RAD 124 midterm: Ch. 5 Shoulder/humerus, Ch. 6 knee, Ch. 7, Pelvis/femur

A radiograph of an axiolateral (inferosuperior) projection shows that the posterior aspect of the acetabulum and femoral head were cut off of the bottom of the image. The emergency room physician requests that the position be repeated. What can be done to avoid this problem on the repeat image?

If possible, elevate the patient approximately 2" by placing sheets/blankets/sponge under pelvis

5 to 15 degrees

If the patient cannot fully abduct the affected arm 980 degrees for the inferosuperior axial projection (Clements modification), the technologist can angle the CR __________ degrees toward the axilla.

What is the most superior part of the hip bone?

Iliac crest

What type of rotation of the humerus will show the lesser tubercle in profile medially for an AP?

Internal

What AP projection of the shoulder is the greater tubercle located anterior and the lesser tubercle is medial (in profile?)

Internal rotation

The deep groove between the greater and lesser tubercles of the proximal humerus

Intertubercular sulcus (bicipital groove)

Which of the following structures are considered the most posterior? A. Ischial spines B. Asis C. Symphysis pubis D. Acetabulum

Ischial spines

If patient is prone, what landmark can you palpate?

Ischial tuberosity

Where did the surgical neck of the proximal humerus get its name?

It is frequently the site of frequent fractures requiring surgery

What part of the pelvis has limited mobility during childbirth?

Symphysis pubis

______________ is an effective tool in studying the shoulder.

Ultrasound

Reduced OID

What is the major advantage of the supine, tangential version of the intertubercular sulcus projection over the erect version?

Suspected AC joint subluxation

What is the most common clinical indication to perform the Alexander method for AC joint?

Projection: left AP unilateral frog leg (modified cleaves) Procedure: hip/proximal femur CR perpendicular to IR and to femoral neck. Aim at inguinal crease. Leg abducted 45 degrees from vertical. (20-30 degrees of abduction if wanting to minimize foreshortening and distortion of femoral neck)

What is the projection? Procedure? CR and positioning?

ball and socket

What is the type of joint movement for the scapulohumeral joint?

Projection: Posterior oblique pelvis-acetabulum, (Judet method) RPO Procedure: pelvis CR: 2" medial to downside ASIS and 2" distal to downside ASIS perpendicular to IR.

What is this projection? Procedure? CR and positioning?

Projection: AP outlet pelvis (Taylor method) Procedure: pelvis CR 1"-2" inferior to the symphysis pubis/greater trochanters. Angled 20-35 degrees cephalad for males and 30-45 degrees cephalad for females. Legs abducted 40-45 degrees from vertical

What is this projection? Procedure? Describe the CR and positioning

Projection: AP pelvis Procedure: pelvis CR midway between the pubic symphysis and the ASIS. Centered midline. Perpendicular to the IR collimation May include entire provides from crest to pubic symphysis. Rotate legs inward 15-20 degrees.

What is this projection? Procedure? Describe the CR and positioning

Osteoporosis

What requires a decrease in manual exposure factors?

Describe the female pelvis

Wider, more shallow, more flared. Pelvic inlet rounder. Pubic arch angle is more obtuse (80-85 degrees). ischial spines protrude less into pelvis inlet.

The shoulder girdle consists of what two bones?

clavicle and scapula

Define osteoarthritis

degenerative joint disease

Osteoarthritis

degenerative joint disease

What does the Grashey method demonstrate?

glenoid cavity/fossa in profile

Pathology: Impingement syndrome

subacromial spurs

A physician orders a bilateral tangential projection of the patella and patellofemoral joint space. The patient is restricted to the wheelchair and cannot lie on the radiographic table due to pain. What projection could be performed with the patient remaining in the wheelchair?

Superoinferior siting tangential method (Hobbs)

This picture represents 15-20 degrees of medial rotation. Femoral heads and necks in profile, true AP projection, lesser trochanters not visible or only slightly visible on some patients.

What would the pelvis radiograph look like if the feet were in this position?

What is the more proximal structure of the humerus: a. neck b. greater trochanter

b. neck

neutral rotation

humeral condyles angled 45 degrees to IR

What is the largest and strongest bone of the upper limb?

humerus

What is the largest section of the hip bone?

ilium

Which of the bones of the pelvic girdle is the largest?

ilium

How can you tell if there is under rotation on your lateral knee?

fibular head will appear more superimposed by the tibia than on a true lateral. Medial condyle will be more posterior, appearance of adductor tubercle in profile, excessive superimposition of fibular head and the neck of the fibula. Fix by rotating the patient up on their hip more laterally.

What projection should the patient be rotated 45-60 degrees toward the IR from the PA position?

lateral scapula

What are the three angles of the scapula?

lateral, superior, inferior

internal rotation

lesser tubercle profiled medially

What is the medical term for arm pit?

Axilla

scapula

Coracoid process is located on:

not part of shoulder girdle

Coronoid process is located on:

What is the CR for the erect Fisk modification tangential intertubercular sulcus shoulder projection?

Cr perpendicular to IR, directed at groove area at mid anterior margin of humeral head

scapula

Crest of spine is located on:

Which two ligaments of the knee joint help stabilize the knee from the anterior and posterior perspective?

Cruciates

What is the mobility type of all three of the shoulder joints?

Diathrodial (Greeley movable)

axilla

What is the anatomic name for the armpit?

AP external rotation & AP internal rotation

Which two routine projections are routinely taken for a shoulder (with no traumatic injury) and proximal humerus?

True

True/False: A 72 inch SID is recommended for adult acromioclavicular joint studies

Which projection provides the greatest amount of gonadal dose for a male patient?

Axiolateral superoinferior

False

True/False: A 72- inch source image distance (SID) is recommended for most shoulder girdle studies

True

True/False: A high-speed screen-IR system is recommended for analog shoulder studies when using a grid

True

True/False: It is recommended to perform shoulder positions on obese in the erect position when possible

False

True/False: Large focal spot setting should be selected for most adult shoulder studies

False

True/False: Low mA with short exposure times should be used for adult shoulder studies

False

True/False: Magnetic resonance imaging (MRI) is an excellent modality for demonstrating bony injuries of the shoulder girdle

How can you determine the position/rotation of the shoulder?

Identifying where the greater and lesser tubercles are located

True

True/False: CT arthrography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space

Outline the technical factors for the Rosenberg method of the knee

"Skier position" 45 degree flexion of knees, CR 10 degrees caudad at 1/2" below apex of patellae. patient facing wall Bucky, 40" SID

Describe how the student radiographer should perform a hip series on a cognitively impaired patient who presents with extreme hip pain

1. AP pelvis 2. Axiolateral Trauma superoinferior

What is the CR for the AP clavicle? Clinical indications for exam?

Perpendicular to mid clavicle, indications are fractures and dislocations of clavicle

What type of CR angle is required for an AP projection of the knee is the distance from ASIS to tabletop is 21cm?

0 degree angle

Where is the CR centered for an AP AC joint bilateral projection (Pearson method)?

1" above jugular notch

What is the CR of the lateral knee projection?

1" distal to medial condyle, angled 5-7 degrees cephalad for lateral recumbant projection

What is the CR location for the Outlet/Taylor pelvis projection? What angle for males? Females?

1"-2" inferior to the symph/greater trochanters. Males- angle CR 20-35 degrees cephalad Females- angle CR 30-45 degrees.

List the two bursae found in the knee joint,

1. Suprapatellar bursa 2. Infrapatellar bursa

What type of CR angulation is required for the PA axial weight bearing projection (Rosenberg method)?

10° cauded

What is the CR for the Alexander method AP axial AC joint projection?

15 degrees cephalad, centered at level of affected AC joint.

What movement of the legs puts the femoral neck in profile?

15-20 degrees internal rotation

A youngster comes to the radiology department with a clinical history of DDH (developmental dysplasia of the hip). What is the most common positioning routine for this condition?

AP pelvis and bilateral frog leg (modified cleaves) projections

How much flexion is recommended for a lateral projection of the knee to best demonstrate the patellofemoral joint space?

20 to 30 degrees

How much flexion for a lateral knee?

20-30 degrees

How much should the leg be flexed for the lateral knee projection?

20-30 degrees

What is the optimum amount of femur abduction to demonstrate the femoral neck while doing a cleaves/frog leg projection of the hip/proximal femur?

20-30 degrees from vertical

What type of CR angle is required for the AP axial outlet projection for a male patient?

20-35 degrees

A patient has just been moved to his hospital room after a bilateral hip replacement surgery. The surgeon has ordered a post operative hip routine for both hips. Which specific positioning routine should be used? (The patient can be bright to the radiology department)

AP pelvis and modified Clements Nakayama method

How much rotation of the leg for the AP patella projection?

3-5 degrees

How much should you rotate the leg in for an AP knee?

3-5 degrees

What is the recommended central-ray angulation for an AP projection of the knee for a patient with thick thighs and buttocks (i.e., measuring greater than 24 cm)? *.

3-5° cephalad

How much CR angulation required for an asthenic patient during an AP axial projection of the clavicle?

30 degrees

What type of CR angle is required for the AP axial outlet projection for a female patient?

30-45 degrees

How much central ray angle from the long axis of the femora is required for the tangential (Merchant method). bilateral projection?_

30° from horizontal

How much is the affected side rotated for the PA axial oblique projection (Teufal method)?

35-40 degrees

How much flexion of the lower leg is required for the PA axial projection (Camp-Coventry method) when the central ray is angled at 40 degrees caudad?

40° flexion

What is the CR for the Rosenberg method?

Angled 10 degrees caudad, centered midpoint between knee joints, 1/2" below patella apex

Which positions will best demonstrate ilioischial column and iliopubic column of the pelvis?

45 degree LPO/RPO (Judet)

What position (in relation to the IR) will the epicondyles of the humerus be in a neutral position?

45 degree oblique

How much flexion of the knees is required for the PA axial weight-bearing projection (Rosenberg method)?

45 degrees

What is the CR for the Garth method (AP apical OBL axial projection)? What are the clinical indications?

45 degrees caudal, centered to scapulohumeral joint. CR enters just inferior to coracoid process Scapulohumeral dislocations, (especially posterior dislocations)

How much do you rotate laterally or medially for an oblique knee? Where is the CR for an oblique knee?

45 degrees- 1/2" distal to the patella

The three corners of the scapula are called what?

Angles

What is the recommended central-ray placement for a lateral knee position on a tall, slender male patient with a narrow pelvis (without support of the lower leg)?

5 degrees cephalad

A line drawn across the most distal aspect of the medial and Jateral femoral condyles would be __________ from being at a right angle (90°) to the long axis of the femur.

5 to 7 degrees

How much flexion for a lateral patella?

5-10 degrees

How much flexion of the knee is recommended for a lateral projection of the patella?

5-10°

How much do you angle for the CR for a lateral knee? Why?

5-7 degrees cephalad- keeps the condyles superimposed, and allows the CR to be parallel to the tibial plateau

How much part flexion is required for the Hughston method?

55°

Your lateral projection of a hip prosthetic device reveals that the proximal end is cut, but was demonstrated on the AP image. Is this acceptable?

No! the entire prosthetic much be visible on both AP and Lateral projections

How much knee flexion is required for the PA axial projection (Holmblad method)?

60 to 70 degrees

What are the technical factors for an average adult humerus and shoulder girdle?

65 to 80 kV for analog, 70-90 kV for digital, 6-10 mAs

A radiograph of an AP hip shows that the lesser trochanter is not visible. Should the tech repeat the exposure?

No, the lesser trochanter should not be visible (or only slightly visible) on a true AP hip.

What is the minimum amount of weight a large adult should have strapped to each wrist for the weight bearing phase of an AC joint study?

8 to 10 lbs

What are the technical, CR, and positioning factors for the clements-nakayama method?

80 (+-5) analog 85 (+-5) digital IR in extended Bucky tray tilted 15 degrees out. CR angle 15 to 20 degrees aimed mediolaterally at femoral neck. Patient spine with legs extended.

How much knee flexion is required for the horizontal beam lateral patella projection?

None

What is the classification and movement of the following joints? 1) femorotibial 2) patellofemoral 3) proximal tibiofibular

Femorotibial: synovial, bicondylar Patellofemoral: synovial, saddle/sellar Proximal tibiofibular: synovial, plane/gliding

How much part flexion is required for the Settegast method?

90°

What is the only bone the patella articulates with?

Femur

False

A central ray angle of 10-15 degrees caudad may be used for the transthoracic lateral shoulder projection if the patient is unable to elevate the uninjured arm and shoulder sufficiently

Define Hill-Sachs defect and give exam that is performed

A compression fracture of the humeral head that is often associated with an anterior dislocation of the humeral head. AP internal rotation, exaggerated external rotation, or transaxillary lateral

Pelvic ring fractures

A fracture resulting from a severe blow to one side of the pelvis

A radiograph of an axial projection for the anterior pelvic bones shows that the pubic and ischial bones are not elongated sufficiently. The following analog factors were used for this study: 86 kV, 7 mAs, Bucky, 20-30 degrees central ray cephalad angle, 40" SID. The female patient was placed in a spine position on the table. What must be changed to improve quality of the image during the repeat exposure?

A greater CR angle is required. Female patients require a CR angle of 30-45 degrees cephalad for the Outlet projection described above

AP internal Posterior oblique Anterior oblique

A patient with a possible Bankart lesion comes to the radiology department. List three projections that can be performed that may demonstrate signs of this injury.

Routine includes anteroposterior of right shoulder and humerus without rotation (neutral position), and a supine, horizontal beam, right transthoracic shoulder. (Supine posterior oblique scapular Y lateral projection could also be performed in this case).

A patient with a possible fracture of the right proximal humerus from an automobile accident enters the emergency room. The patient has other injuries and is unable to stand or sit erect. Which positioning routine should be used to determine the extent of the injury?

superior

A posterior dislocation of the humerus projects the humeral head _________ to the glenoid cavity with the special projection AP apical oblique axial projection.

Rotate body more toward affected side

A radiograph of an anterior oblique (Grashey method) shows that the anterior and posterior glenoid rims are not superimposed. The following positioning factors were used: erect position, body rotated 25 to 30 degrees toward the affected side, central ray perpendicular to scapulohumeral joint space, and affected arm slightly abducted in neutral rotation. Which of the following modifications will superimpose the glenoid rims during the repeat exposure?

Increase the rotation of affected shoulder toward IR closer closer to 45 degrees

A radiograph of the AP oblique (Grashey method) taken with a 30 degree rotation of the affected shoulder toward the IR reveals that the borders of the glenoid cavity are not superimposed. The patient has large, rounded shoulders. What must be done to get better superimposition of the cavity during the repeat exposure.

Situation: A radiograph of an AP knee projection demonstrates that the femorotibial joint space is not open at all. The patient is young and has no history of degenerative disease. What type of positioning modification may improve the outcome of this projection?

Angling the CR correctly to keep it parallel to articular facets (tibial plateau)

What type of dislocation of the shoulder is most common?

Anterior

The cruciate ligaments help stabilize the knee from ________________ movement

Anterior and posterior

Grashey Method

Anterior oblique for glenoid cavity is also known as:

The lesser tubercle is located ___________ and the greater tubercle is located _____________ in a true AP position.

Anteriorly, laterally

What is the pointed inferior region of the patella?

Apex

What ionization chambers for the AEC should be used for a tangential projection of the intertubercular groove?

None- not required for this projection

The CR angulation for the Scapular Y projection is?

None. CR Should be perpendicular to the IR

Which basic projection of a knee best demonstrates the proximal fibula free of superimposition?

AP oblique, 45-degree medial rotation

How should weights be placed for the AC joint-weight bearing studies?

Attached to wrists— to keep arms, hands, and shoulders relaxed

Where is the patellar ligament?

Attaches the patella to the tibial tuberosity

A patient with a history of degenerate disease of the left knee joint comes in to the radiology department. The ortho surgeon orders a radiographic study to determine the extent of the damage to the joint space. Which projection(s) should be performed?

AP or PA weight bearing bilateral knee projection

Which special projection of the knee is best to evaluate the knee joint for cartilage degeneration or deformities?

AP or PA weight bearing knee projections

Describe the projection which the student radiographer should perform first on any type of pelvis/hip trauma

AP pelvis

A patient with hip pain from a fall enters the ER. The physician orders a left hip study. When moved to the radiographic table, the patient complains loudly about the pain in the left hip. Which positioning routine should be used for this patient?

AP pelvis and axiolateral left hip. The AP pelvis radiograph should be taken initially without rotation of the leg, and image should be reviewed by the doctor before attempting to internally rotate left leg for the axiolateral projection.

What projection does the anterior and posterior rims of the glenoid cavity need to be superimposed?

AP OBL projection- glenoid cavity shoulder (Grashey method)

What projection/positioning rotation should be performed for a patient that presents with a possible fracture of the proximal humerus?

AP and horizontal beam transthoracic lateral shoulder in neutral

Garth method

AP apical oblique axial is also known as:

Which additional projection can be performed to demonstrate a possible pelvic ring fracture?

AP axial Inlet

A physician orders a study for an inlet and outlet projections of the pelvis. Which projections could be performed to meet this request?

AP axial outlet (Taylor method) and AP axial inlet projections. And also possibly the posterior oblique (Judet method) projection to provide another perspective of the inlet and outlet regions of the pelvis.

What pelvis projection is used to assess the bilateral pubis and ischium?

AP axial outlet/ Taylor method

What projection may use a 72" SID?

AP bilateral AC joints (Pearson method)

The recommended SID for _______________ is 72"

AP bilateral AC joints (Pearson)

Which position will best demonstrate signs of developmental dysplasia?

AP bilateral frog

What projection would you do for a pediatric patient suspected of having developmental hip dysplasia?

AP bilateral frog-leg pelvis (modified cleaves)

What imaging procedure should be performed first if the physician orders both AC joints and clavicle? Why?

AP clavicle and AP axial clavicle to rule our fractures before doing the weight bearing study

Pathology: Bankart lesion

Avulsion fracture of the glenoid rim

What type of CR angle is required for the PA projection (Holmblad method)?

None. CR is perpendicular to IR

What are the two ligaments that are on the medial and lateral side of the knee? (Attached to the epicondyles of the Femur) What do they do?

Fibular lateral collateral ligament (LCL) Tibial medial collateral ligament (MCL) They prevent adduction and abduction movements

The area inferior to the pelvic brim is called the_____________.

Lesser or true pelvis

The process directly below the anatomic neck on the anterior surface of the proximal humerus is the:

Lesser tubercle

The upper, or superior, portion of the patella is called the:

Base

Why must the central ray be angled 5 to 7 degrees cephalad for a lateral knee position?

Because the medial condyle extends below or more distally than the lateral condyle of the femur.

Where is the patellofemoral joint located?

Between the patella and the patellar surface of the anterior distal femur.

The knee joint is classified as

Bicondylar

Situation: A projection is performed for the patellofemoral caudad from horizontal. The cassette is resting on the lower legs joint with the patient supine and the knee flexed at 40 degrees. The central ray is angled 30 degrees supported by a special cassette-holding device, Which of the following methods has been described?

Bilateral Merchant

What projection would you use for a pediatric patient with displasia of the hip?

Bilateral frog

What positioning error could cause grid lines on an image?

Body part not centered on IR, grid not straight up and down

Each ischium is divided into a _________and a __________.

Body, ramus

How is the scapula attached to the trunk?

By muscles only

Hill-Sachs defect

Compression fracture of humeral head

Pathology: Hill-Sachs defect

Compression fracture of humeral head

What type of CR angle is required for the superoinferior sitting tangential method for the patella?

None. CR is perpendicular to IR

What is the CR for the supine Tangential projection intertubercular sulcus shoulder?

CR 10-15 degrees posterior from horizontal, directed at groove at mid anterior margin of humeral head.

What is the CR for the Neer method (tangential supraspinatus outlet: shoulder trauma)? What are the clinical indications for this exam?

CR angle 10-15 degrees caudal, centered to pass through the superior portion of the humeral head. (Approximately 1" superior to medial aspect of Scapular spine) Demonstrates the coracoacromial arch supraspinatus outlet region for shoulder impingement

What is the CR for a recumbent lateral scapula?

CR to mid scapula lateral border

Which of the following projections is the best suited for the patient with limited movement of both lower limbs to demonstrate a lateral perspective of the proximal femur? A. Taylor method B. Danelius Miller method C. Judet method D. Clements Nakayama method

D. Clements Nakayama method

What is in the popliteal region?

Nerves and blood vessels pass through

Define osteoarthritis and give common exam performed

Degenerative joint disease, non inflammatory joint disease characterized by gradual deterioration of cartilage with hypertrophic bone formation. AP and LAT shoulder (Would decreases exposure factors)

What is the roughened raised triangular elevation along the anterolateral surface of the shaft of the humerus to which the deltoid muscle is attached?

Deltoid tuberosity

What mobility type are the joints of the shoulder?

Diathrodial

What is another name for the axiolateral inferosuperior unilateral hip/proximal femur?

Danelius-Miller Method

For rheumatoid arthritis, osteoporosis, and osteoarthritis, of the shoulder, you should __________________ your exposure factors.

Decrease

What positioning correction does the radiographer need to do if the axillary border appears more lateral than the vertebral border in a Scapular Y projection?

Decrease angle of patient's thorax to be closer to 45 degrees

A radiograph of a unilateral frog-leg (modified Cleaves method) projection reveals that the femoral neck is foreshortened and distorted. The radiologist is concerned about pathology involving the neck. What can the technologist do to improve the visibility of the femoral neck without foreshortening during the repeat exposure?

Decrease the abduction of the femur to 20° to 30° from vertical.

Situation: A radiograph of a lateral patella shows that the patella is drawn tightly against the intercondylar sulcus. Which positioning modification should be performed to improve the quality of the image during the repeat exposure?

Decrease the flexion of the knee to 5 to 10°

What is the CR of the AP knee?

Directed to a point ½ inch distal to apex of patella. (1/2 inch inferior to the apex)

Idiopathic chronic adhesive capsulitis

Disability of the shoulder joint caused by chronic inflammation in and around the joint

Why are posteroanterior (PA) axial projections for the intercondylar fossa recommended instead of AP axial projections (Béclere method)?

Distortion from poor CR to IR alignment and increased OID for AP axial projection

What kind of rotation places the proximal humerus (shoulder)in an oblique position midway between an AP and a lateral?

Neutral rotation

TrueFalse. The posterior surface of the patella is normally rough.

False

TrueFalse: A 20-degree flexion of the knee forces the patella firmly against the patellar surface of the femur.

False

T/F: the false pelvis forms the birth canal in females?

False: the true pelvis forms the birth canal

A radiograph from a modified axiolateral projection of the hip shows excessive grid lines on the image, which also appears underexposed. What can be done to avoid this problem during the repeat exposure?

Ensure that the CR is centered to near the midline of the grid cassette and the face of the IR is perpendicular to the CR.

What is the largest sesamoid bones in the body?

Patella

What is the major disadvantage of the Settegast method?

Requires overflexion of knee

An initial AP pelvis radiograph reveals possible fractures involving the lower anterior pelvis. The emergency room physician asks for another projection to better demonstrate this area of the pelvis. The patient is traumatized and must remain in a supine position. Which projection should be taken?

The AP axial "outlet" projection (Taylor method) will elongate the pubis and the ischium and define this region more completely

A patient enters the ER with a pelvis injury resulting from a motor vehicle accident. The initial AP pelvis projection demonstrates a possible defect or fracture of the left acetabulum. No other fractures are detected and the patient is able to move comfortably. What additional projections can be taken to demonstrate a possible acetabular fracture?

The PA Axial oblique (Teufel method) or the posterior oblique (Judet method) can be taken to demonstrate aspects of the acetabulum more completely.

anterior oblique, grashey

The _____ projection of the shoulder produces an image of the glenoid process in profile. This projection is also referred to as the _______ method

Tangential supraspinatus outlet (Neer method) or AP axial shoulder

The ________ projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create shoulder impingement symptoms

clavicle

The acromial extremity is located on:

What is the long, curved process that extends laterally over the head of the humerus?

The acromion

What makes up the upper parts of the Y on a lateral view of the scapula?

The acromion and the coracoid process

What does the lateral/acromial extremity (end) of the clavicle articulate with? What is this joint called?

The acromion off the scapula, acromioclavicular joint

True

True/False: Even though the amount of radiation exposure is minimal for most shoulder projections, gonadal shielding should be used for children and adults of childbearing age.

10-15 degrees

The supine version of the tangential projection for the intertubercular sulucs requires the central ray be angled _____ posteriorly from the horizontal plane

proximal humerus

The surgical neck is located:

(A) lateral (B) superior (C) inferior

The three angles of the scapula include (A)____, (B)____, (C)_____

(A) sternal extremity (B) body (C) acromial extremity

The three aspects of the clavicle are the:

Where does the shoulder girdle attach to the axial skeleton anteriorly?

The upper sternum

True

The use of a breathing technique can be performed for the transthoracic lateral humerus projection

True

The use of contact shields over the breast, lung, and thyroid regions is recommended for most shoulder projections

Situation: A radiograph of an AP oblique with medial rotation of the knee to demonstrate the proximal fibula shows that there is total superimposition of the proximal tibia and the fibula. What must be modified to correct this projection?

The wrong OBQ position of the knee was obtained. This description is that of a lateral (external) OBQ position of knee.

Pathology: Osteoporosis

Thin bony cortex

What is slipped capital femoral epiphysis (SCFE)?

This condition usually occurs in 10-16 year olds, during rapid growth. The ball at the head of the femur slips off the neck of the bone in a backwards direction.

Shoulder radiography produces significant dose to the _________ and _________.

Thyroid and breasts

Rotate affected arm externally approximately 45 degrees

To best demonstrate a possible Hill-Sachs defect, which additional positioning technique can be added to the inferosuperior axial (Lawrence method) projection?

Use exaggerated external rotation

To best demonstrate the Hill-Sachs defect on the inferosuperior axial projection, which additional positioning maneuver must be used?

Why must the lower limb be rotated 15 to 20 degrees internally for AP hip projections?

To place the femoral neck parallel to the image receptor and to remove the lesser trochanters from view

Lawrence method

Transthoracic lateral is also known as:

define AC joint separation and what radiographic exam is performed

Trauma to the upper shoulder region resulting in partial or complete tear of the AC or CC(coracoclavicular) ligament. Unilateral or bilateral erect AC joints with and without weights (Pearson method)

Rotator cuff tear

Traumatic injury to one or more muscles of the shoulder joint

Define shoulder dislocation and give come exam

Traumatic removal of humeral head from glenoid cavity. 95% are anterior PA OBL (Scapular Y), transthoracic lateral, or Garth method

What are the other two names for the patellar surface? Where is the patellar surface?

Trochlear groove and Intercondylar sulcus— the smooth triangle groove under the patella

T/F: Males and Females can both be shielded for an AP pelvis.

True

T/F: the lesser, true pelvis forms the actual birth canal

True

T/F: the terms pelvis and pelvic girdle are not synonymous

True

True False: The recommended SID is 48 inches (123 cm) to 72 inches (183 cm) for the tangential (bilateral Merchant) projection.

True

True False: To place the interepicondylar line parallel to the image receptor for a PA projection of the patella, the lower limb must be rotated approximately 5 degrees internally.

True

True/False: A 5- to 7-degree cephalad angle of the central ray for a lateral projection of the knee helps superimpose the distal borders of the medial and lateral condyles of the femur when the lower leg has not been supported.

True

TrueFalse: The patella acts as a pivot to increase the leverage of a large muscle found in the anterior thigh.

True

costal surface

The anterior surface of the scapula is referred to as the:

Where is the deltoid tuberosity located?

The anterolateral Surface of the body of the proximal at insertion of deltoid muscle

What makes up the bottom leg of the Y on a lateral view of the scapula?

The body of the scapula

What divides the pelvis into 2 cavities?

The brim

Not part of the shoulder girdle

The condylar process is located on:

What is the beak-like process that projects anteriorly beneath the clavicle?

The coracoid process

What is the Intercondylar fossa?

The depression on the posterior knee that separates the condyles of the femur

How are the epicondyles of the humerus positioned (in relation to the IR) for an internally rotated position?

The epicondyles would be perpendicular to the IR, making for a lateral shoulder/proximal humerus radiograph.

Lower to 70 to 76 kV, which increases radiographic contrast

The following analog factors were used to produce a radiograph of an AP projection of the shoulder: 95 kV, 20 mAs, high-speed screens, 40 inch SID, grid, and suspended respiration. The resultant radiograph demonstrated poor radiographic contrast between bony and soft tissue structures. Which of these factors can be altered during the repeat exposure to improve radiographic study?

What situation is the Clements-Nakayama method used for?

When patient presents with bilateral hip fractures, or cannot get other leg out of the way, has limited mobility or limited movement of lower limbs

What is the anterior surface of the scapula called?

costal surface

Chondrosarcoma

malignant tumor of cartilage

25 to 30 degrees medially

Which type of central ray angle should be used for inferosuperior axial projection for the scapulohumeral joint space?

neutral rotation

palm of hand against thigh

Fractured clavicle

Which type of injury must be ruled out before the weight bearing phase of an AC joint study?

Where are the sacroiliac joints located?

Wide, flat joints located obliquely between the sacrum and each ilium

impingement syndrome

compression between the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch

hill-sachs defect

compression fracture of the articular surface of the humeral head

B. Transthoracic lateral for humerus

With which of the following projections can an orthostatic (breathing) technique can be used? A. Grashey B. Transthoracic lateral for humerus C. Scapular Y lateral D. Garth method

Where is the subscapular fossa?

Within the anterior side of the scapula

What is Legg-Calve-Perthes disease?

avascular necrosis of the femoral head. Radiographs demonstrates a flattened femoral head that can later appear fragmented.

define frozen shoulder and give common exam performed

Idiopathic chronic adhesive capsulitis- disability of the shoulder joint caused by chronic inflammation in and around the joint. Characterized by pain and Limitation of movement AP and LAT shoulder

parent or guardian

If physical immobilization is required, which individual should be asked to restrain a child for a shoulder series?

Define impingement syndrome and give common exam

Impingement of the greater tuberosity and soft tissues on the coracoacromial ligamentous arch and osseus arch, generally during abduction of arm. Apical AP axial shoulder, PA OBL(Scapular Y), Neer method

Projection: Left lateral mid/distal femur Procedure: femur CR @ mid femur, centered midline, knee flexed 45 degrees, perpendicular to IR. Include about 2" below knee in collimation.

What is this projection? Procedure? Describe the CR and positioning.

Which positioning error(s) is (are) present if the distal borders of the femoral condyles are not superimposed on a radiograph of a lateral knee on an average-sized knee (more than one answer possible)?

Improper angle of CR; or lack of support of the lower leg to keep entire lower limb on the same plane.

What should you not see on an AP pelvis?

Lesser Trochanters

What AP projection of the shoulder are the epicondyles located 45 degrees to the IR?

Neutral rotation

What could cause a soft tissue artifact on an image of an axiolateral projection of the hip?

Not bringing unaffected leg up and out of the way.

What will cause the obturator foramina to appear foreshortened on the Taylor (outlet) projection?

Not enough CR angle.

congenital dislocation of the hip

Now referred to as the developmental dysplasia of the hip.

What modality is used to assess bone infection?

Nuclear medicine

What is the largest opening in the body?

Obturator foramina

List the four major ligaments of the knee.

1. Fibular (lat) collateral 2. Tibial (med) collateral 3. Anterior cruciate 4. Posterior cruciate

Where is the central ray centered for an AP projection of the knee?

1/2 inch (1.25 cm) distal to apex of patella

Where is the patella located in relation to the knee joint?

1/2" superior to the knee joint, embedded in the large quadriceps muscle

What type of CR angle is used for the PA axial projection Rosenberg method?

10 degrees caudad

The articular facets making up the tibial plateau slope posteriorly by how many degrees?

10-20 degrees

How should the student radiographer rotate the lower limbs so that the lesser trochanters are not visualized on an AP pelvis image?

15-20* medial rotation of leg

What is the movement type of the SC and AC joints?

Plane/gliding

The __________ region is located proximal to the Intercondylar fossa.

Popliteal

The general region of the posterior knee is called the

Popliteal region

What are the four major ligaments that support/stabilize the knee?

Posterior cruciate ligament Anterior cruciate ligament Fibular (lateral) collateral ligament Tibial (medial) collateral ligament

What causes asymmetry off the distal femoral condyles, articular facets, and Intercondylar fossa on the on the PA axial (camp Coventry) method?

Rotation of the knee

What is MRI utilized for in in the knee?

Soft tissue injuries

What is MRI utilized for in imaging of the knee?

Soft tissue injuries, meniscus and ligaments

What is the CR location and angle for the AP Axial Inlet pelvis projection?

40 degree angle caudad centered at the level of the ASIS.

How much do you abduct femurs for the bilateral frog leg pelvis? How much are knees flexed?

40-45 degrees from vertical, knees flexed 90 degrees with planter surfaces of feet together

Projection: Left mid/distal femur Procedure: Femur CR @ mid thigh, midline, perpendicular to IR, leg rotated in 5 degrees for a true AP knee. Include about 2" below knee in collimation.

What is this projection? Procedure? Describe the CR and positioning.

Projection: Posterior oblique pelvis-acetabulum (Judet method) LPO (upside anatomy of interest) Procedure: pelvis CR 2" inferior to upside ASIS, perpendicular to IR

What is this projection? Procedure? Describe the CR and the positioning.

Projection: AP unilateral hip/proximal femur Procedure: hip and proximal femur CR perpendicular to femoral neck, rotate leg internally 15-20 degrees if not injured. Perform an AP pelvis to make sure before trying to rotate leg.

What is this projection? Procedure? Describe the position and CR.

fracture of clavicle

What must be ruled out before performing the weight-bearing study for acromioclavicular joints?

Palpate superior angle of scapula and AC joint articulation and ensure that the imaginary plane between these points is perpendicular to the IR

A radiograph of a lateral scapula position reveals that it is not a true lateral projection. (Considerable separation exists between the axillary and vertebral borders). The projection was taken using the following factors: erect position, 40 inch SID, 45 degree rotation toward IR from posteroanterior, central ray centered to midscapula, and no central ray angulation. Based on these factors, how can this position be improved during the repeat exposure?

Use orthostatic breathing exposure technique to create blurring of ribs and lung markings

A radiograph of a transthoracic lateral projection demonstrates considerable superimposition of lung markings and ribs over the region of the proximal shoulder. What can the technologist do to minimize this problem during the repeat exposure?

wrong CR direction

A radiograph of an AP axial clavicle projection reveals that the clavicle is projected below the superior border of the scapula. What can the technologist do to correct this problem during the repeat exposure?

Increase central ray angulation

A radiograph of an AP axial clavicle taken on an asthenic type patient shows that the clavicle is projected in the lung field below the top of the shoulder. The following positioning factors were used: erect position, central ray angled 15 degrees caudad, 40 inch SID, and respiration suspended at the end of expiration. Which modification should be made during the repeat exposure?

Supinate hand and ensure epicondyles are parallel to IR for true AP

A radiograph of an AP projection (with external rotation) of a shoulder (with no traumatic injury) reveals that neither the greater nor lesser tubercles are profiled. What must be done to correct this during the repeat exposure?

Humeral condyles were not placed parallel to the IR

A radiograph of an AP projection with external rotation of the shoulder does not demonstrate either the greater or lesser tubercle in profile. What is the most likely cause for this radiographic outcome?

Ensure that the affected arm is abducted 90 degrees and use a breathing technique

A radiograph of an AP scapula reveals that the scapula is within the lung field and difficult to see. Which two things can the technologist do to improve the visibility of the scapula during the repeat exposure?

CR perp to IR, directed 1 inch inferior to coracoid process

Specifically, where is the central ray placed for an AP projection of the shoulder?

What is the movement type of scapulohumeral (shoulder) joint?

Spheroidal (ball and socket)

What type of movement does the scapulohumeral joint have?

Spheroidal (ball and socket)

AP pelvis, errors include no internal rotation of lower limbs evident by the presence of the lesser trochanters. This is a female pelvis, based on the flared iliac wings, obtuse angle of pubic arch, and round pelvic inlet.

What projection? What errors? Male or female pelvis?

What method requires a 15 degree cephalic CR angle for the AC joints?

Alexander method

synovial (diarthrodial)

All of the joints of the shoulder girdle are classified as being:

A patient with a history of degenerativere disease of the left knee joint comes to the radiology department. The orthopedic surgeon orders a radiographic study to determine the extent of damage to the joint space. Which projections should be performed?

An AP or PA weight bearing bilateral knee projection will best evaluate the joint spaces

more

An asthenic patient requires ______ CR angle for an AP axial clavicle projection than a hypersthenic patient

Define Bankart Lesion and give what exam is performed

An injury of the anteroinferior aspect of the glenoid rim. Often caused by anterior dislocation of the proximal humerus. AP internal rotation, PA OBL Scapular Y, or AP OBL Glenoid cavity: Grashey

What is important to see on any axial projection of the patella?

An open patellofemoral joint space

List some structures that are part of the proximal humerus

Anatomic neck, Leser and greater tubercles, head of humerus, surgical neck, anatomic neck, intertubercular groove

What should the radiographer do when the patient cannot raise unaffected arm over his/her head for a transthoracic lateral projection of the shoulder?

Angle CR 10-15 degrees cephalad

AP pelvis, no anatomic side marker, female pelvis as indicated by the obtuse pubic arch, flared iliac wings, and round pelvic inlet.

What projection? What errors? Male or female?

What is the CR for an AP axial clavicle? What is the CR for an asthenic patient? Hypersthenic?

Angle CR 15-30 degrees cephalad to mid clavicle. For asthenic patient- angle CR 25-30 degrees For hypersthenic patient- angle 15-20 degrees

A radiograph of a mediolateral knee projection demonstrates that the medial femoral condyle is projected inferior to the lateral condyle. What can the technologist do to correct this problem during the repeat exposure?

Angle the CR 5-7 degrees cephalad

A radiograph of a mediolateral knee projection demonstrates that the medial femoral condyle is projected inferior to the lateral condyle. What can the technologist do to correct this problem during a repeat exposure?

Angle the CR 5-7 degrees cephalad, the femoral condyles will be superimposed.

What types of fractures of the pelvis are common in adolescent athletes who experience sudden forceful or unbalanced contraction of tendinous or muscular attachments?

Avulsion fractures of the pelvis

A young patient with a clinical history of SCFE (Slipped capital femoral epiphysis) comes to the radiology department. Which projections are most often taken for this condition?

AP pelvis and bilateral frog (modified cleaves)

How should a radiographer perform a trauma shoulder if the patient cannot stand?

AP shoulder with external rotation, recumbent AP OBL (Grashey) and Scapular Y

Describe the CR and positioning for the frog leg/cleaves method

Abduct femur(s) 45 degrees from vertical and CR is perpendicular to IR directed at midfemoral neck.

Pathology: Acromioclavicular joint separation

Abnormal widening of acromioclavicular joint space

Where should the gonadal shield NOT be during pelvic procedures?

Above the pubic bone

What part of the hip is made of 3 parts and is not fused together until teen age years?

Acetabulum

How much of the clavicle should be included on the AP and AP axial projection?

Acromion and sternal end of clavicle (both joints should be included)

Define rotator cuff pathology and give common exam

Acute or chronic, traumatic injury to one or more of the rotator cuff muscles. Rotator cuff injuries limit the range of motion of the shoulder. MRI and sonography are the best forms of exams for this

The slightly raised area located on the posterolateral aspect of the medial femoral condyle is called the :

Adductor tubercle

Which anatomic structure on the posterior femur can be used to determine if a rotation error (over/under) is present on a lateral knee radiograph?

Adductor tubercle on posterolateral aspect of the medial femoral condyle

15 degrees cephalad

What type of CR angle is required for the Alexander method for the AC joint?

30 degree cuadad

What type of CR angle is required for the apical AP axial shoulder projection?

30 degrees cuadad

What type of CR angle is required for the apical AP axial shoulder projection?

None

What type of CR angle is required for the lateral scapula position?

Pathology: Tendonitis

Calcified tendons

What additional knee projections will demonstrate loose bodies or joint mice?

Camp Coventry, holmblad, Rosenberg, merchant

25 to 30 degrees medially

What type of central ray angulation is required for the inferosuperior axial projection for the shoulder?

What classification is the symphysis pubis joint? Mobility type?

Cartilaginous, amphiarthrodial

What classification, mobility type, and movement type is the symphysis pubis?

Cartilaginous, amphiarthrodial, Limited movement

What classification, mobility type, and movement type is the union of the acetabulum?

Cartilaginous, synarthrodial, immovable

What is the CR for a Judet projection where the affected side is down?

Centered 2" distal and 2" medial to downside ASIS

What is the CR for a Judet projection where the affected side is up?

Centered 2" distal to upside ASIS

The CR angle 7-10 degrees ____________ for a lateral projection on a short wide-pelvis

Cephalad

Medical term for runners knee

Chondromalacia patellae

Define rheumatoid arthritis and give common exam

Chronic inflammatory disease characterized by inflammatory changes that occur throughout the connective tissues of the body. AP AND LAT shoulder (Decrease Technical factors)

Rheumatoid arthritis

Chronic systemic disease with arthritic inflammatory changes throughout the body

Pathology: Rheumatoid arthritis

Closed joint space

The Neer method best demonstrates _____________.

Coracoacromial arch for suprapinatus outlet region for possible shoulder impingement.

Boomerang

What type of compensating filter is recommended for use on an AP shoulder projection for a hypersthenic patient?

Where is the CR for the Lawrence (inferosuperior axial shoulder) projection? What are the clinical indications for this exam?

CR angled medially 25-30 degrees at axilla/humeral head. Hill Sachs defect and osteoporosis and osteoarthritis

Where is the CR and collimation for a mid and distal AP femur? Positioning factors?

CR centered mid femur to include light approx 2" below knee joint. Patient's leg rotated in 5 degrees, as for a true AP knee. (15-20 degrees internal rotation for a proximal femur)

Where is the CR for the Clements modification for the inferosuperior axial shoulder projection? What are the clinical indications for this exam?

CR horizontal at axilla, perpendicular to IR. Osteoporosis, osteoarthritis, and Hill Sachs defect with exaggerated rotation.

What is the CR for an AP shoulder with external rotation? What are the clinical indications for this exam?

CR is 1" inferior to the coracoid process, perpendicular to the IR. Clinical indications could be calcium deposits in muscles, tendons, or bursal structures. Or osteoporosis and osteoarthritis.

Femoral necks greatly foreshortened, lesser trochanters visible and in profile.

What would the pelvis radiograph look like if the feet were in this position?

Femoral necks partially foreshortened, lesser trochanters partially visible

What would the pelvis radiograph look like if the feet were in this position?

What are the three joints involved in the shoulder girdle?

Sternoclavicular, acromioclavicular, and scapulohumeral joints

What is the common radiographic appearance of impingement syndrome of the shoulder?

Subacromial spurring

Where will most of the fibula be if your lateral knee is under-rotated?

Superimposed by the tibia

Which two positioning landmarks are aligned perpendicularly to the IR for a LATERAL scapula?

Superior angle and AC joint

Acromioclavicular joint dislocation

Superior displacement of distal clavicle

avulsion fracture

Fractures that occur in adolescent athletes who experience sudden forceful or unbalanced contraction of the tendinous and muscular attachments on the bony pelvis

5 to 15 degrees

How much is the CR angled for the inferosuperior axial projection (Clements modification) if the patient cannot fully abduct the arm 90 degrees?

A benign neoplastic bone lesion caused by a consolidated overproduction of bone at a joint is called what?

Exostosis

What is another term for osteogenic sarcoma? What is it?

Exotosis- highly malignant bone tumors which cause gross destruction of long bones

What type of rotation for an AP shoulder will demonstrate the greater tubercle in profile laterally?

External

What kind of rotation places the proximal humerus (shoulder) in a true AP/frontal position?

External rotation

What type of rotation of the humerus will achieve a true AP?

External rotation

Describe the differences between a male and female clavicle

Female- shorter and less curved Male- thicker and more curved

Between the two condyles of the femur and tibia

Femorotibial

Pathology: Bursitis

Fluid filled joint space

When is neutral rotation acceptable for a shoulder radiograph?

For a trauma patient that cannot rotate their affected limb. Or to rule out fracture before attempting to do a rotational projection.

What is the CR for an AP Pearson method (AC joints) bilateral? Unilateral? What are the clinical indications?

For bilateral- CR perpendicular to midpoint between AC joints, 1" above jugular notch. For unilateral- CR centered 1" below affected AC joint Clinical indications- possible joint separation

10 to 15 degrees

For the erect version of the tangential projection for the intertubercular sulcus, the patient leans forward _________ from vertical.

What projection will best demonstrate a Bankart lesion?

Grashey

The area above the pelvic brim is called the ________________.

Greater or false pelvis

What is the same level of the symphysis pubis?

Greater trochanter

proximal humerus

Greater tubercle is located on

What are the alternate terms for the greater and lesser pelvis

Greater- false Lesser-true

What is another name for the lateral angle of the scapula?

Head of the scapula

What is the Clements-Nakayama Method?

Hip and proximal femur modified axiolateral oblique view. This projection is useful when the patient has limited movement in both lower limbs and the inferosuperior projection cannot be obtained. Also useful to assess possible hip fracture or for arthroplasty (surgery for hip prosthesis)

Describe the projection of the patella that would be utilized for a patient with breathing issues?

Hobbs (superoinferior sitting tangential)

Situation: A bilateral patellofemoral joint space study is ordered. The patient is paraplegic and cannot stand. Which of the following projections is best suited for this patient?

Hobbs modification

Which of the following special projections of the knee best demonstrates the intercondylar fossa? A. Merchant B. Ap weight bearing bilateral C. Holmblad D. Settegast

Holmblad

Perpendicular to IR

How are the humeral epicondyles aligned for a rotational lateromedial projection of the humerus?

Situation: A radiograph of the Camp-Coventry method was produced, but the intercondylar fossa is not open and is foreshortened. The following positioning factors were used: prone position, lower leg flexed 45 degrees, and central ray angled 30 degrees caudad and centered to the popliteal crease. Which of the following should be done during the repeat exposure to produce a more diagnostic image?

Increase CR angle to 45 degrees caudad

an image of an AP axial projection of the clavicle shows that the clavicle is within the mid aspect of the lunch apices. How should the radiographer correct this?

Increase cephalic angle of CR

How can you adjust your technical factors to reduce gonadal dose?

Increase kVp and lower mAs

What would a radiographer need to go to correct the Grashey method of the anterior and posterior Rims of the glenoid cavity were not superimposed?

Increase rotation of patient's thorax, making sure they were 35-45 degrees toward affected side

Using a grid increases or decreases dose to the patient?

Increases

The ischial tuberosity is ____________ to the symphysis pubis.

Inferior

The ischium is ____________ and ____________ to the acetabulum

Inferior and posterior

The pubis is ____________ and _____________ to the acetabulum

Inferior, anterior

Lawrence method

Inferosuperior axial is also known as:

A medial CR angle of 25-30 degrees is required for what projection?

Inferosuperior axial shoulder (Lawrence method)

How is a possible Hill-Sachs defect best demonstrated?

Inferosuperior axial with exaggerated external rotation of affected upper limb. (Lawrence method)

Define Osgood-Schlatter disease. What are the best projections to demonstrate this pathology?

Inflammation of the bone/cartilage of the anterior proximal tibia, large patellar tendon detaches part of the tibial tuberosity. Lateral knee is the best to demonstrate this.

Define bursitis and give what exam is performed

Inflammation of the bursae. It generally involves calcification in associated tendons causing pain and limited joint movement. AP and LAT shoulder

Define Tendonitis and give common exam

Inflammatory condition of the tendon that usually results from strain Neer method, MRI, or sonography

Bankart lesion

Injury to the anteroinferior glenoid labrum

What is the imaginary line that drawn between the epicondyles?

Inter-epicondylar line

What are two other names for the patellar surface of the femur?

Intercondylar Sulcus Trochlear Groove

What is the name of the deep depression found on the posterior aspect of the distal femur?

Intercondylar fossa

A patient with bony, loose bodies (or "joint mice") within the knee joint comes to radiology for a knee series. The AP and lateral knee projections failed to demonstrate any loose bodies. What additional knee projection can be taken to better demonstrate them?

Intercondylar fossa projections, including PA axial (Holmblad/Rosenberg/Camp Coventry) demonstrate entire knee joint and intercondylar fossa region which may be hiding the "joint mice".

What is the name of the depression located on the posterior aspect of the distal femur?

Intercondylar fossa/notch

Which imaginary plane should be placed parallel to the IR for an AP projection of the knee?

Interepicondylar

A radiograph of an AP pelvis shows that the right iliac wing is foreshortened as compared with the left side. Which specific positioning error was made?

LPO

What specific positioning error caused an AP image of the pelvis to demonstrate that the right obturator foramen is more open or elongated as compared to the left?

LPO ( rotation towards the left)

The internal rotation of the humerus will result in a _______________ Position if the proximal humerus.

Lateral

What acts as the shock absorbers for the knee?

Lateral and medial Menisci

What projection of the scapula should the vertebral and axillary borders be superimposed?

Lateral position: scapular Y

Situation: A radiograph of an AP knee shows that the joint spaces are not equally open and the proximal fibula is superimposed over the tibia. Which specific positioning error leads to this radiographic outcome?

Lateral rotation of lower limb

Patient is 45-60 degrees from a PA position for a scapula. Give the projection.

Lateral scapula

What side should be marked for lower limb projections?

Lateral side

An AP projection with external rotation of the proximal humerus should Profile the greater tubercle _____________.

Laterally

How does the lateral patella projection differ from the lateral knee projection?

Leg only flexed 5-10 degrees, and NO CR angle for patella

What can cause less distortion/foreshortening of the femoral necks while doing a bilateral frog leg?

Less abduction of femurs (20-30 from vertical)

Why is a PA projection of the patella preferred to an AP projection?

Less object image receptor distance (OID) Less magnification of patella Less distortion of patella

How can you tell if there is over rotation on your lateral knee projection? What do you do to correct it?

Less superimposition of the fibular head- fibular head will appear less superimposed by the tibia than in a true lateral. medial condyle will be more anterior. most of the fibula will be demonstrated behind the tibia. to fix it the pt hips should be rolled back towards the tube

What is the best modality to examine ligament injuries to the knee?

MRI

Why is a PA patella preferred over an AP?

Magnification

Legg-Calve-Perthes Disease usually involves:

Males between 5 and 10 years old

How much CR angle for the Taylor/outlet pelvis projection?

Males: 20-35 degrees cephalad Females: 30-45 degrees cephalad

Metastatic carcinoma

Malignancy spread to bone via the circulatory and lymphatic systems or direct invasion.

Define Ewing's sarcoma

Malignant bone tumor- has onion peel look on radiographs

The Stendal extremity is the_______________ end of the clavicle.

Medial

For the AP oblique projection of the knee, the __________ rotation best visualizes the lateral condyle of the tibia and the head and neck of the fibula.

Medial (internal)

A 5 to 7 degree cephalad angle of the central ray for a lateral projection of the knee helps superimpose the distal border of the __________ and __________ of the femur

Medial and lateral condyles

The crescent-shaped fibrocartilage disks that act as shock absorbers in the knee joint are called

Medial and lateral menisci

The adductor tubercle is the slightly raised area located on the posterior aspect of the ____________.

Medial condyle

A line drawn from the ___________ and ____________ is 5-7 degrees from being at a right angle to the long axis of the femur

Medial condyle and lateral condyle

What are the two palpable bony landmarks found on the distal femur?

Medial epicondyle Lateral epicondyle

What is the difference between a medial oblique knee and a lateral oblique knee?

Medial oblique- proximal tib fib joint space open, fibula and tibia are not superimposed at all. Patella superimposes medial medial femoral condyle. Lateral oblique-complete superimposition of the Tib and fib, patella superimposes lateral femoral condyle.

Which structures serve as shock absorbers within the knee joint?

Menisci

What knee projection requires a holding device?

Merchant method

Which projection of the patella will best demonstrate loose bodies in the femoropatellar joint space?

Merchant method

Where is the CR centered for an AP pelvis projection?

Midway between the ASIS and the symphysis pubis

What is another name for the frog leg projection?

Modified cleaves

What is another name for the bilateral or unilateral frog-leg projection of the pelvis?

Modified cleaves method

plane

Movement type for acromioclavicular

ball and socket

Movement type for scapulohumeral

plane

Movement type for sternoclavicular

Describe the male pelvis

Narrower, deeper, less flared. Pelvic inlet is more oval or heart shaped. Pubic arch is acute (50-60 degrees). ischial spines protrude farther into pelvis inlet.

Pathology: Osteoarthritis

Narrowing of joint space

What is neutral rotation of the proximal humerus?

Natural position of the arm without internal or external rotation.

Inguinal crease is in line with the _____________ of the femur.

Neck

A unilateral frog leg (modified cleaves) demonstrates foreshortening of the femoral necks. The physician is unsure if there is a defect within the anatomic neck. What can be done to minimize distortion of the neck during a repeat exposure?

Only abduct the femurs 20-30 degrees from vertical rather than the usual 45 degrees to minimize the distortion.

What type of breathing should be used for an AP scapula?

Orthostatic breathing technique

What condition may cause the tibial tuberosity to be pulled away from the tibial shaft?

Osgood-Schlatter disease

What pathology is being looked for in an AP weight bearing projection?

Osteoarthritis and cartilage degeneration

What condition may produce the radiographic appearance of a destructive lesion with an irregular periosteal reaction/sunburst pattern?

Osteogenic sarcoma

What is the medical term for rickets

Osteomalacia

A tangential inferosuperior projection of the patellofemoral joint space shows that the patella is seated into the Intercondylar sulcus and the joint space is not demonstrated. What positioning error might have caused this radiographic outcome?

Over flexion of the knee- this draws the patella into the Intercondylar sulcus. Flexion off lower limb should not exceed 45 degrees. Another possible error is that the CR isn't parallel with the joint space.

Which positioning error is present if the posterior portions of the femoral condyles are not superimposed on a mediolateral knee radiograph?

Over rotation (toward IR); under rotation of knee (away from IR)

What projection should be performed to demonstrate a subacromial spur?

PA Scapular Y lateral with a 10-15 degree caudal angle

A technologist notices that his AP pelvis projections often demonstrate a moderate degree of rotation. What positioning technique can the tech perform to minimize rotation on his AP pelvis projection?

Palpate both ASIS and ensure they are equal distance from the table top.

How is the cassette aligned for the axiolateral (Danelius-Miller method) projection?

Parallel to the femoral neck

What happens to the patella if the knee is flexed too much?

Patella is drawn into the Intercondylar sulcus

Between the patella and distal femur

Patellafemoral

What ligament gives the patella support?

Patellar ligament

Describe the CR and positioning for the PA Axial oblique acetabulum/ Teuful projection?

Patient in 35-40 degree anterior oblique. When anatomy of interest is downside, direct CR perpendicular and centered 1" superior to the level of the greater trochanter. Angle CR 12 degrees cephalad.

Outline the technical factors for the Hughston projection of the patella.

Patient prone, flexed 50-60 degrees, CR 15-20 degrees at patellofemoral joint

Outline the technical factors for the PA axial projection of the Intercondylar fossa (camp Coventry)?

Patient prone, legs on sponge, 40-50 degrees knee flexion. CR @ popliteal , perpendicular to lower leg

Describe technical factors for the Hobbs (superoinferior) modification of the patella

Patient sitting on chair, IR on knees, feet under chair, CR perpendicular to IR, at mid patellofemoral joint. 48-50" SID

A severe blow to one side of the pelvis can result in what kind of fracture? Why?

Pelvic ring fracture, due to the closed ring structure of the pelvis

What is the CR for the AP OBL Grashey projection?

Perp to IR, centered to scapulohumeral joint, 2" inferior and 2" medial from superolateral border of shoulder

The CR is ____________ to the IR for the superoinferior axial projection (Hobbs modification)

Perpendicular

What is the CR for the transthoracic lateral humerus?

Perpendicular to IR, Mid diaphysis of humerus

What is the CR for the PA OBL scapular Y lateral shoulder?

Perpendicular to IR, at scapulohumeral joint. (2" below AC joint)

What is the CR for an AP scapula?

Perpendicular to mid scapula, (2" inferior to coracoid process, and 2" medial from lateral border of patient)

What is the CR for an erect lateral scapula?

Perpendicular to mid vertebral border of scapula

Where is the CR for the Hobb's (PA transaxillary shoulder)? What are the clinical indications for this exam?

Perpendicular to the IR, at the axilla/humeral head to pass through the scapulohumeral joint. Bursitis, should impingement, osteoporosis, osteoarthritis.

Where is the CR for for the Grashey method (AP OBL glenoid cavity shoulder) projection? What are the clinical indications for this exam?

Perpendicular to the IR, at the scapulohumeral joint. This is approximately 2 inches inferior and 2 inches medial from the superolateral border of shoulder. Fractures of the glenoid rim, Bankart lesions, erosion of glenoid rim.

Where is the CR for an AP and Lateral humerus?

Perpendicular to the IR, centered to midpoint of humerus

Describe the CR and positioning for an AP unilateral hip projection

Perpendicular to the femoral neck, and patients affected leg rotated in 15-20 degrees

What is the CR for a mid to distal humerus?

Perpendicular to the midpoint off distal two thirds of humerus. Include elbow joint

A patient with a possible pelvic ring fracture enters the emergency room. The AP pelvis projection, which was taken to determine whether the right acetabulum was fractured, is inconclusive. Which other radiographic projection can be taken to better visualize the acetabulum? What other imaging modality can be used to determine the presence of the pelvic ring fracture?

Posterior oblique (Judet method) and CT is often judged superior in detecting pelvic ring fractures.

What projection is best for demonstrating a possible dislocation of the proximal humerus?

Posterior oblique (Scapular y)

What special projections are used to assess acetabulum fracture?

Posterior oblique projection (Judet) and PA axial oblique acetabulum (Teufel)

Bilateral frog leg, gonadal shield incorrectly placed, hand evident in image, no marker, CR too low.

Projection? Errors?

Unilateral frog leg (modified cleaves). lower limb should not have been rotated due to severity of fracture.

Projection? Errors?

Which joint space should be open or almost open for a well-positioned AP oblique knee projection with medial rotation?

Proximal tibiofibular

The internal projection of the shoulder and proximal humerus is created by doing what with arm/hand?

Putting back of the affected palm against thigh

For which large muscle does the patella serve as a pivot to increase the leverage?

Quadriceps femoris muscle

What specific positioning error caused an AP image of the pelvis to demonstrate that the Left wing is foreshortened as compared to the right wing?

RPO (Patient rotated towards the right.)

False

Radiography is more sensitive than nuclear medicine for demonstrating physiologic aspects of the shoulder girdle

Define osteoporosis and give common exam performed

Reduction in bone quantity and/or atrophy of skeletal tissue. AP AND LAT shoulder Decrease exposure factors

Osteoporosis

Reduction in the quantity of bone

Define AC dislocation and what exam is performed.

Refers to an injury in which the distal clavicle usually is displaced superiorly. More common in children. Unilateral or bilateral erect AC joints

Why do we often take rotational views of the proximal humerus and the shoulder girdle?

Reveals possible calcium deposits or other pathology.

False

Rheumatoid arthritis is more prevalent in men over women

A common term for osteomalacia is:

Rickets

Which of the following special projections of the knee must be performed erect?

Rosenberg method

A radiograph of an AP pelvis projection shows that the lesser trochanters are readily demonstrated on the medial side of the proximal femurs. The patient is ambulatory but has a history of early osteoarthritis in both hips. Which positioning modification needs to be made to prevent this position error?

Rotate the limbs 15-20 degrees internally to place the proximal femurs in true AP position

Situation: A radiograph obtained by using the PA axial (Camp-Coventry method) shows that the distal femoral condyles, articular facets, and intercondylar fossa are asymmetric. What possible positioning errors might have produced this distortion of the anatomy?

Rotation of the affected limb; or incorrect CR angulation to match the degree of flexion of the lower limb

What is a bursae and what does it do?

Sac-like structure filled with lubricating synovial fluid.

What are two other names for the shoulder joint?

Scapulohumeral and glenohumeral

What is the Garth method used for?

Scapulohumeral humeral dislocations (especially posterior dislocations) and fractures.

The humoral head articulates with the glenoid cavity to form what joint?

Scapulohumeral joint (aka shoulder joint)

What level is the upper margin of the scapula located?

Second posterior rib

What level is the lower margin of the scapula?

Seventh posterior rib (T7)

Tangential projection (Fisk)

Situation: A patient comes to the radiology department with a history of tendonitis of the bicep tendon. Which projection will best demonstrate calcification of the tendon within the intertubercular sulcus?

Transthoracic lateral projection for humerus

Situation: A patient enters the ER with a definite fracture to the midhumerus. Because of the trauma the patient is unable to stand. Which lateral projection would demonstrate the entire humerus.

AP and transthoracic lateral of humerus

Situation: A patient enters the ER with a proximal and mid humeral fracture. The patient is in extreme pain. Which of the following positioning routines would demonstrate the entire humerus without excessive movement of the limb?

Perform the projection with the patient's upper chest prone on the table.

Situation: A patient is referred to radiology for a nontrauma shoulder series. The routine calls for a PA transaxillary projection (Hobbs modification) to be included. But the patient is unable to stand and is confined to a wheelchair. What should the technologist do?

inferosuperior axial projection with exaggerated external rotation, inferosuperior axial projection (clements modification), and AP apical oblique axial projection (Garth method)

Situation: A patient with a clinical history of chronic shoulder dislocation comes to the radiology department. The orthopedic physician suspects that a Hill-Sachs defect may be present. Which specific position(s) may be used to best demonstrate this pathologic feature?

Ultrasound

Situation: A patient with a clinical history of tendon injury in the shoulder region comes to the radiology department. The orthopedic physician needs a functional study of the shoulder joint performed to determine the extent of the tendon injury. Which of the following modalities would best demonstrate this injury.

Angle CR 10 to 15 degree cephalad to separate the shoulders

Situation: A patient with a possible right shoulder dislocation enters the emergency room. The technologist attempts to perform an erect transthoracic lateral projection, but the patient is unable to raise the left arm and shoulder high enough. The resultant radiograph reveals that the shoulders are superimposed, and the right shoulder and humeral head are not well visualized. What can be done to improve this image during the repeat exposure?

Acromioclavicular joint series: non-weight-bearing and weight-bearing projections

Situation: A patient with a possible right shoulder separation enters the emergency room. What routine should be used?

MRI

Situation: A patient with a possible rotator cuff tear comes to the radiology department. Which of the following imaging modalities would best demonstrate this injury?

AP apical oblique axial (Garth method)

Situation: A patient with a possible shoulder dislocation enters the emergency room. A neutral AP projection of the shoulder has been taken, confirming a dislocation. Which additional projection should be taken?

Anterior dislocation of proximal humerus

Situation: The AP apical oblique axial projection (Garth method) is performed on a patient with a shoulder injury. The resultant radiograph demonstrates the proximal humeral head projected below the glenoid cavity. What type of trauma or pathology is indicated with this radiographic appearance?

What is another name for PA axial weight bearing (Rosenberg) method?

Skier's position

A radiograph of an axiolateral (inferosuperior) projection of a hip demonstrates a soft tissue density that is visible across the affected hip and acetabulum. This artifact is obscuring the proximal femur. What is the most likely cause of the artifact, and how can it be prevented from showing up on the repeat exposure?

Soft tissue from the unaffected thigh. The leg must be flexed and elevated high enough to keep it from superimposing the affected hip

The tapered area below the head and tubercles of the proximal humerus is the:

Surgical neck

What is the CR for the transthoracic lateral proximal humerus Trauma projection?

Surgical neck

What is the CR for the transthoracic lateral for the proximal humerus? What clinical indications for this exam?

Surgical neck, horizontal beam shoot through. Perpendicular to IR. Fractures and dislocations of proximal humerus

What are the three shoulder girdle joints classified as?

Synovial

What classification are the joints of the shoulder?

Synovial

What classification, mobility type, and movement type are the SI (sacroiliac) joints?

Synovial, amphiarthrodial, with limited movement

What classification, mobility type, and movement type are the hip joints?

Synovial, diathrodial, spheroidal (ball and socket)

What precautions should you take if patient presents with rotation of leg?

Take AP pelvis radiograph without attempting to rotate leg internally as would be necessary for a true AP hip projection.

Fisk modification

Tangential for intertubercular (bicipital) sulcus is also known as:

Which projection should be utilized to demonstrate the intertubercular groove?

Tangential intertubercular (bicipital) sulcus shoulder (Fisk method)

What additional projection can be performed to demonstrate an injury to the symphysis pubis?

Taylor (AP axial outlet)

Patient most likely has a hip fracture, as is typical with one leg/foot externally rotated. Unaffected limb will be in neutral/anatomic position. Lesser trochanter on externally roasted leg will be more visible and femoral neck foreshortened.

What would the pelvis radiograph look like if the feet were in this position?

male

The (male or female) clavicle tends to be thicker and more curved in shape

Wrong direction of CR angle

The AP apical oblique axial (Garth method) radiographic image demonstrates poor visibility of the shoulder joint. The technologist used the following factors: patient erect, facing the x-ray tube, 45 degree of rotation of affected shoulder toward IR, 45 degree cephalad angle, and the CR centered to the scapulohumeral joint. Which factor would have contributed to this poor Garth position?

Projection: modified axiolateral Trauma hip and proximal femur (Clements-Nakayama method) Procedure: hip and proximal femur CR at mid femoral neck, angled 15-20 degrees from vertical aimed at the IR. IR tilted 15 degrees backward and rests on extended Bucky tray. patient's legs extended.

What is the projection? Procedure? CR and positioning?

superior angle of scapula & AC joint articulation

Which two landmarks are placed perpendicular to the IR for the scapular Y lateral projection?

Projection: Axiolateral inferosuperior trauma hip and proximal femur Procedure: hip and proximal femur CR is perpendicular to femoral head and IR.(Shoot through)

What is the projection? Procedure? Describe the CR and positioning.

Superior angle and AC joint

Which two positioning landmarks are aligned perpendicularly to the IR for the lateral scapula projection?

Projection: PA axial oblique acetabulum(Teufel method) Procedure: Pelvis CR angled 12 degrees cephalad at 1" superior to the level of the greater trochanter. Patient in 35-40 anterior oblique position.

What is the projection? Procedure? Describe the CR and the positioning.

Projection: bilateral frog leg (modified cleaves) Procedure: pelvis CR: at level of femoral heads (3" below level of ASIS), superior border of IR at crests. Both knees flexed 90 degrees, plantar side of feet together.

What is this projection? Procedure? Describe the CR and positioning

Projection: mid/proximal left Lateral femur Procedure: femur CR @ mid femur perpendicular to IR, centered midline. Knee flexed 45 degrees, superior border of IR at level of ASIS

What is this projection? Procedure? Describe the CR and positioning

Projection: AP axial inlet pelvis Procedure: pelvis CR @ level of ASIS, midline. Angled 40 degrees caudad.

What is this projection? Procedure? Describe the CR and positioning.

False

True/False: the kV range for adult shoulder projections is between 60 and 70 kV for analog and 100 to 110 kV for digital imaging systems

What modality is of choice for demonstrating shoulder pathology (using dynamic evaluation techniques) such as rotator cuff tears, bursa injuries, and ligaments?

Ultrasound

What modality is safer for evaluating newborns and infants for hip issues such as dislocation and joint stability?

Ultrasound

Which imaging modality has replaced cephalopelvimetry?

Ultrasound

Situation: A radiograph of a lateral recumbent knee shows that the posterior border of the medial femoral condyle (identified by the adductor tubercle) is not superimposed but is slightly posterior to the lateral condyle. The fibular head is also completely superimposed by the tibia. What type of positioning error led to this radiographic outcome?

Under rotation of the knee (excessive rotation of the patella away from the IR)

The proximal humerus is obscured by ribs and lung markings. What can the radiographer do to visualize the proximal humerus?

Use orthostatic breathing

How does the female clavicle differ from the male clavicle?

Usually shorter and less curved than the male's. The male clavicle tends to be thicker and more curved, usually most curved in heavily muscles men.

Where can pelvic cancer (metastatic carcinoma) spread to the bone from?

Via circulatory system or lymphatic system. (Or by direct invasion)

15 degrees cephalad

What CR angle is required for the AP axial projection (Alexander method) for AC joints?

infraspinous fossa & supraspinous fossa

What are the names of the two fossae located on the posterior scapula?

10 to 15 degrees caudad

What central ray angulation is required for the tangential projection supraspinatus outlet (Neer method)?

Center 2 inches below AC joint

What is an alternative CR centering technique for an AP shoulder projection on an obese patient if unable to palpate the coracoid process?

What are the 2 cavities of the pelvis?

The greater (false) pelvis and the lesser (true) pelvis

The larger lateral process of the proximal humerus to which the pectoralis major and supraspinatus muscles attach

The greater tubercle

Where are the greater and lesser tubercles on an externally rotated humerus?

The greater tubercle is seen laterally in profile and the lesser tubercle is seen anteriorly, just medial to the greater tubercle.

proximal humerus

The intertubercular groove is located on:

Where is the femorotibial joint located

The joint space between the distal femur and proximal tibial

What important landmark is formed by the combination of the SC joints on either side of the manubrium?

The jugular notch

An AP projection of the shoulder with internal rotation is actually demonstrating what position of the proximal humerus?

The lateral view

How are the greater and lesser tubercles positioned on an internally rotated proximal humerus radiograph?

The lesser tubercle will be in profile medially and the greater tubercle will be seen on the anterior and medial aspect of the proximal humerus.

The medial (sternal) end of the clavicle articulates with what? What is this articulation called?

The manubrium (the upper part of the sternum), Sternoclavicular joint

supraspinatus

The most common injury to the rotator cuff is to the ______ tendon

What happens to the patella if the knee is over- flexed during a Sunrise projection?

The patella is drawn into the Intercondylar sulcus

What forms the posterior aspect of the shoulder girdle?

The scapula

What does the proximal humerus articulate with? What does it make?

The scapula (shoulder blade) (Makes the shoulder joint)

False

The scapular Y lateral (posterior oblique) position requires the body to be rotated 25 to 30 degrees anteriorly toward the affected side

True

The shoulder is the most common joint to develop bursitis due to repetitive motion

The AP clavicle radiograph reveals what two joints?

The sternoclavicular (SC) and the acromioclavicular (AC) joints

A physician orders a bilateral tangential projection of the patella and patellofemoral joint space. But the patient is restricted to a wheel chair and cannot lie on the radiographic table because of chronic pain. What projection can be performed with the patient remaining in the wheel chair?

The superoinferior sitting tangential method (Hobbs) is best.

False

True/False: A posteroanterior (PA) axial projection of the clavicle requires a 35 to 45 degree caudal central ray angle

True

True/False: Nuclear medicine bone scans can demonstrate signs of osteomyelitis and cellulitis

True

True/False: Orthostatic (breathing) technique is recommended for the AP projection of scapula

True

True/False: Sonography (ultrasound) can provide a functional (dynamic) evaluation of joint movement that MRI cannot

True

True/False: The PA transaxillary projection (Hobbs modification) requires no CR angle

False

True/False: The affected arm must be placed into external rotation for the transthoracic lateral projection

True

True/False: The greatest technical concern during a pediatric shoulder is voluntary motion.

False

True/False: The lateral scapula and posterior oblique (scapular Y) projections are the same projection

false

True/False: The male clavicle is shorter and less curved than the female clavicle

True

True/False: The transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus

True

True/False: The use of a grid is not required for shoulder studies that measure less than 10 cm

A radiograph of an AP pelvis shows overall that the image is underexposed (under penetrated). The following analog factors were used: 80 kV, 40" SID, Bucky, AEC with the center chambers activated. Which of these factors should be changed to produce increased image quality?

When using AEC for an AP pelvis, the left and Right ionization chambers must be activated. The center chamber is over the less dense pelvic cavity which may lead to under exposed image.

CR perp to midscapula, 2 inches inferior to coracoid process, or to the level of the axilla, and approximately 2 inches medial from lateral border of patient

Where is the CR centered for AP scapula projection?

1 inch inferior to the coracoid process

Where is the central ray centered an AP projection- external rotation of the shoulder?

AC joints

Which anatomy is best demonstrated with the Alexander method?

Scapulohumeral joint space

Which anatomy of the shoulder is best demonstrated with a PA transaxillary projection (Hobbs modification)?

scapular spine

Which bony structure separates the supraspinous and infraspinous fossa?

Scapulohumeral dislocations

Which clinical indication is best demonstrated with the Garth method?

Nuclear medicine

Which imaging modality or procedure best demonstrates osteomyelitis?

transthoracic lateral projection for humerus

Which lateral projection should be performed to demonstrate the entire humerus for a patient with a mid humeral fracture?

A. Non grid

Which of the following analog technical considerations does not apply for adult shoulder radiography? A. Nongrid B. High-speed IR C. 40 to 44 inch (102-113 cm) SID D. 70 to 80 kv

Boomerang compensating filter

Which of the following devices permits good visualization of soft tissue and bony anatomy for adult shoulder radiography?

Ultrasound

Which of the following imaging modalities or procedures provides a functional, or dynamic, study of the shoulder joint?

medial angle

Which of the following is not an angle found on the scapula?

80 to 90 kV

Which of the following kV ranges (digital) should be used for a shoulder series on an average adult using a grid.

PA transaxillary projection (Hobbs)

Which of the following nontrauma projections can be performed erect to provide a lateral view of the proximal humerus in relationship to the scapulohumeral joint?

Rheumatoid arthritis

Which of the following pathologic conditions may require a reduction in manual exposure factors?

Osteoarthritis

Which of the following pathologic conditions often produces narrowing of the joint space?

Tangential projection (Neer method)

Which of the following projections best demonstrates the supraspinatus outlet region?

Fisk modification

Which of the following projections produces a tangential projection of the intertubercular sulcus (groove)?

C. Anterior oblique (Grashey method)

Which of the following projections requires the CR to be centered 2 inches inferior and medial from the superolateral border of the shoulder? A. Tangential projection (Fisk modification) B. Inferosuperior axial (Clements method) C. Anterior oblique (Grashey method) D. Posterior oblique-scapula Y lateral projection

Apical AP axial projection

Which of the following projections/and or positions best demonstrates signs of impingement syndrome in the acromiohumeral space?

acromion

Which of the following structures is considered the most posterior?

coracoid process

Which of the following structures of the scapula extends most anteriorly?

Internal rotation

Which position of the shoulder and proximal humerus projects the lesser tubercle in profile medially?

External rotation

Which routine projection of the shoulder requires that the humeral epicondyles be parallel to the IR?

Grashey method

Which special projection of the shoulder places the glenoid cavity in profile for an "open" scapulohumeral joint?

AP apical oblique axial projection

Which special projection of the shoulder requires that the affected side be rotated 45 degrees toward the cassette and uses a 45 degree caudad central ray angle?

acromioclavicular

Which specific joint is found on the lateral end of the clavicle?

A portable AP and lateral hip study is ordered for a patient who is in recovery following hip replacement surgery. The radiograph of the AP hip shows that the upper portion of the acetabular prosthesis is slightly cut off but is included on the lateral projection. Should the technologist repeat the AP projection? Why or why not?

Yes, any appliance or prosthesis must be seen in its entirety on both projections

How should the radiographer correct the AP projection of the knee that reveals total superimposition of the head of the fibula and the proximal tibia?

You've rotated too much laterally. Leg should be internally rotated 3-5 degrees for a true AP.

avascular necrosis

an area of bone tissue death caused by insufficient blood flow, can cause bone to weaken, resulting in fracture of hip

Slightly constricted area just distal to the head of the humerus that appears as a line of demarcation between the rounded head and the adjoining greater and lesser tubercles is:

anatomic neck

osteoporosis

atrophy of skeletal tissue

In the past, which radiographic examination was performed to measure the fetal head in comparison with the maternal pelvis to predict possible birthing problems?

cephalopelvimetry

The shoulder girdle consists of what threebones?

clavicle, scapula, prox humerus

What is the function of the clavicle and scapula?

connect each upper limb to the trunk or axial skeleton

anklosing spondylitis

disease producing extensive calcification of the longitudinal ligament of the spinal column

external rotation

epicondyles parallel to IR

internal rotation

epicondyles perpendicular to IR

external rotation

greater tubercle in profile

tendonitis

inflammatory condition of the tendon

bankart lesion

injury of the anteroinferior glenoid labrum

Which of the following bony landmarks is located posterior to the acetabulum?

ischial tuberosity

Chondrosarcoma

malignant tumor of cartilage that usually occurs in the pelvis and long bones of men older than 45 years.

What tendon attaches to the tibial tuberosity?

patellar tendon

Your patient presents with chronic pain of the left hip. What projections should the student radiographer proceed with?

pelvis and frog-leg (Cleaves)

cephalopelvimetry

process of measuring the baby's head and the mother's pelvis before birth with a metal ruler during the AP and lateral projections. Ultrasound has replaced this method for safety

internal rotation

proximal humerus in lateral position

external rotation

proximal humerus in position for an AP projection

What is the most proximal part of the humerus?

rounded head

What is the common term for chondromalacia patellae?

runner's knee

acromioclavicular joint dislocation

superior displacement of the distal clavicle

What are the three borders of the scapula?

superior, medial (vertebral), lateral (axillary)

external rotation

supination of hand

Neer method

supraspinatus outlet tangential is also known as:

(A) proximal humerus (B) scapula (C) clavicle

the shoulder girdle consists of (A)_____, (B)______, (C)______

rotator cuff tear

traumatic injury to one or more of the supportive muscles of the shoulder girdle

What is the angle of the femoral neck to shaft of femur?

~125 degrees