Positioning & Radiographic Analysis
How should the concavity of the phalanges be demonstrated on a PA projection of the hand?
Equal on both sides
Which patient position will best demonstrate swallowing function?
Erect AP position
What is turning a body part outwards called?
Eversion
What makes C1 atypical?
No body, short spinous processes, long transverse processes, lateral masses
What is the CR for the AP projection of the toes (forefoot) ?
Perpendicular to the 3rd MTP joint
What is the CR for the lateral projection of the ankle?
Perpendicular to the ankle joint, entering the medial malleolus
What must be included on an AP supine projection of the abdomen?
Pubic Symphysis
On an AP supine projection, where will the air be demonstrated in the stomach?
Pylorus
Where will the barium be demonstrated in the stomach when the patient is in a recumbent RAO position?
Pylorus
Gastric peristalsis is most active in which position ?
RAO
What does visualization of the posterior fat pad in a lateral elbow position indicate?
Radial head fracture
What body position has the patient's head raised 15-30 degrees off the table?
Semi-Fowler's
Where will the radial tuberosity be facing in a lateral elbow projection with the hand pronated (internal rotation) ?
posteriorly
What is a reason that a nasopharynx study would be performed on a child?
Epiglottitis
What is the CR for all thumb / D1 projections?
Perpendicular to the 1st MCP joint
Which rib is located at the level of the sternal angle?
Rib 2
What is the degree of obliquity and in which direction do you rotate the angle to demonstrate the ankle mortise joint?
15-20 degrees medially
What SID is used for a lateral sternum?
180cm
How many degrees are there between the OML & IOML ?
7 degrees
Which joints do each of the ribs form?
-Costotransverse -Costovertebral
What makes C7 (vertebra prominens) atypical?
-Long, prominent spinous process -Non bifid -More vertical inferior articular surface
Which pairs of ribs are considered atypical?
1 (strongest , broadest & most curved) , 10 (has only one facet, where others have two), 11, & 12 (floating, do not attach to the sternum, have only one neck and one facet)
Which ribs are true ribs?
1-7, articulate with sternum
Which ribs lack tubercles?
11th & 12th
Which ribs are floating ribs?
11th & 12th, do not attach to sternum in any way
How many joints are associated with one T-spine vertebrae?
12
How many joints are associated with the body of a typical T-spine vertebrae & what are they?
12 Costovertebral (4) Costotransverse (2) Zygapophyseal (4) Intervertebral disk spaces (2)
How many costal facets does the sternum have?
14
How is the CR directed for a PA axial projection (Caldwell) of the cranium when the patient's OML is perpendicular to the IR?
15 degrees caudad
Which palpable landmark can be used to locate T1?
2" above jugular notch
To demonstrate the scaphoid free of superimposition , the CR should be :
20 degrees cephalad towards the scaphoid or angle the IR 20 degrees or perpendicular to the IR with the hand on a 20 degree sponge
What CR angle and direction is used for an AP axial projection of the clavicle with the patient supine?
20 degrees cephalic
How much should the knee be flexed for a lateral projection?
20-30 degrees
What is the CR used for the axiolateral projection of the mandible?
25 degrees cephalad
For the AP oblique projection of the SI joints, how much is the affected side elevated from the table?
25-30 degrees
How many lobes does the right lung have?
3
How many segments are in the coccyx?
3-5
How should the CR be angled on a Swimmer's (cervicothoracic) projection , when the patient can't properly depress their shoulders?
3-5 degrees caudad
Where is the CR directed for a lateral projection of the sacrum ?
3.5" (9cm) posterior to ASIS
How will the CR be directed to obtain an AP axial projection (Townes method) of the cranium when the patient's orbitomeatal line (OML) is perpendicular to the IR ?
30 degrees caudad
What is the CR used for a PA axial projection of the orbits for foreign body localization ?
30 degrees caudad
What is the CR to perform an AP axial projection of the SI joints on a male?
30 degrees cephalad ; 1.5" superior to the pubic symphysis
How much is the foot rotated and in which direction for the AP oblique projection ?
30 degrees medially
How is the CR directed for an AP axial projection of the sacroiliac joints ?
30-35 degrees cephalad
What is the CR for a AP axial sacroiliac joint projection?
30-35 degrees cephalad
When a patient is in a parietoacanthial (Water's) position for facial bones, what is the angle between the OML & the IR ?
37 degrees
How will the CR be directed to obtain an AP axial projection (Townes method) of the skull when the patient's infraorbitomeatal line (IOML) is perpendicular to the IR ?
37 degrees caudad
How many costal demi facets are on a typical T-spine Vertebrae?
4
What number & what type (facet or demifacet) are found on the body of a typical T-spine vertebrae?
4 Right & left superior demifacets & right & left inferior demifacets
How many atypical T-spine Vertebrae are there & what makes them atypical?
4 T1 (superior facets & inferior demifacets) T2 (only superior demifacets) T11 & T12 (single superior facets)
What is the amount of body rotation required on a patient with a sthenic body habitus for the RAO position during an UGI?
40-70 degrees
For the PA oblique shoulder projection (scapular Y), how much do you need to rotate the patient?
45-60 degrees from the IR
How many atypical vertebrae are there in the T-spine?
5
What is the CR for an AP knee if the ASIS to tabletop measurement is < 18cm ?
5 degrees caudad , entering a point 1.3cm / 0.5" inferior to the patellar apex
What is the CR angle for a lateral projection of the knee to ensure the femoral condyles are superimposed?
5-7 degrees cephalad entering at a point 1" distal to the medial epicondyle
How many joints are associated with one typical C-spine vertebrae?
6
How many joints are associated with the sacrum?
6 2 zygapophyseal 2 sacroiliac 1 lumbosacral 1 sacrococcygeal
Which ribs are false ribs?
8-12
Using logical reasoning, which ribs would be classified as "vertebrochondral" ribs?
8th , 9th & 10th pairs
What is bursae?
A small fluid-filled sac or saclike cavity situated in places in tissues where friction would otherwise occur
Which projection of the elbow demonstrates the coranoid process in profile?
AP oblique with medial / internal rotation
Which projection best demonstrates zygapophyseal joints between C1 & 2?
AP open mouth
Which projections & patient positions would be routinely performed for an abdominal series on a stretcher patient?
AP/PA left lateral decubitus abdomen, AP supine abdomen , & AP supine Fowler's sitting chest
Which projection best demonstrates the intervertebral foramina?
AP/PA oblique
The femoral head & neck are localized using a perpendicular line extending from a line joining which structures?
ASIS & superior border of the pubic symphysis
Where should the CR exit when positioning for the parietoacanthial projection (Water's) of the sinuses?
Acanthion
What are 2 radiolucent contrast medias?
Air & gas (carbon dioxide)
Which parts of anatomy must be included on the PA oblique projection of the wrist?
All the carpal bones, distal radius/ulna and the proximal half of the metacarpals
Where will the radial tuberosity be facing in a lateral elbow projection with the hand supinated (external rotation) ?
Anteriorly
Where is the top of the cassette placed for an AP projection of the proximal femur?
At the level of the ASIS
What is the name of the joint between the atlas & the occipital bone?
Atlanto-occipital
What is used to lower the heart rate to less than 65-70 bpm?
Beta blockers
Where is the costotransverse joint found?
Between the tubercle of the rib and the transverse costal facet of the corresponding vertebrae
Which structure(s) are unique to the typical cervical vertebrae?
Bifid spinous processes, short transverse processes & transverse foramina
How can you ensure that there is no rotation of the pelvis when positioning for an AP projection of the pelvis?
Both ASIS should be equidistant from the table
What is the centering point for the lateral projection of the nasal bones ?
Bridge of nose
In a trauma lateral view of the elbow, what soft-tissue structure(s) may be visualized to indicate injury?
Bursae
Which anatomy is best visualized in the right lateral position of an UGI study?
C-loop of the duodenum
Which structure articulates with the radial head?
Capitulum
What joint classification is the manubriosternal joint?
Cartilaginous , slightly moveable
What joint classification is the joint between the body of the sternum & the xiphoid process?
Cartilaginous, immovable
In the bilateral oblique projection using the modified Cleaves method, where should the IR be placed?
Centre of the IR 1" superior to the pubic symphysis
What does the apex of the sacrum articulate with?
Coccyx
Which pathology is defined as incomplete acetabulum formation & is characterized by a clicking of the flexed or abducted hip?
Congenital hip dysplasia
How are true ribs attached anteriorly?
Costal cartilage ; which attaches to the sternum
Where do ribs 8-10 attach ?
Costal cartilages superior to them
Which part of the rib accommodates a nerve, artery & a vein?
Costal groove
What is the name of the joint formed between the head of the rib & the body of the vertebra?
Costovertebral
Which tarsal is shown in profile on a properly positioned AP oblique projection of the foot?
Cuboid
Most PE's are caused from what?
DVT's
Which patient position is the patient lying on their back and a horizontal ray is being used ?
Decubitus
A patient had a trauma and arrives in the x-ray dept. for images of her pelvis. How do you position her lower limbs & why?
Do not internally rotate the patient's lower limbs internally 15-20 degrees due to the suspected fracture
Which structure is demonstrated within the foramen magnum on an AP axial (Townes) projection ?
Dorsum sellae
In the RAO position of an UGI, which anatomy will be demonstrated in profile?
Duodenal bulb & pylorus filling in profile
What movement increases the angle between adjoining bones?
Extension
What movement decreases the angle between adjoining bones?
Flexion
Which body position is semi-sitting with the head raised 45-90 degrees off the bed?
Fowler's
What type of joint is the hip?
Freely moveable , synovial , ball & socket joint
What is another name for the AP oblique projection of the hip / the modified Cleaves method?
Frog leg lateral
Which sinuses are best demonstrated on a PA axial projection (Caldwell) of the sinuses ?
Frontal & anterior ethmoid
What are the breathing instructions for lower ribs & why ?
Full expiration, to raise the diaphragm
What are the breathing instructions for upper ribs & why?
Full inspiration, to lower the diaphragm
On an AP supine projection, where will the barium be demonstrated in the stomach?
Fundus
Where will the air be demonstrated in the stomach when the patient is in a recumbent RAO position?
Fundus
On an AP oblique projection of the shoulder, which scapular structure will be demonstrated in profile?
Glenoid fossa/ cavity
Which palpable landmark can be used to locate the symphysis pubis?
Greater trochanter & coccyx
What structures will be in profile on the AP projection of the humerus ?
Greater tubercle & humeral head
What do the demifacets articulate with?
Heads of the ribs
Which structures on the distal end of the humerus will be superimposed on a true lateral humerus projection?
Humeral epicondyles
Which palpable landmark can be used to locate C3/4?
Hyoid bone
For which body habitus would the IR be positioned crosswise for a PA projection of the chest?
Hypersthenic
If your patient is very thin, how will you need to adjust the rotation for a scapular Y projection?
Increased obliquity
What is the significance if the scottie dog has a "collar" ?
Indicated a fracture of the pars interarticularis
What bony anatomy forms the intervertebral foramina of the lumbar spine?
Inferior & superior vertebral notches of adjacent vertebrae
What is the tibial plafond?
Inferior surface of the tibia which articulates with the trochlear surface of the talus
Which anatomy is found between the two tibial condyles?
Intercondylar eminence
What is the name of the membrane that runs between the shafts of the radius and ulna?
Interosseous membrane
Which structure(s) are best demonstrated when positioning your patient for a lateral projection of the L-spine?
Intervertebral foramina & intervertebral disk spaces
What is turning a body part inwards called?
Inversion
Which palpable landmark can be used to locate T2/3?
Jugular notch
How many atypical L-spine vertebrae are there & what makes them atypical?
L5 wider & wedge shaped to articulate with the sacrum
Which chest projection will best demonstrate interlobar fissures?
Lateral
Which projection will adequately demonstrate all 4 sinus groups?
Lateral
Which positions best demonstrate the sternum?
Lateral & RAO
In which projection of the elbow is the radial tuberosity demonstrated facing anteriorly and the humeral epicondyles superimposed ?
Lateral projection
Which projection of the C-spine will the zygapophyseal joints be best demonstrated?
Lateral projection
Which way do you rotate the foot for a lateral projection of the 4th and 5th toes?
Laterally
With the hand in prone position, which way will you rotate the hand to achieve a lateral projection of the 4th or 5th digits?
Laterally / externally
Which digestive system anatomy is best visualized when the patient is in an LAO position?
Left colic (splenic) flexure & descending colon
Which projection(s) & patient position(s) would best demonstrate air/fluid levels in the abdomen if the patient can't stand?
Left lateral decubitus AP or PA projection of the abdomen
Which lobe of the lung contains the cardiac notch?
Left superior lobe
What type of curve is the C-spine?
Lordotic curve (convex anteriorly)
Where are the petrous pyramids demonstrated on a PA axial (Caldwell) projection of the cranium ?
Lower 1/3rd of the orbits
When critiquing a lateral image of the skull, it is noted that the orbital roofs are not superimposed. What positioning error has occurred?
MSP is not parallel to the IR
Which palpable landmark can be used to locate C1?
Mastoid tip
Which joints are associated with C2?
Medial atlantoaxial , lateral atlantoaxial / zygapophyseal joints (2) & intervertebral disk space (C2/3)
Which part of the clavicle will be seen superimposing the thorax in a properly positioned AP projection of the clavicle ?
Medial half
With the hand in a prone position, which way will you rotate the hand to achieve a lateral projection of the 2nd or 3rd digits?
Medially / internally
When performing a parietoacanthial projection (Water's) of the facial bones, which positioning line should be perpendicular to the IR ?
Mentomeatal line (MML)
Which line must be perpendicular to the IR for an AP open mouth projection of the C-spine ?
Occlusal plane / lower margin of upper incisors to mastoid tip
What makes C2 atypical ?
Odontoid process (dens) projecting from its superior surface , lamina thick & broad
Which positioning line is perpendicular to the IR for a PA axial projection (Caldwell method) of the cranium ?
Orbitomeatal line (OML)
Which projections and patient positions best demonstrate pleural effusions?
PA erect chest, lateral erect chest & AP erect axial chest in lordotic position
For an AP projection of the humerus, how are the epicondyles positioned in relation to the IR?
Parallel to the IR
For an AP projection of the tibfib, how should the femoral epicondyles be in relation to the IR?
Parallel to the IR
Which projection would best demonstrate a displaced fracture of the nasal septum ?
Parietoacanthial / Water's
What is part of the lamina between the superior & inferior articular processes of the lumbar vertebrae called?
Pars interarticularis
For the lateral projection of the skull, the IPL is ______ to the IR
Perpendicular
What is the CR for a lateral projection of the coccyx?
Perpendicular and directed to a point 9cm (3.5") posterior to ASIS and 2" (5cm) inferior
What is the CR for a lateral projection of the sacrum?
Perpendicular at the level of the ASIS, 9cm (3.5") posterior to the ASIS
What is the CR for a lateral projection of the skull?
Perpendicular to a point 2" superior to the EAM
What is the CR for an AP shoulder projection?
Perpendicular to a point 2.5cm/ 1 inch inferior to the coracoid process
What is the CR for an AP projection of the scapula?
Perpendicular to a point 5cm/2 inches inferior to the coracoid process ( mid-body of the scapula)
What is the CR for the lateral projection of the facial bones?
Perpendicular to a point halfway between the outer canthus & the zygoma
What is the CR for an AP or PA projection in a barium enema study?
Perpendicular to the midline at the level of the iliac crests
What is the CR for an inferosuperior projection of the patella , using the Stettegast method, with the patient sitting on the table?
Perpendicular to the patellofemoral joint space OR 15-20 degrees passing through the patellofemoral joint
What is the CR for the lateral projection of the wrist?
Perpendicular to the wrist joint
How many (posterior or anterior) ribs should be visualized above the diaphragm to indicate a proper inspiration on a PA CXR?
Posterior 1-10
What type of curvature is the sacral curve?
Primary & kyphotic
Which part of the mandible is best demonstrated on a PA projection of the mandible?
Rami
Which digestive system anatomy is best demonstrated in a lateral projection ?
Rectum & distal sigmoid of the colon
Which joints are associated with C4?
Right & left zygapophyseal joints & intervertebral disk spaces (C3/4 &C4/5)
Which anatomy is best visualized when the patient is in an RAO position for digestive system studies?
Right colic (hepatic) flexure, ascending colon, cecum & sigmoid
On a RAO of the SC joint, which SC joint is demonstrated ?
Right joint
Which projection & patient position would best demonstrate fluid in the right pleural cavity?
Right lateral decubitus , patient recumbent
Which ribs will be demonstrated on an AP oblique projection of the ribs in RPO position?
Right ribs closest to the IR
In which primary bronchus would you expect to find an inhaled foreign object & why ?
Right, because it's wider & more vertical
What is the peritoneum ?
Serous membrane that lines the abdominal cavity
LPO/RPO of the L-spine demonstrates which side?
Side closest to the IR
When positioning anterior oblique projections of the large intestine, which side is best demonstrated?
Side down
LPO/RPO oblique of the C-spine demonstrated which side?
Side furthest from the IR
When positioning posterior oblique projections of the large intestine, which side is best demonstrated ?
Side up
In which position is the patient placed for the insertion of the enema tip?
Sims
How much interosseous space should be visualized between the 3rd-5th metacarpal shafts to indicate proper obliquity for a PA oblique projection of the wrist?
Slight interosseous space
What are the breathing instructions for an AP scapula and why?
Slow breathing , to blur lung detail
Which sinuses are projected through the open mouth for the parietoacanthial projection (Open-Mouth Water's) projection ?
Sphenoid
Where will the radial tuberosity be facing in a normal lateral elbow projection (lateromedial) ?
Superimposed by the radius & not demonstrated in profile
Which palpable landmark can be used to locate T4/5?
Sternal angle
Where do ribs 1-7 attach?
Sternum
Where is the fibula in relation to the tibia on a lateral projection of the lower leg?
Superimposed on the posterior half / at both articular surfaces
Which palpable landmark can be used to locate L4/5?
Superior iliac crest
Which thoracic vertebrae have demifacets?
T2-8
The xiphoid process lies at what vertebral level?
T9 /10
What is superimposed at the ankle joint?
Talar domes and medial malleolus
Why is a left lateral decubitus of the abdomen preferred ?
The stomach is on the side down ; so we do not mistake air in the stomach for free air in the abdomen
Why do T11 & 12 not have a transverse costal facet?
There are no tubercles on these ribs
Where are costal facets found?
Thoracic vertebrae (1-10) On the transverse processes
Which palpable landmark can be used to locate C5?
Thyroid cartilage
Which joints compose the ankle mortise?
Tibiotalar, talofibular, and medial talomalleolar
Why must diaphragms be included on a AP projection of the abdomen?
To demonstrate free air in the peritoneum
What is the purpose of rotating the feet & lower limbs 15-20 degrees medially for a proximal femur, hip or pelvis?
To place the femoral neck parallel to the IR & prevent foreshortening
Why is angulation of the CR needed to produce AP images of the sacrum & coccyx?
To reduce curvature & to prevent superimposition with the pubic symphysis
For which projection of the skull is the OML at 30 degrees to the IR?
Towne's
What carpal bone must be included on images of the thumb?
Trapezium
Which body position puts the head lower than the body?
Trendelenberg
Which patient position will best demonstrate a hiatal hernia?
Trendelenburg
What is the costotransverse joint an articulation between?
Tubercle of the rib & the transverse process of the vertebra
What do costal facets articulate with?
Tubercles of the ribs
What is a mechanical way in which a more uniform density ay be obtained on a AP projection of the T-spine?
Utilize the anode heel effect ; put the anode side towards the head & the cathode side towards the feet
In addition to patient position, which technique may be used to better visualize esophageal varices?
Valsalva maneuver
At what point in development does the C-spine curve start to form?
When a baby starts to hold up their head ; 3-4 months and it is complete by 8-9 months
Where will the petrous pyramids be demonstrated for a parietoacanthial projection (Water's) of the sinuses when the patient's head is extended less than the suggested 37 degrees?
Within the maxillary sinuses
Which palpable landmark can be used to locate T9/10?
Xiphoid process
What joint is formed where the superior demifacet articulates with the head of the rib?
costovertebral