Procedures Final
When critiquing an average adult PA CXR, what is the minimum number of ribs that should be visualized to ensure adequate inspiration?
10
What CR angle is required for the AP axial, inlet projection?
40 caudad
You have an asthenic patent for a clavicle exam. How many degrees would angle the tube for the axial projection?
30
How much SID is used for a KUB?
40"
Best visualizes bicipital/intertubercular groove
Fisk (Tangential projection)
Best visualizes glenoid cavity with patient in a posterior oblique position with 45° rotation toward IR
Grashey ( AP oblique projection)
Which carpal is better visualized in a PA wrist with radial deviation?
hamate
What anatomy would most likely be demonstrated with the patient is supine, knee flexed 40-45 degrees, CR perpendicular to lower leg, and centered ½ inch distal to apex of patella?
Intercondylar Fossa
Where is the central ray for a KUB?
iliac crest
How much kVp would you most likely use for a shoulder?
75
How much kVp do you use for a KUB?
80
What projection is represented in this image?
Mediolateral
What special projection is described as positioning the patient in posterior 45° obliques (upside and downside) to best visualize acetabulum and ilioiscial/iliopubic column?
judet method
What does KUB stand for?
kidneys, ureters, bladder
What projections are required for a clavicle exam?
AP and axial
What special wrist projection would best demonstrate the posterior (or dorsal) aspect of the carpal bones?
Carpal Bridge (Tangential projection)
What vertebral level is the xiphoid process?
T10
You have a patient for an elbow exam and he/she cannot straighten their arm. It is bent at about 45 degrees. How do you perform the AP elbow?
Take two images: one with the forearm parallel to the IR and one with the humerus parallel to the IR
How much angle do you use on an AP projection of the knee for an average patient size?
no angle
Greater tubercle is anterior but still lateral to lesser tubercle
no rotation
If a patient is unable to separate their toes when positioning for a toe exam, what can you do to assist in proper positioning?
Use tape to separate toes.
If a person accidentally inhales a food particle, which bronchus is it most likely to enter?
right
A radiograph of an AP pelvis reveals that the left obturator foramen is more open or elongated as compared with the right. What is the specific positioning error present on this radiograph?
right rotation
Which carpal is most frequently fractured?
scaphoid
What anatomy is visualized with an internal (medial) oblique elbow projection?
trochlea & coronoid process
T/F: Approximately half of the patella should be seen free of superimposition by the femur in an AP oblique projection of the knee.
true
T/F: Shielding is appropriate for all upper extremity exams.
true
T/F: Shielding the patient is appropriate for lower extremity exams.
true
T/F: The lateral malleolus is about 15° more posterior to the medial malleolus.
true
Why do we perform an AP forearm in the AP position versus the PA position?
The radius and ulna are crossing or overlapping in the PA position
Greater tubercle is lateral in profile
external rotation
T/F: Grids are typically used for toes, foot, ankle and tib/fib exams.
false
T/F: The proximal tibiofibular joint should not be open in an AP oblique projection of the knee with medial rotation (internal rotation).
false
Requires a patient rotation of 45-60, medial & lateral borders of scapula are superimposed
"Y" view
How many bones are in the appendicular skeleton?
126
For an AP proximal femur, the required amount of degree rotation of the affected leg for a true AP is______.
15-20
How many degrees do you rotate the leg/foot for an AP mortise projection of the ankle?
15-20
How many projections are required when imaging a joint?
3
How many degrees and what direction do you angle for a lateral knee on an average sized patient that is recumbent and on the table?
5-7, cephalic
Which bone of the foot has a prominent tuberosity that is frequently fractured?
5th metatarsal
What does ALARA stand for?
As Low As Reasonably Achievable
You are about to perform AC joints on a patient and you notice the patient has broad shoulders and will not fit at 72". How should you perform this exam?
Bring the SID into 40" and take four images
What is the name of a transverse fracture of the distal radius with the distal fragment displaced posteriorly?
Colles' Fracture
A radiograph of a PA oblique of the hand reveals that the midaspect of the fourth and fifth metacarpals are superimposed. What specific positioning error has been committed?
Excessive rotation of the hand and/or wrist
Visualizes the glenoid cavity but with an additional 45 degree caudad angle directed towards the scapulohumeral joint
Garth (AP axial oblique axial)
If you overexpose an image, what adjustments would you make so that it's the correct exposure?
Go down in technique
What vertebral level is the iliac crest?
L4
Patient is supine with affected arm abducted 90 degrees and externally rotated with CR directed at axilla
Lawrence (inferiorsuperior axial projection)
You performed a Leg (Tib/Fib) exam and the distal portion of the leg is clipped on both views. What should you do for the AP and Lateral to ensure all the anatomy is present?
Obtain collimated views of the AP and Lateral ankle.
What anatomy would most likely be demonstrated if the patient is supine with knee flexed 40-45 degrees and the central ray is directed inferior-superiorly at 10-15 degrees from lower leg?
Patella in "sunrise" position
A patient has an obvious wrist deformity and they are unable to move their arm for a lateral position. How you would perform the lateral wrist?
Perform a x-table (horizontal beam) of the wrist, with minimal patient movement.
A patient comes into the ER with an obvious fractured right femur. They are unable to move their right leg, but they can move their left leg very well. The ER physician would like you to perform a right femur exam. How would perform the lateral proximal portion of the femur if the patient cannot turn on their side?
Perform a xtable lateral with the unaffected leg raised.
You have an order for a forearm on a 2 year old and the father is staying in the room to help immobilize the arm. What should you consider before making the exposure?
Position the father's hands so that they are not exposed in the image when immobilizing the arm
Why is the right kidney usually lower in the abdomen than the left kidney?
Presence of the liver
What position describes the patient in this position?
RAO
What area of the elbow is elongated in an axial lateromedial projection with a 45 degree tube angle directed proximally?
Radial Head
What is name of the two small depressions found on the anterior aspect of the distal humerus?
Radial and coronoid fossa
In which of the four major quadrants of the abdomen would the appendix be found?
Right lower quadrant
Why is the routine for a lateral CXR performed with the left side up against the IR versus the right?
The heart will be magnified/larger if performed as a right lateral.
Why should the CR and IR be lowered for a lateral CXR?
There is an increase in OID, therefore the costophrenic angles will project lower
What position is the hand when the radial tuberosity (tubercle) is seen posteriorly, adjacent to the ulna?
Thumb down/hand with maximal internal rotation
You are performing an AP Pelvis and the patient's pelvis is rotated. You try rotating them to a true AP, but they keep rotating back to the original rotated pelvis position. What is your next option to ensure you achieve a true AP?
Use a radiolucent sponge under the pelvis to support and rotate the patient in a true AP
A patient indicates that they are 12 weeks pregnant and your requisition/order says you must perform an AP Pelvis. What should you do?
Verify with the Technologist and/or physician that the patient is pregnant to make sure the order is needed
In a lateral Scapula projection, what structure of the scapula is best demonstrated when the affected arm is reaching across the chest?
body
What is clinical indication for a KUB?
bowel obstruction
What is the largest carpal bone?
capitate
What special projection is described as a Modified Axiolateral for patient who has limited movement in both lower limbs?
clements-makayama method
One way to decrease dose to the pt
collimation
What is a reason to why a CXR should be taken erect?
diaphragm can move further down, prevent engorgement of vessels, & visualize air fluid levels
What is the mobility classification of the three joints that makeup the shoulder girdle?
diarthroidal
What mobility type is considered for the majority of the joints in the lower leg?
diarthroidal
What are the three cardinal principles for radiation safety?
distance, shielding, time
What best describes the sagittal plane of the body?
divided into right and left sections
To place the lower leg and foot in a 90 degree angle at the ankle joint, what motion is required?
dorsiflexion
What positioning considerations are crucial when imaging a lateral forearm or elbow?
elbow and shoulder should be in the same plane, elbow is bent at a 90 degree angle, epicondyles are perpendicular to the IR
What type of respiration should be employed during the exposure for a KUB?
expiration
What position describes the head higher than the feet?
fowler
Which of the following structures is not part of the proximal humerus? - glenoid process - lesser tubercle - intertubercular groove - anatomic neck
glenoid process
What is the best way to perform AC joints supine?
have the pt hold onto gauze or a sheet with knees bent, then slowly straighten legs
Why is the arm abducted for an AP scapula projection?
it moves the scapula away from thoracic structures
What region is the bladder located?
hypogastric
Lesser tubercle is medial profile
internal rotation
Which bones fuse to form the acetabulum?
ischium, pubis, ilium
Which projection would you be able to shield all of the gonadal region? AP Pelvis Lateral Distal Femur AP Proximal Femur Inlet or Outlet
lateral distal femur
A radiograph of an AP pelvis reveals that the right iliac wing is foreshortened as compared with the left side. What specific positioning problem is present on this radiograph?
left rotation
The internal rotation of the long axis of the feet and lower limbs 15-20 degrees will demonstrate the _________.
lesser trochanters not visible/slightly visible
What should be perpendicular to the CR when performing an AP chest in a cart or wheelchair?
long axis of the sternum
Which of the following would best describe a breathing technique that could be used for an AP scapula or a transthoracic lateral humerus projection?
low mA, high seconds
A narrower, acute angle of pubic arch and more oval/heart-shape of inlet describes the general shape of a ___________ pelvis.
male
Regarding the anatomy of the knee, why is it important to angle the x-ray tube 5-7 degrees for a lateral knee?
medial condyle is longer
What oblique of the foot will best demonstrate the space between first and second metatarsals and between first and second cuneiforms?
medial oblique
What plane is parallel to the IR for a lateral CXR?
mid sagittal
On expiration, where is the diaphragm located?
more superior than normal
What is a clinical indication of a CXR?
pneumothorax
What muscle should be demonstrated on a well-exposed abdomen projection on an average size patient?
psoas major
Where in the peritoneum are the kidneys located?
retroperitoneal
How can you tell if a KUB is rotated?
spinous processes are not centered, obturator foramina are not synthetic, iliac wings are not symmetric
Which term describes the medial end of the clavicle?
sternal extremity
Which is the most inferior positioning landmark on the abdomen/pelvis that is typically not palpated?
symphisis pubis
What three bones make up the ankle joint?
tibia, fibula, talus
Is it appropriate to shield for shoulder girdle exams?
yes
