shoulder, clavicle, ac joints, scapula Flashcards
Using the PA projection, which of the following tube angle and direction combinations is correct for an axial projection of the clavicle?
15 to 30 degrees caudad
Using the AP projection, which of the following tube angle and direction combinations is correct for an axial projection of the clavicle?
15 to 30 degrees cephalad
All of the following device(s) are generally used to help reduce patient dose, except
- grid
- collimator
- gonad shield
1 only
X-ray film emulsion is most sensitive to safelight fog
after exposure
An injury of the anteroinferior aspect of the glenoid labrum is termed:
Blankart lesion
Which of the following AP proximal shoulder projections will demonstrate the lesser tubercle in profile?
Internal rotation
Which of the following projections will best demonstrate a possible Hill-Sachs defect?
inferosuperior axial projection (clements modification)
How much is the body rotation for a posterior oblique position (Grashey method)?
35 to 45 toward affected side
What anatomy of the shoulder is best demonstrated with a tangential projection (Fisk modification)?
Intertubecular groove???
How much should the CR be angled for an AP axial projection of the clavicle on an asthenic patient?
more 15-30
The use of automatic exposure control (AEC) is not recommended for the AP projection of the scapula.
True
Which of the following humeral structures is most distal?
lesser tubercule
What is another term for the mid area of the costal surface of the scapula?
Subscapular fossa
Which of the following scapular structures is most posterior?
Acromion
What is the joint classification for the scapulohumeral joint?
ball and socket
When the Epicondyles are parallel to IR
Greater tubercle lateral (in profile)
Lesser tubercle anterior
Where do you center for an AP projection of the shoulder?
1” inferior to the coracoid process
Which rotation of the shoulder best demonstrates the greater tubercule in profile?
External rotation
What is the name of the groove between the greater and lesser tubercules?
Intertubecular groove
Which view of the shoulder will demonstrates the glenoid fossa in profile?
posterior oblique grashey
Which is more superior, anatomical neck or surgical neck?
anatomical neck
Which additional view of the shoulder is usually performed to demonstrate dislocation?
Transthoracic lateral
The female clavicle is usually shorter and less curved than that of the male.
true
Which rotation of the humerus will result in a lateral position of the proximal humerus?
Internal rotation (epicondyles perpendicular to image receptor)
Which AP projection of the shoulder and proximal humerus is created by placing the affected palm of the hand against the thigh?
Neutral rotation
What medial CR angle is required for the inferosuperior axial shoulder (transaxillary method) projection?
25 to 30 degrees
Which of the following shoulder projections best demonstrates the glenoid fossa in profile?
Grashey method
For a Grashey method projection of the shoulder, the CR is centered to the acromion.
false
How much posterior CR angulation is required for the supine version of the tangential projection for intertubercular groove?
10 to 15 degrees
Which ionization chamber(s) for the AEC should be used for a tangential projection for intertubecular groove?
Cannot use AEC with this projection
Which of the following projections can be performed using a breathing technique?
AP scapula
How much CR angulation should be used for a scapular Y projection?
No CR angle should be used
Where is the CR centered for a transthoracic lateral projection of the shoulder?
Level of surgical neck
The proper name for the AP apical oblique axial projection of the shoulder is the Fisk modiciation.
False
Which projection of the shoulder requires that the patient be roatated 45 to 60 degrees toward the IR from a PA position?
Lateral scapula projection
How much CR angulation is required for an asthenic patient for an AP axial projection of the clavicle?
45 degrees
Where is the CR centered for an AC joint projection on a single 14 x 17 inch (35 x 43 cm) image receptor?
1 inch (2.5 cm) above jugular notch
Situation: A radiograph of an AP oblique projection for the glenoid cavity reveals that the anterior and posterior rms of the glenoid process are not superimposed. Which of the following modiciations should be produce a more acceptable image?
Increase rotation of the body
Situation: A radiograph of a transthoracic lateral projection reveals that it is difficult to visualize the proximal humerus due to the ribs and lung markings. The following exposure factors wer used: 75 kV, 30 mAs, 40-inch (102 cm) SID, grid, suspended respiration. Which of the following changes will improve the quality of the image?
Use a breathing technique
Situation: A radiograph for an AP projection with external rotation of the proximal humerus reveals that the greater tubercle is profiled laterally. What should be changed to improve this image for a repeat exposure?
Positioning is acceptable, do not repeat it
Situation: A radiograph of an AP clavicle reveals that the sternal extremity is partially collimated off. What should the technologist do?
Repeat the AP projection and correct collimation
Situation: A patient comes to radiology for treatment of an arthritic condition of the right shoulder. The radiologist orders AP internal/external rotation projections and an inferosuperior axiolateral projection of the scapulohumeral joint. However, the patient cannot abduct the arm for this projection. Which other projection will best demonstate the scapulohumeral joint space?
Posterior oblique (Grashey method)
Situation: A patient comes to the ER with a possible right AC joint separation. Right clavicle and AC joint exams are ordered. The clavicle is taken first, and a small linear fracture of the midshaft of the clavicle is discovered. What should the technologist do in this situation?
Consult with the ER physician before continuing with the AC joint study
Situation: A patient enters ER witha midshaft humeral fracture. The AP projection taken on the cart demonstrates another fracture near the surgical neck of the humerus. The patient is unable to stand or rotate the humerus due to the extent of the trauma. What other projection should be taken for this patient?
Horizontal beam transthoracic lateral projection for humerus
Situation: A patient enters the ER with a possible AC joint separation. The patient is paraplegic; therefore, the study cannot be done erect. Which of the following routines would be performed to diagnose this condition?
Non-weight-bearing and weight-bearing type of projections performed with the patient recumbent by pulling down on the shoulders
Situation: A patient enters the ER with a possible bony defect of the mid body area of the scapula. The patient is able to stand and move the upper limb freely. In addition to the routine AP scapula projection with the arm abducted, which of the following would best demonstrate the invovled area?
Have the pateint reach across the chest and grasp the opposite shoulder for a lateral scapula projection
The recommended SID for AC joints is 72 inches (183 cm).
True
The arm should be abducted about 45 degrees for an AP scapula
False
For AC joint weight-bearing studies, patients should not be asked to hold on to the weights with their hands, rather the weights should be attached to the wrists.
True
Which of the following AP shoulder projections demonstrates the greater tubercle in profile medially?
None of the above
Which of the following AP shoulder projections demonstrates the lesser tubercle in profile medially?
Internal rotation
Situation: A patient enters the ER with multiple injuries including a possible fracture of the left proximal humerus. Which positioning rotation should be performed to determine the extent of the humerus injury?
AP and horizontal beam transthoracic lateral shoulder projection
Situation: A patient enters the ER with a dislocated shoulder. The technologist attempts to position the patient into the transthoracic lateral projection, but the patient is unable to raise the unaffected arm over his head completely. What can the technologist do to compensate for the patient’s inability to raise his arm completely?
Angle the CR 10 to 15 degrees cephalad
Situation: A radiograph of an AP axial projection of the clavicle demonstrates that the clavicle is within the midaspect of the lung apices. What should the technologist do to correct this error?
Increase the cephalic CR angle during repeat exposure
How much should the CR be angled for an AP axial projection of the clavicle on an asthenic patient?
25 to 45 degrees
What structure is not part of the proximal humerus?
Glenoid process
How are the epicondyles of the distal humerus on an AP internal (lateral) projection of the shoulder?
Perpendicular to the IR
The affected arm should be abducted ….. Degrees for a inferosuperior axial projection
90
Superior displacement of distal clavicle
Acromioclavicular joint dislocation
Non trauma routine shoulder projections
AP external and AP internal
What separates the head of the humerus from the shaft of the humerus?
Anatomical neck
Which of the following is the largest bone in the upper extremity of the body?
The Humerus
The acromioclavicular is located on which of the following
Scapula
Which of the following is used to determine if there is any separation of the AC joint
Patient erect holding weights
SAIA: Which of the following projections require that the humeral epicondyles be superimposed?
Lateral hand and lateral humerus
An axial projection of the clavicle is often helpful in demonstrating a fracture not visualized using a perpendicular central ray. When examining the clavicle in the PA position, how is the central ray directed for the axial projection?
Caudad
The scapular Y projection of the shoulder demonstrates
an oblique projection of the shoulder and anterior or posterior dislocation
Corretec: What separates the head of the humerus from the shaft of the humerus?
Anatomical neck
Which of the following is the largest bone in the upper extremity?
Humerus
The acromion is located on which if the following bones?
Scapula
Which of the following is used to determine if there is any separation of the AC joint?
Patient erect , Holding weights
A lateral projection of the scapula requires which of the following?
Affected arm raised
What is another name for the lateral border of the scapula?
Axillary
Where is the scapular notch located?
Superior to the scapular spine
Which of the following will place the humerus in a true lateral position?
AP internal rotation
The capitullum of the humerus articulates with which of the following anatomical structures?
Head of the radius
The trochlea of the humerus articulates with which of the following anatomical structures?
Trochlear notch of the ulna
Where is the anatomical neck of the humerus located in relation to the surgical neck?
Superior
Which two positions/ projections are taken of a shoulder that has not been injured?
AP internal and AP external rotation
What is the name of the projection that can be palpated on the medial aspect of the humerus?
Medial epicondyle
The head of the humerus articulates with which part of the scapula?
glenoid cavity
Which of the following is most likely location for a fracture of the humerus?
Surgical neck
What is the correct term for armpit?
axilla
How must the patients arm be positioned for a good AP projection of the scapula?
Abducted
Which of the following positions could be used if there is an obvious fracture of the upper humerus?
Transthoracic lateral
What is the name of the joint between the two bones of the shoulder girdle?
Acromioclavicular joint
For the best recorded detail, which of the following postions/projections of the clavicle should be used?
PA
Which two bones make up the shoulder girdle?
Clavicle and scapula
Which of the following is NOT a border of the scapula?
Inferior
What is the name of the structure that separates the to posterior fossae of the scapula?
Spine of the scapula
The extremities , the shoulder girdles and the pelvis make up which of the following?
Appendicular
What is the name of the process that extends anteriorly from the scapula?
Coracoid Process
How many degrees should the tube be angled for an AP axial projection of the clavicle of an average patient?
15 cephalad
Which if the following joints articulates with the clavicle?
Scapula and sternum
The scapula is classified as what type of bone?
Flat bone
What angle joins the medial and lateral border of the scapula ?
Inferior angle
What is another name for lateral border of the scapula?
Axillary
Where is the scapular notch located?
Superior to the scapular spine
Breathing technique is used for :
AP scapula and transthoracic lateral
Ap apical oblique Garth method CR angle
45 caudad
Tangential inter tubercular biciptal groove (Fisk) CR angle
10 to 15 posterior from horizontal
HA
Tangential for inter tubercular biciptal groove (Fisk) patient obliquity
10 to 15 from vertical
VO
Scapular y patient obliquity
45 to 60
Tangential supraspinatus outlet CR
10 to 15 caudad
Tangential supraspinatus outlet patient obliquity
45 to 60
A thin-shouldered patient requires (more or less) CR angle for an AP axial clavicle
projection than a large—shouldered patient.
more
Inferosuperior axial (Lawrence) CR angle ? And if arm abducted 90? And if arm can be abducted?
25 to 30 horizontally to axilla; 15 to 20 to axilla; 5 to 15
Super inferior PA transaxillary (Hobbs) patient obliquity
5 to 10
Which of the following requires the smallest thyroid dose?
Scapular Y lateral
Which of the following would result in the highest thyroid dose?
Transthoracic lateral
Which one of the following shoulder projections delivers the greatest skin dose to the patient?
Transthoracic lateral
True/False: A central ray angle of l0° to l5° caudad may be used for the transthoracic lateral projections if the patient is unable to elevate the uninjured arm and shoulder sufficiently.
false
True/False: The transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus.
true
What CR angle is required for the AP axial projection (Alexander method) for AC joints?
15 cephalad
How much is the CR angled for the inferosuperior axial projection (Clements modification) if the patient cannot fully abduct the arm 90°?
5 to 15
Which one of the following pathologic indications requires a decrease in manual exposure factors?
osteoporosis
What type of central ray angulation is required for the inferosuperior axial projection for the shoulder?
25 to 30 medially
Medial border
vertebral
Lateral border
axillary
Which of the following would be the best choice for a right-shoulder examination to rule out fracture?
AP and scapular Y
Proximal humerus in lateral position
Internal rotation
Humeral epicondyles angled 45 degrees to IR
neutral rotation
Which AP projection of the shoulder and proximal humerus is created by placing the affected palm of the hand against the thigh?
Neutral rotation
How much posterior CR angulation is required for the supine version of the tangential projection for intertubercular groove?
10 to 15 degrees
Where is the CR centered for a transthoracic lateral projection of the shoulder?
Level of surgical neck
Which projection of the shoulder requires that the patient be roatated 45 to 60 degrees toward the IR from a PA position?
Lateral Scapula
How much CR angulation is required for an asthenic patient for an AP axial projection of the clavicle?
45
Situation: A radiograph of an AP oblique projection for the glenoid cavity reveals that the anterior and posterior rms of the glenoid process are not superimposed. Which of the following modiciations should be produce a more acceptable image?
Increase rotation of the body
Situation: A radiograph of a transthoracic lateral projection reveals that it is difficult to visualize the proximal humerus due to the ribs and lung markings. The following exposure factors wer used: 75 kV, 30 mAs, 40-inch (102 cm) SID, grid, suspended respiration. Which of the following changes will improve the quality of the image?
Use a breathing technique
Situation: A radiograph for an AP projection with external rotation of the proximal humerus reveals that the greater tubercle is profiled laterally. What should be changed to improve this image for a repeat exposure?
Positioning is acceptable, do not repeat it
Situation: A radiograph of an AP clavicle reveals that the sternal extremity is partially collimated off. What should the technologist do?
Repeat the AP projection and correct collimation
A patient with a possible shoulder dislocation enters the emergency room. A neutral, AP projection of the shoulder has been taken, confirming a dislocation, Which additional projection should be taken?
Garth
A radiograph of an AP axial clavicle taken on an asthenic type patient reveals that the clavicle is projected in the lung field below the top of the shoulder. Patient was erect position, central ray angled 15 degree cephalad, 40” SID, and respiration suspended at the of expiration, What should be modified?
Increase central ray angulation
A Patient has a history of tendonitis of the bicep tendon. Which projection will best demonstrate calcification of the tendon within the intertubercular groove?
Tangential projection- Fisk Modification
A Patient with possible acromioclavicular separation enters the emergency room. Which routine should be used?
Acromioclavicular joint series: non-weight bearing projections
An AP apical oblique axial radiographic image shows poor visibility of the shoulder joint. Patient was erect, facing the x-ray tube, 45 degree of rotation of affected shoulder toward the IR, 45 degree cephalad angle, and the CR centered to the scapulohumeral joint. What would have contributed to the poor Garth position?
wrong direction of CR angle
A Patient is referred to radiology for a nontrauma shoulder series. Routine calls for superoinferior axial projection (Hobbs modification). But the patient is unable to stand and is confined to a wheelchair. What should the technologist do?
Perform the projection with the patient’s upper chest prone on the table.
A patient enters the ER with a proximal and mid-humeral fracture. The patient is in extreme pain. Which position routine would demonstrate the entire humerus without excessive movement of the limb.
AP and transthoracic lateral of humerus
