Image Analysis Chapter 4

A lateral forearm projection with accurate positioning demonstrates 1. the distal scaphoid slightly distal to the pisiform. 2. the ulnar styloid in profile. 3. an open elbow joint space. 4. the radial tuberosity in profile. a. 1, 2, and 3 only b. 1 and 3 only c. 2 and 4 only d. 1, 2, 3, and 4

a

A less than optimal lateral hand projection demonstrating the longest of the second through fifth metacarpal midshafts situated anterior to the others a. was obtained with the hand internally rotated. b. may result if the central ray was centered too anteriorly. c. will also demonstrate closed IP joints. d. will also demonstrate the distal scaphoid posterior to the pisiform.

a

An IR that is large enough to extend at least 1 inch (2.5 cm) beyond the elbow and wrist joints for a forearm projection is a. needed to record the elbow and wrist on the image. b. needed so the beam can be tightly collimated. c. not a required positioning procedure. d. needed only when a joint problem is suspected.

a

For an externally rotated AP oblique elbow projection with accurate positioning, the 1. capitulum is in profile. 2. capitulum-radial joint space is open. 3. coronoid process is in profile. 4. ulna is demonstrated without radial head superimposition. a. 1, 2, and 4 only b. 2, 3, and 4 only c. 2 and 3 only d. 1 and 4 only

a

PA wrist projection obtained in radial deviation demonstrates 1. the lunate positioned distal to the ulna. 2. a foreshortened scaphoid. 3. closed CM joints. 4. an elongated scaphoid. a. 1 and 2 only b. 3 and 4 only c. 1, 2, and 4 only d. 1, 2, and 3 only

a

PP. 207-208 61. A less than optimal AP elbow projection demonstrating the ulna without radial head superimposition a. was obtained with the elbow in external rotation. b. will also demonstrate the radial head articulating surface. c. was obtained with the hand pronated. d. was obtained with the elbow in internal rotation.

a

Sharply recorded details are demonstrated on extremity images when 1. motion is controlled. 2. a large focal spot is used. 3. a small IR is used for computed radiography images. 4. a large OID is used. a. 1 and 3 only b. 2 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4

a

To properly position an AP humerus, place the elbow at the _____ end of the tube, _____ the hand and wrist, and align the humeral condyles _____ with the IR. a. anode; supinate; parallel b. cathode; supinate; perpendicular c. anode; pronate; perpendicular d. cathode; supinate; parallel

a

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a scaphoid wrist fracture is suspected, and the patient is able to ulnar-deviate until the first metacarpal and radius are aligned? a. 15 degrees b. 20 degrees c. 5 to 10 degrees d. 20 to 25 degrees

a

What is the degree of central ray angulation that should be used for an ulnar-deviated PA axial (scaphoid) wrist projection being obtained to demonstrate a proximal scaphoid fracture? a. Use a 10-degree angle if the first metacarpal and ulna are aligned. b. Use a 25-degree angle if the first metacarpal and ulna are not aligned. c. Use a 15-degree angle if the first metacarpal and ulna are aligned. d. Use a 20-degree angle if the first metacarpal and ulna are not aligned.

a

What is the projection for the PA finger? a. Phalanges demonstrate equal concavity. b. Phalanges demonstrate more concavity on one side than on the other. c. Phalanges demonstrate concavity on one side and convexity on the other.

a

Where are the soft tissue structures that can be used to indicate joint effusion located on the lateral wrist projection? a. Anteriorly b. Medially c. Laterally d. Posteriorly

a

Which of the follow statements is true as demonstrated on a lateral elbow projection? a. When the wrist is in a lateral projection, the radial tuberosity is superimposed by the radius. b. The radial tuberosity should be demonstrated in profile posteriorly for optimal positioning. c. When the hand is pronated, the radial tuberosity is seen in profile anteriorly. d. When the hand is supinated, the radial tuberosity is superimposed by the radius.

a

Which of the following projections is used to prevent crossing of the forearm bones? a. AP projection b. PA projection

a

Which side of the arm is positioned against the IR for the lateral fourth finger projection? a. Ulnar b. Radial

a

A PA axial, ulnar-deviated wrist projection with poor positioning demonstrates a closed scaphocapitate joint and an open hamate-capitate joint. How should the positioning setup be adjusted for an optimal image to be obtained? a. Increase the degree of external wrist rotation. b. Decrease the degree of external wrist rotation. c. Extend the fingers, with the hand flat. d. Adjust the degree of central ray angulation.

b

A PA oblique wrist projection with poor positioning demonstrates an obscured trapeziotrapezoidal joint space and excessive trapezoid and capitate superimposition. How should the positioning setup be adjusted for an optimal image to be obtained? a. Externally rotate the wrist. b. Internally rotate the wrist. c. Ulnar-deviate the wrist. d. Unflex the hand.

b

A PA wrist projection obtained in slight external rotation demonstrates 1. superimposition of the laterally located carpal bones. 2. a closed radioulnar articulation. 3. open lateral carpal joint spaces. 4. the radial styloid in profile. a. 1 and 4 only b. 2 and 3 only c. 2, 3, and 4 only d. 1, 2, and 4 only

b

A lateral elbow projection demonstrates the radial head situated anterior and proximal to the coronoid process. How was the patient positioned for such an image to be obtained? 1. The distal forearm was too high. 2. The distal forearm was too low. 3. The proximal humerus was too high. 4. The proximal humerus was too low. a. 1 and 3 only b. 1 and 4 only c. 2 and 3 only d. 2 and 4 only

b

A lateral elbow projection obtained with the distal forearm positioned too low and the proximal humerus positioned too high demonstrates the 1. radial head distal and posterior to the coronoid process. 2. radial head proximal and anterior to the coronoid process. 3. capitulum posterior and proximal to the medial trochlea. 4. capitulum anterior and distal to the medial trochlea. a. 1 and 3 only b. 1 and 4 only c. 2 and 3 only d. 2 and 4 only

b

A lateral hand projection obtained with the hand in slight external rotation demonstrates the 1. shortest of the second through fourth metacarpals anteriorly situated. 2. radius posterior to the ulna. 3. second metacarpal posterior to the other metacarpals. 4. pisiform posterior to the distal scaphoid. a. 1 and 2 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, and 4 only

b

A less than optimal PA finger projection demonstrates unequal soft tissue width and midshaft concavity on each side of the phalanges. The side of the phalanges with the greatest midshaft concavity is facing the shortest finger metacarpal. All of the following are true about this projection except that the a. finger was internally rotated. b. projection will demonstrate more soft tissue width on the lateral surface. c. projection will demonstrate open IP and MP joints as long as the digit remains parallel with the IR. d. projection will demonstrate less phalangeal concavity on the lateral surface.

b

A less than optimal lateral elbow projection demonstrating the capitulum posterior to the medial trochlea will a. also demonstrate the coronoid proximal to the radial head. b. be obtained when the distal forearm is elevated. c. also demonstrate the medial trochlea proximal to the capitulum. d. be obtained when the distal humerus is elevated.

b

A less than optimal ulnar-deviated PA axial (scaphoid) wrist projection demonstrates closed scaphotrapezium, scaphotrapezoidal, and CM joint spaces. How should the positioning setup be adjusted to obtain an optimal projection? a. Externally rotate the wrist until it is at a 25-degree angle with the IR. b. Extend the hand, positioning it flat against the IR. c. Increase the degree of hand flexion. d. Increase the degree of ulnar deviation until the first metacarpal and ulna are aligned.

b

A properly positioned tangential projection of the wrist will demonstrate which of the following? 1. Flexor retinaculum anteriorly and the capitate posteriorly 2. Scaphoid and trapezium laterally 3. Scaphoid and trapezoid medially 4. Pisiform and hamate medially 5. Flexor retinaculum posteriorly and the capitate anteriorly 6. Pisiform and hamate laterally a. 1, 3, and 4 only b. 1, 2, and 4 only c. 3, 5, and 6 only d. 3, 4, and 5 only

b

A tangential, inferosuperior carpal canal wrist projection with accurate positioning demonstrates a. superimposition of the pisiform and hamulus of the hamate. b. the carpal canal. c. the carpal bones with maximum elongation. d. the fifth metacarpal.

b

A tangential, inferosuperior carpal canal wrist projection with poor positioning demonstrates superimposition of the pisiform and hamulus of the hamate. How should the positioning setup be adjusted for an optimal image to be obtained? a. Externally rotate the hand. b. Internally rotate the hand. c. Decrease the central ray angulation. d. Increase the central ray angulation.

b

An AP elbow projection obtained with the elbow internally rotated demonstrates 1. the radial tuberosity in profile. 2. an open capitulum-radial joint space. 3. more than 0.25 inch (0.6 cm) of radial head and ulnar superimposition. 4. less than 0.25 inch (0.6 cm) of radial head and ulnar superimposition. a. 1 and 3 only b. 2 and 3 only c. 2 and 4 only d. 1, 2, and 3 only

b

An optimal internally rotated AP oblique elbow projection will demonstrate all of the following except the a. radial head and neck superimposing the ulna. b. radioulnar articulation as an open space. c. trochlea-coronoid process articulation as an open space. d. trochlear notch and medial trochlea in profile.

b

The IP joint spaces on finger projections are open and demonstrated without distortion when the 1. central ray is aligned parallel with the IP joint spaces. 2. central ray is aligned perpendicular to the IP joint spaces. 3. IP joints are aligned parallel with the IR. 4. IP joints are aligned perpendicular to the IR. a. 1 and 3 only b. 1 and 4 only c. 2 and 3 only d. 2 and 4 only

b

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a scaphoid wrist fracture is suspected, and the patient is unable to ulnar-deviate the wrist? a. 15 degrees b. 20 degrees c. 5 to 10 degrees d. 20 to 25 degrees

b

What is the projection for the PA oblique finger? a. Phalanges demonstrate equal concavity. b. Phalanges demonstrate more concavity on one side than on the other. c. Phalanges demonstrate concavity on one side and convexity on the other.

b

Which of the following technical factors should be chosen when 20 mAs is desired and the patient being imaged has difficulty remaining still? a. 200 mA at 0.1 sec b. 400 mA at 0.05 sec c. 100 mA at 0.4 sec d. 100 mA at 0.2 sec

b

Which side of the arm is positioned against the IR for the lateral second finger projection? a. Ulnar b. Radial

b

A PA wrist projection obtained with the hand flexed and the metacarpals at a 45-degree angle with the IR demonstrates 1. a closed radioulnar articulation. 2. foreshortened metacarpals. 3. a decrease in scaphoid foreshortening. 4. closed second through fifth carpometacarpal joint spaces. a. 1 and 3 only b. 1, 2, and 4 only c. 2, 3, and 4 only d. 1, 2, 3, and 4

c

A PA wrist projection obtained with the wrist in a neutral position demonstrates 1. the scaphoid in partial foreshortening. 2. the center of the lunate positioned distal to the radioulnar articulation. 3. closed CM joints. 4. alignment of the long axis of the third metacarpal and radius. a. 1 and 3 only b. 2 and 4 only c. 1, 2, and 4 only d. 1, 2, 3, and 4

c

A lateral elbow projection obtained with the wrist and hand pronated demonstrates 1. the radial head anterior to the coronoid. 2. the radial tuberosity in profile anteriorly. 3. an open elbow joint. 4. the radial tuberosity in profile posteriorly. a. 2 only b. 4 only c. 3 and 4 only d. 1 and 3 only

c

A lateral elbow projection with accurate positioning demonstrates 1. an open elbow joint space. 2. the radial head distal to the coronoid process. 3. the radius superimposing the radial tuberosity. 4. the anterior fat pad. a. 2 and 3 only b. 1 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4

c

A lateral finger projection obtained with the finger in a 45-degree PA oblique projection demonstrates 1. equal soft tissue width on both sides of the phalanges. 2. more midshaft concavity on one side of the phalanges than on the opposite side. 3. twice as much soft tissue on one side of the phalanges as on the opposite side. 4. convexity on one side of the phalanges and concavity on the opposite side. a. 1 and 2 only b. 1 and 4 only c. 2 and 3 only d. 3 and 4 only

c

A lateral forearm projection obtained in a patient with the proximal humerus elevated and the wrist internally rotated demonstrates the 1. radial head posterior to the coronoid process. 2. pisiform anterior to the distal scaphoid. 3. capitulum distal to the medial trochlea. 4. pisiform distal to the distal scaphoid a. 1 and 2 only b. 1 and 4 only c. 1 and 3 only d. 3 and 4 only

c

A lateral wrist projection obtained with the wrist in slight internal rotation demonstrates the 1. distal scaphoid anterior to the pisiform. 2. radius posterior to the ulna. 3. distal scaphoid distal to the pisiform. 4. radius anterior to the ulna. a. 1 and 2 only b. 3 and 4 only c. 1 and 4 only d. 2 and 3 only

c

A less than optimal PA wrist projection demonstrates an elongated scaphoid and the second through fourth metacarpals superimposing the CM joint spaces. Which of the following is true about this projection? a. The wrist was in ulnar flexion. b. The wrist was flexed. c. The hand was overflexed. d. The wrist was externally rotated.

c

A less than optimal lateral elbow projection demonstrating the radial head positioned posterior to the coronoid process a. will be obtained when the distal forearm is elevated. b. will be obtained when the proximal humerus is depressed. c. will also demonstrate the capitulum distal to the trochlea. d. could also result if the central ray were angled proximally with the humerus.

c

A poorly positioned PA oblique wrist projection demonstrates superimposition of the trapezoid and trapezium, and the capitate is superimposed by the trapezoid. How should the positioning setup be adjusted to obtain an optimal projection? a. Align the third metacarpal and midforearm, decreasing radial flexion. b. Increase the degree of medial wrist rotation. c. Decrease the degree of medial wrist rotation. d. Increase hand extension.

c

A right lateral fourth finger projection obtained with the hand internally rotated to 20 degrees demonstrates 1. equal soft tissue width on both sides of the phalanges. 2. more phalangeal midshaft concavity on the side facing the fifth finger. 3. convexity on one side of the phalanges and concavity on the opposite side. 4. greater phalangeal midshaft concavity on the side facing the third finger. a. 1 and 4 only b. 2 and 3 only c. 4 only d. 2, 3, and 4 only

c

An AP elbow projection with accurate positioning demonstrates 1. the medial and lateral humeral epicondyles in profile. 2. the radial tuberosity in profile medially. 3. an open capitulum-radial joint. 4. the ulna free of radial head and radial tuberosity superimposition. a. 1 and 3 only b. 2 and 4 only c. 1, 2, and 3 only d. 1, 2, 3, and 4

c

An AP forearm projection with accurate positioning demonstrates the 1. radial styloid in profile laterally. 2. radial head superimposing the ulna by 0.25 inch (0.6 cm). 3. ulnar styloid in profile laterally. 4. humeral epicondyles in profile. a. 1 and 3 only b. 2, 3, and 4 only c. 1, 2, and 4 only d. 1, 2, 3, and 4

c

An externally rotated PA oblique wrist projection with accurate positioning demonstrates 1. the trapezoid and trapezium without superimposition. 2. an open radioulnar articulation. 3. the ulnar styloid in profile. 4. superimposition of the medially located carpals. a. 2 and 3 only b. 2 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4

c

An optimal ulnar-deviated PA axial (scaphoid) wrist projection demonstrates all of the following except a. the scaphoid fat stripe. b. open scaphotrapezium and scaphotrapezoidal joint spaces. c. a closed radioscaphoid joint space. d. alignment of the long axis of the first metacarpal and radius.

c

How is a patient positioned for a PA wrist projection to superimpose the anterior and posterior margins of the distal radius and obtain open radioscaphoid and radiolunate joint spaces? a. Align the third metacarpal with the forearm. b. Ulnar-flex the wrist. c. Depress the proximal forearm. d. Flex the hand until the metacarpals are at a 10- to 15-degree angle with the IR.

c

The trapezium is demonstrated without superimposition of other anatomy on a lateral wrist projection when the patient a. positions the wrist in slight internal rotation. b. hyperextends the wrist. c. depresses the distal first metacarpal. d. ulnar-deviates the wrist.

c

To take advantage of the anode heel effect when imaging a forearm, a. a detailed screen is used. b. the elbow is positioned at the anode end of the x-ray tube. c. the wrist is positioned at the anode end of the x-ray tube. d. a 55- to 65-kVp technique is used.

c

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a proximal scaphoid fracture is suspected, and the patient is unable to ulnar-deviate the wrist? a. 15 degrees b. 20 degrees c. 5 to 10 degrees d. 20 to 25 degrees

c

What is the projection for the lateral finger? a. Phalanges demonstrate equal concavity. b. Phalanges demonstrate more concavity on one side than on the other. c. Phalanges demonstrate concavity on one side and convexity on the other.

c

When the patient ulnar-deviates for a PA axial, ulnar-deviated wrist projection, the 1. first metacarpal and radius are aligned. 2. distal scaphoid shifts anteriorly. 3. lunate is demonstrated distal to the radius. 4. distal scaphoid shifts posteriorly. a. 1 and 2 only b. 3 and 4 only c. 1, 3, and 4 only d. 1, 2, and 3 only

c

Where are the soft tissue structures that can be used to indicate joint effusion located on the PA wrist projection? a. Anteriorly b. Medially c. Laterally d. Posteriorly

c

Where are the soft tissue structures that can be used to indicate joint effusion located on the ulnar-deviated PA axial wrist projection? a. Anteriorly b. Medially c. Laterally d. Posteriorly

c

A PA hand projection obtained with the hand flexed demonstrates 1. foreshortened phalanges. 2. the thumb in a lateral projection. 3. closed IP joint spaces. 4. foreshortened metacarpals. a. 1 and 3 only b. 2 and 4 only c. 1, 3, and 4 only d. 1, 2, 3, and 4

d

A PA wrist projection with accurate positioning demonstrates 1. an open radioulnar articulation. 2. the radial styloid in profile. 3. the long axes of the third metacarpal aligned with the midforearm. 4. open second through fifth MC joint spaces. a. 1 and 2 only b. 1, 2, and 3 only c. 3 and 4 only d. 1, 2, 3, and 4

d

A lateral wrist projection obtained with the elbow flexed 90 degrees and the humerus placed parallel with the IR demonstrates 1. the ulnar styloid distal to the midline of the ulnar head. 2. superimposition of the radius and ulna. 3. superimposition of the distal scaphoid and pisiform. 4. the ulnar styloid in profile. a. 1 and 2 only b. 3 and 4 only c. 1, 2, and 3 only d. 2, 3, and 4 only

d

A less than optimal lateral wrist projection demonstrating the distal scaphoid anterior to the pisiform a. will also demonstrate the distal scaphoid proximal to the pisiform. b. will also demonstrate the ulna anterior to the radius. c. was obtained with the wrist in ulnar flexion. d. was obtained with the wrist internally rotated.

d

An AP forearm projection obtained with the wrist and elbow in lateral rotation demonstrates 1. superimposed first and second metacarpal bases. 2. the proximal radius superimposed over the ulna by more than 0.25 inch (0.6 cm). 3. superimposed fourth and fifth metacarpal bases. 4. the proximal radius and ulna without superimposition. a. 1 and 2 only b. 1 and 4 only c. 2 and 3 only d. 3 and 4 only

d

An internally rotated AP oblique elbow projection with accurate positioning demonstrates which of the following structures in profile? 1. Capitulum 2. Radial head 3. Medial trochlea 4. Coronoid process a. 1 and 2 only b. 1 and 4 only c. 2 and 3 only d. 3 and 4 only

d

An optimal AP elbow projection is obtained when a. an imaginary line connecting the humeral epicondyles is aligned perpendicular with the IR. b. the radial tuberosity is demonstrated in profile laterally. c. the radial head articulating surface is demonstrated. d. the radial head superimposes the lateral aspect of the proximal ulna by 0.25 inch (0.6 cm).

d

An optimally positioned PA wrist projection demonstrates all of the following except a. an open radioulnar articulation. b. open second through fifth MC joint spaces. c. alignment of the long axis of the third metacarpal and midforearm. d. the pronator fat stripe.

d

For a carpal canal wrist image, the 1. wrist is hyperextended until the long axes of the metacarpals are vertical. 2. hand is rotated 10 degrees internally until the fifth metacarpal is perpendicular to the IR. 3. central ray is angled 25 to 30 degrees proximally. 4. central ray is centered to the palm of the hand. a. 1 and 4 only b. 2 and 3 only c. 1, 2, and 3 only d. 1, 2, 3, and 4

d

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a distal scaphoid fracture is suspected, and the patient is able to ulnar-deviate until the first metacarpal and radius are aligned? a. 15 degrees b. 20 degrees c. 5 to 10 degrees d. 20 to 25 degrees

d

Which of the following is not true about an optimal axiolateral elbow projection (Coyle method)? a. The elbow is flexed 90 degrees. b. The proximal aspects of the radial head and the coronoid process are aligned. c. The capitulum-radial joint is open. d. The capitulum and medial trochlea demonstrate slight superimposition.

d