Term 3 mock exam Flashcards
- A patient arrives for a CXR.
a. Name TWO (2) ways to ensure full inspiration is achieved on a CXR.
Discuss the instructions with the patient first, letting them know it is important
- Practice the breath in with the patient
- Watch the patient so you expose at the correct time
Identify TWO (2) ways to check whether a patient is rotated on a PA CXR image.
- The ribs should appear symmetrical
- The medial end of the clavicles should be equidistant from the midline
- The distance from the lateral border of the vertebral column to the costal margin should be equal
The request form states ‘CXR – PA AND LATERAL VIEWs please’. Provide a clinical indication that would be expected to be written on the request form (.5) and explain the reason why a lateral view is justified to be performed
Oncology reasons – see mets. behind the lungs
Mass on a particular lung (R/L)– close to ID
. You are looking at a lateral chest image. List THREE (3) ways to judge whether the positioning of the lateral was acceptable:
For a true lateral projection the ribs should appear superimposed posteriorly
- The apices and bases should be included (lean the patient forward to include posterior bases) - The humeri should be elevated so that there is no soft tissue overlap from the arms. - the midsagittal plane should parallel to the IR, no cupping seen of the thoracic vertebra
What is COAD?
Chronic obstructive airways disease
What is LVF?
Left ventricular failure
What is PE?
Pulmonary embolism or pleural effusion
What is CABG?
Coronary artery bypass graft
On a patient’s request form the Doctor has requested an Abdomen X-ray.
a. State TWO (2) clinical reasons which justify this projection
? Obstruction
Pain ? cause
Suggest an average adult exposure for a KUB X-ray, a kVp (.5) and a mAs (.5) value.
70 - 85 kV, and 20 - 35 mAs
Your next patient has arrived on a bed for a knee X-ray after their surgery. On the referral form the clinical indications states ‘Post op TKR’
a. Define the abbreviation TKR
Total Knee replacement
When positioning the patient for an AP Knee projection, suggest ONE (1) positioning consideration you will apply when you are manoeuvring the man’s leg to ensure that the knee is in a true AP position?
The condyles of the knee should be equidistant from the table top.
The patella should be centralised.
You are working in the Orthopaedic department and your next patient is an adult for an Elbow X-ray. The clinical indications states the following ‘Fell onto R elbow. Pain over olecranon’
a. Justify your choice of which X-ray projection would you perform first
Lateral first. More comfortable for patient to begin with as painful over the olecranon
Describe the key points of positioning for an elbow lateral view, including the centre point (.5) and central ray (.5)
Sit the patient alongside the table, with the table raised so that the elbow is level with the shoulder (.5) and the elbow is flexed 90deg (.5). Position the film under the elbow and turn the wrist true lateral (if patient able to) and ensure the epicondyles of the humerus are superimposed (.5). CR should be perpendicular centred to the elbow joint (.5) which is 4cm medial to the olecranon process (.5)
Briefly discuss why is it important to include both the ankle and knee joints when the request card suggests ?# tibia.
With some fractures of the distal tibia there may also be a fracture of the proximal fibula as these bones articulate in a ring formation
You are imaging the tibia and fibula of a tall patient. Suggest two methods that would increase your chances of including both joints on one image.
Increase the FFD
Turn the cassette on a diagonal
You are working in ED when an 80 year old male arrives in the department. The request form states “Fall. Valgus deformity L Hip ?# NOF”
Name TWO (2) views you would take on this patient (2 x .5) and how will a valgus deformity affect your positioning?
AP Pelvis ASIS down
Cross table lateral hip
This means you will not alter the position of the affected leg to risk further damaging the hip and blood vessels (.5). This is of particular importance for the AP pelvis as you will not medially rotate the leg (.5)
What is valgus deformity (.5) and write in full what the pathology is likely to be demonstrated on the images
Valgus deformity: The hip and foot will be turn out laterally.
This is a classic sign of hip fracture - Neck of Femur #
Suggest ONE (1) method you would use to check that the correct exposure was used for producing diagnostic images of a hip fracture.
EI – within range
Cortical outline of femoral shaft and soft tissue
Bony trabecular pattern
A 18 year old female presents to the Radiology Department with an injury to base of thumb. Her GP has requested for her to have routine thumb X-rays with the clinical indications stating ‘Injured thumb yesterday. ++++ swelling ? Base of thumb #’.
a. Name a pathology that involves a fracture at the base of the thumb that would be likely to be demonstrated on the images taken
Bennett’s fracture
. As well as checking the patient’s name, DOB and that the correct anatomy has been requested to be X-rayed, what should you also check with the patient?
Pregnancy check / LMP
With the swelling around base of thumb, name the views that you take to complete the examination (2 x .5) and justify why you would chose to perform these to complete the examination answering the clinical indications
PA and lateral views (1 mark)
PA and too sore for AP (plus swelling – hard on patient to bring dorsal aspect of hand on ID)
Lateral – to show base of thumb in 2 planes – more information of base of thumb fracture if present
A young man arrives in the Radiology department for imaging of his left shoulder from a sporting injury with querying a dislocation.
a. Explain the differences in positioning and image appearance of an AP Shoulder to the Grashey’s method.
The most commonly employed AP method requires a 15 degree rotation towards the affected side so that the body of the scapula is parallel to the cassette and there is a 1/3rd overlap of humeral head on the glenoid fossa
The Grashey’s method, however, uses a 45 degree posterior oblique rotation so that the Glenohumeral joint is open (glenoid rim in profile)
Will accept true AP description with half overlap of humeral head on glenoid.
Describe the key points of positioning for a shoulder Lateral Y view, including the patient positioning technique (2 x .5), central ray (.5) and centre point (.5)
Erect in an anterior oblique position in front of the upright bucky
MSP 45-60degrees in relation to the IR- medial border of scapula and acromion process should align
CR perpendicular to the midpoint of the medial scapula
On the shoulder Lateral Y view image the scapula is not demonstrated in true lateral position and the coracoid process is projected over the rib cage. Explain how this would be corrected for a repeat projection.
The patient must have been over rotated (e.g. greater than 60 degrees) so for the repeat image the patient should be angled less steeply such as 45 degree RAO
The report states ‘Anterior dislocation’. Identify TWO (2) image appearances that would demonstrate this pathology on both an AP and lateral Y view images of the shoulder
On the Y view the humeral head no longer aligns over the glenoid fossa and is demonstrated under the coracoid process
On the AP view the humeral head is low in comparison to the glenoid fossa and is positioned more over the ribs
A 70 year old patient is referred to have routine Thoracic spine X-rays due to complaining of worsening pain between the shoulder blades
a. Justify why you will ask the patient to take a deep breath in and hold their breath for both Thoracic spine X-ray images
Lungs are black – length provides better contrast of the spine
When viewing a Lateral Thoracic spine X-ray image, discuss how you will assess the image appearances for rotation
Perfect square vertebrae
No double borders
Identify a pathology that may be demonstrated on a Lateral Thoracic spine X-ray image
OA: Osteophytic lipping in the upper thoracic spine
. A 35 year old woman is requiring a Lumbar spine X-ray due to falling off her horse.
a. Outline the benefits of PA Erect position for images of the Lumbar spine.
- Erect views of the spine are weight bearing and therefore demonstrate the natural curve or posture for the patient
- PA provides good radiation protection as the gonads sit anteriorly and receive less dose
OR The diverging rays are also more likely to open up the SI joints and the intervertebral disc spaces with the patient in a PA position - Will also accept ease of positioning as you can palpate the spine in PA position.
Discuss TWO (2) key points of advice for gaining an optimal lateral lumbar spine image. Your points may relate to positioning or exposure.
Any two:
- Ensure the MSP is parallel to the table top, by placing a sponge under the waistline (esp. for women)
- Use lead strips behind the spine to absorb scatter
- For true lateral ensure shoulders and hips superimpose, so the plain of the back is perpendicular to the table top
- Any other answer that relates well to the question
- Take the lateral lumbar image on expiration to ensure that the lung fields are well clear of the upper lumbar vertebrae.
You are rostered to the Emergency Dept, while the CT machine is down for maintenance. An elderly gentleman is referred for a skull bones series after falling down a staircase. He has a large haematoma over base of skull.
a. Name the X-ray projections used within your clinical centre to complete the examination
Occipital Frontal
Townes
Lateral skull
On the lateral skull view fluid is seen within the sphenoid sinus. What could this be indicative of?
Base of skull fracture
Describe the key points of positioning for the following supplementary views, including the patient positioning technique (2 x .5), central ray (.5) and centre point
a. Sternoclavicular obliques
Patient stands PA erect. The oblique with the affected side in contact with the IR is demonstrated best although both obliques are done, 10-15 degrees anterior oblique with CR perpendicular to the sternal notch
b. Describe the key points of positioning for the following supplementary views, including the patient positioning technique (2 x .5), central ray (.5) and centre point
AP Lower Ribs
Supine, true AP with shoulders and hips equidistant. CR15-20 degrees cephalid. Centre with iliac crests at the bottom of the IR to show ribs 8-12
Describe the key points of positioning for the following supplementary views, including the patient positioning technique (2 x .5), central ray (.5) and centre point
c. Oblique Sacroiliac Joints
Supine posterior oblique, rotate the patient 15-25 degrees. CR perpendicular to a point 2.5cm medial to the ASIS on the raised side, which is of interest.
A patient arrives in the department for C spine X-ray imaging.
a. Describe THREE (3) key positioning criteria for when positioning the patient for an AP C. spine (3 x .5). Also add the Centre point (.5) and Central Ray
CP: C4
CR: Direct 15 degrees to 20 degrees cephalic level of the lower margin of the thyroid cartilage
Positioning: Patient Erect or supine Align MSP to CR and midline of IR Chin raised – mandible and occiput aligned with CR No rotation
You are positioning the patient for a lateral cervical spine projection. Provide TWO (2) methods that you will incorporate for improving the visualisation of the C7-T1 junction
Ask the patient to relax their shoulders as far down as possible
Give the patient weights (if they have not had a traumatic injury)
Expose on expiration
A patient arrives in the department for C spine X-ray imaging.
c. Provide a clinical indication that is a valid justification for flexion and extension views
Whiplash
Ligament disruption
