chapter 11 ribs&sternum

A patient comes to radiology for an esophagram. The radiologist is concerned about the upper portion of the esophagus, near the level of T1, which did not visualize well on the previous routine projectionposition esophagram. Which of the following special projections and/or positions would be most helpful in demonstrating this region?

swimmers lateral position

classification and movement for sterno clavicular joints

synovial with diarthrodial (plane) movement

costotransverse joint

synovial with diarthrodial movement

Why is the RAO sternum preferred to the LAO position?

the RAO postion projects the sternum over the heart shadow

Which aspect of the gallbladder is located most posterior within the abdomen?

the neck

A 72inch (180 cm) SID is recommended for AP and PA projections of the ribs to reduce skin dose.

true

How much rotation and which oblique are required to best demonstrate the left sternoclavicular joints?

10 to 15 degrees LAO

Female gonadal dose for an RAO upper GI position collimated for a 10 ´ 12inch (25 ´ 30cm) image size is in the ____ range.

10 to 20 mrad C.

Which of the following kV ranges should be used for an upper GI series using barium sulfate (single contrast study)?

100 to 125 KV

The breast dose on an AP above the diaphragm ribs projection is approximately how many times greater than for a PA rib projection.

20 times

How much obliquity is required for the RAO position for the esophagus?

35-40 degrees

How much barium is typically given to a 3 to 10yearold child during an upper GI series?

6-12oz

The average adult gallbladder is ____ long and ____ wide.

7 to 10 cm; 3 cm

which kv range should be used for ribs below diaphram?

70 to 80 kv

The ideal kV range for a doublecontrast barium enema is:

90-100

A patient comes to radiology for an upper GI series. The patient has a clinical history of hiatal hernia. Which of the following positions may be helpful in demonstrating this condition?

AP Trendelenburg position

A radiograph of an RAO projection of the ribs demonstrates the left axillary ribs are foreshortened, whereas the right side is elongated. Which of the following is the most likely reason for this radiographic outcome?

An LAO was performed rather than the RAO position.

A PA projection taken during an upper GI series performed on an infant reveals that the body and pylorus of the stomach are superimposed. What modification needs to be made during the repeat exposure to separate these two

Angle the CR 20° to 25° cephalad.

A PA radiograph taken on a hypersthenic patient during an upper GI series reveals that the pylorus and duodenal bulb are superimposed. Which of the following modifications will best eliminate the superimposition between these structures?

Angle the CR 35° to 45° cephalad.

Which structures create a normal indentation seen along the lateral border of the esophagus?

Aortic arch and left primary bronchus

At what level should the CR and image receptor be centered for the RAO or PA upper GI projection and/or position on a sthenicbody type of patient?

L2

One radiograph of an upper GI series needs repeating. The technologist is unsure which projection and/or position is seen on this radiograph. The fundus is filled with barium and the pylorus and duodenal bulb are profiled and air filled. The patient was recumbent for all projections. Which projection and/or position needs the repeat?

LPO

Which of the following upper GI projections and/or positions will best demonstrate the pylorus and duodenal bulb in profile during a doublecontrast

LPO

A patient enters the ER with blunt trauma to the sternum. The patient is in great pain and cannot lie prone on the table or stand erect. Which of the following routines would be best for the sternum exam in this situation?

LPO and horizontal beam lateral projections

does a lateral projection of the sternum require that respiration be suspended upon expiration?

NO

can both nuclear medicine and MRI studies can be performed to evaluate metastatic rib lesions before conventional rib radiographic examination?

No

A young female patient from the ER is brought to radiology for rib examination. She is able to sit up or stand for the procedure. She indicates that the region of pain is to the right anteriortomid axillary region. Which rib projections should be performed to minimize the effective dose to this patient?

PA and LAO

A patient enters the ER with an injury to the left anterior lower ribs. Which of the following projections should be taken to demonstrate the involved

PA and RAO

A patient with metastatic disease in the ribs comes to radiology following a nuclear medicine scan. The radiologist orders a right, upper posterior rib study performed. Which of the following positioning factors should be followed for this specific study?

Perform positions erect if the patient's condition permits. and Include the RPO position as part of the positioning routine.

Initial PA projections of the SC joints indicate a possible defect involving the left SC joint. The vertebral column is preventing a clear view of it. Which of the following projections will demonstrate the right SC joint without superimposition over the spine?

RAO

Its presence indicates a possible sliding hiatal hernia

Schatzki ring

What type of breathing instructions should be given to the patient during an esophagram using a thin barium mixture?

Shallow breathing and continued swallowing during exposure

A PA radiograph of the sternoclavicular (SC) joints demonstrates unequal distance from the SC joints to the midline of the spine. The left SC joint is farther from the sternum than the right. What specific positioning error is present on this radiograph?

Slight left rotation (left side toward the image receptor)

Centering of the CR for an esophagram should be to the vertebral level of:

T5 T6

Both bony and soft tissue anatomy may be evaluated by CT for pathology involving the sternum or the sternoclavicular joints.

True

Which of the following positioning considerations does not apply for a study of the lower ribs?

Use a kV range between 65 to 70 kV.

Enlarged recess in the distal esophagus

Zenker diverticulum

Dilated distal esophagus due to reduced peristalsis

achalasia

Research suggests that peptic ulcers may be caused by:

bacteria

"Chole" is a prefix for terms pertaining to the:

bile

Multiple myeloma is seen often in the flat bones of the

bony thorax

The dilated portion of the distal esophagus is termed the:

cardiac antrum

Radiographic examination of the biliary ducts only is termed:

cholangiography

A pediatric patient enters the ER with a small, plastic object stuck in her esophagus. PA and lateral chest radiographs fail to demonstrate the foreign body. Which of the following procedures would be most effective in demonstrating the location of the object?

cotton shreds soaked in barium

A patient comes to radiology with a history of a gastric ulcer. Which of the following procedures would be most diagnostic to demonstrate this lesion?

double contrast upper GI series

Narrowing and wormlike appearance of distal esophagus

esophageal varicies

T/F In 80% of all individuals, the common bile duct and the pancreatic duct unite before entering the duodenum.

false

fracture of adjacent ribs in two or more places with associated pulmonary injury is known as:

flail chest rib fractures.

Irregular filling defect within the stomach

gastric carcinoma

Speckled appearance of the gastric mucosa and absence of rugae

gastritis

Which term describes the outer, lateral border of the stomach?

greater curvature

A radiograph taken during an esophagram using thin barium mixture demonstrates that there is very little contrast media in the esophagus. Which of the following points will improve filling of the esophagus? (The exposure was made on inspiration after the last swallow.)

have the patient drink during exposure

Gastric bubble seen above the diaphragm

hiatal hernia

A radiograph of an RAO projection of the sternum demonstrates excessive lung markings obscuring the sternum. A 1second exposure time and a breathing technique were used. Which of the following will produce a more diagnostic image of the sternum?

increase exposure time, decrease mA

Situation: A radiograph of an RAO sternum reveals that it is partially superimposed over the spine. What must be done to eliminate this problem during the repeat exposure?

increase rotation of the body

A radiograph taken during an upper GI series demonstrates poor visibility of the gastric mucosa. The following factors were used: 80 kV, 30 mAs, 1/40second exposure time, highspeed image receptors. Barium sulfate was used during the procedure. Which

increased Kv (decrease Mas as needed)

The RAO position of the esophagus is preferred over the LAO because it:

increases the visibility of the esophagus between the vertebrae and heart.

where is bile formed?

liver

Which of the following definitions would describe a bezoar?

mass of undigested material

Achalasia is generally defined as:

motor disorder of the esophagus.

When using computed radiography (CR), inadequate kV or mAs will produce a ____ image.

mottled

Which of the following imaging modalities is ideal for demonstrating signs of Barrett esophagus?

nuclear medicine

The radiographic appearance of the erosion of bony rib margins is a possible indication of:

osteomyelitis

The following disease or condition may be associated with postoperative complications of open heart surgery

osteomylitis

A congenital defect characterized by anterior protrusion of the lower sternum and xiphoid process is termed:

pectus carinatum.

Gastric emptying studies are performed using:

radionuclides

What are the minimum number of ribs that must be demonstrated for a unilateral rib study above the diaphragm?

ribs 1-9

A patient comes to radiology for an upper GI series. Her clinical history indicates that there may be a tumor posterior to the stomach. Which one of the following projections and/or positions will best demonstrate this condition?

right lateral

Situation: A patient enters the ER with trauma to the bony thorax. The initial radiographs reveal that there are fractured ribs and a possible pneumothorax of the left thorax. The physician orders a chest study to confirm the pneumothorax; however, the patient cannot stand. Which of the following positions would best demonstrate the pneumothorax?

right lateral decube

What is an older term for the hepatopancreatic sphincter?

sphincter of oddi

During an upper GI series, the "lucenthalo" sign appears in the duodenum. Which of the following conditions will produce this radiographic sign?

ulcer

Punctate collection of barium surrounded by a "halo" appearance during upper GI series

ulcers

: A patient comes to radiology with a clinical history of HPS.Which of the following imaging modalities will best demonstrate this condition?

ultrasound

the pancreatic duct is also called

wirsung

A large outpouching of the proximal esophagus above the upper esophageal sphincter is termed:

zenker diverticulum