reached for a kvp smaller than 50 the limit is 2000mas
drastic temp change in developer and fixer could cause
wrinkling reticuluation of the film
bending of the film makes
crescent marks artifacts
factors that affect contrast are
kvp (inversely proportional), screen speed, grid ratio and OID (directly proportional)
for techniques higher than 90kvp
12:1 grid is used
orthocromatic film is sensitive to
green or blue light (rare earth)
safe light for orthrochromatic is
red
ascities you need to increase
mas 50%,
for a pneumo, osteomyltis, obstructions decrease
kvp 8%
WBC are very sensitive to radiation a dose of
25 rads causes a drop
annual occupational dose is
5rads
neuroblas is one of the most
sensitive tissues to radiation
relative biological effect (RBE) ratio of dose of standard radiation necessary to produce a given effect to the dose of the
test radiation needed for the same effect
inherent infiltration general purpose is
0.5mm of AL
collimator 1.0mm of AL
to meet required total filtration of 2.5 mm if AL all manufactor inserts need additional
1.0ml of al equaivalent between the xray tube housing and the collimator
lead gloves need a minimum of
0.25mm thickness for fluro procedures @ 150kvp
acute whole body exposure of 2Gy (200rads) is
hemopeotic death so below 10gy is infection and electrolyte inbalance
biological effects are
somatic and genetic effects
pubic dose is
1/10th of the occupational dose
dose equivalent for the lens of the eye is
150msv for the year occupational for the public its 15msv/year
occupational dose for the skin, hands and feet
500msv/year
whole body dose limit
50msv/yr
dose equivalent for the fetus
0.5msv/mth
a controlled area (booth) should limit exposure to yearly whole body exposure
5rem per year (50msv/year) 10rem/wk
minimial patient tube distance for fixed fluro units is
38cm for mobile 30cm
skin erythema
deterministic effect with a threshold of 2gy (200rads)
gonadal significant dose
20mRads
a femur will benefit from anode heel effect more than foot because this effect is
more prouncecd with larger films and shorter SID
effective focal spot is smaller
at the anode end
focal spot blur smaller at the
anode side
for magnification purposes small focal spot
should used less than 0.3mm
relative speed
mas and rs2
maintain density
mas & distance
penumbra
OID/SOD/FSS
primary factor affecting the brightness of fluro image is the
size or composition of the part
ABC is maintained by
adjusting kvp and mas
tube warm up should be done using
70-80kvp and ma smaller than 200 for 1-2s
when AEC is used for kvp higher than 50 xray exposure must be terminated
after 6s or 600 mas is reached for a kvp smaller than 50 the limit is 2000mas
drastic temp change in developer and fixer could cause
wrinkling reticuluation of the film
bending of the film makes
crescent marks artifacts
factors that affect contrast are
kvp (inversely proportional), screen speed, grid ratio and OID (directly proportional)
for techniques higher than 90kvp
12:1 grid is used
orthocromatic film is sensitive to
green or blue light (rare earth)
safe light for orthrochromatic is
red
ascities you need to increase
mas 50%,
for a pneumo, osteomyltis, obstructions decrease
kvp 8%
accepted blooming for 1.0mm focal spot
40% (fss 0.8-1.5)
accepted blooming for fss smaller than
0.8-50%
developer is alkaline
ph higher than 7 (10-11.5)
fixer is acidic and a ph
smaller than 7 (4-4.5)
turn ratio of a step up transformer
v2/v1- # of turn s
window level
density
window width
contrast
b + F allows for a variation of
+/- 0.05
intensity with constant technical factors (reproducibility) should not be more than
5%
reciprocity and linearity is
+/- 10%
kvp variation is
+/-2%
preservatives in the developer
retard or oxidaize
hyperglycemia
induced insulin overdose, from inadequate food intake, increased exercise, nutritional imbalances that can lead to insulin shock.
symtoms- diaphoresis, confusion, walking difficulty, weakness, double, vison or blurred so give food with sugar (orange juice)
mets the tissue is more
radiolucent (dark)
safelight should be placed at least 3feet
from the film bin
diaphroresis
the patient is pale, cold clammy skin, sweaty, cause shock , diabetes, ilnnes
if the wrong exam is performed then its
battery
tort is
intentional or not intentional act performed based on unreasonable conductex commiting battery or assault
deglutition
swallowing
to reduce the patient dose place the II on
top of the patient and as close as possible to reduce scatter
semicircular canal
balance
RAO demos
duodenal bulb and loop in profile in a double contrast study
communited fracture
many pieces
compound fracture
open
restrainers keep reducing agents from developing
unexposed crystals (potassium bromide)
intrathecal injection
spinal cord
spore bacteria is the most
resistant to asepsis
emphysema is
dilation of the alveoli most comfortable position for the patient is sitting
orthopena
ability to breathe better while sitting
assault
threatening someone verbally
battery
touching someone without permission
CPR the sternum is depressed
1.5-2”
child- 0.5-10.”
EG tubes are used to
inject nutrition into the stomach for patients who cannot swallow
average rate of compressions for adult CPR is
80-100/min
enema bag is plced
30” above the table and
18’24 above the patients hip
tip is not inserted more than 10cm
neurogenic shock
pooling of blood in peripheral vessels aka vasogenic shock seen in severe trauma
septic shock
blood stream exposed to bacteria
nasal cannula oxygen rate
2-3L/min
urticarial-
hives
blood pressure
adult systolic- 110-140 diastolic 60-90
if below 90 the shock is accompanied by hypotension and a faster pulse rate
CPR the best place to check a pulse
adult- carotid artery
child- brachial artery
before myelography CSF fluid is aspirated to check for
syphylis
IV filtration
pull the needle out and apply a cold or warm compression
average pulse rate for infants is
120 BEATS/MIN
adult normal pulse rate
80-100beats per min and above 100 is tachycardia
hypervolemia during a BE study can be prevented by adding
2tbps of salt to the solution because can lead to edemarenal failure death
grieving process
denial, anger, bargaining, depression, acceptance
orthostatic hypertension
sudden change of pressure when moving from the recumbent to sitting position syncope of fainting
normal adult respiratory rate
12-20 breathes per min
child- 20-30
under 1year- 30-60
hyperglycemia
induced insulin overdose, from inadequate food intake, increased exercise, nutritional imbalances that can lead to insulin shock.
symtoms- diaphoresis, confusion, walking difficulty, weakness, double, vison or blurred so give food with sugar (orange juice)
during the seldinger technique
anesthetics are used to prevent vasospam most often lidocaine and epinephrine to reduce bleeding
enteric isolation
to prevent spread of infection thru fecal material
rescue breathing to adult with respiratory arrest
1 breathe every 5sec
child 1 breathe every 3 sec
patient is coming down for a post op hip xrays and is experiencing a high pulse rate of 120 beats per min may be experiencing a
pulmonary embolism one of the operative complication s on long extremities or hip
for a plaster cast you need to
increase mas 50% or 8% in kvp
fiberglass cast
no change is needed
ammonia smell in the developer is
oxidation
fat is the least attenuated compared to
water, muscle, bone, liver
excessive filtration decreases
contrast and density
to decrease exposure time
decrease SID, increase kvp, decrease the back up timer
increase film speed
higher contrast and density
restrainers keep reducing agents from developing
unexposed crystals (potassium bromide)
dyes are added to improve resolution
reflective backing is added to increase speed
AEC used with too tight collimation
over exposed image
sella
CR 0.75 anterior and superior to EAM lateral
AP- IOML perpendicular CR 37 degree caudad
activators cause emulsion to swell
sodium carbonate
when changing from table top technique with no grid to a bucky technique with a grid
mas should be multiplied by 3
lateral femoral condyle is more flat
than medial
lateral femoral condyle is
higher than medial on axial knee
for every 0.25” of misalignment adjust CR
angle by 5degrees
nosocomial infection
acquired during care at the hospital
areas most affected by ulcerations
scapula, sacrum, trochanters, knees, heels
CPR neonate
2 breathes use 2 fingers for compressions , 0.5# sternum
120 compressions per minute
CPR for adult
15 compressions for 2 breathes
CPR under 1 year
1 ventilation, 5 compressions
analyphatic shock
allergic reaction
ketoacidosis
no sufficient insulin body is not able to metabolize glucose
hyperosmolar non ketoacidotic syndrome or coma
complication of mild type 2 diabetes mellitus or it may occur in an elderly patient with known diabetes that had a recent acute illness or had undergone dialysis
body temp for 1-3yrs
37.2- 37.7deg C,
5-13- 36.7-37C
fever causes
increased pulse and respiration rate
hypothemia
less oxygen is needed
when pulse is increased
blood pressure is low
normal pulse is
60-90 beats per min radial
120 beats per min
infant
90-100 beats per min
4-10yrs and apical is most accurate
atherosclerosis
increased BP aka arterialscleroiss
sphygmomanometer
measure BP
nasal cannula
1-4L adults
0.25-0.5l min child
mask is
above 5l/min
PA mandible to demonstrate the body
CR exits the lips AML perpendicular to the IR
mandible PA
oml perpendicular to the IR and to see the body rami and medial / lateral displacement
axiolateral oblique mandible
area of interest is parallel with film, rami patients head in true lateral position (IPL perpendicular to the IR)
body rotate head 30 degrees toward IR
symph- rotate head 45 degrees towards the IR
smv
ioml parallel with the IR, CR perpendicular midway between mandibular angles
demo coronoid and conduloid process of the rami
TMJ AP Axial
OML perpendicular, CR angled 35 degree caudad, 3” above the nasion
demos the condyles and fossa if the mouth is open condyles will be projected below the petrosa
TMJ axiaolateral open;closed
IPL parallel to IR, CR angled 25-30 caudad 0.5” anterior and 2” superior to unaffected EAM
sinuses are overpenetrated
obliterate pathology and underpenetrated simulates pathology (70-75, 28mas waters 8mas lateral with a small focal spot
lateral sinuses
IOML perpendicular to IR 1-1.5” posterior to outer canthus
Caldwell sinuses
CR must be horizontal OML 15 degrees with the IR and CR exits nasion demon a frontal and anterior ethmoid sinsuses
calcaneous
40degree cephalad for axial projection CR at base of the 5th metatarsal
knee distance from ASIS to film
18cm or lower 5 degree caudad
19-24- 0 degrees
24 & up- 5 degree cephalad
lateral patella
cant bend knee more than 10 degrees
sella
CR 0.75 anterior and superior to EAM lateral
AP- IOML perpendicular CR 37 degree caudad
normal towne for cranium
CR 2.5” above glabella
towne for zygoma
CR 1” superior to nasion or glabella
lateral lumbar spine
long axis is parallel with table angle 8 degrees caudad for women and 5 degrees caudad for man 1” inferior to the crest
oblique lumbar
1.5” down from the crest and 2” medial to elevated ASIS
L5-S1 spot
2”posterior to ASIS and 1” inferior from crest
thoracic lateral spine
10 degrees for females and 15 degrees cepahlad for males because of broader shoulders
if the pedicles are to anterior
patient was not rotated enough
SI jts
patient elevated 25-30 degrees CR 1” medial to elevated ASIS
lateral sacrum
3.5” posterior to ASIS
lateral coccyx
3.5” posterior to ASIS and 2” inferior from ASIS
scoliosis
demon thoracic and lumbar 1” crest SID 60”
SI jts AP
30 degrees cephald 1.5” superior to symphysis
cranium lateral
CR 2” above EAM
bladder
10-15 degrees caudad CR 2” superior to upper border of symphysis if the patient is lordotic decrease angle
PA if prostate
area of interest 20-25 degrees cephald CR 1” inferior to tip of coccyx
to see ureters and bladder
RPO/LPO 40-60 degrees
to demo neck of the bladder and male urethra
35-40 degrees body rotation superior border of symkphysis
mean lethal dose
1-2GY
cell with the highest sensitivity
in G2 & Mphase
acute effects of radiation are
inflammation, edema, bleeding and stripping of mucosa
every xray tube must be contained within the housing that reduces
radiation leakage to less than 100mR/hr at a distance of 1m
1-10Gy
bone marrow damage with 2Gy threshold
10-100Gy GI system damage
especially small bowel
above 100GY
CNS damage
stages of response
prodromal - before the disease NVD
latent- healthy appearance
manifest illness- dose dependant person is ill
stocastic
no threshold increased dose increased probablitay
deterministic
threshold increased dose increased severity
somatic effect
cancer, congential defect, cateracts,
genetic
mutation
cataract
threshold 2GY acute, 10Gy chronic
sterility
threshold 2GY, temporary, 5Gy permamnet
fetus
preimplantation (0-10days) increased mitotic rate very radio sensitive prenatal death if born exencephaly brain hernia
major organgenesis
10days to 6wks with congential abnormalities most common is CNS damage increased neonate death most radiosensitve
fetal growth
above 6wks late effects like cancer
increased density and fog
no starter added to new soluition
fixer
clearing agent preservtibe, buffer, activator
fixor acts upon not trapped in specs silver haldies
needs more than 2 silver BR and 2 sensitivity specs
hardening happens in
developer and fixer
damp film
hardner problem or blowing problem
to enhance subject contrast
compression, decrease kvp, small field size, use a grid
diagnosticically useful densities
0.25 + B + F
single emulsion film is used
duplication and in mammo
unexposed film
under 20 degrees C, 30-60 humidity
exposed film
15-27C- 30-50 degrees humidity
left UV junction best demo in
RPO position with 30 degree body rotation
oblique view of sternum
best technique is 60kvp, 80ma and 2.5sec shallow breathing
ap shoulder external rotation
demo greater tuberacle
bone age
most common left hand and wrist sometimes left knee
arm venogram
contrast from wrist up to SVC
tacky film
exhausted hardner in fixer
developer temp accepted variance
+/- 0.5 degree C
C spine shoot through with no grid
70kvp and 5mas
spatial resolution in DR is limited
by size of the pixel
advanatage of DR
increased contrast and increase latitude
all repeats and rejects but not all rejects
are repeats
personal reject rate
total # of repeats and total # of films used
acceptance within
4-5%
every xray tube must be contained within the housing that reduces
radiation leakage to less than 100mR/hr at a distance of 1m
70kvp and up filtration is
2.5mm AL between 50-70 kvp is total filtration and must be 1.5 mm AL and below 50kv 0.5mm AL
image intensifier assembly acts as a primary protective barrier and must be
2mm Pb equaivalent
protective curtain is
0.25mmPB
fluro intensity of xray beam at the table top
shoud not exceed 2.1 R’min for each ma of operation at 80kvp
total intensity must not exceeed
10r/min
body thickness is 20cm , ese at 100cm SID is 110msv. what is the ese when the new SID is 60cm
SODI= 100cm-20cm-80cm
SOD2= 60cm-20cm-40cm
100/new ese= 40 x 40/ 80 x 80
new ese 440msv
dense bone ct #
1000
muscle ct #
50
white matter ct#
45
gray matter ct #
40
blood ct #
20
CSF ct#
15
water ct #
0
fat ct #
-100
lungs ct #
-200
air ct #
-1000
what is pitch
couch movement every 360 degrees/ slice thickness
preferred detectors in ct
solid state with 80% detection efficiency
1gy
100rads
blue sensitive film, safe light is
amber
digital radiography
static images produced with either fan xray beam intercepted by a linear array of radiation detectors or an area of xray beam intercepted by a photostimulable phosphor plane or direct capture solid state device
dose equivalent
radiation quantity that is used for radiation protection and that expresses dose on a common scale for all radiations. it is expressed in rems or SV
dose limit for preganant tech is
0.5msv/mth
dose limit for the fetus
4msv for the period of pregnancy, 2 TLDS must be worn during pregnancy
flux gain
number of output light photons / # of input light photons
minification gain
diameter of input phosphor squared / diameter of output phosphor
brightness gain
minification gain x flux gain
image receptor in CR is
composed of europium activated barium fluor halide compunds which are energized when exposed to light of xrays
sensitivity is equal to 200 speed screen film combination . the latent image consists of valence electrons stored in high energy traps. it manifests exposure to very narrow high sensitity laser beam
red. the laser beam causes electrons to return to their original state the valance band with the emission of blue light (OSL). the blue light is by the ultra sensitive multipier then it is digitzed and stored
spatial resolution of CR is not as
good as CR but contrast is greater and wider latitude is allowed. patient dose is less
TLD made of
litium fluoride crystals that are heated up to emit light
if the calcenous obsures the mortise jt then
dorsiflex the foot
axiallary part of the right upper ribs
RPO 45 deg or LAO PA away
x table knee the flim is
on the medial side angle 5 degree caudad
swimmers view the CR is centered at
JUGULAR NOTCH
what is road mapping
continuous real time subtraction
bony detail ct lspine
2200 ww and 400wl
ivp optimal kvp is
66-75
uneven light fog along on edge is
light fog the cassette was not closed properly
90 kvp AEC back up timer set at 50mas
image is underexposed
what is the variable in AEC and what is fixed
patient and the grid never moves always in the center of the image
what chambers are selected for a abdomen with barium
all 3
what chambers are selected for chest
outer 2
what chambers are selected for a knee
middle
if you have an upside down grid what is the error
it will be like a inverted skunk. fine in the middle and crap on the 2 outer sides
falling 3 phase generator
max setting is 500ma, 400speed, 8:1 stationary grid, focused to 100cm, 2.5mm filtration, 1.5mm FSS, 115kvp, AEC the right cell activated at 180cm
safe infusion rate to avoid edema
15-20 drops per min
crohns affects
ileum, string sign
nephrostogram
75kvp and 3.5ma fluro
if horizontal fracture of the patella is present
do not perform infra superior projection
16:1 grid is focused to 100cm what is the safe distance without primary loss of radiation
95-105cm
small bowel obstruction
dilated loops stacked coins
temp of barium most comfortable for patient is
29-30 deg C
why co2 instead of air
more rapidly absorbed
metareaction
unexpected or exacerbated effect from drug first time a patient receives it
teratogenic effect
drug that adversely affects the fetus causing abnormal develppment
idiosyncratic reaction
allergic reaction of metareaction
thyroid collar for fluro is
0.5mmlead
anticholineric drugs are used
in GI series to paralyze smooth muscles and to better demo the duodenum
topical routes are
eyes, nose, mouth, respiratory muscosa, vagina, rectum
speed point is
1+B+F
if density varies by 0.05
unsafe light time in the dark room
recto sigmoid patient is prone
30-40caudad
sphenoid sinus is located immediately
anterior and inferior to sella turica
greatest risk for breast cancer is
child birth after age 30
when more than one cell is activated the cell receiving the most radiation will
contribute the greatest electrical signal and therefore have the most overall influence on the exposure
what characteristic allows a CCD to provide better contrast resolution than a television camera tube?
higher sensitivity to light (DQE)
when is the mask image obtained during a digital subtraction angiography?
before the contrast injection if the patient is positioned
exam being done for spondylolysis of L5 the patient should be positioned at 60 degrees posterior oblique
CR enters midway between the crest and ASIS to best demonstrate this position
HVL is dependent on?
tube voltage
the biciptal groove of the humerus lies
between the lesser tuberacle and greater tuberacle
what effect does a enlarged SFOV have on a CT image
may make the individual pixels less visable
what is venipuncture
inhert catheter 15 degree angle to avoid nerve damage and avoid using volar aspect of the wrist or dorsal
why is there a considerable extension in density range for CR as to computed flim imageing
CR has one D max curve
what seperates the cerebral hemispheres of the brain
longitiudinal fissue
oral ingestion of contrast is used for visualization of
esophageal varices , the valsava maneuver can be used to increase portal pressure therefore showing it
lossy is how much lost
1/3
lostless is how much lost
1/20th
from what solution is silver reclaimed in most recovery systems
fixer
what documentation do you find compelte information on a specific chemical product
MSDS
how is HIV infection tramsmitted
direct contact
permament filtration mm of al is
less than 50- 0.5mm of al
50-70= 1.5mm of al
more than 70- 2.5mm of al
what angle is used for the scaphoid?
20
what is the beste projection to view the pisiform
ap oblique wrist
edge enhancement shows
smaller details better
the only long bone to ossify by intramembraneous ossification is
the clavicle
structure that connects the lateral ventricles to the 3rd ventricle in the brain in regards to the flow of CSF is
interventricular formina
structure of the nasal septum that continues superiorly as the cristia gali is
perpendicular plate
mengies that protect the spinal cord and brain from the outer layer is
dura mater, arachnoid and pia me mater
noise is the main limiting factor for
contrast resolution acquiring CT images
what is the radiography sign of ulcerative colitis
polypoid lesions along the bowel wall
birds beak
volvulus
RA of epidural hematoma on unenhanced ct
lens shaped area with increase in brightness
prefetching and on demand in PACS means
studies awaiting interpretation by the radioliogist
test tool used for quality control to elevaluate electronic display devices for luminence and luminance uniformity
photometer
barium sulphate mixture for a double contrast BE
75% weight volume & below 30C
what is pyrexia
fever increased respiratory rate, chills, flushed skin
lead apron on the II is
0.25mm of lead
volvulus is seen in
cecum & sigmoid as birds beak
celiac disease is a
malabsorption disorder
2 right lung fissures are
horizontal & oblique
1 left lung fissue is
oblique fissue
trachea divides into the primary bronchi at the
carina T4-T5
endotracheal tube for intubation should be positioned
5-7cm above the carnia
oxygen flow rate for the average patient is
2-5L/min
trauma patient in shock
10L/min
patients with a chronic lung disease need oxygen at a slower rate like emphysema oxygen at
less than 3L/min
oxygen to child with a nasal cannula is
1/2-1/4 L/min because they have a higher respiration rate they need lower oxygen rate so as to note over inflate their lungs
chest tube is placed into
intrapleural space between the parietal pleura and visceral pleura
what is a peripherally insertered central catheter
inserted into a vein into the patient arm and advanced until the tip lies in the SVC
PICC line used for
medications, fluids, draw blood short or long term, ICU, chem patients dialysis, total parenteral nutritioin
average heart beat per min
60 to 100 beats/min
adult respiration
12-20/min
child respiration
20-24/min
baby respiration
24-36/min
polydacly is
extra finger
what is the fat pad by the thumb called
thenar eminence
ankylosis spondolysis is
bamboo spine or marie strumple
begins at the sacroiliac joint with bilateral and symmetric, widening of the joints
bone fusion and calcification seen on the ap lumbar
spondolothesis is
defect in pars artericularis seen on the oblique views, between the superior and inferior articular process of the vertebrae on the lamina
most common in L5
clefts are bilateral
spondoloithesis is
displacement in pars interacrticularis with anterior displacement of L5 over S1
for lateral t spine centering is
to T7 for the lateral and you do not need C7
ap tspine
if you have the adams apple on your centered to high
tuberacle on the clavicle is seen on the
axial
increase technique for the axial clavicle
because your shooting through thicker tissue
clavicle is a
long bone with no medullary cavity, has cancellous bone with compact on the outside, red marrow
on the lateral foot view the sinus tarsi is
more closed
when you stand 90 degrees from the patient you get
the least amount of scatter
