Chapter 4 Workbook Image Analysis

The second through (A)______ digits are separated, demonstrating little superimposition of the bony or soft tissue structures. The second through (B)_______ MCs are superimposed. (C)_______are at the center on the exposure field.

A. Fifth B. Fifth C. MCP joints

Sufficient ulnar deviation of the wrist has been accomplished in the PA axial projection when the long axis of the (A)_______ and (B)______ are aligned and the lunate is positioned distal to the (C)________.

A. First MC B. Radius C. Radius

Each of the second through fifth MC midshafts demonstrates more concavity on one side than on the other and have varying amounts of space between them. The (A)_____ MC heads are not superimposed, then (B)______ MC heads are slightly superimposed and a slight space is present between the (C)_____ MC shafts. (D)_______ is at the center of the exposed field.

A. First and second B. Third through fifth C. Fourth and fifth D. Third MCP joint

If an AP humeral projection is ordered for a patient with a suspected proximal humeral fracture, why is it important not to externally rotate the arm? A.____________________ How can the ordered procedure still be performed without adjusting the arm postion? B.___________________

A. Forced external rotation may result in an increased risk of radial nerve damage. B. Rotate the patient 35 to 40 degrees toward the affected side for the proximal humerus and rotate the patient toward the affected side until the humeral epicondyles are parallel with the IR when the distal humerus is of interest.

State whether the forearm or humerus should be places parallel with the IR to best deomostrate the anatomy listed below in a patient whose arm will not fully extend. A. Coronoid:___________ B. Radial head:___________ C. Medial Trochlea:____________ D. Capitulum:____________ E. Capitulum-radial joint:__________

A. Forearm B. Forearm C. Humerus D. Humerus E. Forearm

On an AP forearm projection with accurate positioning, the (A)______ is centered to the collimated field. This is accomplished by centering (B)_____CR to the (C)_________.

A. Forearm midpoint B. Perpendicular C. Midforearm

When the fifth MC and ulna are aligned with the long axis of the collimation field for a PA wrist projection, the distal scaphoid is (A)______(foreshortened/elongated), and the lunate moves (B)______(medially/laterally).

A. Foreshortened B. Medially

On an AP proximal humeral projection with accurate positioning, the (A)_____ tubercle is demonstrated laterally in profile, the (B) _______ is demonstrated medially in profile, and the (C)______ is visible approximately halfway between the greater tubercle and the humeral head.

A. Greater B. Humeral head C. Lesser tubercle

The (A)_______ (anterior/posterior) margin of the distal radius is demonstrated distal to the (B)_____ (anterior/posterior) margin on a PA wrist projection with accurate positioning.

A. Posterior B. Anterior

Medial and lateral humeral epicondyles are demonstrated in (A)_________. One-eighth of the (B)_______ superimposes the proximal ulna. Radial tuberosuty in profile (C)________, and the radius and ulna are parallel. The elbow joint is (D)_________. (E)______ is at the center of the exposure field.

A. Profile B. Radial head C. Medially D. Open E. Elbow joint

To obtain a PA hand projection, (A)______ the hand and place it (B)_____ against the IR.

A. Pronate B. Flat

An AP humeral projection is ordered for a patient with a humerus that is longer than 17 inches. How should the arm be aligned with the IR to include the entire humerus on the same projection?

Abduct the humerus and place it diagonally on the IR.

Why is the capitulum-radial joint partially or completely obscured on an AP forearm projection?

Because the diverged x-ray beams, used to record this joint, do not align parallel with the joint space

Why is the visualization of the pronator fat stripe on a lateral wrist projection of importance?

Changes in the shape and visualization of this stripe may indicate a fracture.

Describe the shape and location of the scaphoid fat stripe.

Convex in shape and located lateral to the scaphoid

How is the CR angle adjusted for a PA axial wrist projection if a fracture of the proximal scaphoid is suspected?

Decrease 5 to 10 degrees

What is the reason on axiolateral projection may be requested?

Demonstrate fractures of the radial head and capitulum

How is the patient positioned to prevent the first MC from being superimposed over the trapezium?

Depress the distal first MC until it is at the same level as the second MC.

How should the thumb be positioned to obtain open joint spaces and demonstrate the phalanges without foreshortening on a lateral hand projection?

Depress the thumb until it is parallel with the IR.

For a lateral wrist projection, how are the humerus and elbow positioned to demonstrate the ulnar styloid projecting distal to the midline of the ulnar head?

Do not abduct the humerus. Position the humeral epicondyles parallel with the IR in an AP projection.

How is the patient positioned for an AP elbow projection if the elbow is unable to extend at least 30 degrees?

Do two AP views—one with the humerus parallel with the IR and one with the forearm parallel with the IR.

How is the hand positioned to prevent the medial palm soft tissue and possibly the fourth and fifth MCs from being superimposed over the proximal MC?

Draw the medial palm surface away from the thumb by using the opposite hand or an immobilization device.

How is the patient positioned for a PA axial wrist projection with accurate positioning?

Elevate (5-6 degrees) the proximal forearm.

Is the hand rotated internally or externally from the PA projection to place the fifth finger in a later position?

Externally

Which of the fingers metacarpals is the shortest?

Fifth

A poorly positioned AP elbow projection demonstrates a closed elbow joint space. How can one determine if this closure was a result of poor CR placement or elbow flexion?

Find where the CR was positioned by diagonally connecting the corners of the exposure field on the elbow projection. The two lines connect where the CR was located and discern whether the olecranon is within the olecranon fossa.

To prevent finger rotation on a PA finger projection, the hand should be poistioned ____________ against the IR.

Flat

How is the hand positioned for a lateral finger projection to prevent soft tissue overlap of the adjacent fingers onto the affected finger and to best demonstrate the affected finger's proximal phalanx?

Flex the hand into a tight fist with the affected finger extended.

How is the patient positioned far a PA wrist projection to obtain open second through fifth CM joint spaces?

Flex the hand until MCs form a 10- to 15-degree angle with the IR.

For a lateral wrist projection, how is the patient positioned so the the wrist is in a neutral position without extension or flexion?

Flex the hand until the second to fifth MCs are placed at a 10- to 15-degree angle with the anterior plane of the wrist.

When the hand is placed on a flat surface, the wrist will be _______(flexed/extended).

Flexed

On a lateral forearm projection with accurate positioning, the ________ is centered within the collimated field.

Forearm midpoint

On a lateral humeral projection with accurate positioning, the _________ is centered within the collimated field.

Humeral midpoint

On an AP humeral projection with accurate positioning, the __________ is centered within the collimated field.

Humeral midpoint

What are the reason a child's pediatric skeletal and chronologic age may not correspond?

Illness, metabolic or endocrine dysfunction, and taking certain types of medications and therapies

How is the forearm positioned with respect to the x-ray tube to take advantage of the anode-heel effect?

Position the wrist at the anode end and the elbow at the cathode end of the tube.

On a PA oblique wrist projection with accurate positioning, the radioulnar joint space is closed. Which surface of the radius is superimposed over the ulna?

Posterior

If a patient with a large muscular or thick proximal forearms is positioned without hanging the proximal forearm off the IR or imaging table, what type of wrist deviation will result?

Radial

The position of the distal forearm for an axiolateral projection affects the relationship of which anatomic elbow structures?

Radial head and coronoid and the capitulum and medial trochlea

A lateral forearm projection with poor positioning demonstrates the capitulum distal to the distal surface of the medial trochlea. What is the radial head and coronoid relationship on this projection?

Radial head will be too posterior to the coronoid.

Accurate CR centering on an axiolateral elbow projection is accomplished by centering the CR to the:_____

Radial head, located ¾ inch (2 cm) distal to the lateral epicondyle

Which anatomic structure can be used to determine the portion of the radial head that is positioned in profile on an axiolateral elbow projection?

Radial tuberosity

How is the patient positioned to demonstrate the pisiform wothout superimposition of the hamulus of the hamate on the carpal canal projection?

Rotate the hand 10 degrees internally or until the fifth MC is perpendicular to the IR.

A lateral elbow projection with poor positioning demonstrates the radial head positioned posterior on the coronoid process. How would the capitulum and medial trochlea be misaligned on this projection?

The capitulum would be distal to the medial trochlea.

Which anatomic structures are included on an accurately collimated PA oblique wrist projection?

The carpal bones, one fourth of the distal radius and ulna, and half of the proximal MCs

Which anatomic structures are included on an accurately collimated PA wrist projectiong?

The carpal bones, one fourth of the distal ulna and radius, and half of the proximal MCs

Which anatomic structures are included on an accurately collimated lateral wrist projection?

The carpal bones, one fourth of the distal ulna and radius, and half of the proximal MCs

Which anatomic structures are included on a PA axial wrist projection to obtain an open radioscaphoid joint space?

The carpal bones, radioulnar joint, and proximal first through fourth MCs

Why is a pediatric PA bone age hand image taken?

To assess the skeletal versus the chronologic age of a child

Describe how the shoulder and elbow joints can be located to ensure that the IR extends beyond each for an AP humeral projection. A. Shoulder:__________ B. Elbow:_____________

To ensure that the joints will be included after the beam's divergence projects the elbow joint distally and the shoulder joint proximally

The ulnar styloid is projecting distal to the midline of the ulnar head. (In some facilities, this may not be considered poor positioning.) How is the patient miss positioned?

The humerus was not abducted but was placed against the patient, and the elbow was in an AP projection.

Which anatomic structures are included on a lateral humeral projection with accurate positioning?

The humerus, elbow and shoulder joints, and lateral soft tissue

Which anatomic structures are included on an AP humeral projection with accurate positioning?

The humerus, shoulder and elbow joints, and lateral humeral soft tissue

Which of the elbow and humeral positions described in the previous two questions demonstrates the ulna closer to the lunate on the resulting lateral wrist projection?

The position described in the second question, when the elbow is in an AP projection and the humerus is not abducted

Why is it important to flex the elbow 90 degrees for a lateral elbow projection?

The posterior fat pad can be used as a diagnosing tool only when the elbow is flexed 90 degrees and the olecranon is out of the fossa.

If the forearm is positioned parallel with the IR for a PA oblique wrist projection, how is the distal radius demonstrated on the resulting project?

The posterior margin will be projected distal to the anterior margin.

The posterior margin of the distal radius superimposes less than one-fourth of the lunate. How was the patient miss positioned?

The proximal forearm was depressed.

The posterior margin of the distal radius has been projected too far distal to the anterior margin. How was the part miss positioned?

The proximal forearm was elevated.

The radial head is demonstrated too far posterior on the coronoid process. The distal forearm demonstrates accurate positioning. How is the patient miss positioned?

The proximal humerus was elevated.

Why is it necessary to have the IR and collimator light field extend beyond the shoulder and elbow joints when imaging the humerus in the AP projection?

To ensure that the joints will be included after the beam's divergence projects the elbow joint distally and the shoulder joint proximally

When imaging the third and forth fingers, why is it often necessary to position a sponge beneath the distal phalanx?

To prevent the finger from tilting toward the IR

For a PA projection of the wrist, the trapezoid and trapezium are superimposed. Which of these carpal bones is located anteriorly?

Trapezium

For a PA axial projection, how is the patient positioned to obtain open scaphocapitate and scapholunate joint spaces?

Ulnar-deviate the wrist until the long axis of the first MC and radius are aligned and the wrist is externally rotated 25 degrees with the IR.

Where do most fractures occur on the scaphoid?

Waist

Accurate transverse collimation has been obtained when the collimated borders are ___________.

Within ½ inch (1.25 cm) of the finger skin line

To obtain open joint spaces on an AP thumb projection, the thumb is fully_____ and the CR is accurately aligned and centered to the thumb.

extended

As a routine, should the wrist be internally or externally rotated from a PA projection?

externally

In which direction are the hand and finger rotated for a PA oblique projection when imaging the third thorugh fifth fingers?

externally

Is the hand rotated internally or externally from the PA projection to place the forth finger in a later position?

externally

to obtain a lateral projection of the thumb, rest the hand flat against the IR and then __________ it until the thumb rolls into a lateral projection.

flex

In which direction are the hand and finger rotated for a PA oblique projection when imaging the second finger?

internally

What projection is a lateral wrist?

lateromedial

In the lateral wrist, is the pisiform or distal scaphoid positioned closer to the IR?

pisiform

Which side of the wrist is placed against the IR for a routine lateral wrist?

ulnar

The proximal humerus was positioned lower than the distal humerus on a lateral elbow projection. What will be the relationship between the radial head and coronoid and the capitulum and medial trochlea on the resulting projection?

The radial head will be anterior to the coronoid, and the capitulum will be proximal to the medial trochlea.

How can one determine from the projection if the forearm was elevated too high for the axiolateral elbow projection?

The radial head will be proximal to the coronoid, and the capitulum will be posterior to the medial trochlea.

A lateral elbow projection with poor positioning demonstrates the capitulum too far posterior to the medial trochlea. How will the radial head and coronoid be aligned on the projection?

The radial head will be proximal to the coronoid.

The distal forearm positioned too low for a lateral elbow prokection. What will be the relationship between the radial head and coronoid and the capitulum and medial trochlea on the resulting projection?

The radial head would be distal to the coronoid, and the capitulum would be anterior to the medial trochlea.

An AP projection of the distal humerus has been obtained when _______ of the radial head superimposes the ulna

1/8th

If the wrist is adequately ulnar-deviated for a PA axial projection, how much and in which direction is the CR angled if a fracture of the scaphoid waist is suspected?

15 degrees proximally

On a rotated PA projection, the side of the finger that is rolled (A)_______ (father from/ closer to) the IR will demonstrate the greatest phalageal midshaft concavity and the (B)________ soft tissue thickness.

A. Farther B. Greater

The affected finger is rotated _________ degrees from the PA projection for a PA obliques finger projection.

45

The affected thumb is rotated ______ degrees for accurate positioning for a PA oblique thumb position.

45

What routine degree of patient wrist rotation is required for a PA oblique wrist projection?

45

What is the degree of elbow rotation used for AP oblique projections?

45 degrees

Why is the visulatization of the scaphoid fat stripe important on a PA wrist projection?

A change in the convexity of this stripe may indicate joint effusion or fracture.

(A) What CR angulation is used if the patient is unable to adequately ulnar deviate for a PA axial wrist projection? (B) Why is this adjustment needed?

A. 20 degrees proximally B. Without ulnar deviation, the distal scaphoid is positioned anteriorly, and the scaphoid demonstrates increased foreshortening.

The hand is rotated (A)_____ degrees (B)______(internally/externally) from a PA projection for a PA oblique hand projection.

A. 45 B. Externally

(A)________ surface of the middle and proximal phalanges demonstrate midshaft concavity, and the (B)________ surfaces show a slight convexity. (C)_______are demonstrated as open spaces, and the phalanges are not foreshortened. (D)_______is at the center of the exposed field.

A. Anterior B. Posterior C. IP joints D. PIP joint

(A)______ aspect of the proximal phalanx and MC demonstrates midshaft concavity, and the (B)________aspect of the proximal phalanx and MC demonstrates slight convexity. The IP, MCP, and CM joints are demonstrated as (C)_______, and the phalanges are not foreshortened. The proximal first MC is only slightly superimposed by the proximal (D)__________ MC. (E)_______ is at the center of the exposure field.

A. Anterior B. Posterior C. Open spaces D. Second E. MCP joint

List the three soft tissue fat pads that may be demonstrated on a lateral elbow projected and describe their locations. A.______________ B.______________ C._______________ Displacemet of these pads may indicate what to the reviewer? D.___________

A. Anterior fat pad anterior to the distal humerus B. Posterior fat pad within the olecranon fossa C. Supinator fat stripe, seen parallel to the anterior aspect of the distal radius D. Joint effusion and elbow injury

For a fan lateral hand projection, the digits are most effectively fanned by drawing the second and third fingers (A)______(anteriorly/posteriorly) and the fourth and fifth fingers (B)_______(anteriorly/posteriorly).

A. Anteriorly B. Posteriorly

When positioning the patient for a lateral humeral projection, the (A)______ should be internally rotated until an imaginary line connecting the (B)_______ is positioned perpendicular to the IR.

A. Arm B. Humeral epicondyles

What two aspects of the positioning procedure need to be accurately set up to demonstrate the elbow joint space as an open space on an AP elbow projection? A._________ B.__________

A. CR accurately centered to joint B. Forearm aligned parallel with the IR

What three anatomic structures form the three concentric arcs on lateral elbow projection with accurate position? A._________ B.___________ C.__________ Which of these arcs is the smallest? D.__________ Which is the longest? E.___________ How will improper alignment of these arcs affect the elbow joint spaces? F.__________

A. Capitulum B. Trochlear sulcus C. Medial trochlea D. Trochlear sulcus E. Medial trochlea F. It will close it.

IF the finger is flexed for a PA projection, the joint spaces will be (A)_______, and the phalages with be (B)________.

A. Closed B. Foreshortened

(A)______ on both sides of the phalanges and MC midshafts is equal. Equal (B)_______ width on each side of the phalanges. IP,MCP, and CM joints are demonstrated as (C)___________, and the phalanges are not foreshortened. Superimposition of the (D)_______ soft tissue over the proximal first MC and the CM joint is minimal. (F)_________ is at the center of the exposure field.

A. Concavity B. Soft tissue C. Thumb D. Open spaces E. Medial palm F. MCP joint

Ulnar deviation of the wrist causes the distal scaphoid to be demonstrated (A)______(proximal/distal) to the pisiform, and radial deviation causes the distal scaphoid to be demonstrated (B)_______(proximal/distal) to the pisiform on a lateral wrist projection.

A. Distal B. Proximal

Soft tissue width and the midshaft concavity (A) on both side of the phalanges. IP and (B) joints are demonstated as open spaces, and the phalanges are seen without forshortening. The (C) joint is at the the center of the exposure field. The entire finger and half of the (D) are included withing the collimated field.

A. Equal B. MCP C. PIP D. MC

The thumb is places in a PA oblique projection when the hand is (A)_______, and the palm surface is placed (B)_______ against the IR.

A. Extended B. Flat

To obtain open IP and MCP joint spaces, the finger needs to be fully (A)_______ and postioned (B)_______ to the IR.

A. Extended B. Parallel

In which direction is the finger most frquently rotated when rotation occurs on a PA finger projection? Why?

A. Externally into a medial oblique position B. The thumb prevents internal rotation.

When imaging a patient who is unable to extend the wrist enough to place the MCs to within 15 degrees of vertical, the CR angle needs to be (A)_____(increased/decreased). IF a 20-degree angle were required to bring the CR parallel with the palmer surface in this situation, the angle needed for the carpal canal projection would be (B)_______, and the resulting projection would show the carpals and carpal canal, although they will be elongated because of the (C)_______.

A. Increased B. 35 degrees C. Acute angle between the CR and IR

For the thumb to be positioned in an AP projection, the hand is (A)_______(internally/externally) rotated, and the thumbnail is positioned (B)______ against the IR.

A. Internally B. Directly

To demonstrate the ulnar styloid in profile, the elbow is placed in a (A)____ projection, and the humerus is positioned (B)______ with the IR.

A. Lateral B. Parallel

An AP of the distal forearm has been obtained with the radial styloid is demonstrated in profile (A)_______(medially/laterally), and superimposition of the radius and (B)_______ is minimal.

A. Laterally B. Ulna

A lateral humeral projection with accurate positioning demonstrates the (A)_______ tubercle in profile (B)_______ (medially/laterally).

A. Lesser B. Medially

Soft tissue outlines of the second through fifth phalanges are uniform, the distance between the (A)_________ is equal, and the same midshaft concavity is seen on both sides of the (B)_______ and MCs of the second through fifth fingers. (C)________,________, and __________ joints are demonstrated as open, and the phalanges are not foreshortened. The thumb demonstrates a 45-degree oblique projection. (D)_________ is at the center of the exposure field.

A. MC heads B. Phalanges C. IP, MCP, and CM D. Third MCP

Medial Oblique: The coronoid process, trochlear notch, and (A)________ are in profile. (B)________ joint space is open. Three-fourths of the (C)_______ superimposes the ulna. Lateral Oblique: The radial head and (D)______ are in profile. (E)_________ is demonstrated without radial head, neck, and tuberosity superimposition. (F)_______ is at the center of the exposure field.

A. Medial trochlea B. Trochlear-coronoid process C. Radial head D. Capitulum E. Ulna F. Elbow joint

The carpal canal projection is used to evaluate the carpal canal for (A)______ and demonstrate (B)_______ of the pisiform and hamulus of the hamate.

A. Narrowing B. Fractures

List 2 alternative projections that can be used to position the humerus in a lateral projection in a patient with a suspected fracture proximal humerus. A.___________ B.___________

A. PA axial (scapular Y) projection B. Transthoracic lateral projection

To accomplish open joints spaces on a PA finger projection, the CR must be aligned (A)________ (perpendicular/parallel) to the joint space, and the IR must be aligned (B)________ to the joint space.

A. Parallel B. Perpendicular

To accurately seperate the arcs of the distal humerus, an imaginary line connecting the humeral epicondyles is positioned (A)_____ to the IR, and a(n) (B)______ -degree CR angulation is directed (C)________. Will this angle cause the radial head or coronoid to project farther anteriorly? (D)_____ Will this angle cause the medial trochlea or capitulum to project farther proximally?(E)________

A. Perpendicular B. 45 C. Proximally D. Radial head E. Capitulum

Accurate CR centering on a lateral projection is accomplished by centering a (A)______ CR to the (B)______ joint.

A. Perpendicular B. MCP

Accurate CR centering on an AP thumb projection is accomplished by centering (A)_______CR to the (B)_______ joint.

A. Perpendicular B. MCP

Accurate CR centering is seen on a PA finger projection by centering a (A)_______ CR to the (B)_______ joint.

A. Perpendicular B. PIP

Accurate CR centering on a PA oblique finger projection is accomplished by centering a (A)_______ CR to the (B)_________ joint.

A. Perpendicular B. PIP

Accurate CR centering on a lateral elbow projection is accomplished by centering a (A)______ CR to the elbow joint located (B)_______ inch(es) (C)_______ to the lateral humeral epicondyle.

A. Perpendicular B. ¾ inch (2 cm) C. Distal

Accurate CR centering on an AP elbow projection is accomplished by centering a (A)_______ CR (B)_______, (C)_________ to the medial epicondyle.

A. Perpendicular B. ¾ inch (2 cm) C. Distal

Accurate CR centering on an AP oblique elbow projection is accomplished by centering a (A)_______ CR to the elbow joint located at a level (B)________ distal to the (C)__________.

A. Perpendicular B. ¾ inch (2 cm) C. Medial epicondyle

Include within the exposure field on a PA finger projection with accurate positioning at the (A)________ and half of the (B)________.

A. Phalanges B. MC

(A)______ is demonstrated without superimposition of the hamulus of the hamate. (B)________ canal is visualized in its entirety, and the carpal bones are demonstrated with only slight elongation. (C)________ is at the center of the exposure field.

A. Pisiform B. Carpal C. Carpal canal

On a lateral forearm projection with accurate positioning, the anterior aspect of the distal scaphoid and (A)______ are aligned, and the distal radius and ulna are (B)_______.

A. Pisiform B. Superimposed

(A)_______fat stripe is demonstrated. (B)_________ aspects of the distal scaphoid and pisiform are aligned, and the distal radius and ulna are superimposed. (C)______aspect of the distal scaphoid and pisiform are aligned. The second through fifth MCs are placed at the (D)_______-degree angle with the anterior plane of the wirst. The thumb is parallel with the (E)______. Ulnar styloid is demonstrated in profile (F)_________. (G)__________ is demonstrated without superimposition of the first MC.

A. Pronator B. Anterior C. Distal D. 10 to 15 E. IR F. Posteriorly G. Trapezium

The capitulum is (A)______ to the medial trochlea. The radial head superimposes only the anterior tip of the (B)_______. (C)_______ surfaces of the capitulum and medial trochlea are nearly aligned. (D)________ surfaces of the radial head and coronoid process are aligned. (E)_______ is at the center of the exposure field.

A. Proximal B. Coronoid process C. Anterior D. Proximal E. Radial head

(A)______ fat stripe is demonstrated. Radial and ulnar styloids are at the extreme lateral and medial edges, respectively, of each bone. (B)______ articulation is open, and superimposed of the MC based is limited. Anterior and posterior margins of the distal radius are not (C)_____. (D) ________ CM joint spaces are open. Long axes of the third MC and the (E)_____ are aligned with the long axis of the collimated field. (F)_____ are at the center of the exposure field.

A. Scaphoid B. Radioulnar C. Superimposed D. Second through fifth E. Midforearm F. Carpal bones

(A)_____ and scaphotrapezoidal joint spaces are open. Long axis of the (B)______ and the radius are aligned. Radioscaphoid, (C)______, and scapholunate joints are open. Ulanr styloid is in profile (D)_____. (E)______ is at the center of the exposure field.

A. Scaphotrapezium B. First MC C. Scaphocapitate D. Medially E. Scaphoid

The position of the radial tuberosity on a lateral elbow projection is determined by the position of the hand and wrist. For the following positions, describe the location of the radial tuberosity. A. Lateral hand and wrist:_________ B. Supinated hand and wrist:_______ C. Pronated hand and wrist:______ Which of the radial tuberosity positions above is the desired positioned for an accurate lateral elbow projection? D._____________

A. Superimposed by the radius B. In profile, anteriorly C. In profile, posteriorly D. Superimposed by the radius

On a patient whose finger is flexed, open IP joint spaces can be obtained by (A)________ the hand and elevation the proximal metacarpals until the joint of interest is aligned (B)______ to the IR.

A. Supinating B. Perpendicular

An AP oblique elbow projection with poor positioning demonstrates a closed capitulum-radial joint space. List 2 possible positioning problems that might resulted in this projection. (A)___________. (B)____________.

A. The forearm was not positioned parallel with the IR. B. The CR was not centered to the elbow joint.

For each of the following wrist projections, list the location of the radial tuberosity and the aspect of the radial head surface that are demonstrated in profile. A. PA wrist:_____ B. Lateral wrist:______

A. The radial tuberosity will be in profile posteriorly, the lateral surface of the radial head will be in profile anteriorly, and the medial surface will be in profile posteriorly. B. The radial tuberosity will not be in profile but will be superimposed by the radius. The anterior surface of the radial head will appear in profile anteriorly, and the posterior surface will appear in profile posteriorly.

The long axis of which two anatomic structures should be aligned when positioning the patient for a PA oblique wrist projection to ensure that no radial or ulnar deviation will result? A.____________ B.___________

A. Third MC B. Midforearm

(A)______ and (B)_______ are demonstrated without superimposition, and the trapeziotrapezoidal joint space is open. (C) _________ CM and scaphotrapezoidal joint spaces are demonstrated as open spaces. (D)_______is in profile at the far medial edge. (E)_______ are at the center of the exposure field.

A. Trapezoid B. Trapezium C. Second D. Ulnar styloid E. Carpal bones

The distal humerus demonstrates three concentric arcs, which are formed by the (A)__________, capitulum, and medial trochlea. The elbow joint is open, and the distal and (B)________ surfaces of the radial head and the coronoid process are aligned. The radial tuberosity is not demonstrated in (C)_________. (D)_________ is at the center of the exposure field.

A. Trochlear sulcus B. Anterior C. Profile D. Elbow joint

(A)____________ as much soft tissue width is demonstrated on one side of the phalages as on the other side, and more (B)________ is seen on one aspect of the phalangeal midshafts than the others. IP and MCP joints are demonstrated as (C)_________ and the phalanges are not foreshortened. The (D)_______ joints is at the center of the exposure field.

A. Twice B. Concavity C. Open spaces D. PIP

(A)______ as much soft tissue, and more phalangeal and MC midshaft concavity are present on the side of the thumb next to the fingers than on the other side. The IP, MCP, and CM joints are demonstrated as open spaces, and the (B)______ are not foreshortened. (C)_________is at the center of the exposure field.

A. Twice B. Phalanges C. MCP joint

To show the carpal canal and demonstrate the carpals with only slight elongation, the long axis of the MCs is positioned close to (A)______ with the wrist staying in contact with the IR, and the CR is angled (B)_____ degrees proximally.

A. Vertical B. 15

Why is the second finger rotated differently?

This rotation results in the least amount of OID.

How are the hand and forearm aligned to prevent radial or ulnar deviation of the wrist for a lateral wrist projection?

Align the long axes of the third MC and the midforearm parallel with the IR.

How is the patient with large muscular or thick proximal forearms positioned for a PA wrist projection to prevent demonstrating an excessive amount of the radial articular surface?

Allow the proximal forearm to hang off the IR and table enough to slightly depress the proximal forearm.

Why does unlar deviation of the wrist increase the demonstration of the scaphoid?

In ulnar deviation, the scaphoid has the space it needs to move posteriorly and will demonstrate a decrease in foreshortening.

How is the CR angle adjusted for a PA axial wrist projection if a fracture of the distal scaphoid is suspected?

Increase 5 to 10 degrees

Is the hand rotated internally or externally from the PA projection to place the second finger in a later position?

Internally

Is the hand rotated internally or externally from the PA projection to place the third finger in a later position?

Internally

Describe the shape and location of the pronator fat stripe that is demonstrated on a lateral wrist projection with accurate positioning.

It is convex in shape and is located next to the anterior surface of the distal radius.

How can the location of the elbow joint be determined on a AP forearm projection?

It is located ¾ inch (2 cm) distal to the medial epicondyle.

Describe the placement of the ulnar styloid on a lateral forearm projection with accurate positioning?

It will be demonstrated in profile posteriorly.

In what position is the elbow placed to obtain the axiolateral projection of the elbow?

Lateral

The lunate shifts ______(medially/laterally) when the wrist is ulnar-deviated.

Laterally

Which hand is imaged for a pediatric PA bone age image?

Left

If the CR is not aligned parallel with the fracture site for a PA axial wrist projection, will the fracture line be visible?

No

Should the radial tuberosity be demonstrated in profile on a lateral forearm projection with accurate positioning?

No

Which anatomic structures are included on an axiolateral elbow projection with accurate positioning?

One fourth of the proximal forearm, distal humerus, and surrounding soft tissue

In what projection or position will the first digit be placed for accurate positioning for a lateral hand projection?

PA projection to a slight oblique position

On an AP forearm projection with accurate positioning, the radial tuberosity is demonstrated in profile, and the radius and ulna are visualized _______ with each other.

Parallel

Accurate CR centering on a PA oblique wrist projection is accomplished by centering a ______CR to the wrist.

Perpendicular

Accurate CR centering on a PA wrist is accomplished by centering a _________CR to the wrist.

Perpendicular

Accurate CR centering on a lateral wrist projection is accomplished by centering a _______CR to the wrist.

Perpendicular

A patient from the emergency department is unable to position the wrist and elbow in a lateral position simultaneously for a lateral forearm projection. The requisition states that the examination is being performed to rule out a proximal forearm fracture. How should the patient be positioned for this projection?

Place the elbow and proximal forearm in a lateral projection and allow the distal forearm to rotate as close to a lateral projection as the patient will allow.

How must a patient be positioned to obtain the ulnar styloid on a lateral forearm projection?

Place the elbow in a lateral position and abduct the humerus, positioning it parallel with the IR.

For a lateral wrist projection, how are the humerus and elbow positioned to demonstrate the ulnar styloid in profile?

Position the humerus parallel with the IR and the elbow in a lateral projection.

WHich of the fingers Metacarpal is the longest?

Second

Abducting the thumb will decrease the amount of ________ superimposition of the CM joint.

Second proximal MC

How is the forearm positioned for a PA wrist project to obtain open radioscaphoid and radiolunate joint space?

Slightly depress the proximal forearm.

How is the patient positioned for a PA finger projection to prevent soft tissue overlap of adjancent fingers onto the affected finger?

Spread the fingers apart

How is the patient positioned to place the radial tuberosity in profile on an AP forearm projection?

Supinate the hand and wrist, placing them in an AP projection.

How is the patient positioned to see the radial tuberosity in profile on a lateral forearm?

Supinate the hand to place the tuberosity in profile anteriorly and pronate the hand to place the tuberosity in profile posteriorly.

How should one center the CR and collimate differently when a lateral wrist projection is ordered with the request that more than one-fourth of the distal forearm be included?

The CR centering should be the same, but the longitudinally collimated field should be opened to include the needed amount of forearm.

The IP joint spaces are closed, and the phalanges are foreshortened. How was the part miss positioned?

The affected finger was allowed to tilt toward the IR.

The carpal canal is not demonstrated in it entirety, and the carpal bones are foreshortened. How was the patient miss positioned?

The angle between the CR and MCs was too great.

The MC bases obscure the bases of the hamate's hamulus process, pisiform, and scaphoid. How was the patient miss positioned?

The angle between the CR and MCs was too small.

The projection demonstrates the ulna without radial head and tuberosity superimposition. How was the patient miss positioned?

The arm was externally rotated.

The radial head superimposes approximately half of the ulna. How was the patient miss positioned?

The arm was internally (medially) rotated.

An axiolateral elbow projection with poor positioning demonstrates the radial head distal to the coronoid process. What is the relationship of the capitulum and medial trochlea on such a projection?

The capitulum will be anterior to the medial trochlea.

List the anatomic structures that are included within the collimated field on a later thumb projection with accurate positioning.

The distal and proximal phalanges, MC, and CM joint

The first proximal MC is superimposed over the trapezium. How is the patient miss positioned?

The distal first metacarpal was elevated.

The externally rotated AP (lateral) oblique projection deomonstrates a closed capitulum-radial joint space. The olecranon is positioned outside the olecranon fossa, and the radial articulating surface is demonstrated. How is the patient miss positioned?

The distal forearm was elevated.

The projection demonstrates a foreshortened proximal forearm and a closed capitulum-radial joint space. How was the patient miss positioned?

The distal forearm was elevated.

The capitulum-radial joint space is closed, the radial head is demonstrated proximal to the coronoid process, and the capitulum is demonstrated too far posterior to the medial trochlea. How was the part miss positioned?

The distal forearm was positioned too far away from the IR.

On a lateral forearm projection with poor positioning, the ulna is demonstrated posterior to the radius. What will the distal scaphoid and pisiform relationship be?

The distal scaphoid will be anterior to the pisiform.

Which anatomic structures are included on a PA oblique finger prokection with accurate positioning?

The distal, middle, and proximal phalanges and half of the MC

Which anatomic structures are included on a lateral projection with accurate positioning?

The distal, middle, and proximal phalanges and the metacarpal head

which anatomic structures are included on an accurately collimated PA hand projection?

The distal, middle, and proximal phalanges, MCs, and carpals and 1 inch (2.5 cm) of the distal radius and ulna

The radius is crossing over the ulna, and the radial tuberosity is not demonstrated in profile. How is the patient miss position?

The elbow is accurately positioned, but the hand was pronated.

Which anatomic structures are included on an AP oblique elbow projection with accurate positioning?

The elbow joint, one fourth of the distal humerus and proximal forearm, and the lateral soft tissue

Which anatomic structures are included on an accurately collimated AP elbow projection?

The elbow joint, one fourth of the proximal forearm and distal humerus, and the lateral soft tissue

Which anatomic structures are included on a lateral elbow projection with accurate positioning?

The elbow joint, one fourth of the proximal forearm and distal humerus, and the surrounding soft tissue

The distal forearm demonstrates superimposition of the first and second MC bases and laterally located carpal bones. How is the patient miss position?

The elbow was accurately positioned, but the hand and wrist were internally rotated.

The ulnar styloid is projecting distal to the midline ofthe ulnar head. How is the patient miss positioned?

The elbow was not in a lateral projection but was closer to an AP projection.

The ulnar styloid is not demonstrated in profile. How was the part miss positioned?

The elbow was not in a lateral projection, and the humerus was not parallel with the IR.

The projection demonstrates closed IP joints spaces, and the distal and middle phalanges are foreshortened. How was the part miss positioned?

The finger was flexed or tilted toward the IR.

The projection demonstrated closed IP and MCP joints, and the distal and middle phalanges are foreshortened. How was the part miss positioned?

The finger was flexed.

The projection demonstrates unequal soft tissue width and midshaft concavity on each side of the phalanges. The side of the phalanges with the least amount of concavity is facing the longest finger metacarpal. How was the part miss positioned?

The finger was internally rotated into a lateral oblique position.

Concavity is demonstrated on both sides of the middle and proximal phalangeal midshafts. How was the part miss positioned?

The finger was not in a lateral projection but was in an oblique position.

The soft tissue width and midshaft concavity are nearly equal on each side of the digit, How was the part miss positioned?

The finger was not rotated enough and was too close to a PA projection.

More than twice as much soft tissue width is present on one side of the phalanges as on the other. One aspect of the midshafts of the phalanges is concave, and the other aspect is slightly convex. How was the part miss positioned?

The finger was rotated closer to a lateral projection than a 45-degree oblique.

The projection demostrates superimposition MCs and superimposed digits. How was the part miss positioned?

The fingers were not fanned.

The scaphotrapezium, scaphotrapezoidal, and CM joint spaces are closed. How was the patient miss positioned?

The hand and fingers were flexed.

The pisiform is demonstrated anterior to the distal scaphoid, and the ulna is anterior to the radius. The proximal forearm demonstrates accurate positioning. How is the patient miss positioned?

The hand and wrist were externally rotated.

The pisiform is visible posterior to the distal scaphoid, and the distal surface of the capitulum is demonstrated proximal to the distal surfaces of the medial trochlea. How is the patient miss positioned?

The hand and wrist were internally rotated, and the proximal humerus was depressed more than the distal humerus.

What determines how the hand is rotated for a later projection?

The hand is rotated to obtain the least amount of OID.

The scaphoid is foreshortened and the fourth and fifth CM joints are closed. How was the part miss positioned. How was the part miss positioned?

The hand was extended, causing wrist flexion.

The projection demonstrates superimposed third through fifth MC heads and unequal midshaft concavity of the phalanges and MCs. How was the part miss positioned?

The hand was externally rotated into a medial oblique position.

The second through fifth MC midshafts are demonstrated without superimposition. The shortest MC is Demonstrated anterior to the other MCs. How was the part miss positioned?

The hand was externally rotated or supinated.

The soft tissue width and the concavity of the phalangeal and MC midshafts on each side are not equal. The side demonstrating the more concavity is facing toward the second through fifth digits, and the thumbnail is facing away from the second through fifth digits. How was the part miss positioned?

The hand was internally rotated more than needed to place the thumb in an AP projection.

The second through fifth MC midshafts are demonstrated without superimposition. The longest MC is demonstrated anterior to the other MCs. How was the part miss positioned?

The hand was internally rotated or pronated.

The midshafts of the proximal phalanx and MC demonstrate slight convexity on the posterior surfaces and concavity on the anterior surfaces. How was the part miss positioned?

The hand was not flat against the IR, causing the thumb to be rotated closer to a lateral projection.

The projection does not demonstrate a lateral position. The anterior and posterior aspects of the proximal phalanx and MC midshafts demonstrate concavity. The first proximal MC is demonstrated without superimposition of the second and third proximal MCs. How was the part miss positioned?

The hand was not flexed enough, resulting in underrotation.

The proximal phalanges of the unaffected fingers overlap the proximal phalanx of the affected finger. How was the part miss positioned?

The hand was not flexed into a tight fist.

The MC heads are demonstrated without superimposition, and the spaces between the MC midshafts are nearly equal. How was the part miss positioned?

The hand was not rotated 45 degrees but was closer to a PA projection.

The projection does not demonstrate a lateral projection. The second and third proximal MCs are superimposed over the first proximal MC. How was the part miss positioned?

The hand was overflexed, and possibly the thumb was not in maximum abduction.

The scaphoid is elongated and the second and third CM joints are closed. How was the part miss positioned?

The hand was overflexed, causing wrist extension.

The projection demonstrates the radius crossing over the ulna, and the radial tuberosity is not shown in profile. How was the patient miss positioned?

The hand was pronated.

The third through fifth MC midshafts are superimposed. How was the part miss positioned?

The hand was rotated more than 45 degrees.

What changes in the joint spaces, phalanges, and MCs would be expected on a PA hand projection if the hand is in a flexed position when it is taken?

The joint spaces would be closed, and the phalanges and MCs would be foreshortened.

A patient from the emergency department is unable to position the wrist and elbow in a AP projection simultaneously for an AP forearm projection. How is this patient positioned for the projection?

The joint that is closer to the area of interest or near the fracture site should be positioned into an AP projection, but the other joint is positioned as close to an AP projection as possible.

The fifth MC and the medial palm soft tissue are superimposed over the proximal first MC and CM joints. How was the part miss positioned?

The medial palm soft tissue was not drawn away from the proximal first MC.

The olecranon is positioned within the olecranon fossa, and the posterior fat pad is demonstrated proximal to the olecranon process. How is the patient miss positioned?

The patient's arm was in extension.

On the extrenally rotated AP(lateral) oblique projection, a portion of the radial head and tuberosity is superimposed over the ulna. How is the patient miss positioned?

The patient's arm was rotated less than 45 degrees.

On the internally rotated AP (medial) oblique projection, the radial head is demonstrated lateral to the coronoid process, without complete superimposition of the ulna, and the proximal aspect of the olecranon is not demonstrated in profile. How is the patient miss positioned?

The patient's arm was rotated less than 45 degrees.

On the externally rotated AP (lateral) oblique projection, the coronoid is superimposed over a portion of the radial neck, and the radial head and tuberosity are free of superimposition. The radial tuberosity is not demonstrated in profile. How is the patient miss positioned?

The patient's arm was rotated more than 45 degrees.

On the internally rotated AP (Medial) oblique projection, more than three-fourths of the radial head superimposes the ulna. How is the patient miss positioned?

The patient's arm was rotated more than 45 degrees.

The radial head is proximal to the coronoid process, and the capitulum appears to the medial trochlea. How is the patient miss positioned?

The patient's distal forearm was elevated more than needed.

The radial head is distal to the coronoid process, and the capitulum appears anterior to the medial trochlea. How is the patient miss positioned?

The patient's distal forearm was not adequately elevated.

The radial tuberosity is positioned in profile anteriorly. How is the patient miss positioned?

The patient's hand and wrist were supinated.

The radial head is positioned anterior on the coronoid process, and the distal surface of the capitulum is proximal to the distal surface of the medial trochlea. How is the patient miss positioned?

The patient's proximal humerus was depressed.

The radial head is positioned posterior on the coronoid process, and the distal surface of the capitulum is demonstrated distal to the distal surface of the medial trochlea. How is the patient miss positioned?

The patient's proximal humerus was elevated.

The pisiform is superimposed over the hamulus of the hamate. How was the patient miss positioned?

The patient's wrist and distal forearm were either in a PA projection or in slight external rotation.

List the anatomic structures that are included within the collimated field on an AP thumb projection with accurate positioning.

The phalanges, MC, and CM joint

Which anatomic structures are included on a PA oblique thumb projection with accurate positioning?

The phalanges, MC, and CM joint

Which anatomic structures are included on an accurately collimated PA oblique hand projection?

The phalanges, MCs, and carpals and 1 inch (2.5 cm) of the distal radius and ulna

Which anatomic structures are included on an accurately collimated lateral hand projection

The phalanges, MCs, and carpals and 1 inch (2.5 cm) of the distal radius and ulna

Why is it difficult to demonstrate the phalanges and MCs simultaneously on a fan lateral hand projection?

The thicknesses of the fingers and the MCs are so different in this position that uniform image brightness is difficult to obtain.

The projection demonstrates a foreshortening of the distal phalanx and a closed DIP joint spaces. How was the part miss positioned?

The thumb was flexed.

How will the position of the first digit change if the hand is flexed for a PA hand projection?

The thumb would move into a lateral projection.

Which anatomic structures are included on an accurately collimated lateral forearm projection?

The wrist and elbow joints and the forearm soft tissue

which anatomic structures are included on an AP forearm projection with accurate positioning?

The wrist and elbow joints and the forearm soft tissue

If the humeral epicondyles are accurately positioned for an AP elbow projection, what other structure can be manipulated to change the degree of radial tuberosity visualization?

The wrist and hand position

The AP proximal forearm demonstrates the ulna without radial head and tuberosity superimposition. How is the patient miss position?

The wrist and hand were accurately positioned, but the elbow was externally rotated.

The projection demonstrates the radial tuberosity in profile anteriorly. How is the patient miss positioned?

The wrist and hand were in external rotation.

The laterally located carpal and MC joints are demonstrated as open spaces, and the medially located carpals and MCs are superimposed, closing the medially located carpal joints. the radioulnar joint is closed, and the radial styloid is not in profile. How was the part miss positioned?

The wrist was externally rotated (in a medial oblique position).

The pisiform is demonstrated anterior to the scaphoid, and the ulna is demonstrated anterior to the radius. How is the patient miss positioned?

The wrist was externally rotated (or supinated).

The trapezoid and trapezium demonstrate slight superimposition, obscuring the trapeziotrapezoidal joint space, and trapezoid-capitate superimposition is minimal. How was the patient miss positioned?

The wrist was in less than a 45-degree external PA oblique projection.

The scaphoid is foreshortened, the lunate is positioned mostly distal to the ulna, the third MC is not aligned with the long axis of the midforearm, and the CM joints are open. How was the part miss positioned?

The wrist was in radial deviation.

The third MC is pointing toward the lateral side of the wrist and the lunate is positioned laterally. How was the patient miss positioned?

The wrist was in radial deviation.

The distal scaphoid is demonstrated distal to the pisiform. How is the patient miss positioned?

The wrist was in ulnar deviation.

The scaphoid is elongated, the lunated is entirely positioned distal to the radius, and the third MC is not aligned with the long axis of the midforearm. How was the part miss positioned?

The wrist was in ulnar deviation.

The laterally located carpals and MCs are superimposed, the pisiform and hamate hook are well demonstrated, and the radioulnar joint is closed. How was the part miss positioned?

The wrist was internally rotated (in a lateral oblique position).

The scaphocapitate and scapholunate joints are closed, and the lunates is superimposed over a portion of the scaphoid. How was the patient miss positioned?

The wrist was medially (externally) rotated more than needed.

How must the fingers be positioned to demonstrate open IP and MCP joints on a PA hand projection?

They must be extended so they are aligned parallel with the IR.

In patients with average-size forearms, the elbow joint is open on a lateral forearm projection. What two patient forearm shapes result in a closed elbow joint space?

Thick or muscular proximal forearm

When the thumb is rotated away from an AP projection, the amount of phalangeal midshaft concavity increases on the side positioned _____(farther from/closer to) the IR.

closer