Procedures Kettering Audio Flashcards
What does the term Decubitus mean?
Lying down with a horizontal beam
The elbow is ________ in relationship to the wrist.
Proximal
The wrist is _________ in relationship to the elbow
Distal
Sthenic Body Habitus
Average Body Habitus
Where can you find the stomach on a hypersthenic patient? How do you place the cassette to capture?
The stomach is higher, more transverse, more lateral
-Landscape Cassette
On a hypo and asthenic body habitus where is the stomach located?
Lower, more midline, more J shape
-Place the Cassette Portrait
Axial Skeleton Definition:
A portion of the skeleton toward the center or midline of the body. (Skull all the way down through Coccyx)
Appendicular Skeleton Definition:
Upper and Lower Extremities, shoulder and pelvic girdles
Anatomical Position Definition:
Standing erect, palms facing forward, looking straight ahead
In the hand the first digit is ________.
Thumb
More lateral
What is the medial bone of the lower leg?
Tibia
What is the Lateral bone of the lower leg?
Fibula
The medial bone of the forearm is:
The Ulna
The lateral bone of the forearm is:
Radius
Radiographic View Definition:
The body part as seen by the image receptor or other recording medium.
Radiographic Position Definition:
A specific body position or part that’s nearest to the IR
singular surface in contact
Radiographic Projection Definition:
Refers to the path of the CR/path of x-ray beam travel
If you are lying down on your back the position would be?
Supine Position
OR
Posterior Position
If you are standing with your back against the IR (chest stand) the position is:
Erect/Upright Position
If you are standing facing the tube the position is:
Erect/Upright Position
OR
Posterior Position
If the patient is supine the projection is:
AP projection
The path of the x-ray beam travel
Radiographic Projection
In a routine PA chest x-ray the PA stands for:
Posterior-Anterior
Posteroanterior
PA projection definition:
Enters the posterior surface and exits the anterior surface
Supine definition:
Lying down flat on back
If you are in the RPO Position you will also be in the:
Ap oblique projection
What is this image best demonstrating?
Flexion View of the L-Spine L4/L5 Spondylotisthesis (patient leaning forward)
ASIS location:
level of S1
Located at the C4-5 interspace
Thyroid Cartilage
Sternal angle located at the:
Level of T4-5
Sternal Notch is located:
level of T2, T3
Inferior angle of the scapula for a PA chest x-ray is located at the level of:
T7 (PA Projection of the chest)
Tip of the xiphoid process located:
At the level of T10 or T9-10 interspace
The umbilicus located at the level of:
L3-4 interspace of the lumbar spine
The iliac crest located:
At the level of L4-L5
The greater trochanter located:
same level of symphysis pubis
What is the same level of the symphysis pubis?
Greater trochanter
For a Lateral C-spine what are you seeing?
zygopophyseal joints superimposed (no intervertebral foramina)
a. Left Posterior Oblique Position
b. Left Anterior Oblique Position
c. Right Anterior Oblique Position
d. Right Posterior Oblique Position
24/7 36/5 immobilization devices that the technologist can use:
Sand bags, compression bands, sponges, draw sheets, adhesive tape, pig-O-stat.
Devices or custom built devices are commonly used for pediatric or limited population departments
“Pig-O-stat”
Glabellomeatal line (GML)
Orbitomeatal line (OML)
Infraorbitomeatal line (IOML)
Acanthiomeatal line (AML)
Lipsmeatal line (LML)
Mentomeatal line (MML)
External Acoustic Meatus (EAM)
The patient had his or her hands taped against their will:
Illegal restraint
The only person that can order a restraint device is the:
Physician
You can lose your license if you do so
As a technologist if you choose to angle the tube 30 degrees caudally for an AP Axial projection of the skull, then we position the:
OML Perpendicular
As a technologist if you choose to angle the tube 37 degrees caudally for the AP Axial Projection of the skull then we position the:
IOML perpendicular
A patient has trauma to the anterior surface of the ribs. What you should do as a technologist?
Put them in a PA Projection and put the surface in contact with the IR
If you want to demonstrate the best detail of the clavicle:
Put them in the PA Projection
Which of the following projections should a longitudinal arch of the foot be preformed routinely?
Lateromedial Projection
If I patient has a sinus headache what should you do as a technologist?
Ask them “patient what side are you hurting on, left side pain left side against”
When you preform an AP Axial Projection of what bone of the skull is in contact with the IR?
Occipital Bone
OR
Occipital Position
If you as a technologist are doing the AP Axial Projection 30 or 37 degrees of the skull what is the point of demonstration/criteria/purpose?
Project Dorsum cella and posterior clinoids directly through the foramen magnum
If the patient is lying down on their left ear the MSP is:
Parallel to the IR
Or
Parallel to the table
If the patient is lying down on their left ear the IP is:
Perpendicular
For a lateral projection of the skull the CR enters:
Perpendicular to the IR
5cm Superior to the EAM
2 inches x 2.5= 5 cm
1inch= 2.5 cm
PA Axial Projection of the skull CR:
(caldwell) 15 degrees caudad to exit the nasion
MSP and OML perpendicular to the IR
Where can you find the Petrous ridges in the PA Axial Projection?
Lower 1/3 of the orbits
Where can you find the Petrous ridges in the PA Projection of the skull?
Completely fill the orbits
On the PA projection what is in contact with the IR?
Nose and Forehead
OML perpendicular
SMV (full basal) line ______ to the IR:
IOML parallel to the IR
CR is perpendicular
A patient is elderly and cannot lean head all the way back, what do you do?
Unspecified Cephalic angle of the tube
Relationship between the IOML and the IR for SMV:
Parallel
Not flexible patient, the relationship between the CR is always __________ to what baseline of the SMV?
Perpendicular to the IOML
The IOML is positioned if flexible:
Parallel to the CR
THE CR IS _______ to what baseline (not flexible)
Perpendicular to the IOML
For the Lateral Skull the MSP is:
Parallel to the IR
For the Lateral skull the IPL is:
Perpendicular to the IR
The CR for a Lateral Skull:
Perpendicular to the IR to a point 5cm superior to the EAM
Facial bone views should be done _____ whenever possible to demonstrate air fluid levels.
Upright
Lateral Facial Bone CR enters:
halfway between the outercanthus and the EAM at the zygoma
Parietocanthial Projection (facial bones) :
MSP and MML perpendicular to IR
(neck is hyperextended so the OML forms a 37 degree with the IR)
How many degrees does the OML baseline form with the plane of the IR in the parietocanthial projection?
37 degrees*
PA Axial Caldwell:
15 degrees caudal to exit the nasion*
Parietocanthial projection CR exits:
Acanthion*
Where can you find the petrous ridges in the Parietocanthial projection?
The floor to the maxillary sinuses
(Completely below)
Inferior to the maxillary sinuses
PA modified Parietocanthial baseline:
OML forms a 55 degree angle with the plane of the IR*
What is the blow out fracture?
Fracture of the inferior orbital rim
Which of the following procedures will best demonstrate the blow out fracture of the orbit? Inferior orbital rim fracture.
Modified Parietocanthial projection*
What structures/anatomy make up a blowout fracture (fracture of inferior orbital rim)?
Zygomatic Arch
Zygoma
Maxilla
Palatine
Axio-lateral oblique (closed mouth)
Identify the image:
Lateral Flexion View of C-Spine
Identify the image:
Lateral Extension View of the C-Spine.
Identify the Image
External Oblique of the Elbow
Identify the Image
Internal Oblique of the Elbow
For the temporomandibular Joints the CR is angled:
25 degrees cephalic total angle
What is the CR for the axiolaterial oblique mandible?
CR directed 25 degrees Cephalic through the mandibular ramus closest to the IR.
As an operator if you place the patients head in a true lateral position tempomandibular joints then the point of demonstration of the mandible is:
Ramus
If you rotate the patient 30 degrees toward the IR the point of demonstration for the mandible is?
The body
If you rotate the face 45 degrees toward the IR (mandible) the point of demonstration is:
Mental Point (symphysis)
TMJ (Temporalmandibular Joints) routine should always be done:
With both open and closed mouth views
The Parietocanthial projection will demonstrate:
the Nasal Septum
The lateral nasal bone is to be done:
Table top
Bilateral for comparison
MSP parallel
IP perpendicular
CR 3/4 inch (2cm) below the nasion
Image on the left:
Image on the right:
Left: AP
Right: PA
(orbit size is larger because of OID)
Lateral Skull
Looking at the sella turcica (saddle)
2 inches above EAM
When would you use cross table lateral? Truama
PA Haas Method
OR
Reverse Townes
Helpful for Kyphotic Patients
The lateral facial bone projection shows:
Nasal Bone
How many septum’s do you have and nasal bones?
Right and left septum and one nasal bone
Paranasal Sinuses are to be done in what position?
Erect or Upright Position
What is the purpose of performing paranasal sinuses in the erect position?
Show air fluid levels
How many vertebrae are in this lateral c-spine?
7 (if you do not see the T1 articulation) what do you do next? lateral cervical projection
The only time you can demonstrate all four sets of sinuses at one time is through the:
Lateral paranasal sinuses projection
PA Axial projection for paranasal sinuses best demonstrates:
Frontal and anterior ethmoid sinuses
The PA Axial Projection, what sinuses are best demonstrated?
Frontal and anterior ethmoids
On the Parietocanthial projection what sinuses are best demonstrated?
The maxillary sinuses demonstrated free of superimposition
When preforming the open mouth perietocanthial what sinus is projected through the open mouth?
Sphenoid is demonstrated directly through the open mouth
The CR for the AP Axial Cervical Spine:
CR is angled 15-20 degrees Cephalic to the level of C4
40 inch SID
What is the purpose of the angular ion of the tube for the AP axial Cervical Spine?
Help open up the intervertebral disk spaces (joint spaces)
15-20 degrees Cephalic angulation on the Axial C-Spine, what is its purpose?
To open up the intervertebral joint spaces
What demonstrates the C1-2 relationship? (Pivot head back and forth)?
AP Open Mouth (Odontoid)
With the mouth wide open the occlusal plane is:
Perpendicular
Define occlusal plane:
Imaginary line drawn from the upper incisors (the biting surface of the teeth) to the tip of the mastoid or base of the skull
The occlusal plane is:
Perpendicular
If the base of the skull are superimposed on the AP open Mouth (odontoid) how do you fix it?
Place the chin closest to the chest (flexion) flex the head and neck
If you look at an examination and you see that the teeth are superimposing the odontoid process? How do you fix it?
Extend the head and neck. Raise the chin up (extension)
What do you do to the head and neck to fix this?
Extend the head and neck
How do you fix this?
Flex the head and neck
If you see the base of the skull is superimposed on top of the odontoid process:
Flex the head and neck
If you see the teeth are superimposed on top of the odontoid process:
Extend the head and neck
Lateral C-Spine SID:
Performed with 180 cm
Counteracts magnification, decrease OID
Can you count on a lateral C-Spine (C8) articulation. If you count and are missing the T-1 articulation (C-8). What do you do next?
Lateral cervical thoracic projection. Look to use hand weights to relax the shoulders and pull down in order to see the area.
If a patient comes in immobilized on a spine board as a technologist what are we going to do?
Horizontal beam lateral
Properly get it cleared by the attending physician
Anterior obliques positions (back to the c-ray tube) of the cervical spine best demonstrates the:
Intervertebral foramina closest to the IR
If the patient is facing the x-ray tube for a Anterior oblique cervical spine angle the tube:
15-20 degrees cuadad directed to the level of C4
-angle down, face down, side down
If the patient is in a Posterior oblique position for the cervical spine, what angle is the tube?
15-20 degrees cephalad to the level of C4
Face up, angle up, side up
Posterior Obliques of the cervical spine best demonstrates:
The foramina farthest from the IR
AP and PA Axial Obliques of the C-Spine best demonstrates:
The intervertebral foramina
If the patient is in a posterior oblique position (AP oblique projection) (when the patient is facing the tube) of the cervical spine. What angle?
15-20 caudad CR directed to the level of C4
BEST DEMONSTRATES UPSIDE
If the patients back is to the x-ray tube for a cervical spine, (anterior oblique position) what angle?
15-20 Cephalic angle
BEST DEMONSTRATES DOWN SIDE
When you do obliques of the spine C,T,L:
C best demonstrates: intervertebral foramina furthest to the IR
T best demonstrates zygo furthest to the IR
L best demonstrates zygo closest to the IR
When the patient is in the RPO Position facing the tube for the cervical spine best demonstrates:
Intervertebral foramina that is furthest from the IR
When the patient is in the RPO Position facing the x ray tube, the T-Spine best demonstrates:
The zygo furthest from the IR
In an RPO of the lumbar spine you best demonstrate:
Zygo closest to the IR
FFC (Fresh fried chicken)
Furthest furthest closest
When the patient had their back to the x-ray tube:
Anterior oblique position
PA oblique projection
On the anterior oblique positions PA oblique projections you best demonstrate:
Closest intervertebral foramina of the cervical spine
Closest zygo in the thoracic spine
Furthest zygo in the lumbar spine
(CRISPY CRUNCHY FRIES) CCF
When the patient is facing the tube what do we use?
Fresh fried chicken
When the patients back is to the tube:
CCF CRISPY CRUNCHY FRIES
Whose arm is up on the swimmers?
The arm closest to the IR
Which arm is down on the swimmers?
The arm closest to the tube
What is best demonstrated on the lateral swimmers?
Shows the cervical thoracic area or region
For the AP thoracic spine the CR:
Directed perpendicular to the IR to the level of T7 (inferior angle of the scapula)
Who’s part of the tube should be placed over the upper portion of the T-Spine?
Anode
What part of the tube should be placed over the lower part of the T-Spine?
Cathode
Lateral breathing and lateral expiration of the T-Spine CR:
Perpendicular to the IR at the level of T7
Which of the following examinations would require the use of a breathing technique?
- Lateral T-Spine
- AP projection of the Scapula
- Transthoracic lateral for the proximal humerus and shoulder (Lawrence method)
- Soft tissue neck
How do you reduce the ESE to the vitally sensitive organs?
Put them in the PA projection, turn the back to the beam
Definition of Scoliosis:
Abnormal lateral or side to side curvature of the spine
When the patient flexed the knees, what is the purpose?
- Reduce the normal lordotic curvature
- open up the joint (intervertebral) spaces
The CR for the lumbar spine?
Transversely at the top of the iliac crest (L4-L5) interspace
(Biggest cassette)
The CR for a lumbar spine if downsize the cassette?
Transversely 2.5 cm above the crest
The lumbar spine best demonstrates:
The heights of the lumbar vertebral bodies and intervertebral disk spaces
Definition of spondylotisthesis:
Forward displacement of one vertebra on top of another vertebra
Which of the following will best demonstrate the presence of spondylotisthesis?
L5-S1 Spot
Lateral
On an average male angle the tube: (L5-S1 spot lateral)
3-5 degrees caudally
On an average female (L5-S1 Spot) angle the tube:
5-8 degrees caudally
When the patient is on the back AP oblique projection lumbar spine (posterior oblique position) best demonstrates?
Zygopophyseal closest to the IR
The only time you can see a Scotty dog is through the?
Oblique of the lumbar spine
Pedicle of the Scotty dog:
Eye
Superior articular process of the Scotty dog?
Ear
The transverse process of the Scotty dog is the:
Nose
The neck of the Scotty dog is called the:
Pars Interacticularis
The front foot of the Scotty dog is:
The inferior articulating process
The back foot of the Scotty dog?
Inferior articular process of the opposite side
label D
Pedical
A?
Superior
Articular
Process
E?
Transverse Process
B?
zygapophyseal Joint
C?
Pars Interarticularis
The body of the Scotty dog?
Lamina and spinous process
The tail of the Scotty dog is the:
Superior articular process of the other side
The patient is lying on their back in an AP Axial Projection of the sacrum what is the angle of the tube?
15 degrees Cephalic alone the MSP to a point midway between the ASIS and symphysis pubis
When the patient is prone for an AP axial projection of the sacrum what is the angle of the tube?
CR is 15 Caudual along the MSP to a point midway between the ASIS and the symphysis pubis
The patient is lying on their back for the AP Axial coccyx what is the CR?
CR is angled 10 degrees caudad along the MSP to a point 5cm (2 inch) superior to the symphysis pubis
If the patient is prone for the AP axial coccyx what is the CR?
CR angled 10 degrees Cephalic along the MSP to a point 2 inches or (5 cm) superior to the symphysis pubis
What is a myeologram?
Sterile procedure done under fluoroscopic conditions
Where do you inject for a myeologram?
Contrast media is administered via spinal puncture into the subarachnoid space (intrathecal injection)
What does intrathecally refer to?
within the spinal canal
For a myelogram the preferred site of spinal puncture is:
L3-4 interspace
Primary pathology for myelogram is HNP stands for
herniated nucleus pulposus
Conus medullaris
lower border of L1 must inject lower than this level
Water soluble contrast is deposited into the:
Subarachnoid space
Primary purpose of performing a myelography is:
HNP (herniated nucleus pulpous)
Slipped disk
Sacroiliac Joints. When the patient is placed in a 25-30 degree posterior oblique position the CR:
1 inch (2.5 cm) medial to the upside ASIS
1 inch medial to ASIS
SI joint
Myelogram. Never inject into the body inject:
Below L1
When the patient is placed in a 25-30 posterior oblique. The CR will enter 1 inch medial to the upside ASIS, best demonstrated is the:
SI joint farthest from the IR
A patient is in an 25-30 degree anterior oblique and the CR is entering 1 inch medial to the ASIS, what is it best demonstrating?
The SI joint closest to the IR
The CR for an AP hip:
Perpendicular to the IR 6 cm distal to the midpoint of the line drawn between the symphysis pubis and the ASIS
For the AP hip the leg is rotated:
Internally 15 degrees
You have done the AP hip no obvious fracture is indentified, move on to the frog leg lateral? How many degrees from vertical is the leg abducted?
40-45 from vertical
You have done the AP hip, there is an obvious fracture and dislocation identified. Which of the following will take the place of the frog leg lateral?
Danelius-Miller Method
Cross table lateral hip
On a cross table lateral (horizontal beam) the CR is:
Perpendicular to the femoral neck and IR
The patient is lying on their back, the unaffected leg is up and out of the way, and you are shooting through the x-ray tube,neck, IR
Parallel
But the CR is perpendicular to the femoral neck
A patient presents with a bilateral hip fracture, what do you do?
Axiolateral Inferosuperior trauma (Clement’s-Nakayama)
Patient lies supine with lower limbs in neutral position
What is the axiolateral inferosuperior (Clements-Nakayama) preformed for?
Bilateral hip fractures
innominate bone consists of:
Ilium iscium pubis
Right innominate bone and Left innominate bone
What part of the innominate bone is formed by all three innominate bones ilium, ischium, and pubis?
Acetabulum
What bares the weight of the body while a person is sitting down?
Iscial tuberosity
AP pelvis both feet and legs are:
Internally rotated 15-20 degree to overcome the anti- version of the femoral necks (feet are straight up neck are foreshortened)
CR for an AP pelvis?
Perpendicular to the MSP to a point (5 cm) superior to the symphysis pubis
If you see a picture of a pelvis and the lesser trochanters are obvious how are you going to fix that?
rotate the feet 15-20 toward the midline
On the AP pelvis, axial anterior pelvic bone Inlet projection CR:
Directed 40 caudad to the MSP and entering the body at the level of the ASIS
The most common patients for scoliosis series?
Teenagers
AP pelvis, axial anterior pelvic bone outlet projection (Taylor Method) male range when the patient is supine:
20-35 cephalic
PA vs. AP for breast tissue for scoliosis purpose?
Breast tissue dose is decreased with PA
Scoliosis series is done with what SID?
150-180 cm
What is wrong with this image?
They did not center correctly, cutting off the back of the spinous processes. CR is too anterior.
Uses a block to elevate the hip on the convex side (scoliosis)
Ferguson Method
Measurement tool for radiologists:
Cobb Method
Outlet projection (Taylor method) for female supine range:
30 to 45 degrees
Hysterosalingogram demonstrates:
patency (openness) of the filopian tube
May be diagnostic or Therapeutic tool
Primary indication is infertility
Performed with OBGYN
Kink in fallipian tube (could straighten it out)
Endometriosis ( egg is having trouble in transport system)
Ectopic pregnancy (tubal pregnancy)
Egg is having trouble being fertilized
Why do you do a PA chest erect at 180 cm SID?
To reduce heart magnification
What is the purpose of performing a chest in an erect position?
Show air fluid levels
The CR for an AP or PA chest upright?
Perpendicular to the IR at the level of T7 (inferior angle of the scapula)
“Patient take a deep breath in blow it out and take another deep breath in and hold it, please don’t breathe”
Exposure taken at the end of a second deep full inspiration for the chest x-ray
The proper breathing command for a chest?
Second deep full inspiration
Look at an image. Identify a specific letter or number or choose on a hotpot:
Right apex
Left costerphrenic angle,
Right 6th posterior rib
Right Hilar region
Aortic arch
When evaluating a routine PA projection of the chest to look for rotation all of the following are true except:
Medial ends of the clavicle to equal distance from the spine (yes)
Scapula rotated outside of the lung field (yes)
Shoulders rolled forward (yes)
9-10 anterior ribs below the diaphragm *** (no posterior)
Can you look at a lateral chest and see if it is rotated?
Yes or no
Put the following in order from anterior to posterior:
Esophagus
Spine
Trachea
Heart
Anterior to posterior
Heart
Trachea
Esophagus
Spine
Put the following in order from posterior to anterior:
Spine
Esophagus
Trachea
Heart
What is the purpose of performing the chest in the AP lordotic position?
Showing the apices without superimposition
The AP lordotic chest may be performed:
With the patient standing vertically against the IR with the CR angled 15-20 degrees Cephalic or come in horizontal and the patient arches their back
AP supine chest disadvantage:
Lose air fluid levels (yes)
Create cardiomegaly (yes)
The patient comes in and can’t stand or is in the ICU or ICCU the endotracheal tube.
Conus medullaris
Lower border of L1, must inject lower than this level
Cisternal puncture
Between Atlanto-occipital joint space
What does HNP stand for?
Herniated nucleus purposus
The endotracheal tube (ET) should not extend past the level of:
Carina
The main stem bronchus bifurcates at the level of:
Carina
At what level does the carina bifercate?
T5-T5 6 interspace
What main stem bronchus is higher and more vertical?
The right side
How high above should the ET tube be placed above the level of the carina?
The tip of the tube should stop above 5cm above the level of the bifurcation (carina) T5 or sternal angle
If you want to demonstrate the where the air is in the lateral decubitus?
Put that side of the lung up
If you want to best demonstrate the fluid in the lung: (pleural effusion)
Put that side of the lung down
If you best want to demonstrate a right sided pleural effusion, which decubitus would you preform?
Right side down
If you best want to demonstrate a right sided pneumothorax which decubitus would you preform?
Left lateral decubitus
Which of the following would best take the place of air fluid levels if the patient can’t sit or stand erect?
Right lateral
Left lateral decubitus
Decubitus
AP or PA ribs above the diaphragm:
Upright on inspiration
AP or PA ribs below the diaphragm:
Upright and on expiration
Posterior and Anterior oblique rib:
45 degree rotation of the body
When the patient is facing the x-ray tube and it’s an AP oblique projection (posterior oblique position) RPO and LPO best demonstrate:
RPO: Right axillary portion of the ribs
LPO: Left axillary portion of the rib
Which of the following two obliques will best demonstrate the axillary portion of the ribs?
LPO position
RAO position
Why do you preform the obliques for the ribs to demonstrate:
Axillary portion
Lateral margin
Perform the lateral sternum with what SID?
180 cm (72 inches)
How do you counteract OID?
Increase SID (reduce magnification)
The very top of the sternum is called:
Manubrium
The body of the sternum is the:
Gladiolus
Tip of the zyphoid process
If you have a smaller patient how do you oblique the patient for an RAO sternum breathing technique?
20 degrees
If you have a bigger patient how do you oblique the patient for an RAO sternum breathing technique?
15 degrees
What is the purpose of preforming the sternum in the RAO position?
Project the sternum through the homogenous heart shadow
Which chest x-ray is used for active TB?
AP Axial Chest (AP lordotic)
Valsalva maneuver:
Patient bear down like you are going to have a bowel movement
What is the single most common reason the valsalva maneuver is preformed?
Inner ear infection
Esophagial Varices
Hiatal Hernia
KUB stands for:
Kidneys, ureters, bladder
the spongy cancellous bone separating the inner and outer layers of the cortical bone of the skull
Diploe
The name of the lines that separate the regions or planes of the body:
Addison’s planes
X-Axis
Left to Right, Sagittal
Y-axis
Front to Back, Coronal
z axis
head to toe, axial/transverse
Elbow with the hand pronated, medial oblique of the elbow
3. coronoid process in profile
When the patient flexes the knees for the AP supine (KUB) what does that do?
Makes the patient feel more comfortable
Opens up the joint spaces and reduces normal lordotic curvature
AP supine (KUB) CR:
Perpendicular to the MSP to the level of the iliac crest
AP Supine (KUB) breathing instructions
Full Expiration
“Patient blow all of your air out, please don’t breathe”
Identify the right psoas muscle, left SI joint, top of the crest, body of L3. On an image
Identify
The head of the pancreas on a normal body habitus is located?
RUQ
The body’s and the tail of the pancreas on a normal body habitus?
LUQ
How many regions of the body do we have?
9 regions
RUQ anatomy:
Majority of the liver, gallbladder, right kidney, right super adrenal gland, hepatic flexure
Where is the majority of the stomach located? (Quadrant)
LUQ
What quadrant is the appendix located in?
RLQ
When you do erect abdomens you are looking for:
Free intraperitoneal air
Free intraabdominal air
Free air under the diaphragm
What is the most important anatomy to demonstrate when performing the erect abdomen?
The entire diaphragm
Whenever you want to show air fluid levels the relationship between the x-ray tube (beam) and the floor:
Tube Parallel
Horizontal
For an AP upright abdomen the IR:
Is centered approximately 2-3 inches (5-8 cm) above the level of the iliac crest because you are trying to get the entire diaphragm
For the abdomen always do ______ when considering air fluid levels, air will rise to right.
LLD
Left Lateral Decubitus
Recumbent LLD
If the patient can not sit or stand erect which of the following would take its place?
Left lateral decubitus of the abdomen
Upper rib pain is ribs:
1-7
Lower rib pain is ribs:
8-12
What is the minimum time a patient needs to be in a decubitus?
5 minutes
Part of the alimentary canal:
Esophagus
If you better want to evaluate the esophageal wall like the lining of the esophagus:
Use thick barium suspension
What is the best way to demonstrate the esophageal varices?
Trendelenburg
Supine
Recumbent
A thick barium suspension is used to demonstrate:
Esophageal wall
The gastric folds of the stomach are called:
Rugae
Which of the following will best demonstrate the deodunal bulb c-loop?
RAO
Hiatal hernia:
A portion of the stomach balloons into the diaphragm
Which of the following will best demonstrate the presence of hiatal hernia?
Trendelenburg
In a dual contrast study when the patient is supine and in the LPO position:
Barium in the fundus of the stomach
In a dual contrast study when the patient is prone or in the prone oblique (RAO) the patient will have:
Air in the fundus
Give you a dual contrast study, which examination are you dealing with? Picture.
RAO
Supine
Etc.
not a question
Which of the following are timed examinations?
Small Bowel
IVU
KUB
LLD of abdomen
Yes
Yes
No
Yes
I’m a left lateral decubitus the patient should hold position for:
Five full minutes
What is the shortest portion of the small bowel?
Duodenum
What is the largest potion of the small bowel?
Ileum
All of the following are parts of the of the small bowel except:
Ilium
Ileum
Jejunum (feathery appearance of the bowel)
Duodenum
Ilium (iliac crest) does not belong
When is a small bowel series considered to be complete?
Illeocecal
Cecum
Terminal ileum (TI)
Large Intenstine
Ascending Colon (DO NOT PICK THIS ONE)
Feathery appearance of the bowel
Jejunum
The flow of the barium enema:
Cecum
Vermaform
Ascending
Descending
Hepatic Flexture
Transverse Colon
Splenic flexture
Etc, (look up!!)
Which of the following will best demonstrate the presence of/which of the following pathologies would be most enhanced/best demonstrated with the use of a double contrast study?
Polyps
Lying down in the enema tipping position known as the:
Sims position
How do positions the enema tip?
Inserted 2-3 inches (5-8 cm)
Directed anteriorly and superiority upon passage of the rectal opening
Head is lower than the feet
Trendelenburg
Patients feet are elevated
Fowlers
Right side down in a right lateral decubitus, best going to demonstrate:
Medial portion of the ascending
Lasteral portion of the descending
Left side down in a left lateral decubitus demonstrates:
Medial side of the descending colon
Lateral side of the ascending colon
Obliques for a BE the point of demonstration is always the:
Flexture
In a posterior oblique position (LPO) for a BE you best demonstrate:
Up side Flexture
Hepatic Flexture
If you do the RPO position you best donstrate the:
Splenic Flexure and the descending colon
Which two obliques will best demonstrate the splenic Flexture when performing a BE
RPO
LAO
AP axial (sigmoid) or supine in the butterfly requires a CR:
30-40 degrees cephalic
PA Axial (sigmoid) (butterfly) prone CR:
30-40 degrees caudad
What is the purpose of performing the axial sigmoid?
To show the rectosigmoid area or region without significant superimposition
Post-evacuation
Bowel the last image on the BE
Post-Void
Last image on the urinary system such as an IVU/Cystogram
Which of the following examinations will be performed in a retrograde study?
BE
ERCP
(Goes against the flow)
Done in fluoro
Done in the department
What is your access point when performing an ERCP?
The duodenal (duodenum) papilla
Non-functional procedure that evaluates the contours and anatomical structure of the urinary bladder
Cystography (Cystogram)
Requires a 150 to 500 mL of contrast media administered by gravity in a retrograde fashion into the bladder using a Foley catheter
Retrograde Cystogram
AP/AP Axial Cystogram
Supine legs fully extended
CR directed 2 inches (5cm) superior to the symphysis pubis with a 10-15 caudal tube angle
Demonstrates signs of reflux, obstruction, cystitis, and calculi
Esophagus anatomy study!!
Upper esophagus, pharynx
The involuntary construction and relaxation of the muscles of the intestine or another canal creating wave-like movements that push the contents of the canal forward
Peristalsis
Unintended inhalation of fluid or solid material
Aspiration
Swallowing distinction patients (CINE)
Speech pathologist
Uses video fluoroscopy
Stroke patients
For compression of the abdomen and bowel images are performed:
Prone
Single contrast study includes: and shows:
BA only, anatomy and muscle contraction
Double contrast BE uses: shows:
Gas and Ba
Defects in mucosal lining and intraluminal lesions
Voiding cystourethrography (VCUG) for male
30 RPO while voiding
When performing a Cystogram or voiding cystourethrogram what makes it functional?
Fill bladder up image it and continue to image as the patient goes
A Cystogram and voiding cystourethrogram can both commonly be performed to rule out
reflux of the uterus in children
When performing a 25-30 degree posterior oblique position best demonstrate:
The up side kidney because it is parallel in profile (right)
Downside ureter
What is the purpose of performing a retrograde urography? Retrograde study for the urinary system?
Trying to evaluate any filling defects!
Know your anatomy for extremity. Hand foot wrist elbow knee shoulder!
Foot CR (AP or AP axial)
Perpendicular 10 degrees posteriorly to the base of the third metatarsal (10 degree cephalic) 10 degrees posterior, 10 degrees proximally
In the foot you have:
14 phalanges
Great toe: IP
*know anatomy
When performing a medial oblique of the foot the plantar surface forms a ______ angle with plane of the IR.
30 degree angle
When you oblique the foot the plantar surface forms a ______ angle with the IR
30 degree
On the medial oblique of the foot we best demonstrate:
Lateral structures
When you do a lateral oblique of the foot you best demonstrate:
Medial Structures
All of the following structures are best demonstrated on the medial oblique of the foot except:
Base of the fifth metatarsal
Cuboid
3rd cuneiform
1st cuneiform
1st cuneiform
On a 30 degree oblique you best demonstrate on a lateral oblique of the foot except:
1st cuneiform
2nd cuneiform
Nuvicular
Cuboid
Cuboid
Which of the following will best demonstrate the longitudinal arch of the foot?
Perform it in the lateral weight bearing method
How should you routinely perform a longitudinal arch of the foot?
Lateromedial projection
Dorsiflexion (hyperflexion)
90 degrees angle where the foot and the tib fib make a 90 degree angle
Axial calcanious plantodorsal CR:
CR is angled 40 degree to the long axis of the foot angering the level of the base of the 3rd metatarsal
The patient is seated on the table thier leg is placed on the table and their foot is hyperflexed, the CR enters with a 40 degree angular ion of the base of the 3rd matatarsal. Described:
Axial calcaneous (plantodorsal)
The CR enters the dorsal surface of the ankle at 40 degrees caudad angle to the center of the IR, the patient is prone, the ankle is on sandbags and the ankle is dorsiflexed:
Dorsoplantar axial calcaneous
AP Ankle:
Knee is fully extended with the ankle placed in a dorsiflexion position, foot is flexed 90 degrees to the long axis of the lower leg
CR is directed perpendicular to the IR to the mid-malleolar region
Where does the AP ankle CR enter?
Mid malleolar region
How many degrees do you oblique the part for the AP oblique mortise of the ankle?
15-20 degrees toward the midline
Mortise joint:
Wood work joint
Open joint space of the tibia, fibula, and talus
What is the purpose of performing AP projection (stress) images of the ankle?
After an Inversion/Eversion injury for a ligamous tear
Who stresses the joint for the AP (stress) projection for the Ankle?
The physician
(The technologist NEVER stresses the tear)
Which is the weight bearing bone?
Tibula
Which is the non- weight bearing bone of the lower leg?
Fibula
Which bone projects down more distally? The Tibula or Fibula?
The Fibula
The Tibia is in relationship to the Fibula:
Medial and anterior
The fibula is ____; and _____ to the Tibia.
Lateral and posterior
You have a long bone and both joints to demonstrate, clinically what do we do with the SID? How do we turn the cassette
Increase
Turn cassette Diagonally
Know the anatomy of the knee:
Femoral condyles
Medial and lateral
Interconbuka eminences (tibial spine)
The CR of the AP knee is:
1/2 below the patellar apex
Anytime an anatomical part (thin pelvis) for an AP knee measures 19cm or less:
3-5 degree caudal angulation
Anytime an average pelvis for an AP knee is 19-24 cm we angle the tube?
Perpendicular
Anytime we have a large pelvis greater than 24 cm, we angle the tube: (AP knee)
3-5 degrees Cephalad
The anatomical part for the lateral knee is:
Flexed 20-30 degrees
When you place a 5-7 chephalic angulation on the lateral knee the purpose is to:
Superimpose the condyles and epicondyles
Be able to look for rotation for the knee on an image
Abductor tubercle
(Look at the relationship between the proximal Tib and Fib) when they start to seperate from eachother you are overrotated. If the area is more superimposed underrotated
Which of the following will best demonstrate the:
Meniscus
joint spaces
cartilage and it’s joint spaces
Arthritis
Bilateral AP weight bearing knees
When you perform a 45 degree medial oblique of the knee what is best being demonstrated?
Shows the proximal tibia and fibula joint spaces without superimposition
The patient is kneeling on all fours lean forward 20 degree and it’s a 70 degree angle and the CR enters
perpendicular
PA axial intercondylar fossa (Hombland)
If you are going to demonstrate the intercondylar follsa (tunnel view) the CR must always maintain a relationship:
Perpendicular to the Tibia and Fibula
Perpendicular to the lower leg
The lateral patella demonstrates:
Transverse fractures
Prone flexion 90 degree (settagas) demonstrates:
Vertical fractures
When a patient presents with a perforation (gastrografin gastroview):
Water soluble
A tangential projection (Merchant) (Settegast) of the patella is not to be performed until you rule out what type of fracture from the lateral?
Transverse Fracture
A tangential projection demonstrates (prone projection known as the settegast) what type of fracture?
Verticals
The fingers PA of the entire hand CR:
Directed perpendicular to the 3rd metacarpophalangeal joint
The 1st, 2nd, 3rd digit you get what type of rotation?
Medial rotation
4th and 5th digits rotation?
Lateromedial
When performing a routine lateral do the second digit what projection is this being performed in?
Mediolateral
When performing a routine lateral do the fifth digit what projection is this being performed in?
Lateromedial projection
When performing a routine lateral of the second digit what bone of the forearm is touching the IR:
Radius
When performing a routine lateral of the fifth digit what bone of the forearm is touching the IR:
Ulna
When positioning a hand in the PA projection the thumb sits in:
Natural oblique
The PA projection of the Hand the CR enters:
Perpendicular to the base of the 3rd MCP joint
The distal aspect of each digit is called a:
Distal Tuft
Thumb: IP
Other digits: DIP PIP
Heads of metacarpals anatomy
Wrist anatomy
Which of the filling will best demonstrate a A foreign body in the hand:
Lateral and finger extension
When performing a routine fan lateral of the hand will the:
radius and ulna be superimposed
Carpals and metacarpals be superimposed
Phalanges
Yes
Yes
No (phalanges without superimposition)
Know wrist Antony
Proximal row thumb side: scaphoid, triquettum, pisiform, trapezium, capitate, hamate
Distal row thumb side
Some lovers try positions they can not handle
Where is the scaphoid in relationship to pisiform?
Lateral
Where is the scaphoid in relationship to hamate?
Proximal and Lateral
What is the most commonly fractured carpal of all?
Scaphoid
What is the largest carpal of all?
Why do we flex the fingers?
Reduces the OID and helps to demonstrate the anatomy better
Which of the following will best demonstrate the intecarpal spaces?
The AP projection wrist
Any scaphoid view requires the hand to be in:
Ulnar deviation
Scaphoid without as much foreshortening and as much superimposition
Stetcher method:
Elevate the part 20 degrees while the hand is in ulnar devaition
Angling the CR toward the elbow
Tangential Carpal Canal (tunnel) (Gaynor-Hart) CR:
Directed to the palm of the hand approximately 1 inch (2.5 cm) distal to the base of the 3rd metacarpal at an angle of 25-30 degrees to the long axis of the hand
What is the name of the nerve that gets inpenged (pressed upon) in carpal tunnel syndrome that causes all the pain?
Median Nerve
An AP forearm the epicondylar line is of the elbow is:
Positioned parallel to the IR
In a lateral forearm the humerus:
Placed in the same plane as the forearm
Lateral forearm the epicondylar line is:
Perpendicular to the IR
Forearm AP the hand is:
Supinated with the elbow fully extended
When performing the forearm, why do we do the forearm in the AP projection and not the PA?
overlap of the radius and ulna if done in PA
Lateral forearm the elbow is:
Flexed 90 degrees with the hand and wrist placed in true lateral position
What is the medial bone of the forearm?
Ulna
What is the lateral bone of the forearm?
Radius (thumb side)
Know the elbow anatomy.
As the humorous distends it fits into the notch (trochlear notch)
Olecranon
Olecranon process (keeps from hyperextending that fits into the fossa)
For the AP elbow the hand is:
Supinated with the elbow completely extended
What part of the distal humerous will articulate with the:
Ulna (trochlea)
Radius (capitulum)
For the lateral elbow the elbow is flexed:
90 degrees with the hand and wrist in true lateral position
The lateral elbow the epicondylar line is positioned:
Perpendicular to the IR
Th lateral elbow the humerus is:
On the same plane as the forearm
Which of the following will best demonstrate fat pad displacement?
Lateral Elbow
The CR for the lateral elbow:
Perpendicular to the elbow joint
Which of the following will best demonstrate the Olecranon/processin profile?
Lateral Elbow
Show an image which one is an oblique elbow.
Yes or no
On an external oblique of the elbow you best demonstrate:
Radial head with no superimposition over the ulna and capitulum
The medial oblique of the elbow best demonstrates:
The Olecranon as it articulated with the fossa and the coronoid process free of superimposition
If the patient cannot fully extend the arm:
Two views must be taken
One with the humerus parallel and one with the forearm parallel
On the AP projection of the humerous is shows:
Greater tubercle in profile laterally
Where can you find the lesser tubercle in profile?
Lateral non-trauma humerus
For a scapular Y view PA oblique if the shoulder how much do you oblique the patient?
45-60 degree oblique
If the head of the humerous is seated over the base of the Y:
Not dislocated
If the head of the humerous is seated underneath the Coracoid:
Anteriorly displaced
If the head of the humerous sits below the acromium:
Posterior displaced
The transthoracic lateral/inferosuperior axial (Lawrence) thee CR:
Directed at the surgical neck of the affected humerous
Identify on an image internal rotation of a shoulder and external rotation of a shoulder on an image
Yes or no
AP with extrenal rotation shows of the shoulder:
The greater tubercle in profile laterally
AP with internal rotation of the shoulder shows:
Lesser tubercle in profile medially
Right shoulder:
RPO
Left shoulder:
LPO
Posterior Oblique (Grashey)
The patient is supine or upright the body is rotated 35-45 degrees toward the effected side
For the Posterior Oblique (Grashey) what are you showing/demonstrating?
Glenohumeral joint space and the glenoid cavity in profile
Seperate the two
Scapherohumeral joint space without superimposition
What is the most anterior aspect of the scapula?
Coracoid
What is the most superior lateral structure of the scapula?
Acromion process
How do you properly position for an AP scapula?
The patient supine
The arm is abducted to form a right angle with the chest
Elbow is flexed and arm brought to a forehand
CR is directed perpendicular to the IR 2 inches (5cm) inferior to the Coracoid process
AP or PA clavicle
Supine prone or upright the arm of the affected side is relaxed at the side
CR is directed perpendicular to the mid-shaft of the clavicle
As a technologist you are dealing with a AP Axial of the Clavicle:
15-30 Cephalic angle to the mid shaft of the clavicle
Patient positioned similar to AP
Demonstrates the clavicle above the lung field and rib cage
If as a technologist you are dealing with a PA Axial projection of the clavicle:
15-30 cuadad angle to the midshaft of the clavicle
Should AC joints be done all of the following except:
I’m the erect position
Bilateral for comparison
Avoid stressing the joint space if you suspect a shoulder separation?
Erect bilateral
With and without weights
Yes
Yes
No
Bone age study (Greulich and Pyle Method)
Ask the patient what hand they favor
PA left hand or wrist (non-dominant)
Single PA projection of the non dominant hand and wrist
Which of the following pathologies would a shoulder arthrogram be preformed to rule out?
Torn Rotator Cuff
Which of the following pathologies would be best demonstrated for a knee arthrogram?
Minisci
Joint Spaces
Cartilage
Cartilage and it’s joint spaces
Divides the body into equal right and left halves:
Midsagittal/median sagittal (MSP) plane
Any plane running parallel to MSP
Sagittal
Divides the body into equal anterior and posterior halves
Mid coronal/mid axillary (MCP)
Any plane running parallel to MCP
Coronal
Divides the body into superior and inferior portions
Transverse/horizontal
small rounded point of a bone
Tubercle
A round prominence; especially a large prominence on a bone usually serving for the attachment of muscles or ligamnets
Tuberosity
a groove or fissure, especially a fissure between two convolutions of the brain
Sulcus
A shallow depression in the bone surface
Fossa
a long, narrow cut or depression, especially one made to guide motion or receive a corresponding ridge
Groove
a protuberance or projection on a bodily part and especially a bone
Eminence
an opening or hole through tissue, usually bone
Foramen
A type of joint between the bones of the skull where the bones are held tightly together by fibrous tissue
Suture
directed or moving backward
retrograde
antegrade
moving or extending forward
Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen
Retroperitoneal
Within the peritoneal cavity (the area that contains the abdominal organs).
Intraperitoneal
C1
Mastoid Tip
C2-C3
Gonion
C3-C4
Hyoid Bone
C5
Thyroid (Adam’s Apple)
C7
Vertebral Prominens (spinous process)
L2-L3
Inferior Costal (rib) margin
L3-L4
Umbilicus
Iliac Crest
L4-L5
T1
2 inches above the Jugular Notch
T2-T3
Jugular Notch
T4-T5
Sternal Angle
T7
Inferior angle of scapula
T9-T10
Xiphoid Process
S1
ASIS
Coccyx
greater trochanter
label the images, what percentage of the population?
- Massive (hypersthenic)-5%, 2. Average (sthenic)-50%,
- Slender (hyposthenic)-35%, 4. Very Slender (Asthenic)-10%
Stomach is more J-shape more midline
Hyposthenic/Asthenic
Identify each body habitus.
A. Sthenic
B. Hyposthenic
C. Asthenic
D. Hypersthenic
Identify Body Habitus:
A. Hypersthenic
B. Sthenic
C. Hyposthenic/Asthenic
What body habitus is the duodenal bulb to the right of the midline at the level of T11-T12?
Hypersthenic
What body habitus is the duodenal bulb slightly to the right of the midline at the level of L1-L2?
Sthenic
What body habitus is the duodenal bulb at the midline at the level of L3-L4?
Hyposthenic/Asthenic
is this a correct lateral lumbar spine?
no, rotated
What is wrong with this image?
the patient is rotated
seeing double sacrum
no clear intervertebral joint spaces
Pedical is anterior so the patient is under rotated
Patient is over rotated (closer to the lateral position)
The technician forgot to angle the tube
Spondylotisthesis
Flexion Lumbar Spine
Done in lateral position
Extension View of Lumbar Spine
Done in lateral position
Right and Left Bending Views
Done in AP position
