Registry ch 2 A&L

1. The term valgus refers to (A) turned outward (B) turned inward (C) rotated medially (D) rotated laterally

1. (A) The term valgus refers to a part turned/deformed outward —as in hallux valgus and talipes valgus. Hallux valgus is angulation of the great toe away from the midline; talipes valgus is a foot deformity with the heel turned outward—a component of clubfoot. The term varus refers to bent or turned inward . In genu varus, the tibia or femur turns inward causing bowlegged deformity; in talipes varus, the foot turns inward (clubfoot deformity).

100. Which of the following statements is/are true regarding the shoulder image seen in Figure 2-18 ? 1. The unaffected arm is adjacent to the IR 2. It provides a lateral view 3. It is useful in trauma situations (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

100. (C) The image is a transthoracic lateral projection of the proximal humerus, most often used to in trauma situations. The affected humerus is adjacent to the image receptor, the unaffected arm is elevated. The proximal humerus and shoulder joint are projected and visualized through the thorax. The unaffected shoulder is elevated as much as possible to avoid superimposition on the affected shoulder. If sufficient elevation of the unaffected shoulder is not possible, the CR can be directed cephalad 10°-15°. The use of "breathing technique" can further improve visualization of the proximal humerus, as seen in the current image.

10. An accurate critique of the PA projection of the chest seen in Figure 2-3 would include the following: 1. the pulmonary apices are demonstrated 2. the air-filled trachea and carina are demonstrated 3. ten posterior ribs are seen above the diaphragm (A) 1 only(B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

10. (D) The figure illustrates a PA projection of the chest. This projection demonstrates the air-filled trachea, the carina at the bifurcation of the trachea, the lungs from apices to costophrenic angles, both hemidiaphragms, the heart and aortic arch. The shoulders have been rolled forward to effectively remove the scapulae from the lung fields. Adequate inspiration is demonstrated by visualization of 10 posterior ribs above the diaphragm (see numbered ribs in Fig. 2-45 ).

11. A pacemaker electrode can be introduced through a vein in the chest or upper extremity, and advanced to the (A) left atrium (B) right atrium (C) left ventricle (D) right ventricle

11. (D) Pacemakers are electromechanical devices that help to regulate the heart rate. They consist of a pulse generator connected to a lead that has an electrode at its tip. The lead is introduced under fluoroscopic guidance into the subclavian vein, then often moved to the right atrium, and then positioned at the apex of the right ventricle.

101. Elements of correct positioning for PA projection of the chest include 1. weight evenly distributed on feet 2. elevation of the chin 3. shoulders elevated and rolled forward (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

101. (B) To avoid the possibility of rotation, weight should be evenly distributed on the feet. The chin should be elevated/extended in order to prevent its superimposition on pulmonary apices. The shoulders should be depressed and rolled forward in order to remove the scapula from the lung fields. In addition, in the case of large pendulous breasts, the patient should be requested to lift and move them laterally before leaning against the upright mechanism. The well-positioned PA chest should demonstrate scapulae away from lung fields, medial aspect of sternoclavicular joints equidistant from lateral aspect of adjacent vertebra, chin elevated away from lung apices, and inspiration adequate to demonstrate 10 posterior ribs.

102. Which of the following conditions is often the result of ureteral obstruction or stricture? (A) Pyelonephrosis (B) Nephroptosis (C) Hydronephrosis (D) Cystourethritis

102. (C) Hydronephrosis is a collection of urine in the renal pelvis owing to obstructed outflow, such as from a stricture or obstruction. If the obstruction occurs at the level of the bladder or along the course of the ureter, it will be accompanied by the condition of hydroureter above the level of obstruction. These conditions may be demonstrated during IVU. The term pyelonephrosis refers to some condition of the renal pelvis. Nephroptosis refers to drooping or downward displacement of the kidneys. This may be demonstrated using the erect position during IVU. Cystourethritis is inflammation of the bladder and urethra.

103. Important considerations for radiographic examinations of traumatic injuries to the upper extremity include 1. the joint closest to the injured site should be supported during movement of the limb 2. both joints must be included in long bone studies 3. two views, at 90° to each other, are required (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

103. (C) All traumatic injuries require the radiographer to be particularly alert and observant. Patient status must be observed and monitored continually. The radiographer must speak calmly to the patient, explaining the procedure even if the patient appears unconscious or unresponsive. In the case of an injured limb, both joints must be supported if any movement is required. Both joints also must be included when examining long bones. The injured limb need not be placed in exact AP and lateral positions, but any two views of the part at right angles to each other must be obtained.

104. All the following statements regarding large bowel radiography are true, except (A) the large bowel must be completely empty prior to examination (B) retained fecal material can obscure pathology (C) single-contrast studies help to demonstrate intraluminal lesions (D) double-contrast studies help to demonstrate mucosal lesions

104. (C) Perhaps the most important prerequisite to a successful BE examination is a thoroughly clean large bowel. Any retained fecal material can simulate or obscure pathology. A single-contrast examination demonstrates the anatomy and contour of the large bowel, as well as anything that may project out from the bowel wall (e.g., diverticula). In a double-contrast examination, the bowel wall ( mucosa ) is coated with barium, and then the lumen is filled with air. This enables visualization of any intraluminal lesions such as polyps and tumor masses.

105. In a lateral projection of the normal knee, the 1. fibular head should be somewhat superimposed on the proximal tibia 2. patellofemoral joint should be visualized 3. femoral condyles should be superimposed (A) 1 only (B) 2 only (C) 1 and 3 only (D) 1, 2, and 3

105. (D) To better visualize the joint space in the lateral projection of the knee, 20°-30° of flexion is recommended. The femoral condyles are superimposed so as to demonstrate the patellofemoral joint and the articulation between the femur and the tibia. The head of the fibula will be slightly superimposed on the proximal tibia. The correct degree of forward or backward body rotation is responsible for visualization of the patellofemoral joint. Cephalad tube angulation of 5°-7° is responsible for demonstrating the articulation between the femur and the tibia (by removing the magnified medial femoral condyle from superimposition on the joint space).

106. All elbow fat pads are best demonstrated in which position? (A) AP (B) Lateral (C) Acute flexion (D) AP partial flexion

106. (B) There are three important fat pads associated with the elbow. The anterior fat pad is located just anterior to the distal humerus. The posterior fat pad is located within the olecranon fossa at the distal posterior humerus. The supinator fat pad/stripe is located at the proximal radius just anterior to the head, neck, and tuberosity. The posterior fat pad is not visible radiographically in the normal elbow. All three fat pads can be demonstrated only in the lateral projection of the elbow.

107. The term used to describe the presence of blood in vomit is (A) hemoptysis (B) hematemesis (C) chronic obstructive pulmonary disease (COPD) (D) bronchitis

107. (B) Hematemesis is the presence of blood in vomit—this can occur with gastric ulcers, gastritis, esophageal varices, and other conditions. The expectoration of blood from the larynx, trachea, bronchi, or lungs is termed hemoptysis. Hemoptysis can occur in several diseases, including pneumonia, bronchitis, pulmonary tuberculosis, and others.

108. Double-contrast examinations of the stomach or large bowel are performed to better visualize the (A) position of the organ (B) size and shape of the organ (C) diverticula (D) gastric or bowel mucosa

108. (D) Double-contrast studies of the stomach or large intestine involve coating the organ with a thin layer of barium sulfate and then introducing air. This allows the operator to see through the organ to structures behind it and, most especially, allows visualization of the mucosal lining of the organ. A barium-filled stomach or large bowel demonstrates the position, size, and shape of the organ and any lesion that projects out from its walls, such as diverticula. Polypoid lesions, which project inward from the wall of an organ, may go unnoticed unless a double-contrast examination is performed.

109. Which position of the shoulder demonstrates the lesser tubercle in profile medially? (A) AP (B) External rotation (C) Internal rotation (D) Neutral position

109. (C) The external rotation position is the true AP position and places the greater tubercle in profile laterally and places the lesser tubercle anteriorly. The internal rotation position demonstrates the lesser tubercle in profile medially and places the humerus in a true lateral position; the greater tubercle is seen superimposed on the humeral head. The epicondyles should be superimposed and perpendicular to the IR. The neutral position places the epicondyles about 45° to the IR and places the greater tubercle anteriorly but still lateral to the lesser tubercle.

110. In the PA projection of the hand seen in Figure 2-19 , which numeral identifies the head of the fifth metacarpal? (A) 3 (B) 4 (C) 5 (D) 6

110. (B) A PA projection of the hand is seen with seven anatomical features illustrated. Number 1 indicates the triquetrum; number 2 is the pisiform; number 3 is the base of the fifth metacarpal; number 4 is the head of the fifth metacarpal; number 5 is the fifth metacarpophalangeal joint; number 6 is the fifth proximal interphalangeal joint; number 7 is the fifth distal interphalangeal joint.

111. In which position of the shoulder is the greater tubercle seen superimposed on the humeral head? (A) AP (B) External rotation (C) Internal rotation (D) Neutral position

111. (C) The external rotation position is the true AP position and places the greater tubercle in profile laterally and places the lesser tubercle anteriorly. The internal rotation position demonstrates the lesser tubercle in profile medially and places the humerus in a true lateral position; the greater tubercle is seen superimposed on the humeral head. The epicondyles should be superimposed and perpendicular to the IR. The neutral position places the epicondyles about 45° to the IR and places the greater tubercle anteriorly but still lateral to the lesser tubercle.

112. With the patient positioned as illustrated in Figure 2-20 , which of the following structures is best demonstrated? (A) Patella (B) Patellofemoral articulation (C) Intercondyloid fossa (D) Tibial tuberosity

112. (C) The PA axial projection (Camp-Coventry method) of the intercondyloid fossa (tunnel view) is shown. The knee is flexed about 40°, and the CR is directed caudally 40° and perpendicular to the tibia ( Fig. 2-57 ). The patella and patellofemoral articulation are demonstrated in the axial/tangential view of the patella.

113. Which of the following structures is illustrated by the number 2 in Figure 2-21 ? (A) Maxillary sinus (B) Coronoid process (C) Zygomatic arch (D) Coracoid process

113. (C) The parietoacanthial projection (Waters' method) demonstrates a distorted view of the frontal and ethmoidal sinuses. The maxillary sinuses (number 4) are well demonstrated, projected free of the petrous pyramids. This is also the best single position for the demonstration of facial bones. The mandibular angle is illustrated by the number 1, the zygomatic arch by number 2, and the coronoid process by number 3.

114. Which of the following articulations may be described as diarthrotic? 1. Condyloid 2. Sellar 3. Gomphosis (A) 1 only (B) 3 only (C) 1 and 2 only (D) 1, 2, and 3

114. (C) Diarthrotic, or synovial, joints are freely movable. Most diarthrotic joints are associated with a joint capsule containing synovial fluid. Diarthrotic joints are the most numerous in the body and are subdivided according to the type of movement. Classifications of diarthrotic joints include plane/gliding, trochoid/pivot, ginglymus/hinge, spheroid/ball and socket, ellipsoid/condyloid, sellar/saddle, and bicondylar/modified hinge. Amphiarth rotic (cartilaginous) joints are partially movable joints whose articular surfaces are connected by cartilage, such as intervertebral joints. Synarthrotic fibrous joints, such as the cranial sutures and gomphosis (roots of teeth), are immovable.

115. Which of the following carpal(s) is best demonstrated by ulnar flexion/deviation? 1. Medial carpals 2. Lateral carpals 3. Scaphoid (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

115. (C) The carpal scaphoid is somewhat curved and consequently foreshortened radiographically in the PA position. To better separate it from the adjacent carpals, the ulnar flexion (ulnar deviation) maneuver is used frequently. In addition to correcting foreshortening of the scaphoid, ulnar flexion/deviation opens the interspaces between adjacent lateral carpals. Radial flexion/deviation is used to better demonstrate medial carpals.

116. What should be done to better demonstrate the coracoid process shown in Figure 2-22 ? (A) Use a perpendicular CR (B) Angle the CR about 30° cephalad (C) Angle the CR about 30° caudad (D) Angle the MSP 15° toward the affected side

116. (B) The figure shows an AP projection of the shoulder. A plane passing through the epicondyles is parallel to the IR (and perpendicular to the CR). To project the coracoid process with less self-superimposition, the CR must be angled cephalad 15°. The amount of cephalad angulation depends on the degree of thoracic kyphosis; the greater the degree of kyphosis, the greater is the degree of cephalad angulation required. A 30° angle is used for the average patient.

117. Structures comprising the neural, or vertebral, arch include 1. pedicles 2. laminae 3. body (A) 1 only (B) 1 and 2 only (C) 2 and 3 only

117. (B) The typical vertebra has a body and a neural/vertebral arch surrounding the vertebral foramen ( Fig. 2-58 ). The neural arch is composed of two pedicles and two laminae that support four articular processes, two transverse processes, and one spinous process. The pedicles are short, thick processes extending back from the posterior aspect of the vertebral body, each one sustaining a lamina. The laminae extend posteriorly to the midline and join to form the spinous process. Each pedicle has notches superiorly and inferiorly (superior and inferior vertebral notches) that—with adjacent vertebrae—form the intervertebral foramina, through which the spinal nerves pass. The neural arch also has lateral transverse processes for muscle attachment and superior and inferior articular processes for the formation of zygapophyseal joints (classified as diarthrotic). The vertebral column permits flexion, extension, and lateral and rotary motions through its various articulations.

118. In which type of fracture are the splintered ends of bone forced through the skin? (A) Closed (B) Compound (C) Compression (D) Depressed

118. (B) The type of fracture in which the splintered ends of bone are forced through the skin is a compound fracture. In a closed fracture, no bone protrudes through the skin. Compression fractures are seen in stressed areas, such as the vertebrae. A depressed fracture would not protrude but rather would be pushed in.

119. The thoracic zygapophyseal joints are demonstrated with the (A) coronal plane 90° to the IR (B) midsagittal plane 90° to the IR (C) coronal plane 20° to the IR (D) midsagittal plane 20° to the IR

119. (D) The thoracic zygapophyseal joints are demonstrated in an oblique position with the coronal plane 70° to the IR (MSP 20° to the IR). This may be accomplished by first placing the patient lateral and then obliquing the patient 20° "off lateral." The zygapophyseal joints closest to the IR are demonstrated in the PA oblique projection and those remote from the IR in the AP oblique projection. Comparable detail is obtained using either method because the OID is about the same. The thoracic intervertebral foramina are demonstrated in the lateral projection. This places the MSP of the patient parallel to the IR, and the coronal plane perpendicular to the IR.

12. Which of the following conditions is characterized by "flattening" of the hemidiaphragms? (A) Pneumothorax (B) Pleural effusion (C) Emphysema (D) Pneumonia

12. (C) Chest radiographs demonstrating emphysema will show the characteristic irreversible trapping of air that increases gradually and overexpands the lungs. This produces the characteristic "flattening" of the hemidiaphragms and widening of the intercostal spaces. The increased air content of the lungs requires a compensating decrease in technical factors. Pneumonia is inflammation of the lungs, usually caused by bacteria, virus, or chemical irritant. Pneumothorax is a collection of air or gas in the pleural cavity (outside the lungs), with an accompanying collapse of the lung. Pleural effusion is excessive fluid between the parietal and visceral layers of pleura.

120. Which of the following is/are recommended in order to reduce the amount of scattered radiation reaching the IR in CR/DR imaging of the lumbosacral region? 1. Close collimation 2. Lead mat on table posterior to the patient 3. Decreased SID (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

120. (B) Electronic imaging (CR and DR) uses highly sensitive image-capture devices. Consideration must be given to the SR emerging from the patient and striking the IR. To reduce the amount of SR that reaches the IR, the x-ray beam should be tightly collimated, and a lead mat should be placed on the x-ray table just posterior to the patient's lumbosacral area. The x-ray photons that would have extended posterior to the patient's skin and simply struck the x-ray table—causing increased SR to reach the IR—will be absorbed by the lead mat. The SID is unrelated to scattered radiation production.

121. The long, flat structures that project posteromedially from the pedicles are the (A) transverse processes (B) vertebral arches (C) laminae (D) pedicles

121. (C) The typical vertebra has two parts: the body and the vertebral arch. The body is the dense, anterior bony mass. Posteriorly attached is the vertebral arch, a ring-like structure. The vertebral arch is formed by two pedicles (short, thick processes projecting posteriorly from the body) and two laminae (broad, flat processes projecting posteriorly and medially from the pedicles).

122. Which type of ileus is characterized by cessation of peristalsis? (A) Mechanical (B) Paralytic (C) Asymptomatic (D) Sterile

122. (B) Obstruction of the small bowel is termed ileus; there are two types of ileus: paralytic/adynamic and mechanical. Paralytic or adynamic ileus is characterized by an absence of peristalsis. This can be caused by infection (e.g., appendicitis or peritonitis) or postoperative difficulty. Mechanical ileus is caused by some sort of physical obstruction such as tumor or adhesions.

123. The projection/method often used to detect carpal canal defect is (A) PA projection wrist, radial deviation (B) PA axial projection wrist, Stecher method (C) AP oblique hands/Norgaard method (D) tangential projection wrist, Gaynor-Hart method

123. (D) The tangential projection of the wrist, Gaynor-Hart method demonstrates the carpal canal and several carpals/portions of carpals. This position can be used to evaluate compression of median nerve and to detect carpal fractures. AP oblique hands/Norgaard method, often referred to as the ball-catcher's position, is used to detect evidence of early rheumatoid arthritis. Radial deviation of the wrist is used to demonstrate medial carpals and their articulations. The PA axial projection wrist, Stecher method, is used to demonstrate scaphoid fracture.

124. Narrowing of the upper airway, as seen in pediatric croup, can be best visualized in the (A) AP projection (B) lateral projection (C) axial projection (D) lordotic projection

124. (A) Croup is a viral infection generally seen in children 1-3 years of age. It is characterized by a dry cough, sometimes accompanied by fever. Soft-tissue projections of the neck are frequently used to evaluate the upper airway. Narrowing of the upper airway is best demonstrated in the AP projection.

125. Which of the following statements is/are correct with respect to the images shown in Figure 2-23 ? 1. Image A was made with cephalad angulation 2. Image B was made with caudal angulation 3. Images A and B were made with CR 15° cephalad (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

125. (B) There are five fused sacral vertebrae; the fused transverse processes form the alae. The anterior and posterior sacral foramina transmit spinal nerves. The sacrum articulates superiorly with the fifth lumbar vertebra, forming the L5-S1 articulation, and inferiorly with the coccyx , forming the sacrococcygeal joint. The sacrum curves posteriorly and inferiorly, whereas the coccyx curves anteriorly ; thus, they require different tube angles to "open them up." Image A demonstrates an AP axial projection of the sacrum with CR angulation of 15° cephalad . Image B is an AP axial projection of the coccyx using the required 10° caudal CR angle.

126. Which body habitus type is characterized by a short and wide heart and lung area and a high transverse stomach? (A) Asthenic (B) Hyposthenic (C) Sthenic (D) Hypersthenic

126. (D) The four types of body habitus describe differences in visceral shape, position, tone, and motility. One body type is hypersthenic, characterized by the very large individual with short and wide heart and lungs, and high transverse stomach. The hyperstatic habitus also has a high horizontal gallbladder and peripheral colon. The sthenic individual is the average, athletic, most predominant type. The hyposthenic patient is somewhat thinner and a little frailer, with organs positioned somewhat lower. The asthenic type is smaller in the extreme, with a long thorax, a very long, almost pelvic stomach, and a low medial gallbladder. The colon is medial and redundant. Hypersthenic patients usually demonstrate the greatest motility.

127. Which of the following should be performed to rule out subluxation or fracture of the cervical spine? (A) Oblique cervical spine, seated (B) AP cervical spine, recumbent (C) Horizontal beam lateral (D) Laterals in flexion and extension

127. (C) When a cervical spine radiograph is requested to rule out subluxation or fracture, the patient will arrive in the radiology area on a stretcher. The patient should not be moved before a subluxation is ruled out. Any movement of the head and neck could cause serious damage to the spinal cord. A horizontal beam lateral projection is performed and evaluated. The physician then will decide what further images are required.

128. Structures located proximal to the carpal bones include (A) distal interphalangeal joints (B) proximal interphalangeal joints (C) metacarpals (D) radial styloid process

128. (D) The term proximal refers to structures closer to the point of attachment. For example, the elbow is described as being proximal to the wrist; that is, the elbow is closer to the point of attachment (the shoulder) than is the wrist. Referring to the question, then, the interphalangeal joints (both proximal and distal) and the metacarpals are both distal to the carpal bones. The radial styloid process is proximal to the carpals.

129. The following statements regarding the scapular Y projection of the shoulder is/are true: 1. the midsagittal plane should be about 60° to the IR 2. the scapular borders should be superimposed on the humeral shaft 3. an oblique projection of the shoulder is obtained (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

129. (C) The scapular Y projection requires that the coronal plane be about 60° to the IR (MSP is about 30°), thus resulting in an oblique projection of the shoulder. The vertebral and axillary borders of the scapula are superimposed on the humeral shaft, and the resulting relationship between the glenoid fossa and humeral head will demonstrate anterior or posterior dislocation. Lateral or medial dislocation is evaluated on the AP projection.

13. Structures located in the right lower quadrant (RLQ) include the following: 1. cecum 2. vermiform appendix 3. sigmoid (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

13. (B) The cecum is a blind pouch located at the most proximal (first) portion of the large intestine. Extending from the lower end of the cecum is the wormlike vermiform appendix. The cecum and the vermiform appendix are both located in the right lower quadrant (RLQ). The sigmoid colon is located in the left lower quadrant (LLQ) .

130. The following position is used to demonstrate the lumbosacral zygapophyseal articulation: (A) AP (B) lateral (C) 30° RPO (D) 45° LPO

130. (C) The articular facets (zygapophyseal joints) of the L5-S1 articulation form a 30° angle with the MSP; they are, therefore, well demonstrated in a 30° oblique position. The 45° oblique position demonstrates the zygapophyseal joints of L1-L4.

131. The most proximal portion of the pharynx is the (A) laryngopharynx (B) nasopharynx (C) epiglottis (D) oropharynx

130. (C) The articular facets (zygapophyseal joints) of the L5-S1 articulation form a 30° angle with the MSP; they are, therefore, well demonstrated in a 30° oblique position. The 45° oblique position demonstrates the zygapophyseal joints of L1-L4.

132. With the patient's head in a PA position and the CR directed 20° cephalad, which part of the mandible will be best visualized? (A) Symphysis (B) Rami (C) Body (D) Angle

132. (B) With the patient in the PA position, the rami are well visualized with a perpendicular ray or with 20°-25° of cephalad angulation. A portion of the mandibular body is demonstrated in this position, but most of it is superimposed over the cervical spine.

133. During IV urography, the prone position is generally recommended to demonstrate 1. ureteral filling 2. the renal pelvis 3. superior calyces (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

133. (B) The kidneys lie obliquely in the posterior portion of the trunk with their superior portion angled posteriorly and their inferior portion and ureters angled anteriorly. Therefore, to facilitate filling of the most anteriorly placed structures, the patient is examined in the prone position. Opacified urine then flows to the most dependent part of the kidney and ureter— the ureteropelvic region, inferior calyces, and ureters.

134. The plane passing vertically through the body and dividing it into anterior and posterior halves is the (A) median sagittal plane (MSP) (B) midcoronal plane (C) sagittal plane (D) transverse plane

134. (B) The median sagittal, or midsagittal, plane (MSP) passes vertically through the midline of the body, dividing it into left and right halves. Any plane parallel to the MSP is termed a sagittal plane. The midcoronal plane is perpendicular to the MSP and divides the body into anterior and posterior halves. A transverse plane passes through the body at right angles to a sagittal plane. These planes, especially the MSP, are very important reference points in radiographic positioning ( Fig. 2-59 ).

135. To demonstrate a profile view of the glenoid fossa, the patient is AP recumbent and obliqued 45° (A) toward the affected side (B) away from the affected side (C) with the arm at the side in the anatomic position (D) with the arm in external rotation

135. (A) In an AP projection of the shoulder, there is superimposition of the humeral head and glenoid fossa. With the patient obliqued 45° toward the affected side, the glenohumeral joint is open, and the glenoid fossa is seen in profile. The patient's arm is abducted somewhat and placed in internal rotation.

136. The number 2 in Figure 2-24 indicates (A) body of L2 (B) spinous process of L1 (C) spinous process of L3 (D) transverse process of L3

136. (B) The radiograph shown illustrates an AP projection of the lumbar spine. The intervertebral disk spaces (number 3) are well visualized because the patient's knees were flexed with feet flat on the table. Number 2 points out the body/spinous process of the first lumbar vertebrae; number 4 is the transverse process of L3. Number 1 indicates the right 12th rib. Number 5 indicates the well-defined margins of the psoas muscle.

137. During an air-contrast BE, in what part of the colon is air most likely to be visualized in the AP recumbent position? (A) Transverse colon (B) Descending colon (C) Ascending colon (D) Left and right colic flexures

137. (A) During a double-contrast BE, barium and air will distribute themselves according to the position of parts of the colon within the body and according to body position. When the body is in the AP recumbent position, the most anterior structures will be air filled. Anterior structures include the transverse colon and a portion of the sigmoid colon. Both flexures would be air filled in the erect position.

138. Central ray angulation may be required for 1. magnification of anatomic structures 2. foreshortening or self-superimposition 3. superimposition of overlying structures (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

138. (C) If structures are overlying or underlying the area to be demonstrated (e.g., the medial femoral condyle obscuring the joint space in the lateral knee projection), CR angulation is used (e.g., 5° cephalad angulation to see the joint space in the lateral knee). If structures are likely to be foreshortened or self-superimposed (e.g., the scaphoid in a PA wrist), CR angulation may be used to place the structure more closely parallel with the IR.. Another example is the oblique cervical spine, where cephalad or caudad angulation is required to "open" the intervertebral foramina. Magnification is controlled by object-to-image-receptor distance (OID) and SID; it is unrelated to CR angulation.

146. A kyphotic curve is formed by which of the following? 1. Sacral vertebrae 2. Thoracic vertebrae 3. Lumbar vertebrae (A) 1 only (B) 1 and 2 only (C) 3 only (D) 1 and 3 only

146. (B) The lordotic curves are secondary curves; that is, they develop sometime after birth. The cervical and lumbar vertebrae form lordotic curves. The thoracic and sacral vertebrae exhibit the primary kyphotic curves, those that are present at birth.

139. Which of the following is recommended to better demonstrate the tarsometatarsal joints in a dorsoplantar projection of the foot? (A) Invert the foot (B) Evert the foot (C) Angle the CR 10° posteriorly (D) Angle the CR 10° anteriorly

139. (C) In the dorsoplantar projection of the foot, the CR may be directed perpendicularly or angled 10° posteriorly. Angulation serves to "open" the tarsometatarsal joints that are not well visualized on the dorsoplantar projection with perpendicular ray. Inversion and eversion of the foot do not affect the tarsometatarsal joints.

14. Which of the following statements regarding Figure 2-4 is correct? (A) The right kidney is more parallel to the IR (B) The image was made in the LPO position (C) The right ureter is better visualized (D) The image was made post-void

14. (C) The image shown is one of a series of IVU images taken 15 min after injection of the contrast medium. The urinary collecting system is well demonstrated. An RPO position is illustrated, with the right marker indicating the right side; also, the right ilium is more "open" (i.e., parallel to the IR) than the left. The RPO position places the left kidney and right ureter parallel to the IR. The urinary bladder contains considerable contrast, indicating that it is most likely a pre void image.

140. Valid evaluation criteria for a lateral projection of the forearm require that 1. the epicondyles be parallel to the IR 2. the radius and ulna be superimposed distally 3. the radial tuberosity should face anteriorly (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

140. (C) To accurately position a lateral forearm, the elbow must form a 90° angle with the humeral epicondyles perpendicular to the IR and superimposed. The radius and ulna are superimposed distally. Proximally, the coronoid process and radial head are superimposed, and the radial head faces anteriorly. Failure of the elbow to form a 90° angle or the hand to be lateral results in a less than satisfactory lateral projection of the forearm.

141. Which of the following positions will provide an AP projection of the L5-S1 interspace? (A) Patient AP with 30°-35° angle cephalad (B) Patient AP with 30°-35° angle caudad (C) Patient AP with 0° angle (D) Patient lateral, coned to L5

141. (A) The routine AP projection of the lumbar spine demonstrates the intervertebral disk spaces between the first four lumbar vertebrae. The space between L5 and S1, however, is angled with respect to the other disk spaces. Therefore, the CR must be directed 30°-35° cephalad to parallel the disk space and thus project it open onto the IR.

142. Subject/object unsharpness can result from all of the following, except when (A) object shape does not coincide with the shape of x-ray beam (B) object plane is not parallel with x-ray tube and/or IR (C) anatomic object(s) of interest is/are in the path of the CR (D) anatomic object(s) of interest is/are at a distance from the IR

142. (C) A certain amount of object unsharpness is an inherent part of every radiographic image because of the position and shape of anatomic structures within the body. Structures within the three-dimensional human body lie in different planes . In addition, the three-dimensional shape of solid anatomic structures rarely coincides with the shape of the divergent beam. Consequently, some structures are imaged with more inherent distortion than others, and shapes of anatomic structures can be entirely misrepresented. Structures farther from the IR will be distorted (i.e., magnified ) more than those closer to the IR; structures closer to the x-ray source will be distorted (i.e., magnified) more than those farther from the x-ray source. For the shape of anatomic structures to be accurately recorded, the structures must be parallel to the x-ray tube and the IR, and aligned with the central ray (CR). The shape of anatomic structures lying at an angle within the body or placed away from the CR will be misrepresented on the IR. There are two types of shape distortion. If a linear structure is angled within the body, that is, not parallel with the long axis of the part/body and not parallel to the IR, then that anatomic structure will appear smaller —it will be foreshortened . On the other hand, elongation occurs when the x-ray tube is angled. Image details placed away from the path of the CR will be exposed by more divergent rays, resulting in rotation distortion . This is why the CR must be directed to the part of greatest interest. Unless the edges of a three-dimensional object conform to the shape of the x-ray beam, blur or unsharpness will occur at the partially attenuating edge of the object. This can be accompanied by changes in radiographic/image density, according to the thickness of areas traversed by the x-ray beam.

143. Patients are instructed to remove all jewelry, hair clips, metal prostheses, coins, and credit cards before entering the room for an examination in (A) sonography (B) computed tomography (CT) (C) magnetic resonance imaging (MRI) (D) nuclear medicine

143. (C) Patients are instructed to remove all jewelry, hair clips, metal prostheses, coins, and credit cards before entering the room for MRI. MRI does not use radiation to produce images but instead uses a very strong magnetic field. All patients must be screened before entering the magnetic field to be sure that they do not have any metal on or within them. Proper screening includes questioning the patient about any eye injury involving metal, cardiac pacemakers, aneurysm clips, insulin pumps, heart valves, shrapnel, or any metal in the body. This is extremely important, and if there is any doubt, the patient should be rescheduled for a time after it has been determined that it is safe for him or her to enter the room. Patients who have done metalwork or welding are frequently sent to diagnostic radiology for screening images of the orbits to ensure that there are no metal fragments near the optic nerve. Any external metallic objects, such as bobby pins, hair clips, or coins in the pocket, must be removed, or they will be pulled by the magnet and can cause harm to the patient. Credit cards and any other plastic cards with a magnetic strip will be wiped clean if they come in contact with the magnetic field.

144. The true lateral position of the skull uses which of the following principles? 1. Interpupillary line perpendicular to the IR 2. MSP perpendicular to the IR 3. Infraorbitomeatal line (IOML) parallel to the transverse axis of the IR (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

144. (C) A lateral projection generally is included in a routine skull series. The patient is placed in a PA oblique position. The MSP is positioned parallel to the IR, and the IOML is adjusted so as to be parallel to the long axis of the IR. The interpupillary line must be perpendicular to the IR. In a routine lateral projection of the skull, the CR should enter approximately 2 inches superior to the EAM.

145. The radiograph shown in Figure 2-25 was most likely made in the following position: (A) supine recumbent (B) prone recumbent (C) PA upright(D) supine Trendelenburg

145. (B) The radiograph shown in Figure 2-25 is a prone recumbent projection. If the patient were in the supine recumbent position, barium would be located in the fundus of the stomach because the fundus is more posterior, and barium would flow down to fill the posterior structure. If the patient were in the supine Trendelenburg position, barium flow to the fundus would be facilitated even more. If the patient were erect, air-fluid levels would be clearly defined. In addition, the barium-filled stomach tends to spread more horizontally in the prone position (as is seen in the radiograph).

147. To evaluate the interphalangeal joints in the oblique and lateral positions, the fingers (A) rest on the IR for immobilization (B) must be supported parallel to the IR (C) are radiographed in natural flexion (D) are radiographed in palmar flexion

147. (B) The fingers must be supported parallel to the IR (e.g., on a finger sponge) in order that the joint spaces parallel the x-ray beam. When the fingers are flexed or resting on the IR, the relationship between the joint spaces and the IR changes, and the joints appear "closed."

148. That portion of long bone where lengthening growth takes place is the (A) diaphysis (B) epiphysis (C) metaphysis (D) apophysis

148. (C) Long bones are composed of a body/shaft, or diaphysis, and two extremities. The diaphysis is the primary ossification center. In the growing bone, the cartilaginous epiphyseal plate (located at the extremities of long bones) is gradually replaced by bone. The epiphyses are referred to as the secondary ossification centers. The wider portion of bone adjacent to the epiphyseal plate is the metaphysis —that portion of long bone where lengthening/bone growth takes place . Apophysis refers to a bony projection without an independent ossification center.

149. How should a mobile chest examination be performed to demonstrate air-fluid levels on a patient seated semi-upright about 70°? (A) With CR directed 20° caudad (B) With CR directed 20° cephalad (C) With CR parallel to the floor (D) With CR perpendicular to coronal plane

149. (C) One of the most important principles in chest radiography is that it be performed, whenever possible, in the erect position. It is in this position that the diaphragm can descend to its lowest position during inspiration, and any air-fluid levels can be detected. However, patients semi-upright position. If the patient is seated at a 70° angle, rather than 90°, the CR must be directed parallel to the floor. If the CR is angled caudally to compensate for the patients being only semierect, any air-fluid levels can be distorted or obliterated.

15. During an upper GI examination of a stomach of average size and shape, a barium-filled fundus and double contrast of the pylorus and duodenal bulb are demonstrated. The position used is most likely (A) AP erect(B) PA (C) RAO (D) LPO

15. (D) In the recumbent position, the upper portion of the stomach occupies a more posterior position in the body than the distal aspect of the stomach. Therefore, in the AP recumbent position (or LPO position), barium moves easily into the fundus of the stomach (from the more distal portions of the stomach), displacing/drawing the stomach somewhat superiorly. The fundus is filled with barium, whereas the air that had been in the fundus is now displaced into the gastric body, pylorus, and duodenum , illustrating them in double contrast . Double-contrast delineation of these structures allows us to see through the stomach to the retrogastric areas and structures. The RAO position demonstrates a barium-filled pylorus and duodenum. Anterior and posterior aspects of the stomach are visualized in the lateral position; medial and lateral aspects of the stomach are visualized in the AP projection.

150. The ileocecal valve normally is located in which of the following body regions? (A) Right iliac (B) Left iliac (C) Right lumbar (D) Hypogastric

150. (A) The abdomen is divided into nine regions. The upper lateral regions are the left and right hypochondriac, with the epigastric separating them. The middle lateral regions are the left and right lumbar, with the umbilical region between them. The lower lateral regions are the left and right iliac, with the hypogastric region between them. The ileocecal valve, cecum, and appendix (if present) are located in the lower right abdomen—therefore,

151. Which of the following is/are true regarding radiographic examination of the acromioclavicular joints? 1. The procedure is performed in the erect position 2. Use of weights can improve demonstration of the joints 3. The procedure should be avoided if dislocation or separation is suspected (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 2 and 3 only

151. (B) Evaluation of the acromioclavicular joints requires bilateral AP or PA erect projections with and without the use of weights. Weights are used to emphasize the minute changes within a joint caused by separation or dislocation. Weights should be anchored from the patient's wrists rather than held in the patient's hands, because this encourages tightening of the shoulder muscles and obliteration of any small separation.

152. A type of cancerous bone tumor occurring in children and young adults and arising from bone marrow is (A) Ewing sarcoma (B) multiple myeloma (C) enchondroma (D) osteochondroma

152. (A) Ewing sarcoma is a (primary) malignant bone tumor that arises from bone marrow and occurs in children and young adults. The disease is characterized by new bone formation in a layering effect, giving the bone the characteristic "onion peel" appearance radiographically. Multiple myeloma is also a cancerous bone tumor usually affecting adults between the ages of 40 and 70 years. Bone undergoes osteolytic changes, and radiographic demonstration appears as circular areas of bone loss. As their name implies ( chondr ), enchondroma and osteochondroma involve cartilage, they are both benign conditions.

153. With the patient recumbent on the x-ray table with the head lower than the feet, the patient is said to be in the (A) Trendelenburg position (B) Fowler position (C) decubitus position (D) Sims position

153. (A) When the patient is recumbent with the head lower than the feet, he or she is said to be in the Trendelenburg position. The decubitus position is used to describe the patient who is recumbent (prone, supine, or lateral) with the CR directed horizontally. In the Fowler position, the patient's head is positioned higher than the feet. The Sims position is the (LAO) position assumed for enema tip insertion.

154. The following skull position will demonstrate the cranial base, sphenoidal sinuses, atlas, and odontoid process: (A) AP axial (B) lateral (C) parietoacanthial (D) submentovertical (SMV)

154. (D) The SMV projection is made with the patient's head resting on the vertex and the CR directed perpendicular to the IOML. This position may be used as part of a sinus survey to demonstrate the sphenoidal sinuses or as a view of the cranial base for the basal foramina (especially the foramina ovale and spinosum). It also demonstrates the bony part of the auditory (Eustachian) tubes. AP or PA axial projections are used frequently to demonstrate the occipital region or evaluate the sellar region. A lateral projection is usually part of a routine skull evaluation. The parietoacanthial projection is the single best position to demonstrate facial bones.

155. Which of the following statements is/are true with respect to the radiograph shown in Figure 2-26 ? 1. The acromion process is seen partially superimposed on the third rib 2. This projection is performed to evaluate the scapula 3. This projection is performed to evaluate the acromioclavicular articulation (A) 1 only (B) 2 only (C) 1 and 2 only (D) 2 and 3 only

155. (B) The radiograph in Figure 2-26 illustrates a lateral projection of the scapula. The axillary and vertebral borders are superimposed. The acromion and coracoid process are visualized; the coracoid process is partially superimposed on the axillary portion of the third rib. A scapular Y projection is often performed to demonstrate shoulder dislocation, but the affected arm is left to rest at the patient's side; the arm in this radiograph is abducted somewhat to better view the body of the scapula.

156. Which of the following is/are located on the anterior aspect of the femur? 1. Patellar surface 2. Intertrochanteric crest 3. Linea aspera (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

156. (A) The femur is the longest and strongest bone in the body. The femoral shaft is bowed slightly anteriorly and presents a long, narrow ridge posteriorly called the linea aspera. The proximal femur consists of a head that is received by the pelvic acetabulum. The femoral neck, which joins the head and shaft, normally angles upward about 120° and forward (in anteversion) about 15°. The greater and lesser trochanters are large processes on the posterior proximal femur. The intertrochanteric crest runs obliquely between the trochanters; the intertrochanteric line parallels the intertrochanteric crest on the anterior femoral surface. The intercondyloid fossa , a deep notch, is found on the distal posterior femur between the large femoral condyles, and the popliteal surface is a smooth surface just superior to the intercondyloid fossa. Just opposite the popliteal surface, on the distal anterior femur is the patellar surface —a smooth surface for patellar motion during flexion and extension of the knee.

157. In which of the following tangential axial projections of the patella is complete relaxation of the quadriceps femoris required for an accurate diagnosis? 1. Supine flexion 45° (Merchant) 2. Prone flexion 90° (Settegast) 3. Prone flexion 55° (Hughston) (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3 only

157. (A) The tangential axial projections of the patella are also often referred to as sunrise or skyline view s. The supine flexion 45° (Merchant) position requires a special apparatus, and the patellae can be examined bilaterally. This position also requires patient comfort without muscle tension —muscle tension can cause a subluxed patella to be pulled into the intercondyler sulcus, giving the appearance of a normal patella. The two prone positions differ according to the degree of flexion used. The 90° flexion (Settegast) position must not be used with suspected patellar fracture.

158. In Figure 2-27 , the structure indicated as number 2 is which of the following? (A) Neck of rib (B) Tubercle of rib (C) Transverse process (D) Head of rib

158. (B) The typical vertebra is divided into two portions: the (anterior) body (number 11) and the (posterior) vertebral arch . The vertebral arch supports seven processes: two transverse (number 8), one spinous (number 1), two superior articular processes, and two inferior articular processes. A thoracic vertebra is shown. The thoracic vertebrae are unique in that they have downward-angling spinous processes and articulations for ribs. Numbers 5 and 10 illustrate the facets where the heads of ribs (number 7) articulate to form the costovertebral articulations (number 6). Number 2 illustrates the ribs' tubercle—it articulates with the transverse process facet (number 9) to form the costotransverse articulation (number 3). 159. (B) In a PA projection of the chest, there should be no rotation, as evidenced by symmetry of sternal extremities of clavicles equidistant from vertebral borders. The shoulders are rolled forward to remove the scapulae from the lung fields. Inspiration should be adequate to demonstrate 10 posterior ribs above the diaphragm. The air-filled trachea should be seen midline; the esophagus is unlikely to be visualized without a contrast agent.

159. Which of the following statements is/are correct with respect to evaluation criteria for a PA projection of the chest for lungs? 1. Sternal extremities of clavicles are equidistant from vertebral borders 2. Ten posterior ribs are demonstrated above the diaphragm 3. The esophagus is visible in the midline (A) 1 only (B) 1 and 2 only (C) 2 and 3 only

159. (B) In a PA projection of the chest, there should be no rotation, as evidenced by symmetry of sternal extremities of clavicles equidistant from vertebral borders. The shoulders are rolled forward to remove the scapulae from the lung fields. Inspiration should be adequate to demonstrate 10 posterior ribs above the diaphragm. The air-filled trachea should be seen midline; the esophagus is unlikely to be visualized without a contrast agent.

16. Which of the following articulations participate(s) in formation of the ankle mortise? 1. Talotibial 2. Talocalcaneal 3. Talofibular (A) 1 only (B) 1 and 3 only (C) 2 and 3 only (D) 3 only

16. (B) The ankle mortise, or ankle joint, is formed by the articulation of the tibia, fibula, and talus ( Fig. 2-46 ). Two articulations form the ankle mortise: the talotibial and talofibular articulations. The calcaneus is not associated with formation of the ankle mortise.

160. In which of the following positions/projections will the talocalcaneal joint be visualized? (A) Dorsoplantar projection of the foot (B) Plantodorsal projection of the os calcis (C) Medial oblique position of the foot (D) Lateral foot

160. (B) The talocalcaneal, or subtalar, joint is a three-faceted articulation formed by the talus and the os calcis (calcaneus). The plantodorsal and dorsoplantar projections of the os calcis should exhibit sufficient density to visualize the talocalcaneal joint ( Fig. 2-60 ). This is the only "routine" projection that will demonstrate the talocalcaneal joint. If evaluation of the talocalcaneal joint is desired, special views (such as the Broden and Isherwood methods) are required.

161. In the lateral projection of the ankle, the 1. talotibial joint is visualized 2. talofibular joint is visualized 3. tibia and fibula are superimposed (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

161. (C) In a lateral projection of the ankle, the tibia and fibula are superimposed, and the foot is somewhat dorsiflexed to better demonstrate the talotibial joint. The talofibular joint is not visualized because of superimposition with other bony structures. It may be well visualized in the medial oblique projection of the ankle.

163. All the following positions are likely to be used for both single- and double-contrast examinations of the large bowel, except (A) lateral rectum (B) AP axial rectosigmoid (C) right and left lateral decubitus abdomen (D) RAO and LAO abdomen

163. (C) Radiographic examinations of the large bowel generally include the AP or PA axial position to "open" the S-shaped sigmoid colon, the lateral position especially for the rectum, and the LAO and RAO (or LPO and RPO) positions to "open" the colic flexures. The left and right decubitus positions usually are used only in double-contrast barium enemas to better demonstrate double contrast of the medial and lateral walls of the ascending and descending colon.

164. Which of the following statements regarding the Norgaard method, "Ball-Catcher's position," is/are correct? 1. Bilateral AP oblique hands are obtained 2. It is used for early detection of rheumatoid arthritis 3. The hands are obliqued about 45°, palm up (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

164. (D) Bilateral AP oblique hands are obtained using the Norgaard method or "Ball-Catcher position." The method is used to detect early rheumatoid arthritis changes or fracture to the base of the fifth metacarpal. The hands are positioned and supported in a 45° oblique, palm-up position. The CR is directed to the level of the fifth metacarpophalangeal joint (MPJ) midway between the hands—both hands are exposed simultaneously.

165. During atrial systole, blood flows into the 1. right ventricle via the mitral valve 2. left ventricle via the bicuspid valve 3. right ventricle via the tricuspid valve (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

165. (C) Venous blood is returned to the right atrium via the superior (from the upper body) and inferior (from the lower body) venae cavae (see Fig. 2-61 ). During atrial systole, blood passes from the right atrium through the tricuspid valve into the right ventricle and from the left atrium through the bicuspid/mitral valve into the left ventricle. During ventricular systole, the pulmonary artery (the only artery to carry deoxygenated blood) carries blood from the right ventricle to the lungs for oxygenation, whereas the left ventricle moves oxygenated blood through the aortic semilunar valve into the aorta and to all body tissues.

166. Which aspect(s) of the scapula are demonstrated in Figure 2-29 ? 1. Its posterior aspect 2. Its costal surface 3. Its sternal articular surface (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

166. (A) Visualization of the scapular spine (number 13) indicates that this is a view of the posterior aspect of the scapula. The scapula's anterior, or costal, surface is that which is adjacent to the ribs. The scapula has no sternal articulation.

167. Which of the following is represented by the number 2 in Figure 2-29 ? (A) Acromion process (B) Superior angle (C) Coracoid process (D) Apex

167 - 168. (167, C; 168, A) Figure 2-29 depicts a posterior view of the right scapula and its articulation with the humerus (number 4). The scapula presents two borders: the lateral or axillary border (number 7) and the medial or vertebral border (number 9). It also presents three angles: the apex or inferior angle (number 8), the superior angle (number 12), and the lateral angle (number 6). The processes of the scapula are the coracoid (number 2), the acromion (number 3), and the scapular spine (number 13). The scapula has a (supra) scapular notch (number 1), a supraspinatus fossa (number 11), and an infraspinatus fossa (number 10). Number 5 identifies the glenoid fossa—the articular surface for the humeral head, forming the glenohumeral articulation.

168. Which of the following is represented by the number 9 in Figure 2-29 ? (A) Medial border (B) Lateral border (C) Inferior angle (D) Superior angle

167 - 168. (167, C; 168, A) Figure 2-29 depicts a posterior view of the right scapula and its articulation with the humerus (number 4). The scapula presents two borders: the lateral or axillary border (number 7) and the medial or vertebral border (number 9). It also presents three angles: the apex or inferior angle (number 8), the superior angle (number 12), and the lateral angle (number 6). The processes of the scapula are the coracoid (number 2), the acromion (number 3), and the scapular spine (number 13). The scapula has a (supra) scapular notch (number 1), a supraspinatus fossa (number 11), and an infraspinatus fossa (number 10). Number 5 identifies the glenoid fossa—the articular surface for the humeral head, forming the glenohumeral articulation.

169. With the patient in the PA position and the OML and CR perpendicular to the IR, the resulting image will demonstrate the petrous pyramids (A) below the orbits (B) in the lower third of the orbits (C) completely within the orbits (D) above the orbits

169. (C) For the PA projection of the skull, the OML is adjusted perpendicular to the IR, and the MSP must be perpendicular to the IR. The CR is directed so as to exit the nasion. In this position, the petrous pyramids should completely fill the orbits. When caudal angulation is used with this position, the petrous pyramids are projected in the lower portion, or out of, the orbits. If cephalad angulation is used with this position, the petrous pyramids are projected up toward the occipital region (as in the nuchofrontal projection)..

17. The upper surface of the foot may be described as the 1. plantar surface 2. anterior surface 3. dorsum (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

17. (C) The foot has anterior, posterior, medial, and lateral surfaces. The upper surface is the anterior , or dorsum /dorsal surface. The lower surface is the plantar surface. Hence, the AP projection of the foot is also called the dorsoplantar projection of the foot (describing the path of the CR traversing from dorsum to plantar surface).

170. When evaluating a PA axial projection of the skull with a 15° caudal angle, the following should be demonstrated: 1. petrous pyramids in the lower third of the orbits 2. equal distance from the lateral border of the skull to the lateral rim of the orbit bilaterally 3. symmetrical petrous pyramids (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

170. (D) A PA axial projection of the skull with a 15° caudad angle will show the petrous pyramids in the lower third of the orbits. If no angulation is used, the petrous pyramids will fill the orbits. Either PA projection should demonstrate symmetrical petrous pyramids and an equal distance from the lateral border of the skull to the lateral border of the orbit on both sides. This determines that there is no rotation of the skull.

171. Which of the following barium-filled anatomic structures is best demonstrated in the LPO position? (A) Hepatic/right colic flexure (B) Splenic/left colic flexure (C) Sigmoid colon (D) Ileocecal valve

171. (A) The AP oblique positions (RPO and LPO) demonstrate the colonic structures farther from the IR. The LPO position will demonstrate the hepatic/right colic flexure and ascending colon, whereas the RPO position demonstrates the splenic/left colic flexure and descending colon. In the prone oblique positions (RAO and LAO), the flexure disclosed is the one closer to the IR. Therefore, the LAO position will "open up" the left colic flexure, and the RAO position will demonstrate the right colic flexure.

172. The uppermost portion of the iliac crest is at approximately the same level as the (A) costal margin (B) umbilicus (C) xiphoid tip (D) fourth lumbar vertebra

172. (D) Surface landmarks, prominences, and depressions are very useful to the radiographer in locating anatomic structures that are not visible externally. The costal margin is at about the same level as L3. The umbilicus is at approximately the same level as the L3-L4 interspace. The xiphoid tip is at about the same level as T10. The fourth lumbar vertebra is at approximately the same level as the iliac crest.

173. What is the position of the stomach in a hypersthenic patient? (A) High and vertical (B) High and horizontal (C) Low and vertical (D) Low and horizontal

173. (B) The position, shape, and motility of various organs can differ greatly from one body habitus to another. The hypersthenic individual is large and heavy; the lungs and heart are high, the stomach is high and transverse, the gallbladder is high and lateral, and the colon is high and peripheral. In contrast, the other habitus extreme is the asthenic individual. This patient is slender and light and has a long and narrow thorax, a low and long stomach, a low and medial gallbladder, and a low medial and redundant colon. The radiographer must consider these characteristic differences when radiographing individuals of various body types.

174. In the PA axial oblique position of the cervical spine, the structures best seen are the (A) intervertebral foramina nearest the IR (B) intervertebral foramina furthest from the IR (C) interarticular joints (D) intervertebral joints 175. During chest radiography,

174. (A) The cervical intervertebral foramina lie 45° to the MSP and 15°-20° to a transverse plane. When the PA axial oblique position (LAO or RAO) is used, the cervical intervertebral foramina demonstrated are those closer to the IR. In the AP axial oblique position (LPO or RPO), the foramina disclosed are those farther from the IR. There is, therefore, some magnification of the foramina in the posterior oblique positions. The interarticular (zygapophyseal) joints and intervertebral joints are best visualized in the lateral projection.

175. During chest radiography, the act of inspiration 1. elevates the diaphragm 2. raises the ribs 3. depresses the abdominal viscera (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

175. (C) With inspiration, the diaphragm moves inferiorly and depresses the abdominal viscera. The ribs and sternum are elevated. As the ribs are elevated, their angle is decreased. Radiographic density can vary considerably in appearance depending on the phase of respiration during which the exposure is made.

176. In the lateral projection of the scapula, the 1. vertebral and axillary borders are superimposed. 2. acromion and coracoid processes are superimposed. 3. inferior angle is superimposed on the ribs. (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

176. (A) A lateral projection of the scapula superimposes its medial and lateral borders (vertebral and axillary, respectively). The coracoid and acromion processes should be readily identified separately (not superimposed) in the lateral projection. The entire scapula should be free of superimposition with the ribs. The erect position is probably the most comfortable position for a patient with scapular pain.

177. Which of the following statements is/are true regarding Figure 2-30 ? 1. It demonstrates RAO sternum 2. Exposure was made during shallow respiration 3. Sternum is projected in the left thorax (A) 1 only (B) 2 only (C) 2 and 3 only (D) 1, 2, and 3

177. (D) The image demonstrates the PA oblique sternum ( RAO position). Minimal rotation succeeds in projecting the sternum free of superimposition with the vertebral column. The RAO position projects the sternum to the left side of the thorax. Superimposing the length of the sternum onto the heart and other mediastinal structures promotes more uniform exposure of the entire sternum. Exposure made during shallow respiration serves to obliterate pulmonary vascular markings.

178. To better visualize the knee-joint space in the radiograph in Figure 2-31 , the radiographer should (A) flex the knee more acutely (B) flex the knee less acutely (C) direct the CR 5°-7° cephalad (D) direct the CR 5°-7° caudad

178. (C) In the lateral projection of the knee, the joint space is obscured by the magnified medial femoral condyle unless the CR is angled 5°-7° cephalad. The degree of flexion of the knee is important when evaluating the knee for possible transverse patellar fracture. In such a case, the knee should not be flexed more than 10°. The knee normally should be flexed 20°-30° in the lateral position.

179. The AP axial projection of the cervical spine demonstrates the following: 1. C3-C7 cervical bodies 2. Intervertebral foramina 3. Zygapophyseal joints (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

179. (A) The AP axial projection of the cervical spine demonstrates the bodies and intervertebral spaces of the last five vertebrae (C3-C7). The intervertebral foramina are 45° to the MSP and are therefore demonstrated in the oblique projection. The cervical zygapophyseal joints are 90° to the MSP and are demonstrated in the lateral projection.

18. The outermost wall of the digestive tract is the (A) mucosa (B) muscularis (C) submucosa (D) serosa

18. (D) The walls of the digestive tract/alimentary canal from outer to inner are serosa, muscularis, submucosa, and mucosa. The outermost serosa is thin and membranous. The muscular layer assists with peristaltic activity and the formation of sphincter muscles. The submucosa is a fairly thick layer of loose connective tissue. The mucosa is the innermost layer which forms folds called ruga.

180. With which of the following does the trapezium articulate? (A) Fifth metacarpal (B) First metacarpal (C) Distal radius (D) Distal ulna

180. (B) The base of the first metacarpal, on the lateral side of the hand, articulates with the most lateral carpal of the distal carpal row, the trapezium /greater multangular. This articulation forms a rather unique and very versatile sellar/saddle joint named for the shape of its articulating surfaces.

181. Which of the following statements is/are true regarding a PA projection of the paranasal sinuses? 1. The OML is elevated 15° from the horizontal 2. The petrous pyramids completely fill the orbits 3. The frontal and ethmoidal sinuses are visualized (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

181. (C) The PA (Caldwell) projection of the paranasal sinuses is used to demonstrate the frontal and ethmoidal sinuses. The patient's skull is placed PA, and the OML is elevated 15° from the horizontal. This projects the petrous pyramids into the lower third of the orbits, thus permitting optimal visualization of the frontal and ethmoidal sinuses.

182. Tracheotomy is an effective technique used to restore breathing when there is (A) respiratory pathway obstruction above the larynx (B) crushed tracheal rings owing to trauma (C) respiratory pathway closure owing to inflammation and swelling (D) all of the above

182. (A) The respiratory passageways include the nose, pharynx, larynx (upper respiratory structures), trachea, bronchi, and lungs (lower structures). If obstruction of the breathing passageways occurs in the upper respiratory tract, above the larynx (i.e., in the nose or pharynx), tracheotomy may be performed to restore breathing. Intubation can be done into the lower structures, larynx, and trachea, moving aside any soft obstruction and restoring the breathing passageway.

183. During GI radiography, the position of the stomach may vary depending on 1. the respiratory phase 2. body habitus 3. patient position (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

183. (D) During GI radiography, the position of the stomach may vary depending on the respiratory phase, the body habitus, and the patient position. Inspiration causes the lungs to fill with air and the diaphragm to descend, thereby pushing the abdominal contents downward. On expiration, the diaphragm will rise, allowing the abdominal organs to ascend. Body habitus is an important factor in determining the size and shape of the stomach. An asthenic patient may have a long, J-shaped stomach, whereas the stomach of a hypersthenic patient may be transverse. The body habitus is an important consideration in determining the positioning and placement of the IR. The patient position also can alter the position of the stomach. If a patient turns from the RAO position into the AP position, the stomach will move into a more horizontal position. Although the cardiac sphincter and the pyloric sphincter are relatively fixed, the fundus is quite mobile and will vary in position.

184. For which of the following conditions is operative cholangiography a useful tool? 1. Patency of the biliary ducts 2. Biliary tract calculi 3. Duodenal calculi (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

184. (B) Operative cholangiography can play a vital role in biliary tract surgery. The contrast medium is injected, usually through the CBD, and images are usually made following the cholecystectomy. The procedure is used to investigate the patency of the bile ducts, the function of the hepatopancreatic sphincter (of Oddi), and the presence of previously undetected biliary tract calculi.

185. For the average patient, the CR for a lateral projection of a barium-filled stomach should enter (A) midway between the midcoronal line and the anterior abdominal surface (B) midway between the vertebral column and the lateral border of the abdomen (C) at the midcoronal line at the level of the iliac crest (D) perpendicular to the level of L2

185. (A) Lateral projections of the barium-filled stomach ( Fig. 2-62 ) may be performed recumbent or upright for demonstration of the retrogastric space. With the patient in the (usually right) lateral position, the CR is directed to a point midway between the midcoronal line and the anterior surface of the abdomen at the level of L1. When the patient is in the LPO or RAO position, the CR should be directed midway between the vertebral column (MCP) and the anterior surface of the abdomen. For the PA projection, the CR is directed perpendicular to the IR at the level of L2.

186. When examining a patient whose elbow is in partial flexion, how should an AP projection be obtained? 1. With humerus parallel to IR, CR perpendicular 2. With forearm parallel to IR, CR perpendicular 3. Through the partially flexed elbow, resting on the olecranon process, CR perpendicular (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

186. (B) When injury requires that the elbow be examined in partial flexion, the lateral projection offers little difficulty, but the AP projection requires special attention. If the AP radiograph is made with a perpendicular CR and the olecranon process resting on the tabletop, the articulating surfaces are obscured. With the elbow in partial flexion, two exposures are necessary. One is made with the forearm parallel to the IR (humerus elevated), which demonstrates the proximal forearm. The other is made with the humerus parallel to the IR (forearm elevated), which demonstrates the distal humerus. In both cases, the CR is perpendicular if the degree of flexion is not too great or is angled slightly into the joint space with greater degrees of flexion.

187. Which of the following is/are appropriate technique(s) for imaging a patient with a possible traumatic spine injury? 1. Instruct the patient to turn slowly and stop if anything hurts 2. Maneuver the x-ray tube instead of moving the patient 3. Call for help and use the log-rolling method to turn the patient (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

187. (C) When imaging a patient with a possible traumatic spine injury, it is appropriate to either maneuver the x-ray tube head or, if the patient must be moved, to use the log-rolling method. This cannot be done by one person; the radiographer must summon assistance. If the patient is on a backboard and in a neck collar, as most patients with suspected spine injury are, it is never appropriate to ask the patient to turn, scoot, or slide over. The only movement that should be permitted is movement of the entire spine, body, and head together, as in log-rolling. Any twisting could cause severe and permanent damage to the spinal cord, resulting in paralysis or even death.

188. Which of the following positions is used to demonstrate vertical patellar fractures and the patellofemoral articulation? (A) AP knee (B) Lateral knee (C) Tangential patella (D) Tunnel view

188. (C) In the tangential (sunrise) projection of the patella, the CR is directed parallel to the longitudinal plane of the patella, thereby demonstrating a vertical fracture and providing the best view of the patellofemoral articulation. The AP knee projection could demonstrate a vertical fracture through the superimposed femur, but it does not demonstrate the patellofemoral articulation. The tunnel view of the knee is used to demonstrate the intercondyloid fossa.

189. The structure labeled 4 in Figure 2-32 is the (A) anterior arch of C1 (B) body of C1 (C) body of C2 (D) odontoid process

189 - 190. (189, D; 190, A) The radiograph shown is a lateral projection of the cervical spine taken in flexion. Flexion and extension views are useful in certain cervical injuries, such as whiplash , to indicate the degree of anterior and posterior motion. The structure labeled number 1 is a zygapophyseal joint; because zygapophyseal joints form a 90° angle with the MSP, they are well visualized in the lateral projection. The structure labeled number 2 is a vertebral body. Numbers 3 through 6 are various components of C1 (atlas) and C2 (axis). The large body of C2 ( number 6 ) has a process superiorly, the odontoid process/dens ( number 4 ). The odontoid process fits into, and articulates with C1. The superimposed posterior arch of C1 is indicated by number 3 . The dens (number 4) is articulated with the anterior arch of C1 ( number 5 )..

190. The structure labeled 1 in Figure 2-32 is the (A) zygapophyseal joint (B) intervertebral foramen (C) intervertebral disc space (D) vertebral body

189 - 190. (189, D; 190, A) The radiograph shown is a lateral projection of the cervical spine taken in flexion. Flexion and extension views are useful in certain cervical injuries, such as whiplash , to indicate the degree of anterior and posterior motion. The structure labeled number 1 is a zygapophyseal joint; because zygapophyseal joints form a 90° angle with the MSP, they are well visualized in the lateral projection. The structure labeled number 2 is a vertebral body. Numbers 3 through 6 are various components of C1 (atlas) and C2 (axis). The large body of C2 ( number 6 ) has a process superiorly, the odontoid process/dens ( number 4 ). The odontoid process fits into, and articulates with C1. The superimposed posterior arch of C1 is indicated by number 3 . The dens (number 4) is articulated with the anterior arch of C1 ( number 5 )..

19. Terms used to describe movement include 1. plantar flexion 2. abduct 3. oblique (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 2 and 3

19. (B) Plantar flexion describes upward movement of the foot and toes, decreasing the angle between the dorsum (upper surface) of the foot and lower leg. This movement can be used in projections of the calcaneus. The term abduct refers to a part turned/moved away from the midline of the body or from another part. Similarly, the term adduct refers to a part turned/moved toward the midline of the body or toward another part . The term oblique is a term used in positioning that refers to longitudinal sections or body planes.

191. Which of the following examinations is used to demonstrate vesicoureteral reflux? (A) Retrograde urogram (B) Intravenous urogram (IVU) (C) Voiding cystourethrogram (D) Retrograde cystogram

191. (C) The voiding cystourethrogram ( VCUG ) is a functional study performed to evaluate the physiology of urination to demonstrate possible vesicoureteral reflux (backup of urine from bladder into ureters, causing repeated urinary tract infections). The retrograde urogram and retrograde cystogram demonstrate the anatomy (not function) of the urinary tract. The intravenous/excretory urogram does demonstrate function of the urinary tract but does not evaluate the urethra.

192. Which of the following should be demonstrated in a true AP projection of the clavicle? 1. Clavicular body 2. Acromioclavicular joint 3. Sternocostal joint (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

192. (B) The AP projection of the clavicle should demonstrate the clavicular body/shaft and its two extremities: the sternal extremity and its associated sternoclavicular articulation, and the acromial extremity and its associated acromioclavicular articulation. The sternocostal joint is the articulation between the sternum and rib and is not delineated in the AP clavicle image.

193. In which of the following projections is the talofibular joint best demonstrated? (A) AP (B) Lateral oblique (C) Medial oblique (D) Lateral

193. (C) The AP projection demonstrates superimposition of the distal fibula on the talus; the joint space is not well seen. The 15°-20° medial oblique position shows the entire mortise joint; the talofibular joint is well visualized, as well as the talotibial joint. There is considerable superimposition of the talus and fibula in the lateral and lateral oblique projections.

194. Free air in the abdominal cavity is best demonstrated in which of the following? (A) AP projection, left lateral decubitus position (B) AP projection, right lateral decubitus position (C) PA recumbent position (D) AP recumbent position

194. (A) The erect position is used most often to demonstrate air-fluid levels in the chest or abdomen or both. However, patients with traumatic injuries frequently must be examined in the recumbent position. The recumbent position will not demonstrate air-fluid levels unless it is a decubitus position. If free air is being questioned, we will look for that quantity of air on the "up" side because air rises. However, because liver tissue is so homogenous, a small amount of air will be perceived more easily superimposed on it rather than on left-sided structures. Thus, an AP projection obtained in the left lateral decubitus position will best demonstrate a small amount of free air because that air will be superimposed on the liver.

195. Which of the following sequences correctly describes the path of blood flow as it leaves the left ventricle? (A) Arteries, arterioles, capillaries, venules, veins (B) Arterioles, arteries, capillaries, veins, venules (C) Veins, venules, capillaries, arteries, arterioles (D) Venules, veins, capillaries, arterioles, arteries

195. (A) Blood is oxygenated in the lungs and carried to the left atrium by four pulmonary veins. From the left atrium, blood flows through the bicuspid (mitral) valve into the left ventricle. Blood leaving the left ventricle is bright red, oxygenated blood that travels through the systemic circulation, which delivers oxygenated blood via arteries and returns deoxygenated blood to the lungs via veins. From the left ventricle, blood first goes through the largest arteries and then goes to progressively smaller arteries (arterioles), to the capillaries, to the smallest veins (venules), and on to progressively larger veins.

196. Which of the following projections of the elbow will demonstrate the radial head free of ulnar superimposition? (A) AP (B) Lateral (C) Medial oblique (D) Lateral oblique

196. (D) On the AP projection of the elbow, the radial head and ulna normally are somewhat superimposed. The lateral oblique projection demonstrates the radial head free of ulnar superimposition. The lateral projection demonstrates the olecranon process in profile. The medial oblique projection demonstrates considerable overlap of the proximal radius and ulna but should clearly demonstrate the coronoid process free of superimposition and the olecranon process within the olecranon fossa.

197. An acromioclavicular separation will be best demonstrated in the following projection: (A) AP recumbent, affected shoulder (B) AP recumbent, both shoulders (C) AP erect, affected shoulder (D) AP erect, both shoulders

197. (D) Acromioclavicular (AC) joints usually are examined when separation or dislocation is suspected. They must be examined in the erect position, because in the recumbent position a separation appears to reduce itself. Both AC joints are examined simultaneously for comparison because separations may be minimal.

198. Causes of death in 70% of people older than 65 years include 1. stroke 2. heart disease 3. digestive disorders (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

198. (B) Geriatrics deals with health care of the aging population; gerontology addresses health maintenance, quality of life, disease prevention and management of this same population. The number of older adults is steadily increasing and health care professionals recognize the unique problems associated with this group. There is an increasing need for chronic care. The causes of death in 70% of people older than 65 years are stroke , heart disease , and cancer . Radiographers and all health care professionals must be prepared to meet the needs and challenges of this increasing population.

199. Which of the following is a major cause of bowel obstruction in children? (A) Appendicitis (B) Intussusception (C) Regional enteritis (D) Ulcerative colitis

199. (B) Intussusception is the telescoping of one part of the intestinal tract into another. It is a major cause of bowel obstruction in children, usually in the region of the ileocecal valve, and is much less common in adults. Radiographically, intussusception appears as the classic "coil spring," with barium trapped between folds of the telescoped bowel. The diagnostic BE procedure occasionally can reduce the intussusception, although care must be taken to avoid perforation of the bowel. Appendicitis occurs when an obstructed appendix becomes inflamed. Distension of the appendix occurs, and if the appendix is left untended, gangrene and perforation can result. Regional enteritis (Crohn disease) is a chronic granulomatous inflammatory disorder that can affect any part of the GI tract but generally involves the area of the terminal ilium. Ulceration and formation of fistulous tracts often occur. Ulcerative colitis occurs most often in young adults; its etiology is unknown, although psychogenic or autoimmune factors seem to be involved.

2. Demonstration of the posterior fat pad on the lateral projection of the adult elbow can be caused by 1. trauma or other pathology 2. greater than 90° flexion 3. insufficient flexion (A) 1 only (B) 3 only (C) 1 and 2 only (D) 1 and 3 only

2. (D) There are three important fat pads associated with the elbow, best demonstrated in the true lateral projection. They are not demonstrated in the AP projection because of their superimposition on bony structures. The anterior fat pad is located just anterior to the distal humerus. The posterior fat pad is located within the olecranon fossa at the distal posterior humerus. The supinator fat pad/stripe is located at the proximal radius just anterior to the head, neck, and tuberosity. The posterior fat pad is not visible radiographically in the normal elbow. The posterior fat pad is visible in cases of trauma or other pathology and when the elbow is insufficiently flexed, i.e., extended somewhat beyond the 90° flexion.

20. Which of the following is best demonstrated in the AP axial projection (Towne method) of the skull, with the CR directed 30° caudad to the orbitomeatal line (OML) and passing midway between the external auditory meati? (A) Occipital bone20. (B) Frontal bone (C) Facial bones (D) Basal foramina

20. (A) The AP axial projects the anterior structures (frontal and facial bones) downward, thus permitting visualization of the occipital bone without superimposition (Towne method). The dorsum sella and posterior clinoid processes of the sphenoid bone should be visualized within the foramen magnum. This projection may also be obtained by angling the CR 30° caudad to the OML ( Fig. 2-47 ). The frontal bone is best shown with the patient PA and with a perpendicular CR. The parietoacanthial projection is the single best position for facial bones. Basal foramina are well demonstrated in the submentovertical projection.

200. With the patient PA, the MSP centered to the IR, the OML forming a 37° angle with the IR, and the CR perpendicular and exiting the acanthion, which of the following is best demonstrated? (A) Occipital bone (B) Frontal bone (C) Facial bones (D) Basal foramina

200. (C) The parietoacanthial projection (Waters' position) provides an oblique frontal projection of the facial bones. The maxilla (and antra), zygomatic arches, and orbits are well demonstrated. The patient is positioned PA with the head resting on the extended chin so that the OML forms a 37° angle with the IR. The position may be reversed if the patient is positioned AP and the CR is directed 30° cephalad to the IOML. This position is not preferred, however, because the facial bones are significantly magnified as a result of increased OID.

201. The inhalation of liquid or solid particles into the nose, throat, or lungs is referred to as (A) asphyxia (B) aspiration (C) atelectasis (D) asystole

201. (B) Inhalation of a foreign substance such as water or food particles into the airway and/or bronchial tree is called aspiration. Asphyxia is caused by deprivation of oxygen as a result of interference with ventilation from trauma, electric shock, and so on. Atelectasis is incomplete expansion of a lung or portion of a lung. Asystole is cardiac standstill—failure of the heart muscle to contract and pump blood to vital organs.

202. Endoscopic retrograde cholangiopancreatography (ERCP) usually involves 1. cannulation of the hepatopancreatic ampulla 2. introduction of contrast medium into the common bile duct 3. introduction of barium directly into the duodenum (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

202. (B) ERCP may be performed to investigate abnormalities of the biliary system or pancreas. The patient's throat is treated with a local anesthetic in preparation for the passage of the endoscope. The hepatopancreatic ampulla (of Vater) is located, and a cannula is passed through it so that contrast medium may be introduced into the common bile duct. Spot images of the common bile duct and pancreatic duct are taken frequently in the oblique position. Direct injection of barium mixture into the duodenum occurs during an enteroclysis procedure of the small bowel.

203. Which of the following is/are associated with a Colles' fracture? 1. Transverse fracture of the radial head 2. Chip fracture of the ulnar styloid 3. Posterior or backward displacement (A) 1 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

203. (C) A Colles fracture usually is caused by a fall onto an outstretched (extended) hand to "brake" a fall. The wrist then suffers an impacted transverse fracture of the distal inch of the radius with an accompanying chip fracture of the ulnar styloid process. Because of the hand position at the time of the fall, the fracture usually is displaced backward approximately 30°.

204. The axiolateral, or horizontal beam, projection of the hip requires the IR to be placed 1. parallel to the central ray (CR) 2. parallel to the long axis of the femoral neck 3. in contact with the lateral surface of the body (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

204. (C) The IR for a cross-table (axiolateral or horizontal beam) lateral projection of the hip is placed in a vertical position. The top edge of the IR should be placed directly above the iliac crest and adjacent to the lateral surface of the affected hip. The IR is positioned parallel to the femoral neck; the CR is perpendicular to the femoral neck and IR.

205. Appropriate radiation protection strategies for the pediatric patient include the following: 1. use appropriate gonadal shielding 2. shield torso when examining upper extremities 3. examine thorax and skull in AP position rather than PA (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

205. (B) Radiation protection is exceedingly important in pediatric imaging. Immature tissues have higher radiosensitivity. Gonadal shielding should be used whenever possible; male reproductive organs can be more easily and effectively shielded. When upper extremities are being examined, the torso should be shielded. Radiography of the thorax and skull should be performed PA whenever possible to decrease dose to breast tissue and lens of eye. If fluoroscopy is required, pulsed systems with last-image-hold

206. Which of the following interventional procedures can be used to increase the diameter of a stenosed vessel? 1. Percutaneous transluminal angioplasty (PTA) 2. Stent placement 3. Peripherally inserted central catheter (PICC line) (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

206. (B) Radiologic interventional procedures function to treat pathologic conditions as well as provide diagnostic information. Percutaneous transluminal angioplasty (PTA) uses an inflatable balloon catheter under fluoroscopic guidance to increase the diameter of a plaquestenosed vessel. A stent is a cage-like metal device that can be placed in the vessel to provide support to the vessel wall. A peripherally inserted central catheter (PICC) is also placed under fluoroscopic control. It is simply a venous access catheter that can be left in place for several months. It provides convenient venous access for patients requiring frequent blood tests, chemotherapy, or large amounts of antibiotics.

207. Which of the following examinations involves the introduction of a radiopaque contrast medium through a uterine cannula? (A) Retrograde pyelogram (B) Voiding cystourethrogram (C) Hysterosalpingogram (D) Myelogram 208. Correct preparation

207. (C) Hysterosalpingography involves the introduction of a radiopaque contrast medium through a uterine cannula into the uterus and uterine (Fallopian) tubes. This examination is often performed to document patency of the uterine tubes in cases of infertility. A retrograde pyelogram requires cystoscopy and involves introduction of contrast medium through the vesicoureteral orifices and into the renal collecting system. A voiding cystourethrogram also requires cystoscopy and involves filling the bladder with contrast medium and documenting the voiding mechanism. A myelogram is performed to investigate the spinal canal.

215. The AP projection of the sacrum requires that the CR should be directed 1. 15° cephalad 2. two inches superior to the pubic symphysis 3. to a level midway between the ASIS and pubic symphysis (A) 1 only (B) 2 only (C) 1 and 2 only (D) 1 and 3 only

215. (D) The AP projection of the sacrum requires a 15° cephalad angle centered at a point midway between the pubic symphysis and the ASIS. The AP projection of the coccyx requires the CR to be directed 10 ° caudally and centered 2 inches superior to the pubic symphysis.

208. Correct preparation for a patient scheduled for an upper gastrointestinal (GI) series is most likely to be (A) iodinated contrast administration evening before examination; water only in the morning (B) NPO after midnight (C) cathartics and cleansing enemas (D) NPO after midnight, cleansing enemas, and empty bladder before scout image

208. (B) Diagnostic x-ray examinations that require contrast agents include upper gastrointestinal (GI) series, lower GI series (BE), intravenous urogram (IVU), and the occasional gallbladder (GB) series. Patient preparation is somewhat different for each of these examinations. An iodinated contrast agent, usually in the form of several pills, is taken by the patient the evening before a scheduled GB examination, and only water is allowed the morning of the examination. The patient scheduled for an upper GI series must receive NPO (nothing by mouth) after midnight. A lower GI series (BE) requires that the large bowel be very clean prior to the administration of barium; this requires the administration of cathartics (laxatives) and cleansing enemas. Preparation for an IVU requires that the patient be NPO after midnight; some institutions also require that the large bowel be cleansed of gas and fecal material. Aftercare for barium examinations is very important. Patients typically are instructed to take milk of magnesia, increase their intake of fiber, drink plenty of water, and expect changes in stool color until all barium is evacuated and to call their physician if they do not have a bowel movement within 24 h. Because water is removed from the barium sulfate suspension in the large bowel, it is essential to make patients understand the importance of these instructions to avoid barium impaction in the large bowel. The use of barium sulfate suspensions is contraindicated when ruling out visceral perforation.

209. The contraction and expansion of arterial walls in accordance with forceful contraction and relaxation of the heart are called (A) hypertension (B) elasticity (C) pulse (D) pressure

209. (C) Because the heart contracts and relaxes while functioning to pump blood from the heart, arteries that are large and those that are in closest proximity to the heart will feel the effect of the heart's forceful contractions in their walls. The arterial walls pulsate in unison with the heart's contractions. This movement may be detected with the fingers in various parts of the body and is referred to as the pulse.

21. The RPO position (Judet method) of the right acetabulum will demonstrate the (A) anterior rim of the right acetabulum (B) anterior iliopubic column (C) left iliac wing (D) posterior rim of the right acetabulum

21. (A) The posterior oblique positions (AP oblique projections) of the acetabulum (Judet method) require a 45° obliquity of the entire MSP. With the internal oblique position, affected side up , the anterior iliopubic column and/or posterior rim of the acetabulum are best demonstrated. With the external oblique position, affected side down , the posterior ilioischial column and/or anterior rim of the acetabulum are best demonstrated. In the RPO position, the down side (the right side in this case) will demonstrate the anterior rim of the right acetabulum , the right posterior ilioischial column , and the right iliac wing . When centered to the up side (left in this case), the structures demonstrated are the posterior rim of the left acetabulum, left anterior iliopubic column, and the left obturator foramen.

210. Which of the following structures should be visualized through the foramen magnum in an AP axial projection (Towne method) of the skull for occipital bone? 1. Posterior clinoid processes 2. Dorsum sella 3. Posterior arch of C1 (A) 1 only (B) 2 only (C) 1 and 2 only (D) 2 and 3 only

210. (C) The AP axial projection (Towne method) of the skull requires that the CR be angled 30° caudad if the OML is perpendicular to the IR (37° caudad if the IOML is perpendicular to the IR). The frontal and facial bones are projected down and away from superimposition on the occipital bone. If positioning is accurate, the dorsum sella and posterior clinoid processes will be demonstrated within the foramen magnum. If the CR is angled excessively, the posterior aspect of the arch of C1 will appear in the foramen magnum.

211. Which of the following projections/positions would be the best choice for a right shoulder examination to rule out fracture? (A) Internal and external rotation (B) AP and tangential (C) AP and AP axial (D) AP and scapular Y

211. (D) The AP projection will give a general survey and show mediolateral and inferosuperior joint relationships. The scapular Y projection (LAO or RAO position) is used to demonstrate anterior (subcoracoid) or posterior (subacromial) humeral dislocation. The humerus is normally superimposed on the scapula in this position; any deviation from this may indicate dislocation. Rotational projections must be avoided in cases of suspected fracture. The AP and scapular Y combination is the closest to two projections at right angles to each other.

212. Which of the following projections will best demonstrate the tarsal navicular with minimal superimposition? (A) AP oblique, medial rotation (B) AP oblique, lateral rotation (C) Mediolateral (D) Lateral weight-bearing

212. (A) The medial oblique projection requires that the leg be rotated medially until the plantar surface of the foot forms a 30° angle with the IR. This position demonstrates the navicular with minimal bony superimposition. The lateral oblique projection of the foot superimposes much of the navicular on the cuboid. The navicular is also superimposed on the cuboid in lateral projections.

213. The following bones participate(s) in the formation of the obturator foramen: 1. ilium 2. ischium 3. pubis (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

213. (C) The obturator foramen is a large oval foramen below each acetabulum and is formed by the ischium and pubis. The acetabulum is the bony socket that receives the head of the femur to form the hip joint. The upper two-fifths of the acetabulum are formed by the ilium, the lower anterior one-fifth is formed by the pubis, and the lower posterior two-fifths are formed by the ischium. Thus, the acetabulum is formed by all three of the bones that form the pelvis—the ilium, the ischium, and the pubis.

214. All of the following are associated with the knee joint, except (A) labrum (B) fat pad (C) menisci (D) collateral ligament

214. (A) The knee is formed by three bones—the proximal tibia, the patella, and the distal femur —which form two articulations , the femorotibial (hinge joint) and femoropatellar (gliding joint). The femoral and tibial condyles articulate to form the femorotibial joint. Semilunar cartilages, the menisci , lie medially and laterally between these articulating bones and, together with the cruciate and collateral ligaments , help form the articular capsule of the knee. The patella is a triangular bone with its base superior and apex inferior. The patella is the largest sesamoid bone and is attached to the tibial tuberosity by the patellar ligament and glides over the patellar surface of the distal femur (femoropatellar joint) during flexion and extension of the knee.

216. Which of the following positions/projections would best demonstrate arthritic changes in the knees? (A) AP recumbent (B) Lateral recumbent (C) AP erect (D) Medial oblique

216. (C) Arthritic changes in the knee result in changes in the joint bony relationships. These bony relationships are best evaluated in the AP position. Narrowing of the joint spaces is readily detected more on AP weight-bearing projections than on recumbent projections.

217. Which of the following are characteristics of the hypersthenic body type? 1. Short, wide, transverse heart 2. High and peripheral large bowel 3. Diaphragm positioned low (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

217. (A) The hypersthenic body type is large and heavy. The thoracic cavity is short, the lungs are short with broad bases, and the heart is usually in an almost transverse position. The diaphragm is high; the stomach and gallbladder are high and transverse. The large bowel is positioned high and peripheral (and often requires that 14 × 17 inches IRs be placed cross-wise for imaging a BE).

217. Which of the following are characteristics of the hypersthenic body type? 1. Short, wide, transverse heart 2. High and peripheral large bowel 3. Diaphragm positioned low (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3 (D) 2 and 3 only

218. (D) When the shoulder is placed in internal rotation, a greater portion of the glenoid fossa is superimposed by the humeral head, and the lesser tubercle is visualized, as in image B. External rotation (image A) removes the humeral head from a large portion of the glenoid fossa and better demonstrates the greater tubercle.

Which of the following will best demonstrate the size and shape of the liver and kidneys? (A) Lateral abdomen (B) AP abdomen (C) Dorsal decubitus abdomen (D) Ventral decubitus abdomen

219. (B) The AP projection provides a general survey of the abdomen showing the size and shape of the liver, spleen, and kidneys. When performed erect, it should demonstrate both hemidiaphragms. The lateral projection is sometimes requested and is useful for evaluating the prevertebral space occupied by the aorta. Ventral and dorsal decubitus positions provide a lateral view of the abdomen that is useful for demonstration of air-fluid levels.

22. Which of the following conditions is demonstrated in Figure 2-5 ? (A) Right upper lobe atelectasis (B) Left upper lobe atelectasis (C) Pneumothorax (D) Dextrocardia

22. (D) The figure illustrates a PA projection of the chest and the side marker correctly placed. The heart is seen on the right side—this is termed dextrocardia . Atelectasis (partial or complete collapse of lung) would be demonstrated as increased tissue density in the affected area. A classic pneumothorax (air within the thoracic cavity) would demonstrate an absence of lung markings in the affected area and flattening of the hemidiaphragm on the affected side. A small pneumothorax can be easily missed on a chest image with excessive density.

Correct preparation for a patient scheduled for a lower GI series is most likely to be (A) iodinated contrast evening before examination; water only in the morning (B) NPO after midnight (C) (D) cathartics and cleansing enemas NPO after midnight, cleansing enemas, and empty bladder before scout image

220. (C) Diagnostic x-ray examinations that require contrast agents include upper GI series, lower GI series (BE), IVU, and the occasional GB series. Patient preparation is somewhat different for each of these examinations. An iodinated contrast agent, usually in the form of several pills, is taken by the patient the evening before a scheduled GB examination, and only water is allowed the morning of the examination. The patient scheduled for an upper GI series must receive NPO (nothing by mouth) after midnight. A lower GI series (BE) requires that the large bowel be very clean prior to the administration of barium; this requires the administration of cathartics (laxatives) and cleansing enemas. Preparation for an IVU requires that the patient be NPO after midnight; some institutions also require that the large bowel be cleansed of gas and fecal material. Aftercare for barium examinations is very important. Patients typically are instructed to take milk of magnesia, increase their intake of fiber, drink plenty of water, and expect changes in stool color until all barium is evacuated and to call their physician if they do not have a bowel movement within 24 h. Because water is removed from the barium sulfate suspension in the large bowel, it is essential to make patients understand the importance of these instructions to avoid barium impaction in the large bowel. The use of barium sulfate suspensions is contraindicated when ruling out visceral perforation.

221. In the AP axial projection, or bilateral "frog-leg" position, which of the following is most likely to place the long axes of the femoral necks parallel with the plane of the IR? (A) Adducted 25° from the horizontal (B) Abducted 25° from the vertical (C) Adducted 40° from the horizontal (D) Abducted 40° from the vertical

221. (D) The patient is supine with the leg(s) abducted (drawn away from the midline) approximately 40°. This 40° abduction from the vertical places the long axes of the femoral necks parallel to the IR. The term adduction refers to drawing the extremity closer to the midline of the body.

222. Examples of synovial pivot articulations include the 1. atlantoaxial joint 2. radioulnar joint 3. temporomandibular joint (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3 only

222. (B) Synovial pivot joints are diarthrotic, that is, freely movable. Pivot joints permit rotation motion. Examples include the proximal radioulnar joint that permits supination and pronation of the hand. The atlantoaxial joint is the articulation between C1 and C2 and permits rotation of the head. The temporomandibular joint is diarthrotic, with both hinge and planar movements..

223. Which of the following projections require(s) that the humeral epicondyles be perpendicular to the IR? 1. AP humerus 2. Lateral forearm 3. Internal rotation shoulder (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

223. (C) When the arm is placed in the AP position, the epicondyles are parallel to the plane of the IR, and the shoulder is placed in external rotation. In this position, an AP projection of the humerus, elbow, and forearm can be obtained; it places the greater tubercle of the humerus in profile. For the lateral projection of the humerus and the internal rotation projection of the shoulder, the arm is internally rotated, elbow somewhat flexed, with the back of the hand against the thigh, and the epicondyles are superimposed and perpendicular to the IR. The lateral projections of the humerus, elbow, and forearm all require that the epicondyles be perpendicular to the plane of the IR.

224. Image identification markers should include 1. patient's name and/or ID number 2. date 3. a right or left marker (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

224. (D) Correct and complete patient information on every radiograph is of paramount importance. Each radiographic image must be accurately labeled with such patient information as name or identification number , institution name , date of examination , and side marker . Other information may be included according to institution policy.

225. To demonstrate the entire circumference of the radial head, exposure(s) must be made with the possible 3. hand lateral and in internal rotation (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

225. (D) Although routine elbow projections may be essentially negative, conditions may exist (such as an elevated fat pad) that seem to indicate the presence of a small fracture of the radial head. To demonstrate the entire circumference of the radial head, four exposures are made with the elbow flexed 90° and with the humeral epicondyles superimposed and perpendicular to the IR—one with the hand supinated as much as possible, one with the hand lateral, one with the hand pronated, and one with the hand in internal rotation, thumb down. Each maneuver changes the position of the radial head, and a different surface is presented for inspection.

226. The image shown in Figure 2-34 was made in what position? (A) AP or PA erect (B) Dorsal decubitus (C) Left lateral decubitus (D) Right lateral decubitus

226. (D) The radiograph shown is made in the right lateral decubitus position. It is part of a series of radiographs made during an air contrast (double-contrast) BE examination. A double-contrast examination of the large bowel is performed to see through the bowel to its posterior wall and to visualize any intraluminal (e.g., polypoid) lesions or masses . Various body positions are used to redistribute the barium and air. To demonstrate the medial and lateral walls of the bowel, decubitus positions are used. The radiograph shows a right lateral decubitus position because the barium has gravitated to the right side (the side of the hepatic flexure). The air rises and delineates the medial side of the ascending colon and the lateral side of the descending colon. The posterior wall of the rectum could be visualized using the ventral decubitus position and a horizontal beam lateral to the rectum.

227. In myelography, the contrast medium generally is injected into the (A) cisterna magna (B) individual intervertebral disks (C) subarachnoid space between the first and second lumbar vertebrae (D) subarachnoid space between the third and fourth lumbar vertebrae

227. (D) Generally, contrast medium is injected into the subarachnoid space between the third and fourth lumbar vertebrae ( Fig. 2-63 ). Because the spinal cord ends at the level of the first or second lumbar vertebra, this is considered to be a relatively safe injection site. The cisterna magna can be used, but the risk of contrast medium entering the ventricles and causing side effects increases. Diskography requires injection of contrast medium into the individual intervertebral disks.

228. Which of the following is/are required for a lateral projection of the skull? 1. The IOML is parallel to the IR 2. The MSP is parallel to the IR 3. The CR enters 3⁄4 inch superior and anterior to the EAM (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

228. (B) In the lateral position of the skull, the midsagittal plane must be parallel to the IR and the interpupillary line vertical. Flexion of the head is adjusted until the IOML is parallel to the IR. The CR should enter about 2 inches superior to the EAM. The centering point for a lateral sella turcica is 3⁄4 inch anterior and superior to the EAM.

229. Which of the following is/are effective in reducing exposure to sensitive tissues for frontal views during scoliosis examinations? 1. Use of PA position 2. Use of breast shields 3. Use of compensating filtration (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

229. (D) Spinal column studies often are required for evaluation of adolescent scoliosis, thus presenting a twofold problem—radiation exposure to youthful gonadal and breast tissues and significantly differing tissue densities/thicknesses. Electronic imaging (CR/DR) helps to reduce the exposure required for the examination. Exposure-dose concerns are also addressed with the use of a compensating filter (for uniform density) that incorporates lead shielding for the breasts and gonads ( Fig. 2-64 )..

23. Which of the following positions/projections is used to demonstrate a nearly frontal view of the sternum? (A) AP (B) PA (C) RAO (D) LAO

23. (C) Because the sternum and vertebrae would be superimposed in a direct PA or AP projection, a slight oblique (just enough to separate the sternum from superimposition on the vertebrae) is used instead of a direct frontal projection. In the RAO position, the heart superimposes a homogenous density over the sternum, thereby providing more clear radiographic visualization of its bony structure. If the LAO position were used to project the sternum to the right of the thoracic vertebrae, the posterior ribs and pulmonary markings would cast confusing shadows over the sternum because of their differing densities.

230. Which type of articulation is evaluated in arthrography? (A) Synarthrodial (B) Diarthrodial (C) Amphiarthrodial (D) Cartilaginous

230. (B) Diarthrodial joints are freely movable joints that distinctively contain a joint capsule. Contrast medium is injected into this joint capsule to demonstrate the menisci, articular cartilage, bursae, and ligaments of the joint under investigation. Synarthrodial joints are immovable joints composed of either cartilage or fibrous connective tissue. Amphiarthrodial joints allow only slight movement.

231. The laryngeal prominence is formed by the (A) thyroid gland (B) thyroid cartilage (C) vocal cords (D) pharynx

231. (B) The laryngeal prominence, or "Adam's apple," is formed by the thyroid cartilage —the principal cartilage of the larynx. The thyroid gland, one of the endocrine glands, is lateral and inferior to the thyroid cartilage. The vocal cords are within the laryngeal cavity. Portions of the pharynx serve as passages for both air and food.

240. Which of the following projections is most likely to demonstrate the carpal pisiform free of superimposition? (A) Radial flexion/deviation (B) Ulnar flexion/deviation (C) AP (medial) oblique (D) AP (lateral) oblique

240. (C) In the direct PA projection of the wrist, the carpal pisiform is superimposed on the carpal triquetrum. The AP oblique projection (medial surface adjacent to the IR) separates the pisiform and triquetrum and projects the pisiform as a separate structure. The pisiform is the smallest and most palpable carpal.

232. In the AP projection of the ankle, the 1. plantar surface of the foot is vertical 2. fibula projects more distally than the tibia 3. calcaneus is well visualized (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

232. (B) To demonstrate the ankle joint space to best advantage, the plantar surface of the foot should be vertical in the AP projection of the ankle. Note that the fibula is the more distal of the two long bones of the lower leg and forms the lateral malleolus. The calcaneus is not well visualized in this projection because of superimposition with other tarsals.

233. Which of the following examinations most likely would be performed to diagnose Wilms' tumor? (A) BE (B) Upper GI (C) IVU (D) Bone survey

233. (C) Wilms' tumor is a rapidly developing tumor of the kidney(s). It is the most common childhood renal tumor, usually affecting only one kidney. Newer treatments are effective in controlling about 90% of these tumors. As the kidneys are affected, an IVU would be the most appropriate of the examinations listed. Other useful examinations would be CT scan and sonography.

234. To visualize or "open" the right sacroiliac joint, the patient is positioned (A) 30°-40° LPO (B) 30°-40° RPO (C) 25°-30° LPO (D) 25°-30° RPO

234. (C) Sacroiliac joints lie obliquely within the pelvis and open anteriorly at an angle of 25°-30° to the midsagittal plane. A 25°-30° oblique position places the joints perpendicular to the IR. The right sacroiliac joint may be demonstrated in the LPO and RAO positions with little magnification variation.

235. Which of the following sinus groups is demonstrated with the patient positioned as for a parietoacanthial projection (Waters' method) with the CR directed through the patient's open mouth? (A) Frontal (B) Ethmoidal (C) Maxillary (D) Sphenoidal

235. (D) This is a modification of the parietoacanthial projection (Waters' method) in which the patient is requested to open the mouth, and then the skull is positioned so that the OML forms a 37° angle with the IR. The CR is directed through the sphenoidal sinuses and exits the open mouth. The routine parietoacanthial projection (with mouth closed) is used to demonstrate the maxillary sinuses projected above the petrous pyramids. The frontal and ethmoidal sinuses are best visualized in the PA axial position (modified Caldwell method).

236. Which of the following women is likely to have the most homogenous glandular breast tissue? (A) A postpubertal adolescent (B) A 20-year-old with one previous pregnancy (C) A menopausal woman (D) A postmenopausal 65-year-old

236. (A) Breast tissue is most dense, glandular, and radiographically homogenous in appearance in the postpubertal adolescent. Following pregnancy and lactation, changes occur within the breast that reduce the glandular tissue and replace it with fatty tissue (a process called fatty infiltration ). Menopause causes further atrophy of glandular tissue..

237. Standard radiographic protocols may be reduced to include two views, at right angles to each other, in which of the following situations? (A) Barium examinations (B) Spine radiography (C) Skull radiography (D) Emergency and trauma radiography

237. (D) Standard radiographic protocols may be reduced to include two views, at right angles to each other, in emergency and trauma radiography. Department policy and procedure manuals include protocols for radiographic examinations. In the best interest of the patient, and to enable the radiologist to make an accurate diagnosis, standard radiographic protocols should be followed. If the radiographer must deviate from the protocol or believes that additional projections may be helpful, then this should be discussed with the radiologist. Emergency and trauma radiography occasionally is an exception to this. rule. If the emergency department physician's request varies from the department protocol, the radiographer must respect this. A note should be added to the request so that the radiologist is informed of the reason for a change in protocol. For example, a patient who has been involved in a motor vehicle accident may need many radiographic studies, but the emergency department physician may order an AP chest and an AP and cross-table lateral C-spine only. Standard protocol may include a lateral chest and a cone-down view of the atlas and axis, as well as cervical oblique views. The emergency department physician has made a decision based on experience and expertise that overrules standard protocols. At a later time, when the patient has been stabilized, the patient may be sent back to radiology for additional views.

238. Which of the following structures is/are located in the right upper quadrant (RUQ)? 1. Spleen 2. Gallbladder 3. Hepatic flexure (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

238. (C) The abdomen can be divided into four quadrants or nine regions. The liver, gallbladder, and hepatic/right colic flexure are all located in the RUQ. The stomach and spleen are both normally located in the LUQ.

239. What hormone is secreted by the duodenal mucosa to stimulate contraction of the gallbladder following the ingestion of a fatty meal? (A) Insulin (B) Cholecystokinin (C) Adrenocorticotropic hormone (D) Gastrin

239. (B) About 30 min after the ingestion of fatty foods, cholecystokinin is released from the duodenal mucosa and absorbed into the bloodstream. As a result, the gallbladder is stimulated to contract, releasing bile into the intestine.

24. What is the name of the condition that results in the forward slipping of one vertebra upon the vertebra below it?(A) Spondylitis (B) Spondylolysis (C) Spondylolisthesis (D) Spondylosis

24. (C) The forward slipping of one vertebra on the one below it is called spondylolisthesis. Spondylolysis is the breakdown of the pars interarticularis; it may be unilateral or bilateral and results in forward slipping of the involved vertebra—the condition of spondylolisthesis. Inflammation of one or more vertebrae is called spondylitis. Spondylosis refers to degenerative changes occurring in the vertebra.

241. Myelography is a diagnostic examination used to demonstrate 1. internal disk lesions 2. posttraumatic swelling of the spinal cord 3. posterior disk herniation (A) 1 only (B) 2 only (C) 2 and 3 only (D) 1, 2, and 3

241. (C) Myelography is used to demonstrate encroachment on and compression of the spinal cord as a result of disk herniation, tumor growth, or posttraumatic swelling of the cord. This is accomplished by placing positive or negative contrast medium into the subarachnoid space. Myelography will demonstrate posterior protrusion of herniated intervertebral disks or spinal cord tumors. Anterior protrusion of a herniated intervertebral disk does not impinge on the spinal cord and is not demonstrated in myelography. Internal disk lesions can be demonstrated only by injecting contrast medium into the individual disks ( diskography

242. Which of the following blood chemistry levels must the radiographer check prior to excretory urography? 1. Creatinine 2. Blood urea nitrogen (BUN) 3. Red blood cells (RBCs) (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

242. (B) The radiographer must check blood chemistry levels that are associated with renal function before beginning excretory urography. These levels are blood urea nitrogen (BUN) and creatinine. Normal BUN range is 8-25 mg/100 mL. Normal creatinine range is 0.6-1.5 mg/100 mL. Elevated levels can indicate poor renal function.

243. Which of the following are components of a trimalleolar fracture? 1. Fractured lateral malleolus 2. Fractured medial malleolus 3. Fractured anterior tibia (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

243. (B) A trimalleolar fracture involves three separate fractures. The lateral malleolus is fractured in the "typical" fashion, but the medial malleolus is fractured on both its medial and posterior aspects. The trimalleolar fracture frequently is associated with subluxation of the articular surfaces.

244. Mineral homeostasis, protection, and triglyceride storage are functions of which body system? (A) Endocrine (B) Integumentary (C) Skeletal (D) Muscular

244. (C) The skeleton's design functions to protect vital internal organs such as the heart and lungs. Bone stores important minerals (e.g., calcium and phosphorus) and releases them into the blood as needed. Yellow bone marrow is composed mainly of fat cells and stores triglycerides for use as an energy reserve. The endocrine system is associated with hormone production; the integumentary system includes the skin that is important in protection and excretion; the muscular system is responsible for movement and heat production.

245. The four major arteries supplying the brain include the 1. brachiocephalic artery 2. common carotid arteries 3. vertebral arteries (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

245. (C) Major branches of the common carotid arteries (internal carotids) function to supply the anterior brain, whereas the posterior brain is supplied by the vertebral arteries (branches of the subclavian artery). The brachiocephalic (innominate) artery is unpaired and is one of the three branches of the aortic arch, from which the right common carotid artery is derived. The left common carotid artery comes directly off the aortic arch.

246. Ingestion of barium sulfate is contraindicated in which of the following situations? 1. Suspected perforation of a hollow viscus 2. Suspected large-bowel obstruction 3. Preoperative patients (A) 1 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

246. (D) Barium sulfate suspension is the usual contrast medium of choice for investigation of the alimentary tract. There are, however, a few exceptions. Whenever there is the possibility of escape of contrast medium into the peritoneal cavity, barium sulfate is contraindicated, and a water-soluble iodinated medium is recommended because it is easily aspirated before surgery (or resorbed and excreted by the kidneys). Patients with a ruptured hollow viscus (e.g., perforated ulcer and diverticulitis), those with suspected large bowel obstruction, and those who are scheduled for surgery are examples of patients who should ingest only water-soluble iodinated media.

247. The term that refers to parts away from the source or beginning is (A) cephalad (B) proximal (C) distal (D) lateral

247. (C) There are many terms (with which the radiographer must be familiar) that are used to describe radiographic positioning techniques. Cephalad refers to that which is toward the head, and caudad refers to that which is toward the feet. Structures close to the source or beginning are said to be proximal, whereas those lying away from the source or origin are distal. Parts close to the midline are said to be medial, and those away from the midline are lateral.

248. Which of the following is/are well demonstrated in the lumbar spine shown in Figure 2-35 ? 1. Zygapophyseal articulations 2. Intervertebral foramina 3. Inferior articular processes (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

248. (C) An oblique projection of the lumbar spine is shown. This is a 45° LPO projection demonstrating the zygapophyseal joints closest to the IR. The zygapophyseal joints are formed by the articulation of the inferior articular facets of one vertebra with the superior articular facets of the vertebra below. Note the "Scotty dog" images that appear in the oblique lumbar spine. Intervertebral foramina are best visualized in the lateral lumbar position.

249. Which of the following statements is/are correct, with respect to a left lateral projection of the chest? 1. The MSP must be perfectly vertical and parallel to the IR 2. The right posterior ribs will be projected slightly posterior to the left posterior ribs 3. Arms must be raised high to prevent upper-arm soft-tissue superimposition on lung field (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

249. (D) The chest should be examined in the upright position whenever possible to demonstrate any air-fluid levels. For the lateral projection, the patient elevates the arms well enough to avoid upper-arm soft-tissue superimposition on the lung fields. In the left lateral position, the right posterior ribs, being remote from the IR, will be somewhat magnified and very slightly posterior to the left posterior ribs. The MSP must remain vertical to avoid "tilt" distortion, and the coronal plane must be vertical to avoid rotation distortion.

25. Which of the following can be used to demonstrate the intercondyloid fossa? 1. Prone, knee flexed 40°, CR directed caudad 40° to the popliteal fossa 2. Supine, IR under flexed knee, CR directed cephalad to knee, perpendicular to tibia 3. Prone, patella parallel to IR, heel rotated 5°-10° lateral, CR perpendicular to knee joint (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

25. (B) Statement number 1 describes the PA axial projection (Camp-Coventry method) for demonstration of the intercondyloid fossa. Statement number 2 describes the AP axial projection (Béclère method) for demonstration of the intercondyloid fossa. The positions are actually the reverse of each other. Statement number 3 describes the method of obtaining a PA projection of the patella.

250. Which of the following is well demonstrated just posterior to the lumbar vertebra in Figure 2-36 ? (A) Inferior vena cava (B) Aorta (C) Gallbladder (D) Psoas muscle

250. (D) A cross-sectional image of the abdomen is shown in Figure 2-36 . The large structure on the right, labeled number 1, is the liver. The gallbladder is seen as a somewhat darker density on the medial border of the liver. The left kidney is labeled number 4; the right kidney is seen clearly on the other side. The vertebra is labeled number 5, and the psoas muscles are seen just posterior to the vertebra. Just anterior to the body of the vertebra is the circular aorta, labeled number 3 (some calcification can be seen as brighter densities). The somewhat flattened inferior vena cava (number 2) is seen to the left of and slightly anterior to the aorta.

251. Which of the following bones participate(s) in the formation of the knee joint? 1. Femur 2. Tibia 3. Patella (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

251. (A) The knee (tibiofemoral joint) is the largest joint of the body, formed by the articulation of the femur and tibia. However, it actually consists of three articulations: the patellofemoral joint, the lateral tibiofemoral joint (lateral femoral condyle with tibial plateau), and the medial tibiofemoral joint (medial femoral condyle with tibial plateau). Although the knee is classified as a synovial (diarthrotic) hinge-type joint, the patellofemoral joint actually is a gliding joint, and the medial and lateral tibiofemoral joints are hinge type.

252. All the following are palpable bony landmarks that can be used in radiography of the pelvis, except (A) the femoral neck (B) the pubic symphysis (C) the greater trochanter (D) the iliac crest

252. (A) Femoral necks are nonpalpable bony landmarks. The ASIS, pubic symphysis, and greater trochanter are palpable bony landmarks used in radiography of the pelvis and for localization of the femoral necks.

253. Lateral deviation of the nasal septum may be best demonstrated in the (A) lateral projection (B) PA axial (Caldwell method) projection (C) parietoacanthial (Waters' method) projection (D) AP axial (Towne method) projection

253. (C) The full length of the nasal septum is best demonstrated in the parietoacanthial (Waters' method) projection. This is also the single best view for facial bones. The PA axial (Caldwell method) projection superimposes the petrous structures over the nasal septum, whereas the lateral projection superimposes and obscures good visualization of the septum. The AP axial projection is used to demonstrate the occipital bone.

254. The AP Trendelenburg position is often used during an upper GI examination to demonstrate (A) the duodenal loop (B) filling of the duodenal bulb (C) hiatal hernia (D) hypertrophic pyloric stenosis

254. (C) Placing the patient in a 20°-30° AP Trendelenburg position during an upper GI examination helps to demonstrate the presence of a hiatal hernia. A 10°-15° Trendelenburg position with the patient rotated slightly to the right also will help demonstrate regurgitation and hiatal hernia. Filling of the duodenal bulb and demonstration of the duodenal loop are best seen in the RAO position. Congenital hypertrophic pyloric stenosis is caused by excessive thickening of the pyloric sphincter. It is noted in infancy and characterized by projectile vomiting. The pyloric valve will let very little pass through, and as a result, the stomach becomes enlarged (hypertrophied).

255. What is the structure labeled number 5 in Figure 2-37 ? (A) Base of the second metacarpal (B) Pisiform (C) Trapezium (D) Trapezoid

255 - 256. (255, B; 256, A) The image illustrates a PA projection of the wrist. This projection best demonstrates visualization of the distal radioulnar joint, the proximal and distal rows of carpals, and the proximal metacarpals (more of the metacarpals should be seen here). The base of the fifth metacarpal is number 4. The trapezium (lateral carpal, distal row) is number 1; the base of the first metacarpal is seen articulating with the trapezium forming the (saddle) carpometacarpal articulation. Number 2 is the scaphoid—the most lateral carpal of the proximal carpal row. Number 3 is the radial styloid process. Number 5 is the pisiform, seen just lateral to, and partially superimposed upon, the triquetrum. Number 6 is the ulnar styloid process.

256. What is the structure labeled number 1 in Figure 2-37 ? (A) Trapezium (B) Scaphoid (C) Ulnar styloid (D) Radial styloid

255 - 256. (255, B; 256, A) The image illustrates a PA projection of the wrist. This projection best demonstrates visualization of the distal radioulnar joint, the proximal and distal rows of carpals, and the proximal metacarpals (more of the metacarpals should be seen here). The base of the fifth metacarpal is number 4. The trapezium (lateral carpal, distal row) is number 1; the base of the first metacarpal is seen articulating with the trapezium forming the (saddle) carpometacarpal articulation. Number 2 is the scaphoid—the most lateral carpal of the proximal carpal row. Number 3 is the radial styloid process. Number 5 is the pisiform, seen just lateral to, and partially superimposed upon, the triquetrum. Number 6 is the ulnar styloid process.

257. In the PA axial oblique projection of the cervical spine, the CR should be directed (A) parallel to C4 (B) perpendicular to C4 (C) 15° cephalad to C4 (D) 15° caudad to C4

257. (D) The PA axial oblique projections (LAO and RAO positions) of the cervical spine require a 15° caudal angulation and demonstrate the intervertebral foramina closest to the IR. The AP axial oblique projections (LPO and RPO positions) require that the CR be directed 15° to C4. PA axial oblique projections demonstrate the intervertebral foramina farther away from the IR.

258. Which of the following is a functional study used to demonstrate the degree of AP motion present in the cervical spine? (A) Open-mouth projection (B) Moving-mandible AP (C) Flexion and extension laterals (D) Right and left bending AP

258. (C) The degree of anterior and posterior motion occasionally is diminished with a whiplash type of injury. Anterior (forward, flexion) and posterior (backward, extension) motion is evaluated in the lateral position, with the patient assuming the best possible flexion and extension. Left- and right-bending images of the thoracic and lumbar vertebrae are obtained frequently when evaluating scoliosis.

259. If a patient's zygomatic arch has been traumatically depressed or the patient has flat cheekbones, the arch may be demonstrated by modifying the SMV projection and rotating the patient's head (A) 15° toward the side being examined (B) 15° away from the side being examined (C) 30° toward the side being examined (D) 30° away from the side being examined

259. (A) When one cheekbone is depressed, a tangential projection is required to "open up" the zygomatic arch and draw it away from the overlying cranial bones. This is accomplished by placing the patient in the SMV position, rotating the head 15° toward the affected side, and centering to the zygomatic arch. A 30° rotation places the mandibular shadow over the zygomatic arch.

26. How should a chest examination to rule out air-fluid levels be obtained on a patient with traumatic injuries? (A) Perform the examination in the Trendelenburg position (B) Erect inspiration and expiration images should be obtained (C) Include a lateral chest examination performed in dorsal decubitus position (D) Perform the examination AP supine at 44-in SID

26. (C) One of the most important principles in chest radiography is that it be performed, whenever possible, in the erect position. It is in this position that the diaphragm can descend to its lowest position during inspiration, and any air-fluid levels can be detected. However, patients with traumatic injuries frequently must be examined in the supine position. An AP supine chest is performed first. If the examination is also being performed to rule out air-fluid levels, this can be determined by performing the lateral projection in the dorsal decubitus position. The patient is lying supine, and a horizontal (cross-table) x-ray beam is used.

260. Which of the following factors can contribute to hypertension? 1. Obesity 2. Smoking 3. Stress (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

260. (D) Normal blood pressure is 110-140 mm Hg systolic and 60-80 mm Hg diastolic. High blood pressure (hypertension) is indicated by systolic pressure higher than 140 mm Hg and diastolic pressure higher than 90 mm Hg. Hypertension can be identified as extreme or moderate. Extreme hypertension can result in brain damage within just a few minutes. Moderate hypertension can cause damage to organs: the lungs, kidneys, brain, heart, and so on. Various disease processes can produce hypertension as well as contributing factors, such as medications, obesity, smoking, and stress.

261. What is the degree of difference between the baselines numbered 2 and 3 in Figure 2-38 and used for various projections of the skull? (A) 7° (B) 9° (C) 15° (D) 23°

261. (A) Accurate positioning of the skull requires the use of several baselines. In the figure, line 1 represents the glabellomeatal line (GML), line 2 is the orbitomeatal line (OML), line 3 is the infraorbitomeatal line (IOML), and line 4 is the acanthomeatal line (AML). The OML and the IOML usually are separated by 7°. The OML and the GML usually are separated by 8° (therefore, there is a 15° difference between the GML and the IOML). It is useful to remember these differences because CR angulation must be adjusted when using a baseline other than the one recommended for a particular position. For example, if it is recommended that the CR be angled 30 ° to the OML, then the CR would be angled 37 ° to the IOML.

262. Referring to Figure 2-38 , which of the following positions requires that baseline number 3 be parallel to the IR? (A) Parietoacanthial (B) PA axial (Caldwell) (C) AP axial (Towne) (D) SMV

262. (D) The SMV projection of the skull requires that the patient's neck be extended, placing the vertex adjacent to the IR holder/upright Bucky so that the IOML is parallel with the IR. This projection is useful for demonstrating the ethmoidal and sphenoidal sinuses, pars petrosae, mandible, and foramina ovale and spinosum. The lateral projection of the skull requires that the patient be in the prone oblique position with the MSP parallel to the IR and the interpupillary line perpendicular to the IR. This position also requires that the IOML (line 3) be parallel to the long axis of the IR. The AP and PA axial projections of the skull require the OML or IOML to be perpendicular to the IR.

263. Radiographic measurement of long bones of an upper or lower extremity requires which of the following? 1. Special ruler/Bell-Thompson scale 2. Precise collimation 3. Cannula (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

263. (B) The term Orthoroentgenography is sometimes used to describe the radiographic measurement of long-bone length. Long bone measurement can be required on adults or children with extremity length (especially leg) discrepancies. This can be performed most easily with the use of a special metallic ruler/scale ( Bell-Thompson scale ) secured to the x-ray tabletop adjacent to the limb being examined (or between both limbs for simultaneous bilateral examination). A 14 × 17 inches IR is in the Bucky tray (to permit movement of the IR between exposures), and three well-collimated exposures are made—at the hip joint, the knee joint, and the ankle joint. The visible ruler markings adjacent to the limb enable accurate limb measurements. A cannula is a tube placed in a cavity to introduce or withdraw material and is unrelated to long bone measurement.

264. Which of the following is/are demonstrated in a lateral projection of the cervical spine? 1. Intervertebral foramina 2. Zygapophyseal joints 3. Intervertebral joints (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

264. (C) Intervertebral joints (occupied by the intervertebral disks) are well visualized in the lateral projection of all the vertebral groups. Cervical articular facets (forming zyg apophyseal/interarticular joints ) are 90° to the midsagittal plane and, therefore, are well demonstrated in the lateral projection. The cervical intervertebral foramina lie 45° to the midsagittal plane (and 15°-20° to a transverse plane) and, therefore, are demonstrated in the oblique position.

265. In a lateral projection of the nasal bones, the CR is directed (A) half inch posterior to the anterior nasal spine (B) half inch posterior to the glabella (C) half inch distal to the nasion (D) half inch anterior to the EAM

265. (C) The patient is placed in a true lateral position, and the CR is directed perpendicular to a point 1/2 inch distal to the nasion. An 8 × 10 inches IR divided in half may be used for this procedure.

266. What is the relationship between the midsagittal and midcoronal planes? (A) Parallel (B) Perpendicular (C) 45° (D) 70°

266. (B) The midsagittal plane passes vertically through the midline of the body, dividing it into left and right halves. Any plane parallel to the MSP is termed a sagittal plane. The midcoronal plane is perpendicular to the MSP and divides the body into anterior and posterior halves. The transverse plane passes across the body, also perpendicular to a sagittal plane. These planes, especially the MSP, are very important reference points in radiographic positioning.

267. Which of the following statements regarding knee x-ray arthrography is/are true? 1. Ligament tears can be demonstrated 2. Sterile technique is observed 3. MRI can follow x-ray (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

267. (D) X-ray arthrography requires the use of local anesthesia; sterile technique must be observed to avoid introducing infection into the joint. Fluoroscopy is used for proper placement of the needle and to obtain images immediately after the introduction of contrast medium. Many physicians follow up the x-ray arthrogram with a magnetic resonance (MR) arthrogram to visualize additional soft-tissue structures. Arthrography is performed to detect compromised knee capsule structures, meniscal damage, ligament tears, and Baker cysts.

268. Structures involved in blowout fractures include the 1. orbital floor 2. inferior rectus muscle 3. zygoma (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

268. (B) Blowout fractures of the orbital floor are caused by a direct blow to the eye. The orbital floor is caused to collapse; this carries the inferior rectus muscle through the fracture site and into the maxillary sinus . Diplopia (double vision) often results. Blowout fractures are well demonstrated with the Waters' method (parietoacanthial projection) and by using tomographic studies. A parietoacanthial projection with the OML perpendicular and the CR angled 30° caudad also will demonstrate the orbital floor in profile. The zygoma usually is not involved with a blowout fracture but rather with a tripod fracture.

269. Inspiration and expiration projections of the chest are performed to demonstrate 1. partial or complete collapse of pulmonary lobe(s) 2. air in the pleural cavity 3. foreign body (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

269. (D) The phase of respiration is exceedingly important in thoracic radiography, because lung expansion and the position of the diaphragm strongly influence the appearance of the finished radiograph. Inspiration and expiration radiographs of the chest are taken to demonstrate air in the pleural cavity ( pneumothorax ), to demonstrate atelectasis (partial or complete collapse of one or more pulmonary lobes) or the degree of diaphragm excursion, or to detect the presence of a foreign body. The expiration image will require a somewhat greater exposure (6-8 kV more) to compensate for the diminished quantity of air in the lungs.

27. According to ACR (2017), patients with acute kidney injury or severe chronic kidney disease, or those undergoing arterial catheter study, should adhere to the following guideline(s) for iodinated contrast medium administration: 1. patients should temporarily discontinue metformin at time of (or prior to) the procedure 2. withhold metformin for 48 h after the procedure 3. metformin may be reinstituted only after renal function studies have been re-evaluated and found acceptable (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

27. (D) With the use of iodinated contrast agents, there is a potential concern for increased renal damage in patients with acute kidney injury (AKI) and/or in patients with severe chronic kidney disease (as determined by estimated glomerular filtration rate/eGFR). Current (2017) American College of Radiology (ACR) recommendations state that "there have been no reports of lactic acidosis following intravenous iodinated contrast medium administration in patients properly selected for metformin use." The ACR recommends that metformin (Glucophage) patients be classified in two categories. Category 1 patients taking metformin are those with no evidence of AKI and with eGFR of 30 mL/min/l.732; these patients need not discontinue metformin before or after receiving contrast, and it is not required that renal function be reassessed following the exam. Category 2 patients taking metformin are those with AKI or severe chronic kidney disease as indicated by eGFR, or those who will be undergoing an arterial catheter study; these patients should temporarily discontinue metformin at time of (or prior to) the procedure, and withhold metformin for 48 h after the procedure. Metformin should be reinstituted only after renal function studies have been reevaluated and found to be acceptable.

270. Shoulder arthrography is performed to 1. evaluate humeral luxation 2. demonstrate complete or partial rotator cuff tear 3. evaluate the glenoid labrum (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

270. (C) Shoulder arthrograms ( Fig. 2-65 ) are used to evaluate rotator cuff tear, glenoid labrum (a ring of fibrocartilaginous tissue around the glenoid fossa), and frozen shoulder. Routine radiographs demonstrate arthritis, and the addition of a transthoracic humerus or scapular Y projection would be used to demonstrate luxation (dislocation).

271. Which of the following positions will separate the radial head, neck, and tuberosity from superimposition on the ulna? (A) AP (B) Lateral (C) Medial oblique (D) Lateral oblique

271. (D) In the AP projection of the elbow, the proximal radius and ulna are partially superimposed. In the lateral projection, the radial head is partially superimposed on the coronoid process, facing anteriorly. In the medial oblique projection, there is even greater superimposition. The

272. The most significant risk factor for breast cancer is (A) age (B) gender (C) family history (D) personal history

272. (B) Changes in hormone levels affect changes in the glandular tissue of the breast. These breast tissue changes are seen during breast development, during pregnancy and lactation, and during menopause. Women at higher risk of developing breast cancer include those with experienced early menses (before age 12 years), late menopause (after age 52 years), and nulliparity (no full- or late-term pregnancies). Risks other than hormonal include family and personal history and age. The greatest single risk factor for breast cancer is gender—being female. Although occurrence of breast cancer in men is not unknown, it is fairly rare.

273. Which of the following structures is located at the level of the interspace between the second and third thoracic vertebrae? (A) Manubrium (B) Jugular notch (C) Sternal angle (D) Xiphoid process

273. (B) There are several surface landmarks and localization points that can help the radiographer in positioning various body structures. The jugular notch, located at the superior aspect of the manubrium, is approximately opposite the T2-T3 interspace. The sternal angle is located opposite the T4-T5 interspace. The xiphoid (or ensiform) process is located opposite T10.

274. For the AP projection of the scapula, the 1. patient's arm is abducted at right angles to the body 2. patient's elbow is flexed with the hand supinated 3. exposure is made during quiet breathing (A) 1 and 2 only (B) 1 and 3 only (C) 3 only (D) 1, 2, and 3

274. (D) With the patient in the AP position, the scapula and upper thorax are normally superimposed. With the arm abducted, the elbow flexed, and the hand supinated, much of the scapula is drawn away from the ribs. The patient should not be rotated toward the affected side, because this causes superimposition of ribs on the scapula. The exposure is made during quiet breathing to obliterate pulmonary vascular markings.

275. The innominate bone is located in the (A) middle cranial fossa (B) posterior cranial fossa (C) foot (D) pelvis

275. (D) The two innominate bones (os coxae) make up the pelvis . Each innominate bone is made three bones: ilium, ischium, and pubis. These three bones contribute to form the formation of the acetabulum. When the interior of the acetabulum is viewed, the ilium comprises its upper two-thirds, the ischium comprises its lower posterior two-thirds, and the pubis comprises the lower anterior one-third of the acetabulum.

276. With the patient in a 40° RPO position, affected side down, hip joint centered to IR, and CR directed perpendicularly to the IR at the level of the ASIS, the structure best demonstrated is the (A) right SI joint (B) left SI joint (C) right ilium (D) left ilium

276. (C) The bony pelvis is shaped like a basin and the ilia are foreshortened in an AP projection. If the patient is obliqued 40°, affected side down, this places the iliac wing parallel to the IR. The hip of the affected side is centered to the midline and the CR is directed perpendicularly at the level of the ASIS. Sacroiliac joints can be demonstrated using AP oblique (25°-30°)

277. Deoxygenated blood from the head and thorax is returned to the heart by the (A) pulmonary artery (B) pulmonary veins (C) superior vena cava (D) thoracic aorta

277. (C) Deoxygenated (venous) blood from the upper body (i.e., head, neck, thorax, and upper extremities) empties into the superior vena cava. Deoxygenated (venous) blood from the lower body (i.e., abdomen, pelvis, and lower extremities) empties into the inferior vena cava. The superior and inferior venae cavae empty into the right atrium. The coronary sinus, which returns venous blood from the heart, also empties into the right atrium. Deoxygenated blood passes from the right atrium through the tricuspid valve into the right ventricle. From the right ventricle, blood is pumped (during ventricular systole) through the pulmonary semilunar valve into the pulmonary artery—the only artery that carries deoxygenated blood. From the pulmonary artery, blood travels to the lungs, picks up oxygen, and is carried by the four pulmonary veins (the only veins carrying oxygenated blood) to the left atrium. The oxygenated blood passes through the mitral (or bicuspid) valve during atrial systole and into the left ventricle. During ventricular systole, oxygenated blood from the left ventricle passes through the aortic semilunar valve into the aorta and into the systemic circulation.

278. Below diaphragm, ribs are better demonstrated when 1. the patient is in the AP erect position 2. respiration is suspended at the end of full exhalation 3. the patient is in the recumbent position (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

278. (C) The ribs below the diaphragm are best demonstrated with the diaphragm elevated. This is accomplished by placing the patient in a recumbent position and by taking the exposure at the end of exhalation. Conversely, the ribs above the diaphragm are best demonstrated with the diaphragm depressed. Placing the patient in the erect position and taking the exposure at the end of deep inspiration accomplishes this.

279. Which of the following positions is essential in radiography of the paranasal sinuses? (A) Erect (B) Recumbent (C) Oblique (D) Trendelenburg

279. (A) Because sinus examinations are performed to evaluate the presence or absence of fluid, they must be performed in the erect position with a horizontal x-ray beam . The PA axial (Caldwell) projection demonstrates the frontal and ethmoidal sinus groups, and the parietoacanthial projection (Waters' method) shows the maxillary sinuses. The lateral position demonstrates all the sinus groups, and the SMV position is used frequently to demonstrate the sphenoidal sinuses..

28. Which of the following methods was used to obtain the image seen in Figure 2-6 ?

28. (C) The radiograph shown is a PA projection (Caldwell method) of the frontal and anterior ethmoidal sinuses. The frontal sinuses are seen centrally in the vertical plate of the frontal bone behind the glabella and extending laterally over the superciliary arches. The ethmoidal sinuses are seen adjacent and inferior to the medial aspect of the orbits. The patient is positioned PA erect with the chin extended so that the OML is 15° from the horizontal. With the OML perpendicular to the IR, the petrous pyramids would fill the orbits (true PA). In the PA position with chin extended (choice A) and OML 37° to the IR (parietoacanthial projection, Waters' method), the petrous pyramids are projected below the maxillary sinuses.

280. What projection of the calcaneus is obtained with the leg extended, the plantar surface of the foot vertical and perpendicular to the IR, and the CR directed 40° cephalad? (A) Axial plantodorsal projection (B) Axial dorsoplantar projection (C) Lateral projection (D) Weight-bearing lateral projection

280. (A) The plantodorsal projection of the os calsis/calcaneus is described. It is performed supine and requires cephalad angulation. The CR enters the plantar surface and exits the dorsal surface. The axial dorsoplantar projection requires that the CR enter the dorsal surface of the foot and exit the plantar surface.

281. To demonstrate the first two cervical vertebrae in the AP projection, the patient is positioned so that (A) the glabellomeatal line is vertical (B) the acanthiomeatal line is vertical (C) a line between the mentum and the mastoid tip is vertical (D) a line between the maxillary occlusal plane and the mastoid tip is vertical

281. (D) To clearly demonstrate the atlas and axis without superimposition of the teeth or the base of the skull, a line between the maxillary occlusal plane (edge of upper teeth) and mastoid tip must be vertical. If the head is flexed too much, the teeth will be superimposed. If the head is extended too much, the cranial base will be superimposed on the area of interest. A line between the mentum and the mastoid tip is used to demonstrate the odontoid process only through the foramen magnum (Fuchs method).

282. With a patient in the PA position and the OML perpendicular to the table, a 15°-20° caudal angulation would place the petrous ridges in the lower third of the orbit. To achieve the same result in an infant or a small child, it is necessary for the radiographer to modify the angulation to (A) 10°-15° caudal (B) 25°-30° caudal (C) 15°-20° cephalic (D) 3°-5° caudal

282. (A) With a patient in the PA position and the OML perpendicular to the table, a 15°-20° caudal angulation would place the petrous ridges in the lower third of the orbit. To achieve the same result in an infant or a small child, it is necessary for the radiographer to decrease the angulation or modify the angulation to 10°-15° caudal. The reason for this can be understood by examining the baselines for skull positioning. In the adult skull, the OML and IOML are about 7° apart. In an infant or small child, the difference is larger, about 15° apart. Remember that in adults, the head makes up about one-seventh the length of the body. In children, the head is about one-fourth the length of the body. These differences must be considered in radiographic examination of the skull for infants.

65. With the patient in the PA position, which of the following tube angle and direction combinations is correct for an axial projection of the clavicle? (A) 5°-15° caudad (B) 5°-15° cephalad (C) 15°-30° cephalad (D) 15°-30° caudad

65. (D) When the clavicle is examined in the PA recumbent position, the CR must be directed 15°-30° caudad to project most of the clavicle's length above the ribs. The direction of the CR is reversed when examining the patient in the AP position.

283. The structure labeled number 6 in Figure 2-39 is the (A) left subclavian artery (B) brachiocephalic artery (C) right common carotid artery 283. The structure labeled number 6 in Figure 2-39 is the (A) left subclavian artery (B) brachiocephalic artery (C) right common carotid artery

283 - 284. (283, B; 284, D) The figure illustrates the aortic arch (number 1) and its three main branches—the brachiocephalic artery (number 6), the left common carotid artery (number 4), and the left subclavian artery (number 2). The right common carotid artery (number 5) and the right subclavian artery (number 7) are branches of the brachiocephalic. The vertebral arteries are the first main branch of the subclavian arteries. The left vertebral artery is labeled number 3.

284. The structure labeled number 3 in Figure 2-39 is the (A) left subclavian artery (B) brachiocephalic artery (C) right common carotid artery (D) left vertebral artery

283 - 284. (283, B; 284, D) The figure illustrates the aortic arch (number 1) and its three main branches—the brachiocephalic artery (number 6), the left common carotid artery (number 4), and the left subclavian artery (number 2). The right common carotid artery (number 5) and the right subclavian artery (number 7) are branches of the brachiocephalic. The vertebral arteries are the first main branch of the subclavian arteries. The left vertebral artery is labeled number 3.

285. In the lateral projection of the foot, the 1. plantar surface should be perpendicular to the IR 2. metatarsals are superimposed 3. talofibular joint should be visualized (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

285. (B) When the foot is positioned for a lateral projection, the plantar surface should be perpendicular to the IR so as to superimpose the metatarsals. This may be accomplished with the patient lying on either the affected or the unaffected side (usually the affected), that is, mediolateral or lateromedial. The talofibular articulation is best demonstrated in the medial oblique projection of the ankle.

286. Which of the following positions demonstrates the sphenoid sinuses? 1. Modified Waters' (mouth open) 2. Lateral 3. PA axial (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

286. (B) The parietoacanthial (Waters' method) projection demonstrates the maxillary sinuses. The modified Waters' position, with the CR directed through the open mouth, will demonstrate the sphenoid sinuses through the open mouth. The PA axial projection demonstrates the frontal and ethmoidal sinus groups. The lateral projection, with the CR entering 1 inch posterior to the outer canthus, demonstrates all the paranasal sinuses. X-ray examinations of the sinuses always should be performed erect to demonstrate leveling of any fluid present.

287. The number 2 in Figure 2-40 represents which of the following structures? (A) Body (B) Pedicle (C) Inferior articular process (D) Superior articular process

287. (C) The typical vertebra, shown in Figure 2-66 , is divided into two portions: the body (anteriorly) and the vertebral arch (posteriorly). The vertebral arch supports seven processes: two transverse, one spinous (number 3), two superior articular (number 4), and two inferior articular (number 2). The superior articular processes and the superjacent inferior articular processes join to form zygapophyseal joints. Pedicles (number 5) project posteriorly from the vertebral body (number 6). Their upper and lower surfaces form vertebral notches. Superjacent vertebral notches form intervertebral foramina. The lamina is represented by number 1. The transverse and spinous processes serve as attachments for muscles or articulations for ribs in the thoracic region. The superior and inferior surfaces of the vertebral body are covered with articular cartilage, and between the vertebral bodies lie the intervertebral disks.

288. To demonstrate the mandibular body in the PA projection, the (A) CR is directed perpendicular to the IR (B) CR is directed cephalad to the IR (C) skull is obliqued away from the affected side (D) skull is obliqued toward the affected side

288. (A) The straight PA projection (0°), with CR directed perpendicular to the IR, effectively demonstrates the mandibular body. In this position, the rami and condyles are superimposed on the occipital bone and petrous portion of the temporal bone. To better visualize the rami and condyles, the CR is directed cephalad 20°-30°..

289. Which of the following equipment is necessary for ERCP? 1. A fluoroscopic unit with imaging device and tilt-table capabilities 2. A fiberoptic endoscope 3. Polyethylene catheters (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

289. (D) A fluoroscopic unit with spot device and tilt table should be used for endoscopic retrograde pancreatography. The Trendelenburg position is sometimes necessary to fill the interhepatic ducts, and a semierect position may be necessary to fill the lower end of the common bile duct. Also necessary are a fiberoptic endoscope for locating the hepatopancreatic ampulla and polyethylene catheters for the introduction of contrast medium.

29. Which of the following statements regarding the radiograph in Figure 2-6 is/are true? 1. The position is used to demonstrate the frontal and ethmoid sinuses 2. The ethmoid sinuses are seen near the medial aspect of the orbits 3. The perpendicular plate is visualized in midline of the nasal cavity (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

29. (D) The radiograph shown is a PA projection (Caldwell method) of the frontal and anterior ethmoid sinuses. The frontal sinuses are seen centrally in the vertical plate of the frontal bone behind the glabella and extending laterally over the superciliary arches. The ethmoid sinuses are seen adjacent and inferior to the medial aspect of the orbits. The nasal cavity is seen, with the perpendicular plate and vomer, in the midline. The patient is positioned PA erect with the chin extended so that the OML is 15° from the horizontal.

290. Types of mechanical obstruction found in pediatric patients include 1. volvulus 2. intussusception 3. paralytic ileus (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

290. (B) Intussusception is a type mechanical obstruction involving telescoping of a portion the pediatric large intestine, causing obstruction. Volvulus is a condition of the pediatric intestine involving twisting of intestinal loops, causing obstruction. These are described as mechanical conditions. Paralytic (adynamic) ileus is a type of obstruction caused as a result loss of intestinal motility/contraction.

291. The act of expiration will cause the 1. diaphragm to move inferiorly 2. sternum and ribs to move inferiorly 3. diaphragm to move superiorly (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

291. (C) The diaphragm is the major muscle of respiration. On inspiration/inhalation, the diaphragm and abdominal viscera are depressed, enabling the filling and expansion of the lungs, accompanied by upward movement of the sternum and ribs. During expiration/exhalation, air leaves the lungs and they deflate, and the diaphragm relaxes and moves to a more superior position along with the abdominal viscera. As the diaphragm relaxes and moves up, the sternum and ribs move inferiorly.

292. A patient unable to extend his or her arm is seated at the end of the x-ray table, elbow flexed 90°. The CR is directed 45° medially. Which of the following structures will be demonstrated best ? 1. Radial head 2. Capitulum 3. Coronoid process (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

292. (B) The axial trauma lateral (Coyle) position is described. If routine elbow projections in extension are not possible because of limited part movement, this position can be used to demonstrate the coronoid process and/or radial head. With the elbow flexed 90 ° and the CR directed to the elbow joint at an angle of 45° medially (i.e., toward the shoulder), the joint space between the radial head and capitulum should be revealed. With the elbow flexed 80 ° and the CR directed to the elbow joint at an angle of 45° laterally (i.e., from the shoulder toward the elbow), the elongated coronoid process will be visualized.

293. Which of the following articulate(s) with the bases of the metatarsals? 1. The heads of the first row of phalanges 2. The cuboid 3. The cuneiforms (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

293. (C) The foot is composed of the 7 tarsal bones, 5 metatarsals, and 14 phalanges. The metatarsals and phalanges are miniature long bones; each has a shaft, base (proximal), and head (distal). The bases of the first to third metatarsals articulate with the three cuneiforms. The bases of the fourth and fifth metatarsals articulate with the cuboid. The heads of the metatarsals articulate with the bases of the first row of phalanges.

294. Which of the following positions will best demonstrate the right zygapophyseal articulations of the lumbar vertebrae? (A) PA (B) Left lateral (C) RPO (D) LPO

294. (C) The posterior oblique positions (LPO and RPO) of the lumbar vertebrae demonstrate the zygapophyseal joints closer to the IR. The left zygapophyseal joints are demonstrated in the LPO position, whereas the right zygapophyseal joints are demonstrated in the RPO position. The lateral position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes.

295. What projection was used to obtain the image seen in Figure 2-41 ? (A) AP, internal rotation (B) AP, external rotation (C) AP, neutral position (D) AP axial

295 - 297. (295, B; 296, C; 297, C) An AP, external rotation, projection of the shoulder is pictured. The hand is supinated, and the arm is in the anatomical position. Therefore, the greater tubercle (number 3) is well visualized. The greater portion of the clavicle is seen, the acromioclavicular joint (number 1), the acromion process (number 2), the coracoid process (number 4), and the glenohumeral joint (number 5). The coronoid process is located on the ulna..

296. The structure labeled number 3 in Figure 2-41 is the (A) acromion process (B) coronoid process (C) greater tubercle (D) lesser tubercle

295 - 297. (295, B; 296, C; 297, C) An AP, external rotation, projection of the shoulder is pictured. The hand is supinated, and the arm is in the anatomical position. Therefore, the greater tubercle (number 3) is well visualized. The greater portion of the clavicle is seen, the acromioclavicular joint (number 1), the acromion process (number 2), the coracoid process (number 4), and the glenohumeral joint (number 5). The coronoid process is located on the ulna..

297. The structure labeled number 5 in Figure 2-41 is the (A) sternoclavicular joint (B) acromioclavicular joint (C) glenohumeral joint (D) acromiohumeral joint

295 - 297. (295, B; 296, C; 297, C) An AP, external rotation, projection of the shoulder is pictured. The hand is supinated, and the arm is in the anatomical position. Therefore, the greater tubercle (number 3) is well visualized. The greater portion of the clavicle is seen, the acromioclavicular joint (number 1), the acromion process (number 2), the coracoid process (number 4), and the glenohumeral joint (number 5). The coronoid process is located on the ulna..

298. Which of the following is demonstrated in a 25° RPO position with the CR entering 1 inch medial to the elevated ASIS? (A) Left sacroiliac joint (B) Right sacroiliac joint (C) Left ilium (D) Right ilium

298. (A) The sacroiliac joints angle posteriorly and medially 25° to the MSP. Therefore, to demonstrate the sacroiliac joints with the patient in the AP position, the affected side must be elevated 25°. This places the joint space perpendicular to the IR and parallel to the CR. Therefore, the RPO position will demonstrate the left sacroiliac joint, and the LPO position will demonstrate the right sacroiliac joint. When the examination is performed with the patient in the PA position, the unaffected side will be elevated 25°.

299. Which of the following positions is most likely to place the right kidney parallel to the IR? (A) AP (B) PA (C) RPO (D) LPO

299. (D) Because the kidneys do not lie parallel to the IR in the AP position, the oblique positions are used during IVU to visualize them better. With the AP oblique projections (RPO and LPO positions), the kidney that is farther away is placed parallel to the IR, and the kidney that is closer is placed perpendicular to the IR. Therefore, in the LPO position, the left kidney , being closer, is perpendicular to the IR. The right kidney, the one farther away, is placed parallel to the IR.

3. What is that portion of bone labeled C in the pediatric PA hand image seen in Figure 2-1 ? (A) Diaphysis (B) Epiphysis (C) Metaphysis (D) Apophysis

3. (C) Long bones are composed of a body/shaft, or diaphysis, and two extremities. The diaphysis is the primary ossification center. In the growing bone, the cartilaginous epiphyseal plate (located at the extremities of long bones) is gradually replaced by bone. The epiphyses are referred to as the secondary ossification centers. The wider portion of bone adjacent to the epiphyseal plate is the metaphysis —that portion of long bone where lengthening/bone growth takes place . Apophysis refers to a bony projection without an independent ossification center.

30. Which of the following serves to avoid excessive metacarpophalangeal joint overlap in the oblique projection of the hand? (A) Oblique the hand no more than 45° (B) Use a support sponge for the phalanges (C) Clench the fist to bring the carpals closer to the IR (D) Use ulnar flexion

30. (A) The oblique projection of the hand should demonstrate minimal overlap of the third, fourth, and fifth metacarpals. Excessive overlap of these metacarpals is caused by obliquing the hand more than 45 ° . The use of a 45° foam wedge ensures that the fingers will be extended and parallel to the IR, thus permitting visualization of the interphalangeal joints and avoiding foreshortening of the phalanges. Clenching of the fist and ulnar flexion are maneuvers used to better demonstrate the carpal scaphoid.

300. Which of the following projections require(s) that the humeral epicondyles be superimposed? 1. Lateral thumb 2. Lateral wrist 3. Lateral humerus (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

300. (C) For the lateral projections of the hand, wrist, forearm, and elbow, the elbow must be flexed 90° to superimpose the distal radius and ulna and humeral epicondyles. Although a lateral humerus can be performed with the elbow flexed, if flexion is not possible, the elbow may remain in the anteroposterior (AP) position and a transthoracic lateral projection of the upper one-half to two-thirds of the humerus may be obtained. Because a coronal plane passing through the epicondyles (interepicondylar line) is perpendicular to the IR in this position, the epicondyles will be superimposed. To obtain a lateral projection of the thumb (first digit), the patient's wrist must be somewhat internally rotated. Remember that an oblique projection of the thumb is obtained in a PA projection of the hand.

31. Sternoclavicular articulations are likely to be demonstrated in all of the following, except (A) weight-bearing (B) RAO (C) LAO (D) PA

31. (A) Sternoclavicular articulations may be examined with the patient PA, either bilaterally with the patient's head resting on the chin or unilaterally with the patient's head turned toward the side being examined. The sternoclavicular articulations may also be examined in the oblique position, with either the patient rotated slightly or the CR angled slightly medialward. Weight-bearing positions are used frequently for evaluation of acromioclavicular joints.

32. The relationship between the fractured ends of long bones is referred to as (A) angulation (B) apposition (C) luxation (D) sprain

32. (B) Various terms are used to describe the position of fractured ends of long bones. The term apposition is used to describe the alignment , or misalignment , between the ends of fractured long bones. The term angulation describes the direction of misalignment. The term luxation refers to a dislocation. A sprain refers to a wrenched articulation with ligament injury.

33. Which of the following positions of the abdomen is obtained with the patient lying supine on the radiographic table and the CR directed horizontally to the iliac crest? (A) AP abdomen (B) PA abdomen (C) Ventral decubitus position (D) Dorsal decubitus position

33. (D) A decubitus projection is obtained using a horizontal x-ray beam. The type of decubitus projection is dependent on the patient's recumbent position. When the patient is lying AP recumbent (i.e., supine ), the patient is said to be in the dorsal decubitus position. When the patient is lying prone, he or she is in the ventral decubitus position. If the patient is lying in the left or right lateral recumbent position with the x-ray beam directed horizontally, the patient is said to be in the left or right lateral decubitus position, respectively. A perpendicular x-ray beam is used to obtain an AP or PA abdomen.

34. Small amounts of air in the peritoneal cavity can be demonstrated in which of the following positions? (A) Lateral decubitus, affected side up (B) Lateral decubitus, affected side down (C) AP Trendelenburg (D) AP supine

34. (A) Air or fluid levels will be clearly delineated only if the CR is directed parallel to them. Therefore, to demonstrate air or fluid levels, the erect or decubitus position should be used. Small amounts of fluid within the peritoneal or pleural space are best demonstrated in the lateral decubitus position, affected side down. Small amounts of air within the peritoneal or pleural space are best demonstrated in the lateral decubitus position, affected side up.

35. Which of the following anatomic structures is seen most anteriorly in a lateral 35. Which of the following anatomic structures is seen most anteriorly in a lateral

35. (C) The relationship of these three structures is easily appreciated in a lateral projection of the chest. The heart is seen in the anterior half of the thoracic cavity, with its apex extending inferior and anterior. The air-filled trachea can be seen in about the center of the chest, and the air-filled esophagus is seen just posterior to the trachea ( Fig. 2-48 ). The superimposed vertebral and axillary borders of the scapulae would be seen most posteriorly.

36. For an AP projection of the knee on a patient whose measurement from ASIS to tabletop is 21 cm, which CR direction will best demonstrate the knee joint? (A) 5° caudad (B) 10° caudad (C) 5° cephalad (D) 0° (perpendicular)

36. (D) The knee structures are formed by the proximal tibia, the patella, and the distal femur, which articulate to form the femorotibial and femoropatellar joints. The knee joint is the femorotibial joint. Body habitus can considerably change the knee joint and tabletop/IR relationship. The CR should be directed to 1⁄2 inch below patellar apex (knee joint). The direction of CR depends on distance between the ASIS and tabletop/IR. When this distance is up to 19 cm (thin pelvis), the CR should be directed 3°-5° caudad; when the distance is between 19 and 24 cm, the CR is directed vertically/perpendicular (0°); when the distance is greater than 24 cm (thick pelvis), the CR is directed 3°-5° cephalad.

37. In which of the following projections was the image in Figure 2-7 made? (A) AP (B) Medial oblique (C) Lateral oblique (D) Acute flexion

37. (B) The image illustrates a medial oblique ( internal rotation ) projection of the elbow with epicondyles 45° to the IR. An oblique view of the proximal radius and ulna and the distal humerus is obtained. This projection is particularly useful to demonstrate the coronoid process in profile, the trochlea , and the medial epicondyle . The external oblique (lateral rotation) projection demonstrates the radial head free of superimposition as well as the radial neck and the humeral capitulum. The acute flexion projection (Jones Method) of the elbow is a two-projection method demonstrating the elbow anatomy when the part cannot be extended for an AP projection.

38. Which of the following anatomic structures is indicated by the number 3 in Figure 2-7 ? (A) Medial epicondyle (B) Trochlea (C) Capitulum (D) Olecranon process

38. (B) The image illustrates a medial oblique ( internal rotation ) projection of the elbow with epicondyles 45° to the IR. An oblique view of the proximal radius and ulna and the distal humerus is obtained. This projection is particularly useful to demonstrate the coronoid process in profile (number 4), the trochlea (number 3), and the medial epicondyle (number 1). The olecranon process (number 2) fits into the olecranon fossa during extension of the elbow. A small portion of the radial head (number 5) not superimposed on the ulna can be seen. The external oblique (lateral rotation) projection demonstrates the entire radial head free of superimposition as well as the radial neck and the humeral capitulum.

39. The following is/are well demonstrated in the lumbar spine seen in Figure 2-8 : 1. pedicles 2. vertebral foramina 3. zygapophyseal articulations (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

39. (A) A lateral projection of the lumbar spine is illustrated. The intervertebral articulations (disk spaces) are well demonstrated. The intervertebral foramina are 90° to the MSP, forming the pedicles, and are well demonstrated in the lateral projection. The vertebral foramina, forming the space occupied by the spinal cord, can only be visualized via CT. The articular facets, forming the zygapophyseal joints, lie 30°-50° to the MSP and are visualized in the oblique position.

4. The proximal radius and ulna are seen free of superimposition in the following projection: (A) scapular Y (B) AP scapula (C) medial oblique elbow (D) lateral oblique elbow

4. (D) The lateral oblique elbow projection demonstrates the proximal radius and ulna free of superimposition. The coronoid process is located on the proximal anterior ulna. The medial oblique projection of the elbow demonstrates the coronoid process in profile, as well as the ulnar olecranon process within the humeral olecranon fossa. The coracoid process is located on the scapula.

40. An intrathecal injection is associated with which of the following examinations? (A) Intravenous urogram (B) Retrograde pyelogram (C) Myelogram (D) Cystogram

40. (C) An intrathecal injection is one made within the spinal meninges. A myelogram requires an intrathecal injection to introduce contrast medium into the subarachnoid space. An IVU requires an intravenous injection; a retrograde pyelogram requires that contrast medium be introduced into the ureters by way of cystoscopy. A cystogram requires that contrast medium be introduced via catheter into the urinary bladder.

41. Which of the following projections can be used to supplement the traditional "open-mouth" projection when the upper portion of the odontoid process cannot be well demonstrated? (A) AP or PA through the foramen magnum (B) AP oblique with right and left head rotation (C) Horizontal beam lateral (D) AP axial

41. (A) A diagnostic image of C1-C2 depends on adjusting the flexion of the neck so that the maxillary occlusal plane and the base of the skull are superimposed. Accurate adjustment of these structures will usually allow good visualization of the odontoid process and the atlantoaxial articulation. Should the patient anatomy occasionally prevent the usual visualization, the odontoid process can be visualized through the foramen magnum, either AP or PA. In the AP position (Fuchs method) or the PA position (Judd method), the patient's chin is extended to be in line vertically with the mastoid tip (similar to a Waters' or reverse Waters' position). The CR is directed to the midline and perpendicularly at the level of the mastoid tip. The resulting image demonstrates the odontoid process through the foramen magnum. These positions should not be attempted if the patient has a suspected, new, or healing fracture or destructive disease.

42. The floor of the cranium includes all of the following bones, except (A) the temporal bones (B) the occipital bone (C) the ethmoid bone (D) the sphenoid bone

42. (B) The skull is divided into two parts: the cranial bones and the facial bones. There are eight cranial bones. Four of them comprise the calvarium : the frontal, the two parietals, and the occipital. The bones that comprise the floor of the cranium are the two temporals , the ethmoid , and the sphenoid.

43. A lateral projection of the hand in extension is often recommended to evaluate 1. a fracture 2. a foreign body 3. soft tissue (A) 1 only (B) 2 only (C) 2 and 3 only (D) 1 and 3 only

43. (C) The lateral hand in extension, with appropriate technique adjustment, is recommended to evaluate foreign-body location in soft tissue. A small lead marker frequently is taped to the spot thought to be the point of entry. The physician then uses this external marker and the radiograph to determine the exact foreign-body location. Extension of the hand in the presence of a fracture would cause additional and unnecessary pain and possibly additional injury.

44. In which of the following positions was Figure 2-9 made? (A) RPO (B) LPO (C) AP axial (D) Right lateral decubitus

44 - 45. (44, A; 45, A) The radiograph shown is an oblique position of a double-contrast study of the large bowel, illustrating an "open" view of the splenic/left colic flexure (number 1) and descending colon, with the hepatic/right colic flexure (number 2) somewhat superimposed on the transverse and ascending (number 3) colon. Therefore, the radiograph must have been made in either an RPO (if the patient was supine) or an LAO (if the patient was prone) position. The LPO and RAO positions are used to demonstrate the hepatic flexure and ascending colon free of self-superimposition. The distal ileum is well visualized (number 6), as well as the commencement of the large bowel—the cecum (number 4)—and its vermiform appendix (number 5). The descending colon is labeled number 7. The AP or PA axial position is generally used to visualize the rectosigmoid colon.

45. The ascending colon is labeled in Figure 2-9 as number (A) 3 (B) 4 (C) 5 (D) 6

44 - 45. (44, A; 45, A) The radiograph shown is an oblique position of a double-contrast study of the large bowel, illustrating an "open" view of the splenic/left colic flexure (number 1) and descending colon, with the hepatic/right colic flexure (number 2) somewhat superimposed on the transverse and ascending (number 3) colon. Therefore, the radiograph must have been made in either an RPO (if the patient was supine) or an LAO (if the patient was prone) position. The LPO and RAO positions are used to demonstrate the hepatic flexure and ascending colon free of self-superimposition. The distal ileum is well visualized (number 6), as well as the commencement of the large bowel—the cecum (number 4)—and its vermiform appendix (number 5). The descending colon is labeled number 7. The AP or PA axial position is generally used to visualize the rectosigmoid colon.

46. Persistent connection between the fetal aorta and pulmonary artery is referred to as (A) an atrial septal defect (B) a ventricular septal defect (C) a patent ductus arteriosus (D) coarctation of the aorta

46. (C) The ductus arteriosus is a short fetal blood vessel connecting the aorta and pulmonary artery that usually closes within 10-15 h after birth. A patent ductus arteriosus is one that persists and requires surgical closure. Atrial septal defect is a small hole (the remnant of the fetal foramen ovale) in the interatrial septum. It usually closes spontaneously in the first months of life; if it persists or is unusually large, surgical repair is necessary. Ventricular septal defect is a congenital heart condition characterized by a hole in the interventricular septum that allows oxygenated and unoxygenated blood to mix. Some interventricular septal defects are small and close spontaneously; others require surgery. Coarctation of the aorta is a narrowing or constriction of the aorta.

47. Which of the following projections/positions will best demonstrate a subacromial or subcoracoid dislocation? (A) Tangential (B) AP axial (C) Transthoracic lateral (D) PA oblique scapular Y

47. (D) The scapular Y refers to the characteristic Y formed by the humerus, acromion, and coracoid processes. The patient is placed in a PA oblique position—an RAO or LAO position depending on which is the affected side. The midcoronal plane is adjusted approximately 60° to the IR, and the affected arm remains relaxed at the patient's side. The scapular Y position is used to demonstrate anterior (subcoracoid) or posterior (subacromial) humeral dislocation. The humerus is normally superimposed on the scapula in this position; any deviation from this may indicate dislocation.

48. Arteries and veins enter and exit the medial aspect of each lung at the (A) root (B) hilus (C) carina (D) epiglottis

48. (B) The hilus (hilum) is the slit-like opening on the medial aspect of the lung through which arteries, veins, and lymphatics enter and exit. The carina is an internal ridge located at the bifurcation of the trachea into right and left primary, or main stem, bronchi. The epiglottis is a flap of elastic cartilage that functions to prevent fluids and solids from entering the respiratory tract during swallowing. The root of the lung attaches the lung, via dense connective tissue, to the mediastinum. The root of the left lung is at the level of T6, and the root of the right is at T5.

49. Which of the following positions can be used to demonstrate the axillary ribs of the right thorax? 1. RAO 2. LAO 3. RPO (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

49. (C) The axillary portion of the ribs is best demonstrated in a 45° oblique position. The axillary ribs are demonstrated in the AP oblique projection with the affected side adjacent to the IR and in the PA oblique projection with the affected side away from the IR. Therefore, the right axillary ribs would be demonstrated in the RPO (AP oblique with affected side adjacent to the IR) and LAO (PA oblique with affected side away from the IR) positions.

64. Which of the following are mediastinal structures? 1. Heart 2. Trachea 3. Esophagus (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

64. (D) The mediastinum is the space between the lungs that contains the heart, great vessels, trachea, esophagus, and thymus gland. It is bounded anteriorly by the sternum and posteriorly by the vertebral column, and extends from the upper thorax to the diaphragm.

5. The female bony pelvis differs from the male bony pelvis in the following way(s): 1. the male greater/false pelvis is deep 2. the male acetabulum faces more laterally 3. the female coccyx is more vertical (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

5. (B) The male and female bony pelves have several differing characteristics; male/female pelvic anatomy differs more than any other body anatomy. An overview of comparisons is listed as follows: Male pelvis • The general structure is heavy and thick. • The greater, or false, pelvis is deep. • The pelvic brim, or inlet, is small and heart-shaped. • The acetabulum is large and faces laterally. • The pubic angle is less than 90°. • The ilium is more vertical. Female pelvis • The general structure is light and thin. • The greater, or false, pelvis is shallow. • The pelvic brim, or inlet, is large and oval. • The acetabulum is small and faces anteriorly. • The pubic angle is more than 90°. • The ilium is more horizontal.

50. The interspaces between the first and second cuneiforms best demonstrated in which of the following projections? (A) Lateral oblique foot (B) Medial oblique foot (C) Lateral foot (D) Weight-bearing foot

50. (A) The lateral oblique demonstrates the interspaces between the first and second metatarsals and between the first and second cuneiforms. To best demonstrate most of the tarsals and intertarsal spaces (including the cuboid, sinus tarsi, and tuberosity of the fifth metatarsal), a medial oblique projection is required (plantar surface and IR form a 30° angle). A weight-bearing lateral projection of the feet is used to demonstrate the longitudinal arches.

51. The sternal angle is at approximately the same level as the (A) T2-T3 interspace fifth thoracic vertebra (B) T9-T10 interspace (C) T5 (D) costal margin

51. (C) Surface landmarks, prominences, and depressions are very useful to the radiographer in locating anatomic structures that are not visible externally. The fifth thoracic vertebra is at approximately the same level as the sternal angle. The T2-T3 interspace is about at the same level as the manubrial (suprasternal) notch. The costal margin is about the same level as L3.

52. The condition in which an occluded blood vessel stops blood flow to a portion of the lungs is referred to as (A) pneumothorax (B) atelectasis (C) pulmonary embolism (D) hypoxia

52. (C) Blood pressure in the pulmonary circulation is relatively low, and therefore, pulmonary vessels can easily become blocked by blood clots, air bubbles, or fatty masses, resulting in a pulmonary embolism. If the blockage stays in place, it results in an extra strain on the right ventricle, which is now unable to pump blood. This can result in congestive heart failure. Pneumothorax is air in the pleural cavity. Atelectasis is a collapsed lung or part of a lung. Hypoxia is a condition of low tissue oxygen.

53. To demonstrate esophageal varices, the patient must be examined in (A) the recumbent position (B) the erect position (C) the anatomic position (D) the Fowler position

53. (A) Esophageal varices are tortuous dilatations of the esophageal veins. They are much less pronounced in the erect position and always must be examined with the patient recumbent. The recumbent position affords more complete filling of the veins because blood flows against gravity.

54. Select the incorrect statement regarding Figure 2-10 . 1. The degree of obliquity is too great 2. The midphalanges are foreshortened 3. The interphalangeal joints are well demonstrated (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

54. (C) A PA oblique projection of the hand is shown. The correct degree of obliquity (45°) is evidenced by no overlap of midshaft third, fourth, and fifth metacarpals and minimal overlap of their heads. The phalanges are foreshortened and the interphalangeal joint spaces are not visualized because the fingers are not adjusted to be parallel to the IR.

55. The tissue that occupies the central cavity of the adult long bone body/shaft is (A) red marrow (B) yellow marrow (C) endosteum (D) cancellous tissue

55. (B) Within the body/shaft of a long bone is the medullary cavity, containing bone marrow and lined by a membrane called endosteum. In adults, yellow marrow is the most abundant and occupies the body/shaft, and red marrow is found within the proximal and distal extremities of long bones. Bone marrow, particularly red, is important in the production of blood cells—a process called hematopoiesis .

56. All the following structures are associated with the posterior femur, except (A) popliteal surface (B) intercondyloid fossa (C) intertrochanteric line (D) lineaaspera

56. (C) The femur is the longest and strongest bone in the body. The femoral shaft is bowed slightly anteriorly and presents a long, narrow ridge posteriorly called the linea aspera. The distal femur is associated with two large condyles; the deep depression separating them posteriorly is the intercondyloid fossa ( Fig. 2-49 ). Just superior to the large condyles are the smaller medial and lateral epicondyles. The posterior distal femoral surface presents the popliteal surface , whereas the distal anterior surface presents the patellar surface. Proximally, the femur presents a head, neck, and greater and lesser trochanters. The intertrochanteric crest is a prominent ridge of bone between the trochanters posteriorly; anteriorly the intertrochanteric line is seen. The femoral head presents a roughened prominence, the fovea capitis femoris—ligaments attached here secure the femoral head to the acetabulum.

57. The following projection of the ankle best demonstrates the mortise: (A) medial oblique l5°—20° (B) lateral oblique l5° - 20° (C) medial oblique 45° (D) lateral oblique 45°

57. (A) The 15 ° medial oblique projection is used to demonstrate the ankle mortise (joint). Although the joint is well demonstrated in the 15° medial oblique projection, there is some superimposition of the distal tibia and fibula, and greater obliquity is required to separate the bones. To best demonstrate the distal tibiofibular articulation, a 45 ° medial oblique projection of the ankle is required.

58. What condition(s) is/are demonstrated in Figure 2-11? 1. Emphysema 2. Pneumothorax 3. Pleural Effusion (A) 1 only (B) 1 and 2only (C) 2and3only (D) l,2,and3

58. (C) Pneumothorax results from an accumulation of air in the plural cavity, resulting in partial or complete collapse of the associated lung. The affected lung in this case can be seen displaced away from the chest wall. Pleural effusion is also demonstrated here by an accumulation of fluid in the pleural cavity. Air-fluid levels are well demonstrated in the erect position. In emphysema, however, air is trapped in the alveoli; it is a condition that is characterized by increased amount of air in the lungs, flattening of the hemidiaphragms, and widening of the intercostal spaces. Notice that Figure 2-11 has an expiration marker—recall that a pneumothorax diagnosis usually requires inspiration and expiration images.

Which of the following bony landmarks is in the same transverse plane as L2-L3? (A) Inferior costal margin (B) Greater trochanter (C) Iliac crest (D) ASIS

59. (A) The inferior costal margin (inferior margin of the ribs) is located at the level of L2-L3. The ASIS is in the same transverse plane as S2. The ASIS and the pubic symphysis are the bony landmarks used to locate the hip joint, which is located midway between the two points. The uppermost portion of the iliac crest is at the approximate level of L4-L5. The most prominent part of the greater trochanter is at the same level as the pubic symphysis—both

6. Which of the following techniques would provide a posteroanterior (PA) projection of the gastroduodenal surfaces of a barium-filled high and transverse stomach? (A) Place the patient in a 35°-40° right anterior oblique (RAO) position (B) Place the patient in a lateral position (C) Angle the CR 35°-45° cephalad (D) Angle the CR 35°-45° caudad

6. (C) In the PA position, portions of the barium-filled hypersthenic stomach superimpose on themselves. Thus, patients with a hypersthenic body habitus usually present a high transverse stomach with poorly defined curvatures. If the PA stomach is projected with a 35 ° -45 ° cephalad CR, the stomach "opens up." That is, the curvatures, the antral portion, and the duodenal bulb all appear as a sthenic habitus stomach would appear. A 35°-40° RAO position is used to demonstrate many of these structures in the average, or sthenic, body habitus. A lateral position is used to demonstrate the anterior and posterior gastric surfaces and retrogastric space.

60. A radiolucent sponge can be placed under the patient's waist for a lateral projection of the lumbosacral spine to 1. make the vertebral column parallel with the IR 2. place the intervertebral disk spaces perpendicular to the IR 3. decrease the amount of SR reaching the IR (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

60. (B) When placed in the recumbent lateral position, the average adult's lumbar spine will not be parallel to the x-ray tabletop. Because the shoulders and hips generally are wider than the waist, the vertebral column slopes downward in the central areas—making the lower thoracic and upper lumbar spine closer to the tabletop than the upper thoracic and lower lumbar spine. One solution is to place a radiolucent sponge under the patient's waist. This will elevate the sagging spinal area and make the vertebral column parallel to the x-ray tabletop and IR. It will also open the intervertebral disks better, placing more of them parallel to the path of the x-ray photons and perpendicular to the IR. This position also places the intervertebral foramina parallel with the path of the CR. The radiolucent sponge is strictly a positioning aid and has no impact on the amount of SR reaching the IR.

61. Which of the following may be used to evaluate the glenohumeral joint? 1. Scapular Y projection 2. Inferosuperior axial 3. Transthoracic lateral (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

61. (D) The scapular Y projection is an oblique projection of the shoulder that is used to demonstrate anterior or posterior shoulder dislocation. The inferosuperior axial projection may be used to evaluate the glenohumeral joint when the patient is able to abduct the arm. The transthoracic lateral projection is used to evaluate the glenohumeral joint and upper humerus when the patient is unable to abduct the arm.

62. Which of the following is/are distal to the tibial plateau? 1. Intercondyloid fossa 2. Tibial condyles 3. Tibial tuberosity (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

62. (C) The knee (femorotibial) joint is formed by the femur and tibia. The most superior aspect of the tibia is the tibial plateau— formed by the tibial condyles just distal to it. The proximal tibia also presents the tibial tuberosity on its anterior surface, just distal to the condyles. Proximal to the tibial plateau, and articulating with it, are the femoral condyles— the deep notch separating them is the intercondyloid fossa. The term proximal refers to a part located closer to the point of attachment; the term distal refers to a part located farther away from the point of attachment.

63. Evaluation criteria for a lateral projection of the humerus include 1. epicondyles parallel to the IR 2. lesser tubercle in profile 3. superimposed epicondyles (A) 1 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

63. (C) The greater and lesser tubercles are prominences on the proximal humerus separated by the intertubercular (bicipital) groove. The lateral projection of the humerus places the shoulder in extreme internal rotation with the epicondyles perpendicular to the IR and superimposed. The lateral projection of the humerus should demonstrate the lesser tubercle in profile. The AP projection of the humerus/shoulder places the epicondyles parallel to the IR and the shoulder in external rotation and demonstrates the greater tubercle in profile.

66. Which of the following fracture classifications describes a small, bony fragment pulled from a bony process? (A) Avulsion fracture (B) Torus fracture(C) Comminuted fracture (D) Compound fracture

66. (A) An avulsion fracture is a small, bony fragment pulled from a bony process as a result of a forceful pull of the attached ligament or tendon. A comminuted fracture is one in which the bone is broken or splintered into pieces. A torus fracture is a greenstick fracture with one cortex buckled and the other intact. A compound fracture is an open fracture in which the fractured ends have perforated the skin.

67. That portion of the humerus which articulates with the ulna to help form the elbow joint is the (A) semilunar/trochlear notch (B) radial head (C) capitulum (D) trochlea

67. (D) The distal humerus articulates with the proximal radius and ulna to form the elbow joint. Specifically, the semilunar/trochlear notch of the proximal ulna articulates with the trochlea of the distal medial humerus. The capitulum is lateral to the trochlea and articulates with the radial head ( Fig. 2-50 ).

68. Foot motion caused by turning the ankle outward is termed (A) eversion (B) inversion (C) abduction (D) adduction

68. (A) All of these are the terms used to describe particular body movements. Eversion refers to movement of the foot caused by turning the ankle outward. Inversion is foot motion caused by turning the ankle inward. Abduction is movement of a part away from the midline. Adduction is movement of a part toward the midline.

69. During myelography, contrast medium is introduced into the (A) subdural space (B) subarachnoid space (C) epidural space (D) epidermal space

69. (B) The central nervous system (brain and spinal cord) is located within three protective membranes, the meninges. The inner membrane is the pia mater, the middle membrane is the arachnoid, and the outer membrane is the dura mater. The subarachnoid space is located between the pia and arachnoid mater and contains cerebrospinal fluid (CSF). During myelography, the needle is introduced into the subarachnoid space (L3-L4 or L4-L5), a small amount of CSF is removed, and the contrast medium is introduced ( Fig. 2-51 ). The subdural space is located between the arachnoid and dura mater. The epidural space is located between the two layers of the dura mater.

7. The structures visualized when positioned as in Figure 2-2 could also be seen when performed with the patient in the following position(s): 1. lateral recumbent 2. seated 3. erect AP (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

7. (B) Note the relationship between the thigh, lower leg, patella, and CR. The CR is directed parallel to the plane of the patella , thereby providing a tangential projection of the patella (i.e., patella in profile) and an unobstructed view of the patellofemoral articulation ( Fig. 2-42 ). Figure 2-2 illustrates how the image is obtained with the patient in the prone position. Many patients may not be able to assume the prone position. The same relationship between the CR, part, and IR can be obtained in the lateral recumbent position or the seated position (see Fig. 2-42 A and B). The erect AP would superimpose the patella on other bony structures.

70. The junction of the sagittal and coronal sutures is the (A) diploe (B) lambda (C) bregma (D) pterion

70. (C) The skull has two major parts: the cranium , which is composed of 8 bones and houses the brain, and the 14 irregularly shaped facial bones ( Fig. 2-52 ). The inner and outer compact tables of the cranial skull are separated by cancellous tissue called diploe. The internal table has a number of branching meningeal grooves and larger sulci that house blood vessels. The bones of the skull are separated by immovable (synarthrotic) joints called sutures. The major sutures of the cranium are the sagittal , which separates the parietal bones; the coronal, which separates the frontal and parietal bones; the lambdoidal , which separates the parietal and occipital bones; and the squammosal , which separates the temporal and parietal bones. The sagittal and coronal sutures meet at the bregma, which corresponds to the fetal anterior fontanel. The sagittal and lambdoidal sutures meet posteriorly at the lambda, which corresponds to the fetal posterior fontanel. The parietal, frontal, and sphenoid bones meet at the pterion, the location of the anterolateral fontanel. The highest point of the skull is called the vertex.

71. Which of the following statements is/are true regarding the radiograph in Figure 2-12 ? 1. The patient is placed in an RAO position 2. The midcoronal plane is about 60° to the IR 3. The acromion process is free of superimposition (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

71. (D) A right scapular Y is illustrated; this refers to the characteristic Y formed by the clearly visible humerus, acromion, and coracoid. The patient is positioned in a PA oblique position—in this case, an RAO position to demonstrate the right side. The MCP is adjusted to approximately 60° to the IR, and the affected arm is left relaxed at the patient's side. The scapular Y position is used to demonstrate anterior or posterior humeral dislocation. The humerus is superimposed on the scapula in this position; any deviation from this may indicate dislocation.

72. Which of the following precautions should be observed when radiographing a patient who has sustained a traumatic injury to the hip? 1. When a fracture is suspected, manipulation of the affected extremity should be performed by a physician 2. The AP axiolateral projection should be avoided 3. To evaluate the entire region, the pelvis is typically included in the initial examination (A) 1 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

72. (B) Typically, traumatic injury to the hip requires a cross-table (axiolateral) lateral projection, as well as an AP projection of the entire pelvis. Both of these are performed using minimal manipulation of the affected extremity, reducing the possibility of further injury. A physician should perform any required manipulation of the traumatized hip.

73. The lumbar vertebral pedicle is represented by which part of the "Scotty dog" seen in a correctly positioned oblique lumbar spine? (A) Eye (B) Nose (C) Body (D) Ear

73. (A) The zygapophyseal 45 ° oblique projection of the lumbar spine generally is performed for demonstration of the zyg apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated (Figs. 2-53 and 2-54). Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front leg to the inferior articular process.

74. An injury to a structure located on the side opposite that of the primary injury is referred to as (A) blowout (B) Le Fort (C) contracture (D) contrecoup

74. (D) An injury to a structure located on the side opposite of the primary injury is called a contrecoup injury. For example, a blow to the back of the head will injure frontal and temporal lobes because they are forced forward against the irregularly shaped bones of the anterior cranial vault. Blowout fractures occur to the floor of the orbit on a direct blow. A Le Fort fracture involves severe bilateral maxillary fractures. Contracture refers to shortening of muscle fibers.

75. Which of the following places the anatomical points of the hand's third digit in correct order from proximal to distal? (A) Base of metacarpal, head of middle phalanx, carpometacarpal joint, metacarpophalangeal joint, distal interphalangeal joint, proximal interphalangeal joint, ungual tuft (B) Carpometacarpal joint, base of metacarpal, metacarpophalangeal joint, proximal interphalangeal joint, head of middle phalange, distal interphalangeal joint, ungual tuft (C) Ungual tuft, distal interphalangeal joint, head of middle phalanx, proximal interphalangeal joint, metacarpophalangeal joint, base of metacarpal, carpometacarpal joint (D) Carpometacarpal joint, metacarpophalangeal joint, base of metacarpal, head of middle phalanx, proximal interphalangeal joint, distal interphalangeal joint, ungual tuft

75. (B) The hand (Fig 2-55) is composed of five metacarpal bones (A, B), corresponding to the palm of the hand, and 14 phalanges (F, G, H), the fingers. The second through fifth fingers have three phalanges each: proximal, middle, and distal rows (proximal is closest to point of attachment; distal is furthest from point of attachment) and the first finger, or thumb ( pollex ), has two phalanges (proximal and distal). The rows of phalanges articulate with each other forming proximal and distal interphalangeal joints (J, K), which permit flexion and extension motion. The proximal portion of each phalange and metacarpal is its base (C); its distal portion is its head (E). The most distal, flattened, portion of the phalanges is the ungual tuft (H).

76. Which of the following conditions is limited specifically to the tibial tuberosity? (A) Ewing sarcoma (B) Osgood-Schlatter disease (C) Gout (D) Exostosis

76. (B) Osgood-Schlatter disease is most common in adolescent boys, involving osteochondritis of the tibial tuberosity epiphysis. The large patellar tendon actually will pull the tibial tuberosity away from the tibia. Immobilization generally will resolve the issue. Ewing sarcoma is a malignant bone tumor most common in young children. It attacks long bones and presents a characteristic "onion peel" appearance. Gout is a type of arthritis that most commonly attacks the knee and first metatarsophalangeal joint, although other joints also can be involved. High levels of uric acid in the blood are deposited in the joint. Exostosis is a bony growth arising from the surface of a bone and growing away from the joint. It is a benign and sometimes painful condition.

84. The CR is parallel to the intervertebral foramina in the following projection(s): 1. lateral cervical spine 2. lateral thoracic spine 3. lateral lumbar spine (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

84. (C) If the x-ray photons can pass through/between structures such as joint spaces and foramina, these joint spaces and foramina must be situated perpendicular to the IR and parallel to the CR. The intervertebral foramina of the thoracic and lumbar vertebrae are perpendicular to the IR and, therefore, parallel to the CR in the lateral projection. The cervical intervertebral foramina are well demonstrated when placed 45° to the IR and CR.

77. AP stress studies of the ankle may be performed 1. to demonstrate fractures of the distal tibia and fibula 2. following inversion or eversion injuries 3. to demonstrate a ligament tear (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

77. (C) After forceful eversion or inversion injuries of the ankle, AP stress studies are valuable to confirm the presence of a ligament tear. Keeping the ankle in an AP position, the physician guides the ankle into inversion and eversion maneuvers. Characteristic changes in the relationship of the talus, tibia, and fibula will indicate ligament injury. Inversion stress demonstrates the lateral ligament, whereas eversion stress demonstrates the medial ligament. A fractured ankle would not be manipulated in this manner.

78. Which of the following is/are part of the bony thorax? 1. Manubrium 2. Clavicles 3. 24 ribs (A) 1 only (B) 1 and 2 only (C) 1 and 3 only (D) 1, 2, and 3

78. (C) The bony thorax consists of 12 pairs of ribs and the structures to which they are attached anteriorly and posteriorly: the sternum (consisting of manubrium, body/gladiolus, and xiphoid/ensiform process) and the 12 thoracic vertebrae ( Fig. 2-55 ). These structures form a bony cage that surrounds and protects the vital organs within (the heart, lungs, and great vessels). The scapulae, together with the clavicles, form the shoulder (pectoral) girdle of the upper extremity.

79. Aspirated foreign bodies in older children and adults are most likely to lodge in the (A) right main stem bronchus (B) left main stem bronchus (C) esophagus (D) proximal stomach

79. (A) Because the right main stem bronchus is wider and more vertical, aspirated foreign bodies are more likely to enter it than the left main stem bronchus, which is narrower and angles more sharply from the trachea. An aspirated foreign body does not enter the esophagus or the stomach because they are not respiratory structures. The esophagus and stomach are digestive structures; a foreign body would most likely be swallowed to enter these structures.

8. All of the following statements regarding respiratory structures are true, except (A) the right lung has two fissures (B) the inferior portion of a lung is its base (C) each lung is enclosed in pleural membrane (D) the main stem bronchi enter the lung fissure

8. (D) The trachea bifurcates into left and right main stem bronchi, each entering its respective lung hilum. The left bronchus divides into two portions, one for each lobe of the left lung. The left lung has one fissure: the oblique. The right bronchus divides into three portions, one for each lobe of the right lung ( Fig. 2-43 ). The right lung has two fissures: the horizontal and the oblique. The lungs are conical in shape, consisting of upper pointed portions, termed the apices (plural of apex) and broad lower portions (or bases ). The lungs are enclosed in a double-walled serous membrane called the pleura.

80. The PA chest radiograph shown in Figure 2-13 demonstrates 1. rotation 2. scapulae removed from lung fields 3. adequate inspiration (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

80. (B) A PA projection of the chest is shown. The shoulders are rolled forward, removing the scapulae from the lung fields. Rotation of the chest is demonstrated by the unequal distance between the sternum and medial extremities of the clavicles. Adequate inspiration is not demonstrated because 10 posterior ribs are not visualized above the diaphragm. Pulmonary apices and costophrenic angles are demonstrated adequately. An air-filled trachea is seen in the lower cervical and upper thoracic region as an area of increased density. Adequate long-scale contrast has been achieved, as indicated by visualization of pulmonary vascular markings.

81. The letter A in Figure 2-13 indicates (A) a left anterior rib (B) a right posterior rib (C) a left posterior rib (D) a right anterior rib

81. (C) A PA projection of the chest is shown. The letter A indicates a left posterior rib, B represents a left anterior rib, and C represents the right costophrenic angle. Rotation of the chest is demonstrated by asymmetrical sternoclavicular joints. The apices and costophrenic angles should be included on every chest radiograph. Inadequate inspiration is demonstrated because 10 posterior ribs are not visualized above the diaphragm.

82. With the patient seated at the end of the x-ray table, elbow resting on table and flexed 80°, and the CR directed 45° laterally from the shoulder to the elbow joint , which of the following structures will be demonstrated best? (A) Radial head (B) Ulnar head (C) Coronoid process (D) Olecranon process

81. (C) A PA projection of the chest is shown. The letter A indicates a left posterior rib, B represents a left anterior rib, and C represents the right costophrenic angle. Rotation of the chest is demonstrated by asymmetrical sternoclavicular joints. The apices and costophrenic angles should be included on every chest radiograph. Inadequate inspiration is demonstrated because 10 posterior ribs are not visualized above the diaphragm.

83. Types of articulations lacking a joint cavity include 1. fibrous 2. cartilaginous 3. synovial (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

83. (B) Fibrous , or immovable (synarthrotic), articulations are tightly joined by fibrous connective tissue and have no joint cavity. The articular surfaces in cartilaginous (amphiarthrotic) joints are held together by cartilage, offering them little movement. Only synovial (diarthrotic, freely movable) joints possess a joint cavity, thus permitting them free movement. Synovial type joints are the most numerous in the body.

85. The structure located midway between the anterosuperior iliac spine (ASIS) and pubic symphysis is the (A) dome of the acetabulum (B) femoral neck (C) greater trochanter (D) iliac crest

85. (A) The dome of the acetabulum lies midway between the ASIS and the symphysis pubis. On an adult of average size, a line perpendicular to this point will parallel the plane of the femoral neck. In an AP projection of the hip, the CR should be directed to a point approximately 2 inches down the perpendicular line so as to enter the distal portion of the femoral head.

86. The structure labeled 4 in Figure 2-14 is the (A) maxillary sinus (B) sphenoidal sinus (C) ethmoidal sinus (D) frontal sinus

86 - 87. (86, A; 87, D) Figure 2-14 illustrates an anatomic lateral view of the paranasal sinuses. Number 1 points to the frontal sinuses and number 2 to the ethmoidal sinuses; both can be visualized using the PA projection (Caldwell method). Number 3 is the sphenoidal sinuses, which are well demonstrated in the SMV projection. Number 4 is the maxillary sinuses, which are best demonstrated using the parietoacanthial projection (Waters' method). The lateral projection demonstrates the four groups of paranasal sinuses superimposed on each other.

87. Which of the following would best evaluate the structure labeled 3 in Figure 2-14 ? (A) PA axial projection (Caldwell method) (B) Parietoacanthial projection (Waters' method) (C) Lateral projection (D) Submentovertex projection

86 - 87. (86, A; 87, D) Figure 2-14 illustrates an anatomic lateral view of the paranasal sinuses. Number 1 points to the frontal sinuses and number 2 to the ethmoidal sinuses; both can be visualized using the PA projection (Caldwell method). Number 3 is the sphenoidal sinuses, which are well demonstrated in the SMV projection. Number 4 is the maxillary sinuses, which are best demonstrated using the parietoacanthial projection (Waters' method). The lateral projection demonstrates the four groups of paranasal sinuses superimposed on each other.

88. Hysterosalpingography may be performed for demonstration of 1. uterine tubal patency 2. mass lesions in the uterine cavity 3. uterine position (A) 1 and 2 only (B) 1 and 3 only (C) 2 and 3 only (D) 1, 2, and 3

88. (D) Hysterosalpingography may be performed for demonstration of uterine tubal patency, mass lesions in the uterine cavity, and uterine position. Although hysterosalpingography is often performed to check tubal patency, the uterine anatomy, position, and morphology are also exhibited. In addition, polyps, fibroids, or space-occupying lesions within the uterus are well demonstrated.

89. The radiograph shown in Figure 2-15 demonstrates the articulation between the 1. talus and the calcaneus 2. calcaneus and the cuboid 3. talus and the navicular (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3

89. (C) The radiograph shown is a medial oblique foot. With the foot rotated medially so that the plantar surface forms a 30 ° angle with the IR, the sinus tarsi, the tuberosity of the fifth metatarsal, and several articulations should be demonstrated—the articulations between the talus and the navicular, between the calcaneus and the cuboid, between the cuboid and the bases of the fourth and fifth metatarsals, and between the cuboid and the lateral (third) cuneiform.

9. All of the following statements regarding an exact PA projection of the skull are true, except (A) the OML is perpendicular to the IR (B) the petrous pyramids fill the orbits (C) the MSP is parallel to the IR (D) the CR is perpendicular to the IR and exits the nasion

9. (C) In the exact PA projection of the skull, the perpendicular CR exits the nasion and the petrous pyramids should be demonstrated filling the orbits ( Fig. 2-44 ). As the CR is angled caudally, the petrous ridges/pyramids are projected lower in the orbits. At about 25°-30° caudad, they are projected below the orbits. The OML must be perpendicular to the IR for the petrous pyramids to be projected into the expected location, that is, within the orbital cavities. The MSP must be perpendicular to the IR, or the skull will be rotated and left/right symmetry will be lost.

90. The base of the fifth metacarpal seen in Fig 2-16 is indicated by number (A) 7 (B) 8 (C) 11 (D) 12

90. (A) The AP projection of the radius and ulna in Figure 2-16 has anatomical features numbered from 1 to 12 (1, radial tuberosity; 2, neck of radius; 3, head of radius; 4, proximal radioulnar joint; 5, radius; 6, ulna; 7, base of fifth metacarpal; 8, lunate; 9, styloid process of ulna; 10, head of ulna; 11, scaphoid; 12, radial styloid process).

91. The articular facets of L5-S1 are best demonstrated in a/an (A) AP projection (B) 30° oblique (C) 45° oblique (D) AP axial projection

91. (B) Lumbar articular facets, forming the zygapophyseal joints, are demonstrated in the oblique position. L1 through L4 are best demonstrated in a 45° oblique, whereas L5-S1 are best seen in the 30° oblique. The AP axial projection is used to demonstrate an AP projection of L5-S1.

92. The patient's chin should be elevated during chest radiography to (A) permit the diaphragm to move to its lowest position (B) avoid superimposition on the apices (C) assist in maintaining an upright position (D) keep the MSP parallel

92. (B) Chest positioning must be correct and accurate; thoracic structures are easily distorted. To avoid superimposition on the upper medial apices, the patient's chin should be sufficiently elevated. Movement of the diaphragm to its lowest position is a function of the erect position and of making the exposure after the second inspiration. The MSP is perpendicular to the IR in the PA projection and parallel to the IR in the lateral projection. The position of the chin has little to do with the MSP.

93. That portion of a long bone from which it lengthens/grows is the (A) diaphysis (B) epiphysis (C) metaphysis (D) apophysis

93. (C) Long bones are composed of a body/shaft, or diaphysis, and two extremities. The diaphysis is the primary ossification center. In the growing bone, the cartilaginous epiphyseal plate (located at the extremities of long bones) is gradually replaced by bone. The epiphyses are referred to as the secondary ossification centers. The wider portion of bone adjacent to the epiphyseal plate is the metaphysis —that portion of long bone where lengthening/bone growth takes place . Apophysis refers to a bony projection without an independent ossification center.

94. Medial displacement of a tibial fracture would be best demonstrated in the (A) AP projection (B) lateral projection (C) medial oblique projection (D) lateral oblique projection

94. (A) A frontal projection (AP or PA) demonstrates the medial and lateral relationships of structures. A lateral projection demonstrates the anterior and posterior relationships of structures. Two views, at right angles to each other, generally are taken of most structures.

95. What part of the "Scotty dog," seen in a correctly positioned oblique lumbar spine, represents the lumbar transverse process? (A) Eye (B) Nose (C) Body (D) Neck

95. (B) The 45° oblique projection of the lumbar spine generally is performed for demonstration of the zygapophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated. The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process ( Fig. 2-56 ).

96. All the following statements regarding the position shown in Figure 2-17 are true, except (A) a left pleural effusion could be demonstrated (B) a right pneumothorax could be demonstrated (C) a left lateral decubitus position is illustrated (D) the CR is directed vertically to the level of T7

96. (D) The illustration shows the patient positioned on his left side with the IR behind his back. This is a left lateral decubitus position. The x-ray beam is directed horizontally in decubitus positions to demonstrate air-fluid levels. Air or fluid levels will be clearly delineated only if the CR is directed parallel to them. Fluid levels will be best detected on the down side (in this case, left ); air levels will be best detected on the up side (in this case, right ). If the patient were lying on the right side, it would be a right lateral decubitus position. If the patient were lying on his or her back with a horizontal x-ray beam, it would be a dorsal decubitus position. Lying prone with a horizontal x-ray beam is termed a ventral decubitus position.

97. Which of the following positions best demonstrates the proximal tibiofibular articulation? (A) AP (B) 90° mediolateral (C) 45° internal rotation (D) 45° external rotation

97. (C) In the AP projection, the proximal fibula is at least partially superimposed on the lateral tibial condyle. Medial rotation of 45° will "open" the proximal tibiofibular articulation. Lateral rotation will obscure the articulation even more.

98. At what level do the carotid arteries bifurcate? (A) Foramen magnum (B) Trachea (C) Pharynx (D) C4

98. (D) The common carotid arteries function to supply oxygenated blood to the head and neck. Major branches of the common carotid arteries (internal carotids) function to supply the anterior brain, whereas the posterior brain is supplied by the vertebral arteries (branches of the subclavian). The carotid arteries bifurcate into internal and external carotid arteries at the level of C4. The foramen magnum and pharynx are superior to the level of bifurcation, and the larynx is inferior to the level of bifurcation.

99. During a double-contrast BE, which of the following positions would afford the best double-contrast visualization of the lateral wall of the descending colon and the medial wall of the ascending colon? (A) AP or PA erect (B) Right lateral decubitus (C) Left lateral decubitus (D) Ventral decubitus

99. (B) A right lateral decubitus position will demonstrate a double-contrast visualization of left-sided bowel structures, that is, the lateral side of the descending colon and the medial side of the ascending colon. A left lateral decubitus position will demonstrate a double-contrast visualization of right-sided bowel structures, that is, the lateral side of the ascending colon and the medial side of the descending colon. With the patient in the erect position, barium moves inferiorly and air rises to provide double-contrast visualization of the hepatic and splenic flexures.