RadReview: Procedures

A compression fracture of the posterolateral humeral head and associated with an anterior dislocation of the glenohumeral joint is called a(an) A. Hill-Sachs defect. B. Bankart lesion. C. rotator cuff tear. D. adhesive capsulitis.

The Correct Answer is: A A Hill-Sachs defect is a compression fracture of the posterolateral humeral head, usually associated with anterior dislocation of the shoulder joint. It can involve the cartilage of the humeral head, causing instability and predisposing the shoulder to subsequent dislocations. A Bankart lesion is a fracture of the anteroinferior portion of the rim of the glenoid fossa. A rotator cuff tear involves injury to one or more of the muscles participating in formation of that muscular structure. The supraspinatus, infraspinatus, subscapularis, and teres minor are the major muscles of the rotator cuff. Adhesive capsulitis, or "frozen shoulder," causes very diminished shoulder movement as a result of chronic joint inflammation.

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

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

In the anterior oblique position of the cervical spine, the structures best seen are the A. intervertebral foramina nearest the IR B. intervertebral foramina furthest from the IR C. interarticular joints D. intervertebral joints

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

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

C

All the following can be associated with the distal ulna except A. head. B. radioulnar joint. C. styloid process. D. trochlear notch.

D. The distal ulna presents a head and styloid process and articulates with the distal radius to form the distal radioulnar joint. The ulna is slender distally but enlarges proximally and becomes the larger of the two bones of the forearm. At its proximal end, the ulna presents the olecranon process (posteriorly) and coronoid process (anteriorly) that are joined by a large articular cavity, the semilunar, or trochlear notch. The coronoid process fits into the humeral coronoid fossa during flexion, and the olecranon process fits into the humeral olecranon fossa during extension. Just distal and lateral to the semilunar/trochlear notch is the radial notch, which provides articulation for the radial head to form the proximal radioulnar articulation. The ulna is the principal bone of the elbow joint, and the radius is the principal bone of the wrist joint.

All the following statements regarding an exact PA projection of the skull are true except A. the orbitomeatal line is perpendicular to the IR. B. the petrous pyramids fill the orbits. C. the midsagittal plane (MSP) is parallel to the IR. D. the central ray is perpendicular to the IR and exits at the nasion.

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

The PA axial Caldwell is used to demonstrate? A. ethmoidal and frontal sinuses. B. maxillary sinuses. C. sphenoidal sinuses through the open mouth. D. mastoid sinuses.

The Correct Answer is: A A PA axial Caldwell position is shown, demonstrating the frontal and ethmoidal sinuses. The Caldwell position requires an angle of 15 degrees caudad, exiting the nasion. The petrous ridges should be projected in the lower third of the orbits. The radiograph shown demonstrates somewhat excessive angulation because the petrous pyramids are projected at the bottom of the orbits. The maxillary sinuses are demonstrated in the parietoacanthal projection (Waters position), and the sphenoidal sinuses are demonstrated through the open mouth in a modified Waters position. The mastoid sinuses/air cells are part of the temporal bone and are radiographically unrelated to the paranasal sinuses.

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

The Correct Answer is: A A diagnostic image of C1-2 depends on adjusting the flexion of the neck so that the maxillary occlusal plane and the base of the skull are superimposed. Accurate adjustment of these structures usually will allow good visualization of the odontoid process and the atlantoaxial articulation. Should patient anatomy occasionally prevent the usual visualization, the odontoid process can be visualized through the foramen magnum, either AP or PA. In the AP position (Fuchs method) or the PA position (Judd method), the patient's chin is extended to be in line vertically with the mastoid tip (similar to a Waters' or reverse Waters' position). The CR is directed to the midline and perpendicularly at the level of the mastoid tip. The resulting image demonstrates the odontoid process through the foramen magnum. These positions should not be attempted if the patient has a suspected, new, or healing fracture or destructive disease.

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

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

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

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

What is the anatomic structure indicated by number 1 in the radiograph shown in Figure 6-20? A. Mandibular angle B. Coronoid process C. Zygomatic arch D. Maxillary sinus

The Correct Answer is: A A parietoacanthal projection (Waters position) of the skull is shown. The chin is elevated sufficiently to project the petrous ridges below the maxillary sinuses (number 4). Note that the foramen rotundum is seen near the upper margin of the maxillary sinuses. Other paranasal sinus groups are not well visualized in this position, although a modification with the mouth open may be taken to demonstrate the sphenoidal sinuses. This is also the single best projection to demonstrate the facial bones. The zygomatic arch (number 2) is well demonstrated; the mandible, its angle (number 1), and the coronoid process (number 3) are also well demonstrated. The odontoid process is seen projected through the foramen magnum. The mastoid air cells are seen adjacent to the mandibular angle as multiple small, air-filled, bony spaces.

All the following are palpable bony landmarks used in radiography of the pelvis except A. the femoral neck B. the pubic symphysis C. the greater trochanter D. the iliac crest

The Correct Answer is: A Femoral necks are nonpalpable bony landmarks. The ASIS, pubic symphysis, and greater trochanter are palpable bony landmarks that may be used, according to policy of the facility, in radiography of the pelvis and for localization of the femoral necks.

Which of the following is most useful for bone age evaluation? A. Lateral skull B. PA chest C. AP pelvis D. PA hand

The Correct Answer is: D A PA projection of the left hand and wrist is obtained most often to evaluate skeletal maturation. These images are compared with standard normal images for the age and sex of the child. Additional supplemental images may be requested.

What is the degree of difference between the baselines numbered 2 (OML) and 3 (IOML) in Figure 2-38 and used for various projections of the skull? A. 7 degrees B. 12 degrees C. 15 degrees D. 23 degrees

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

Which of the following positions is required to demonstrate small amounts of air in the peritoneal cavity? A. Lateral decubitus, affected side up B. Lateral decubitus, affected side down C. AP Trendelenburg D. AP supine

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

What is the anatomic structure indicated by number 1 (ear of scotty dog) in the radiograph shown in Figure 6-21? A. Superior articular process B. Inferior articular process C. Transverse process D. Lamina

The Correct Answer is: A An LPO projection of the lumbar spine is shown. The patient is positioned so that the lumbar spine forms a 45-degree angle with the IR. The apophyseal joints (those closest to the IR) are well demonstrated in this position. The typical "Scotty dog" image is depicted. The "ear" of the Scotty is the superior articular process (number 1), and the front foot is the inferior articular process (number 4). The Scotty's eye is the pedicle, its body is the lamina (number 3), and its nose is the transverse process (number 2)

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

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

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

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

What are the positions most commonly employed for a radiographic examination of the sternum? 1. Lateral 2. RAO 3. LAO A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: A Because the sternum and vertebrae would be superimposed in a direct PA or AP projection, a slight oblique (just enough to separate the sternum from superimposition on the vertebrae) is used instead of a direct frontal projection. In the RAO position, the heart superimposes its homogeneous density over the sternum, thereby providing clearer radiographic visualization of its bony structure. If the LAO position were used to project the sternum to the right of the thoracic vertebrae, the posterior ribs and pulmonary markings would cast confusing shadows over the sternum because of their differing tissue densities. The lateral projection requires that the shoulders be rolled back sufficiently to project the sternum completely anterior to the ribs. Prominent pulmonary vascular markings can be obliterated using a "breathing technique," that is, using an exposure time long enough (with appropriately low milliamperage) to equal at least a few respirations.

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

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

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

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

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

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

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

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

Which of the following is (are) accurate positioning or evaluation criteria for an AP projection of the normal knee? 1. Femorotibial interspaces equal bilaterally. 2. Patella superimposed on distal tibia. 3. CR enters ½ in. distal to base of patella. A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: A In the AP projection of the normal knee, the space between the tibial plateau and the femoral condyles is equal bilaterally. It is, therefore, important that there be no pelvic rotation that could change the appearance of an otherwise normal relationship. The AP projection of the knee superimposes the patella and femur. The CR should enter at the knee joint, located ½ in. distal to the patella apex.

The AP axial projection of the pulmonary apices requires the CR to be directed A. 15 degrees cephalad B. 15 degrees caudad C. 30 degrees cephalad D. 30 degrees caudad

The Correct Answer is: A It is occasionally necessary to view the lung apices free of superimposition with the clavicles. This objective can be achieved in an AP axial projection. The patient is positioned AP erect with the CR directed 15 degrees cephalad, entering the manubrium. An AP axial projection can also be obtained with the patient in the lordotic position. If sufficient lordosis can be assumed, the CR is directed perpendicular to the IR.

Knee arthrography may be performed to demonstrate a 1. torn meniscus. 2. Baker's cyst. 3. torn rotator cuff. A. 1 and 2 only B .1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: A Knee arthrography may be performed to demonstrate torn meniscus (cartilage), Baker's cyst, loose bodies, and ligament damage. A torn rotator cuff would be demonstrated on a shoulder, not a knee arthrogram.

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

The Correct Answer is: A Lateral projections of the barium-filled stomach (Figure 2-61) may be performed recumbent or upright for demonstration of the retrogastric space. With the patient in the (usually right) lateral position, the CR is directed to a point midway between the midcoronal line and the anterior surface of the abdomen at the level of L1. When the patient is in the LPO or RAO position, the CR should be directed midway between the vertebral column and the lateral border of the abdomen. For the PA projection, the CR is directed perpendicular to the IR at the level of L2.

The primary center of ossification in long bones is the A. diaphysis. B. epiphysis. C. metaphysis. D. apophysis.

The Correct Answer is: A Long bones are composed of a shaft, or diaphysis, and two extremities. The diaphysis is referred to as the primary ossification center. In the growing bone, the cartilaginous epiphyseal plate (located at the extremities of long bones) is gradually replaced by bone. For this reason, the epiphyses are referred to as the secondary ossification centers. The ossified growth area of long bones is the metaphysis. Apophysis refers to vertebral joints formed by articulation of superjacent articular facets.

The patient usually is required to drink barium sulfate suspension in order to demonstrate which of the following structures? 1. Descending duodenum 2. Ilium 3. Splenic flexure A. 1 only B. 1 and 3 only C. 2 and 3 only D. 3 only

The Correct Answer is: A Oral administration of barium sulfate is used to demonstrate the upper digestive system, esophagus, fundus, and body and pylorus of the stomach and barium progression through the small bowel/intestine. The small intestine is composed of the duodenum, jejunum, and ileum. The duodenum is the shortest portion, beginning just beyond the pyloric sphincter and dividing into four portions—the duodenal cap or bulb, the descending duodenum, the transverse duodenum, and the ascending duodenum. These portions form a C-shaped loop that is occupied by the head of the pancreas. The descending portion receives the hepatopancreatic ampulla and duodenal papilla. The ascending portion terminates at the duodenojejunal flexure (angle of Treitz). Whereas the position of the short (9 in.) duodenum is fixed, the jejunum (9 ft) and ileum (13 ft) are very mobile. The large bowel, including the cecum, usually is demonstrated via rectal administration of barium. The approximately 5-ft-long large intestine (colon) begins at the terminus of the small intestine; its first portion is the dilated saclike cecum, located inferior to the ileocecal valve. Projecting posteromedially from the cecum is the short vermiform appendix. The ascending colon is continuous with the cecum, bending and forming the right colic (hepatic) flexure. The colon traverses the abdomen as the transverse colon and bends to form the left colic (splenic) flexure. The descending colon continues down the left side and moves medially to form the S-shaped sigmoid colon. The rectum is that part of the large intestine, approximately 5 in. in length, between the sigmoid and the anal canal. The ilium is the bony pelvis, whereas the ileum is the small bowel—which would be demonstrated by oral administration of barium.

Cells concerned with the formation and repair of bone are A. osteoblasts. B. osteoclasts. C. osteomas. D. osteons.

The Correct Answer is: A Osteoblasts are cells of mesodermal origin that are concerned with formation and repair of bone. Osteoclasts are cells concerned with the breakdown and resorption of old or dead bone. An osteoma is a benign bony tumor. An osteon is the microscopic unit of compact bone, consisting of a haversian canal and its surrounding lamellae.

Abnormal accumulation of air in pulmonary tissues, resulting in overdistention of the alveolar spaces, is A. emphysema. B. empyema. C. pneumothorax. D. pneumoconiosis.

The Correct Answer is: A Overdistention of the alveoli with air is emphysema. The condition is often a result of many years of smoking and is characterized by dyspnea, especially when recumbent. Empyema is pus in the thoracic cavity; pneumothorax is air or gas in the pleural cavity. Pneumoconiosis is a condition of the lungs characterized by particulate matter having been deposited in lung tissue; it sometimes results in emphysema

A spontaneous fracture most likely would be associated with A. pathology. B. crepitus. C. trauma. D. metabolism.

The Correct Answer is: A Spontaneous fractures most often affect bone weakened by a pathologic condition, for example, metastatic bone disease. The spontaneous fracture occurs suddenly, without trauma. One measure of a good radiographer is his or her ability to be cautious and resourceful when examining injured or debilitated patients having pathologic or traumatic conditions such as metastatic bone disease, arthritis, or bone fractures. Crepitus refers to a crackling sound made by a body part—such as the sound of fractured ends of bones rubbing together. Metabolism refers to the numerous energy and material transformations that take place in the body and is not associated with spontaneous fractures.

Which of the following projections of the ankle would best demonstrate the mortise? A. Medial oblique 15 to 20 degrees B. Lateral oblique 15 to 20 degrees C. Medial oblique 45 degrees D. Lateral oblique 45 degrees

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

The pedicle is represented by what part of the "scotty dog" seen in a correctly positioned oblique lumbar spine? A. Eye B. Front foot C. Body D. Neck

The Correct Answer is: A The 45° oblique position of the lumbar spine is generally performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "scotty dog" images are demonstrated. The scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process

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

The Correct Answer is: A The AP axial projects the anterior structures (frontal and facial bones) downward, thus permitting visualization of the occipital bone without superimposition (Towne method). The dorsum sella and posterior clinoid processes of the sphenoid bone should be visualized within the foramen magnum. This projection may also be obtained by angling the CR 30 degrees caudad to the OML (Figure 2-46). The frontal bone is best shown with the patient PA and with a perpendicular CR. The parietoacanthal projection is the single best position for facial bones. Basal foramina are well demonstrated in the submentovertical projection.

Which of the following anatomic structures is best demonstrated in the LPO position, in a positive-contrast exam? A. Hepatic flexure B. Splenic flexure C. Sigmoid colon D. Ileocecal valve

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

The pyloric canal and duodenal bulb are best demonstrated during an upper GI series in which of the following positions? A. RAO B. Left lateral C. Recumbent PA D. Recumbent AP

The Correct Answer is: A The RAO position affords a good view of the pyloric canal and duodenal bulb. It is also a good position for the barium-filled esophagus, projecting it between the vertebrae and the heart. The left lateral projection of the stomach demonstrates the left retrogastric space, the recumbent PA projection is used as a general survey of the gastric surfaces, and the recumbent AP projection with slight left oblique affords a double contrast of the pylorus and duodenum.

Which of the following groups of organs/structures are located in the left upper quadrant? A. Left kidney, left suprarenal gland, and gastric fundus B. Left suprarenal gland, pylorus, and duodenal bulb C. Hepatic flexure, cecum, and pancreas D. Gastric fundus, liver, and cecum

The Correct Answer is: A The abdomen is divided anatomically into nine regions and four quadrants. The region designation usually is used for anatomic studies, whereas the quadrant designation is used most often to describe the location of a lesion, pain, tumor, or other abnormality. Some of the structures found in the left upper quadrant (LUQ) are the fundus of the stomach, the left kidney and suprarenal gland, and the splenic flexure.

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

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

Which of the following statements regarding the male pelvis is (are) true? 1. The angle formed by the pubic arch is less than that of the female. 2. The pelvic outlet is wider than that of the female. 3. The ischial tuberosities are further apart. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: A The architectural features of the female pelvis are designed to accommodate childbearing. The female pelvis as a whole is broader and more shallow than its male counterpart, having a wider and more circular pelvic outlet. The ischial tuberosities and acetabula are further apart. The sacrum is wider and extends more sharply posteriorly. The pubic arch of the man is significantly narrower than that of the woman.

Which of the following articulates with the base of the first metatarsal? A. First cuneiform B. Third cuneiform C. Navicular D. Cuboid

The Correct Answer is: A The base of the first metatarsal articulates with the first (medial) cuneiform. The base of the second metatarsal articulates with the second (intermediate) cuneiform; the third base of the metatarsal articulates with the third (lateral) cuneiform. The bases of the fourth and fifth metatarsals articulate with the cuboid. The navicular articulates with the first and second cuneiforms anteriorly and the talus posteriorly.

In the anterior oblique position of the cervical spine, the structures best seen are the A. intervertebral foramina nearest the IR B. intervertebral foramina furthest from the IR C. interarticular joints D. intervertebral joints

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

The right anterior oblique position of the cervical spine requires which of the following combinations of tube angle and direction? A. 15° to 20° caudad B. 15° to 20° cephalad C. 25° to 30° caudad D. 25° to 30° cephalad

The Correct Answer is: A The cervical intervertebral foramina lie 45° to the midsagittal plane (MSP) and 15° to 20° to a transverse plane. When the posterior oblique position (LPO, RPO) is used, the central ray is directed 15° to 20° cephalad and the cervical intervertebral foramina demonstrated are those farther from the image recorder. There is therefore some magnification of the foramina (because of the OID). In the anterior oblique position (LAO, RAO), the central ray is directed 15° to 20° caudad, and the foramina disclosed are those closer to the image recorder.

All the following can be associated with the distal radius except A. head. B. styloid process. C. ulnar notch. D. radioulnar joint.

The Correct Answer is: A The distal radius presents a styloid process laterally; the ulnar notch is located medially, helping to form the distal radioulnar articulation. The distal surface of the radius (carpal articular surface) is smooth for accommodating the scaphoid and lunate to form the radiocarpal (wrist) joint. The proximal radius has a cylindrical head with a medial surface that participates in the proximal radioulnar joint; its superior surface articulates with the capitulum of the humerus. Fracture of the distal radius is one of the most common skeletal fractures. Fractures of the radial head and neck frequently result from a fall onto an outstretched hand with the elbow partially flexed. Severe fractures often are accompanied by posterior dislocation of the elbow joint. Colles' fractures of the distal radius usually result from a fall onto an outstretched hand with the arm extended.

What structure can be located midway between the anterosuperior iliac spine (ASIS) and pubic symphysis? A. Dome of the acetabulum B. Femoral neck C. Greater trochanter D. Iliac crest

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

Dorsal decubitus projections of the chest are used to evaluate small amounts of 1. fluid in the posterior chest 2. air in the posterior chest 3. fluid in the anterior chest A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: A The dorsal decubitus position is obtained with the patient supine and the x-ray beam directed horizontally. The finished image looks similar to a lateral projection of the chest. However, small amounts of fluid will gravitate to the posterior chest, and small amounts of air will rise to the anterior chest. The ventral decubitus position is obtained with the patient prone and the x-ray beam directed horizontally. The finished image can demonstrate small amounts of fluid anteriorly and small amounts of air posteriorly.

A dorsal decubitus position of the chest may be used to evaluate small amounts of 1. fluid in the posterior chest. 2. air in the posterior chest. 3. fluid in the anterior chest. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: A The dorsal decubitus position is obtained with the patient supine and the x-ray beam directed horizontally. The finished radiograph looks similar to a routine lateral projection of the chest. However, small amounts of fluid will gravitate posteriorly, and small amounts of air will rise anteriorly.

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

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

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

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

The fifth metacarpal is located on which aspect of the hand? A. Medial B. Lateral C. Radial D. Volar

The Correct Answer is: A The fifth metacarpal is located on the medial aspect of the hand. Remember to always view a part in its anatomic position. With the arm in the anatomic position, the fifth metacarpal and the ulna lie medially.

The body habitus characterized by a long and narrow thoracic cavity and low midline stomach and gallbladder is the A. asthenic B. hyposthenic C. sthenic D. hypersthenic

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

The greater tubercle should be visualized in profile in which of the following? A. AP shoulder, external rotation B. AP shoulder, internal rotation C. AP elbow D. Lateral elbow

The Correct Answer is: A The greater and lesser tubercles are prominences on the proximal humerus, separated by the bicipital groove. The AP projection of the humerus in external rotation demonstrates the greater tubercle in profile. With the arm placed in internal rotation, the humerus is placed in a true lateral position and the lesser tubercle is demonstrated.

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

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

Which of the following is (are) located on the proximal aspect of the humerus? 1. Intertubercular groove 2. Capitulum 3. Coronoid fossa A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: A The intertubercular (bicipital) groove is located on the proximal humerus, distal to the head, between the greater and lesser tubercles. The distal humerus articulates with the radius and ulna to form the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, which articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar notch of the ulna. Just proximal to the capitulum and the trochlea are the lateral and medial epicondyles; the medial is more prominent and palpable. The coronoid fossa is found on the anterior distal humerus and functions to accommodate the coronoid process with the elbow in flexion.

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

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

In which projection of the foot are the interspaces between the first and second cuneiforms best demonstrated? A. Lateral oblique foot B. Medial oblique foot C. Lateral foot D. Weight-bearing foot

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

The submentovertical (SMV) oblique axial projection of the zygomatic arches requires that the skull be rotated A. 15 degrees toward the affected side. B. 15 degrees away from the affected side. C. 45 degrees toward the affected side. D. 45 degrees away from the affected side.

The Correct Answer is: A The oblique axial projection is valuable when the zygomatic arches cannot be demonstrated bilaterally with the submentovertical projection because they are not prominent enough or because of a depressed fracture. The patient still may be positioned as for an SMV projection, but the head is obliqued 15 degrees toward the side being examined. This serves to move the zygomatic arch away from superimposed structures and provides a slightly oblique axial projection of the arch.

Which of the following is an important consideration to avoid excessive metacarpal joint overlap in the oblique projection of the hand? A. Oblique the hand no more than 45 degrees. B. Use a support sponge for the phalanges. C. Clench the fist to bring the carpals closer to the IR. D. Use ulnar flexion.

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

A patient in a recumbent position with the head lower than the feet is said to be in which of the following positions? A. Trendelenburg B. Fowler C. Sims D. Stenver

The Correct Answer is: A The patient is said to be in the Trendelenburg position when the head is positioned lower than the feet. This position is helpful in several radiographic procedures, such as separating redundant bowel loops and demonstration of hiatal hernias. It is also used in treating shock. In the Fowler position, the head is higher than the feet. The Sims position is the left anterior oblique (LAO) position with the right leg flexed up for insertion of the enema tip. The Stenver position is a radiographic position for radiographing the mastoids.

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

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

Which of the following positions will most effectively move the gallbladder away from the vertebrae in an asthenic patient? A. LAO B. RAO C. LPO D. Erect

The Correct Answer is: A The position of the gallbladder varies with the body habitus of the patient. Hypersthenic patients are more likely to have their gallbladder located high and lateral. The asthenic patient's gallbladder is most likely to occupy a low and medial position, occasionally superimposed on the vertebrae or iliac fossa. The LAO position is used most often to move the gallbladder away from the spine. The erect position would make the gallbladder move even more inferior and medial.

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

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

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

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

With the patient supine, the left side of the pelvis elevated 25 degrees, and the CR entering 1 in. medial to the left anterosuperior iliac spine (ASIS), which of the following is demonstrated? A. Left sacroiliac joint B. Left ilium C. Right sacroiliac joint D. Right ilium

The Correct Answer is: A The sacroiliac joints angle posteriorly and medially 25 degrees to the MSP. Therefore, to demonstrate them with an AP oblique projection, the affected side must be elevated 25 degrees. This places the joint space perpendicular to the IR and parallel to the CR. When the PA oblique projection is used, the unaffected side will be elevated 25 degrees.

The carpal scaphoid can be demonstrated in which of the following projection(s) of the wrist? 1. PA oblique 2. PA with radial flexion 3. PA with elbow elevated 20 degrees A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: A The scaphoid can be difficult to image because its curved shape lends itself to foreshortening and self-superimposition. The lateral carpals, especially the scaphoid, are well demonstrated in the PA oblique projection. The ulnar flexion maneuver helps to overcome the scaphoid's self-superimposition. The scaphoid may also be demonstrated with less foreshortening with the wrist PA and elevated 20 degrees. The CR is directed perpendicular to the carpal scaphoid. The medial carpals, especially the pisiform, are well demonstrated in the AP oblique projection with the radial flexion maneuver.

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

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

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

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

The thoracic cavity is lined by A. parietal pleura. B. visceral pleura. C. parietal peritoneum. D. visceral peritoneum.

The Correct Answer is: A The thoracic and abdominal cavities are associated with serous membranes: the thoracic cavity with the pleura and the abdominal cavity with the peritoneum. The pleura and peritoneum each have two walls, a parietal (outer) wall and a visceral (inner) wall. The parietal pleura lines the thoracic cavity, while the visceral pleura is reflected over the surface of the lungs and projects between the fissures. The parietal peritoneum lines the abdominal cavity, and the visceral peritoneum invests the abdominal viscera.

All of the following statements regarding respiratory structures are true except A. the right lung has two lobes. B. the uppermost portion of the lung is the apex. C each lung is enclosed in pleura. D the trachea bifurcates into mainstem bronchi.

The Correct Answer is: A The trachea (windpipe) bifurcates into left and right mainstem bronchi, each entering its respective lung hilum. The left bronchus divides into two portions, one for each lobe of the left lung. The right bronchus divides into three portions, one for each lobe of the right lung (Fig. A). The lungs are conical in shape, consisting of upper pointed portions, termed the apices (plural of apex), and broad lower portions (or bases). The lungs are enclosed in a double-walled serous membrane called the pleura.

The usual patient preparation for an upper GI examination is A. nothing by mouth (NPO) 8 hours before the examination. B. light breakfast only on the morning of the examination. C. clear fluids only on the morning of the examination. D. 2 oz of castor oil and enemas until clear.

The Correct Answer is: A To obtain a diagnostic examination of the stomach, it must first be empty. The usual preparation is NPO (nothing by mouth) after midnight (approximately 8 hours before the examination). Any material in the stomach can simulate the appearance of disease.

The scapula shown ( posterior view of scapula) in Figure 2-29 demonstrates 1. its posterior aspect 2. its costal surface 3. its sternal articular surface A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

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

When examining a patient whose elbow is in partial flexion, A. the AP projection requires two separate positions and exposures. B. the AP projection is made through the partially flexed elbow, resting on the olecranon process, CR perpendicular to IR. C. the AP projection is made through the partially flexed elbow, resting on the olecranon process, CR parallel to the humerus. D. the AP projection is eliminated from the routine.

The Correct Answer is: A When a patient's elbow needs to be examined in partial flexion, the lateral projection offers little difficulty, but the AP projection requires special attention. If the AP projection is made with a perpendicular CR and the olecranon process resting on the table-top, the articulating surfaces are obscured. With the elbow in partial flexion, two exposures are necessary to achieve an AP projection of the elbow joint articular surfaces. One is made with the forearm parallel to the IR (humerus elevated), which demonstrates the proximal forearm. The other is made with the humerus parallel to the IR (forearm elevated), which demonstrates the distal humerus. In both cases, the CR is perpendicular if the degree of flexion is not too great or angled slightly into the joint space with greater degrees of flexion.

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

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

Which of the following projections require(s) that the shoulder be placed in external rotation? 1. AP humerus 2. Lateral forearm 3. Lateral humerus A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: A When the arm is placed in the AP position, the epicondyles are parallel to the plane of the cassette, and the shoulder is placed in external rotation. In this position, an AP projection of the humerus, elbow, and forearm can be obtained. For the lateral projection of the humerus, elbow, or forearm, the epicondyles must be perpendicular to the plane of the cassette.

To obtain an AP projection of the right ilium, the patient's A. left side is elevated 40°. B. right side is elevated 40°. C. left side is elevated 15°. D. right side is elevated 15°.

The Correct Answer is: A When the pelvis is observed in the anatomic position, the ilia are seen to oblique forward, giving the pelvis a "basin-like" appearance. To view the right iliac bone, the radiographer must place it parallel to the IR by elevating the left side about 40° (RPO). The left iliac bone is radiographed in the 40° LPO oblique position.

To demonstrate the pulmonary apices with the patient in the AP position, the A. central ray is directed 15° to 20° cephalad. B. central ray is directed 15° to 20° caudad. C. exposure is made on full exhalation. D. patient's shoulders are rolled forward.

The Correct Answer is: A When the shoulders are relaxed, the clavicles are usually carried below the pulmonary apices. To examine the portions of the lungs lying behind the clavicles, the central ray is directed cephalad 15° to 20° to project the clavicles above the apices when the patient is examined in the AP position.

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

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

Characteristics of a patient with pulmonary emphysema include 1. shoulder girdle elevation 2. increased AP diameter of the chest 3. hyperventilation A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B Emphysema is a chronic obstructive pulmonary disease (COPD) characterized by pathologic distension of the pulmonary alveoli with (destructive) changes in their walls, resulting in a loss of elasticity. Emphysema is seen occasionally following asthma or tuberculosis, but it is caused most frequently by cigarette smoking. Because the emphysematous patient's greatest difficulty is exhalation, it becomes a conscious, forced effort. Breathing is shallow and rapid. Forced and ineffective breathing results in expansion of the AP diameter of the chest and elevated shoulder girdle in established emphysema. Hyperventilation results from too frequent deep breaths in the anxious or tense individual, and is generally not related to pulmonary emphysema. Hyperventilation results in a feeling of dizziness and tingling of the extremities.

Gas-producing powder or crystals usually are ingested for which of the following examinations? A. Double-contrast barium enema (BE) B. Double-contrast gastrointestinal (GI) series C. Oral cholecystogram D. IV urogram (IVU)

The Correct Answer is: B A double-contrast GI examination requires that the patient ingest gas-producing powder, crystals (eg. calcium and magnesium citrate), pills, or beverage followed by a small amount of high-density barium. The patient then may be asked to roll in the recumbent position in order to coat the gastric mucosa while the carbon dioxide expands. This procedure provides optimal visualization of the gastric walls. Although a double-contrast BE uses a negative contrast agent, it is not ingested but rather is delivered rectally. An oral cholecystogram can be performed approximately 3 hours after ingestion of special ipodate calcium granules. An IVU requires an IV injection of iodinated contrast medium.

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

The Correct Answer is: B A frontal projection (AP or PA) demonstrates the medial and lateral relationship of structures. A lateral projection demonstrates the anterior and posterior relationship of structures. Two views, at right angles to each other, are generally taken of most structures.

Which of the following radiographic procedures requires an intrathecal injection? A. IV pyelogram B. Myelogram C. Lymphangiogram D. Computed tomography (CT)

The Correct Answer is: B A myelogram, or radiographic examination of the spinal canal, requires an intrathecal (intraspinal) injection. Intrathecal administration of contrast medium is usually at the level of L2/3 or L3/4. An intravenous pyelogram is performed with an injection of contrast medium into the venous system. A lymphangiogram requires that contrast medium be delivered into the lymphatic vessels. A CT scan may or may not require the use of an IV injection.

Which of the following examinations require(s) restriction of a patient's diet? 1. Barium enema 2. Pyelogram 3. Metastatic survey A. 1 only B. 1 and 2 only C. 1 and 3 only D. 2 and 3 only

The Correct Answer is: B A patient who is having a BE generally is required to have a low-residue diet for 1 or 2 days, followed by cathartics and cleansing enemas prior to the examination. Any retained fecal material can simulate or obscure pathology. A patient who is scheduled for a pyelogram must have the preceding meal withheld to avoid the possibility of aspirating vomitus in case of an allergic reaction. A metastatic survey does not require the use of contrast media, and no patient preparation is necessary.

A lesion with a stalk projecting from the intestinal mucosa into the lumen is a(n) A. fistula B. polyp C. diverticulum D. abscess

The Correct Answer is: B A polyp is a tumor with a pedicle (stalk) that is found commonly in vascular organs projecting inward from its mucosal wall. Polyps usually are removed surgically because, although usually benign, they can become malignant. A diverticulum is an outpouching from the wall of an organ, such as the colon. A fistula is an abnormal tube-like passageway between organs or between an organ and the surface. An abscess is a localized collection of pus as a result of inflammation.

Following the ingestion of a fatty meal, what hormone is secreted by the duodenal mucosa to stimulate contraction of the gallbladder? A. Insulin B. Cholecystokinin C. Adrenocorticotropic hormone D. Gastrin

The Correct Answer is: B About 30 minutes after the ingestion of fatty foods, cholecystokinin is released from the duodenal mucosa and absorbed into the bloodstream. As a result, the gallbladder is stimulated to contract, releasing bile into the intestine.

Adult orthoroentgenography, or radiographic measurement of long bones of an upper or lower extremity, requires which of the following accessories? 1. Bell-Thompson scale 2. Bucky tray 3. Cannula A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: B Adult orthoroentgenography is the radiographic measurement of long-bone length. It can be required on adults or children having extremity length (especially leg) discrepancies. This can be performed most easily with the use of the metallic Bell-Thompson scale secured to the x-ray tabletop adjacent to the limb being examined (or between both limbs for simultaneous bilateral examination). A 14 × 17 inch cassette is in the Bucky tray (to permit movement of the cassette between exposures), and three well-collimated exposures are made—at the hip joint, the knee joint, and the ankle joint. A cannula is a tube placed in a cavity to introduce or withdraw material and is unrelated to orthoroentgenography.

Which of the following positions is required to demonstrate small amounts of fluid in the pleural cavity? A. Lateral decubitus, affected side up B. Lateral decubitus, affected side down C. AP Trendelenburg D. AP supine

The Correct Answer is: B Air or fluid levels will be clearly delineated only if the central ray is directed parallel to them. Therefore, to demonstrate air or fluid levels, the erect or decubitus position should be used. Small amounts of fluid within the pleural space are best demonstrated in the lateral decubitus position, affected side down. Small amounts of air within the pleural space are best demonstrated in the lateral decubitus position, affected side up.

Which of the following projections of the abdomen may be used to demonstrate air or fluid levels? 1. Dorsal decubitus 2. Lateral decubitus 3. AP Trendelenburg A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: B Air or fluid levels will be clearly demonstrated only if the central ray is directed parallel to them. Therefore, to demonstrate air or fluid levels, the erect or decubitus position should be used. Small amounts of fluid are best demonstrated in the lateral decubitus position, affected side down. Small amounts of air are best demonstrated in the lateral decubitus position, affected side up. Dorsal and ventral decubitus positions made with a horizontal x-ray beam can also be used to demonstrate air or fluid levels.

What is the anatomic structure indicated by the number 3 in the radiograph ? A. Spinous process B. Transverse process C. Pedicle D. Intervertebral foramen

The Correct Answer is: B An oblique projection of the cervical spine is shown. The patient has been accurately positioned RAO with the MSP 45 degrees to the IR and the CR angled 15 to 20 degrees caudad, but the chin should be elevated to avoid superimposition on the first two cervical vertebrae. This position offers excellent delineation of the intervertebral foramina (number 1) formed by the adjacent vertebral notches of pedicles (number 2). This projection gives an "on end" view of the transverse processes (number 3). A portion of the spinous processes (number 4) may be seen, especially in the lower cervical vertebrae.

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

The Correct Answer is: B Blowout fractures of the orbital floor are caused by a direct blow to the eye. The orbital floor is caused to collapse; this carries the inferior rectus muscle through the fracture site and into the maxillary sinus. Diplopia (double vision) often results. Blowout fractures are well demonstrated with the modified Waters method (modified parietoacanthal projection) and with CT studies. A modified parietoacanthal projection with the lips-meatal line (LML) perpendicular and the OML 55degrees to the IR will demonstrate the orbital floor. The zygoma usually is not involved with a blowout fracture but rather with a tripod fracture.

Impingement on the wrist's median nerve causing pain and disability of the affected hand and wrist is known as A. carpal boss syndrome B. carpal tunnel syndrome C. carpopedal syndrome D. radioulnar syndrome

The Correct Answer is: B Carpal tunnel syndrome involves pain and numbness to some parts of the median nerve distribution (i.e., palmar surface of the thumb, index finger, and radial half of the fourth finger and palm). Carpal tunnel syndrome occurs frequently in those who continually use vibrating tools or machinery. Carpopedal spasm is spasm of the hands and feet, commonly encountered during hyperventilation. Carpal boss is a bony growth on the dorsal surface of the third metacarpophalangeal joint.

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

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

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

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

Widening of the intercostal spaces is characteristic of which of the following conditions? A. Pneumothorax B. Emphysema C. Pleural effusion D. Pneumonia

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

The main forms of COPD include 1. chronic bronchitis. 2. pulmonary emphysema. 3. asthma. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B Chronic obstructive pulmonary disease (COPD) is the abbreviation for chronic obstructive pulmonary disease; it refers to a group of disorders. COPD has two main forms, chronic bronchitis and emphysema. Many experts believe that asthma should be included, others do not. COPD is irreversible and decreases the ability of the lungs to perform their ventilation functions. There is often less than half the normal expected maximal breathing capacity.

Which of the following is the preferred scheduling sequence? A. Lower GI series, abdomen ultrasound, upper GI series B. Abdomen ultrasound, lower GI series, upper GI series C. Abdomen ultrasound, upper GI series, lower GI series D. Upper GI series, lower GI series, abdomen ultrasound

The Correct Answer is: B Diagnostic imaging examinations must be scheduled appropriately. Retained barium sulfate contrast medium can obscure necessary anatomic details in x-ray or ultrasound studies that are scheduled later. Therefore, the ultrasound examination should come first, followed by the lower GI series (BE), and finally the upper GI series. Retained barium from the lower GI series probably will not obscure upper GI structures.

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

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

An esophagram would most likely be requested for patients with which of the following esophageal disorders/symptoms? 1. Varices 2. Achalasia 3. Dysphasia A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: B Dilated, twisted veins, or varices, of the esophagus are frequently associated with obstructive liver disease or cirrhosis of the liver. These esophageal veins enlarge and can rupture, causing serious hemorrhage. Achalasia is dilation of the esophagus as a result of the cardiac sphincter's failure to relax and allow food to pass into the stomach. Dysphasia is a speech impairment resulting from a brain lesion; it is unrelated to the esophagus. Dysphagia refers to difficulty swallowing and is the most common esophageal complaint. Hiatal hernia is another common esophageal problem; it is characterized by protrusion of a portion of the stomach through the cardiac sphincter. It is a common condition, and many individuals with the condition are asymptomatic. Each of these conditions of the esophagus may be evaluated with an esophagogram. Positions usually include the posteroanterior, right anterior oblique, and right lateral positions.

In which of the following conditions is a double-contrast BE essential for demonstration of the condition? 1. Polyps 2. Colitis 3. Diverticulosis A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: B Double-contrast studies of the large bowel are particularly useful for demonstration of the bowel wall and anything projecting into it, for example, polyps. Polyps are projections of the bowel wall mucous membrane into the bowel lumen. Colitis is inflammation of the large bowel, often associated with ulcerations of the mucosal wall. A single-contrast study most likely would obliterate these mucosal conditions, but coating of the bowel mucosa with barium and subsequent filling of the bowel with air (double contrast) provide optimal delineation. Single-contrast studies will demonstrate projections/outpouchings from the intestinal wall such as diverticulitis.

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

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

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

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

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

The Correct Answer is: B Electronic imaging (CR and DR) uses image-capture devices having increased sensitivity compared with film/screen imaging. Therefore, special consideration must be given to the SR emerging from the patient and striking the IR. To reduce the amount of SR that reaches the IR, the x-ray beam should be tightly collimated, and a lead mat should be placed on the x-ray table just posterior to the patient's lumbosacral area. The x-ray photons that would have extended posterior to the patient's skin and simply struck the x-ray table—causing increased SR to reach the IR—will be absorbed by the lead mat. Of course, these same methods are used successfully in improving image quality in screen/film technology as well. The SID is unrelated to scattered radiation production.

Characteristics of a patient with pulmonary emphysema include 1. shoulder girdle elevation 2. increased AP diameter of the chest 3. hyperventilation A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B Emphysema is a chronic obstructive pulmonary disease (COPD) characterized by pathologic distension of the pulmonary alveoli with (destructive) changes in their walls, resulting in a loss of elasticity. Emphysema is seen occasionally following asthma or tuberculosis, but it is caused most frequently by cigarette smoking. Because the emphysematous patient's greatest difficulty is exhalation, it becomes a conscious, forced effort. Breathing is shallow and rapid. Forced and ineffective breathing results in expansion of the AP diameter of the chest and elevated shoulder girdle in established emphysema. Hyperventilation results from too frequent deep breaths in the anxious or tense individual. This results in a feeling of dizziness and tingling of the extremities.

Which of the following conditions would require an increase in exposure factors? 1. Congestive heart failure 2. Pleural effusion 3. Emphysema A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: B Emphysema is abnormal distention of the alveoli (or tissue spaces) with air. The presence of abnormal amounts of air makes it necessary to decrease from normal exposure factors. Congestive heart failure and pleural effusion involve abnormal amounts of fluid in the chest and thus require an increase in exposure factors.

Esophageal varices are best demonstrated in which of the following positions? A. Erect B. Recumbent C. Fowler D. Sims

The Correct Answer is: B Esophageal varices are best demonstrated when there is increased venous pressure and when blood is flowing against gravity. Therefore, to demonstrate the twisted, dilated condition of venous varicosities, esophagograms must be performed in the recumbent position. In the erect position, the veins appear more smooth and normal. The Fowler position describes a position in which the patient's head is higher than the feet, and the Sims position is preferred for insertion of the enema tip.

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

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

The structure labeled 3 in Figure 2-14 is the A. maxillary sinus B. sphenoidal sinus C. ethmoidal sinus D. frontal sinus

The Correct Answer is: B Figure 2-14 illustrates an anatomic lateral view of the paranasal sinuses. Number 1 points to the frontal sinuses and number 2 to the ethmoidal sinuses; both can be visualized using the PA axial projection (Caldwell method). Number 3 is the sphenoidal sinuses, which are well demonstrated in the SMV projection. Number 4 is the maxillary sinuses, which are best demonstrated using the parietoacanthal projection (Waters method). The lateral projection demonstrates the four pairs of paranasal sinuses superimposed on each other

What should be done to better demonstrate the mandibular rami seen in PA projection in Figure A? A. use a perpendicular CR B. angle the CR cephalad C. angle the CR caudad D. oblique the head 15° medial

The Correct Answer is: B Figure A shows a PA projection of the mandible. The head is positioned PA with the OML perpendicular to the IR. The mandibular body is well demonstrated in this position. With the patient in the PA position, the rami can be better demonstrated with 20° to 25° cephalad angulation. A caudal angle could be employed if the skull was positioned in the AP position.

In the lateral projection of the knee, the central ray is angled 5° cephalad to prevent superimposition of which of the following structures on the joint space? A. Lateral femoral condyle B. Medial femoral condyle C. Patella D. Tibial eminence

The Correct Answer is: B For the lateral projection of the knee, the patient is turned onto the affected side. This places the lateral femoral condyle closest to the IR and the medial femoral condyle remote from the IR. Consequently, there is significant magnification of the medial femoral condyle and, unless the central ray is angled slightly cephalad, subsequent obliteration of the joint space.

In which of the following examinations is exposure on full expiration required? A. PA chest B. Below diaphragm ribs C. AP lordotic chest D. Lateral thoracic spine

The Correct Answer is: B Full or forced expiration is used to elevate the diaphragm and demonstrate the ribs below the diaphragm to best advantage. Deep inspiration is used to depress the diaphragm and demonstrate as many ribs above the diaphragm as possible. Shallow breathing is used occasionally to visualize the ribs above the diaphragm while obliterating pulmonary vascular markings. Shallow breathing is also used during exposure of the lateral thoracic spine and functions to blur prominent vascular markings. Posteroanterior (PA) and apical lordotic chest radiographs require full inspiration.

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

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

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

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

What is the most superior structure of the scapula? A. Apex B. Acromion process C. Coracoid process D. Superior angle

The Correct Answer is: B It is easy to determine the highest point of the scapula when it is viewed laterally. The coracoid process projects anteriorly and is quite superior. However, the acromion process, which is an anterior extension of the scapular spine, projects considerably more superior than the coracoid.

The secondary center of ossification in long bones is the A. diaphysis B. epiphysis C. metaphysis D. apophysis

The Correct Answer is: B Long bones are composed of a shaft, or diaphysis, and two extremities. The diaphysis is referred to as the primary ossification center. In the growing bone, the cartilaginous epiphyseal plate (located at the extremities of long bones) is gradually replaced by bone. For this reason, the epiphyses are referred to as the secondary ossification centers. The ossified growth area of long bones is the metaphysis. An apophysis is a normal bony outgrowth arising from a separate ossification center which fuses in time. An apophysis is the site of ligament or tendon attachment (whereas an epiphysis contributes to joint formation).

The articular facets of L5-S1 are best demonstrated in a(n) A. AP projection B. 30-degree oblique C. 75-degree oblique D. AP axial

The Correct Answer is: B Lumbar articular facets, forming the apophyseal joints, are demonstrated in the oblique position. L1 through L4 are best demonstrated in a 45-degree oblique, while L5-S1 are best seen in the 30-degree oblique (up to 60° oblique could be required). The AP axial projection is used to demonstrate an AP projection of L5-S1.

Demonstration of which anatomic structures require(s) ingestion of barium sulfate suspension? 1. Duodenum 2. Pylorus 3. Ilium A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B Oral administration of barium sulfate is used to demonstrate the upper digestive system—the esophagus, fundus, body, and pylorus of the stomach—and barium progression through the small bowel. The small bowel includes the duodenum, jejunum, and ileum (ilium is part of the pelvis).

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

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

Which of the following pathologic conditions probably will require a decrease in exposure factors? A. Osteomyelitis B. Osteoporosis C. Osteosclerosis D. Osteochondritis

The Correct Answer is: B Osteoporosis is a condition, often seen in the elderly, marked by increased porosity and softening of bone. The bones are much less dense, and thus a decrease in exposure is required. Osteomyelitis and osteochondritis are inflammatory conditions that usually increase bone density. Osteosclerosis is abnormal hardening of the bone, and an increase in exposure factors would be required.

Which of the following is a radiologic procedure that functions to dilate a stenotic vessel? A. Percutaneous nephrolithotomy B. Percutaneous angioplasty C. Renal arteriography D. Surgical nephrostomy

The Correct Answer is: B Plaque deposited on arterial walls in cases of atherosclerosis causes arterial stenosis. Percutaneous transluminal angioplasty (PTA) is a procedure that uses a balloon catheter to permanently increase the size of the arterial lumen, thus reopening the vessel and restoring blood flow. A percutaneous nephrolithotomy is a procedure performed to remove a renal calculus from a kidney or proximal ureter. Renal arteriography is the radiologic investigation of the renal arteries. Nephrostomy is the surgical formation of an artificial opening into the kidney.

Which of the following radiologic procedures requires that a contrast medium be injected into the renal pelvis via a catheter placed within the ureter? A. Nephrotomography B. Retrograde urography C. Cystourethrography D. IVU

The Correct Answer is: B Retrograde urography requires ureteral catheterization so that a contrast medium can be introduced directly into the pelvicalyceal system. This procedure provides excellent opacification and structural information but does not demonstrate the function of these structures. IV studies such as the IVU demonstrate function. Cystourethrography is an examination of the bladder and urethra, frequently performed during voiding. Nephrotomography is performed after IV administration of a contrast agent; it may be used to evaluate small intrarenal lesions and renal hypertension.

Conditions in which there is a lack of normal bone calcification include 1. rickets. 2. osteomalacia. 3. osteoarthritis. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B Rickets and osteomalacia are disorders in which there is softening of bone. Rickets results from a deficiency of vitamin D and usually is found affecting the growing bones of young children. The body's weight on the soft bones of the legs results in bowed and misshapen legs. Osteomalacia is an adult condition in which new bone fails to calcify. It is a painful condition and can result in easily fractured bones, especially in the lower extremities. Osteoarthritis is seen often in the elderly and is characterized by degeneration of articular cartilage in adjacent bones. The resulting rubbing of bone against bone results in pain and deterioration.

The left sacroiliac joint is positioned perpendicular to the IR when the patient is positioned in a A. left lateral position. B. 25° to 30° LAO position. C. 25° to 30° LPO position. D. 30° to 40° LPO position.

The Correct Answer is: B Sacroiliac joints lie obliquely within the pelvis and open anteriorly at an angle of 25° to 30° to the midsagittal plane. A 25° to 30° oblique position places the joints perpendicular to the IR. The left sacroiliac joint may be demonstrated in the LAO and RPO positions with little magnification variation.

Which of the following conditions require(s) a decrease in technical factors? 1. Emphysema 2. Osteomalacia 3. Atelectasis A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B Subcutaneous emphysema is a pathologic distension of tissues with air; pulmonary emphysema is a chronic disease characterized by overdistension of the alveoli with air. Osteomalacia is a softening of bone so that it becomes flexible, brittle, and deformed. All three of these conditions involve a decrease in tissue density and, therefore, require a decrease in technical factors. Atelectasis is a collapsed or airless lung; it requires an increase in technical factors.

Which of the following is (are) evaluation criteria for a PA chest radiograph of the heart and lungs? 1. Ten posterior ribs should be seen above the diaphragm. 2. The medial ends of the clavicles should be equidistant from the vertebral column. 3. The scapulae should be seen through the upper lung fields. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B Sufficient inspiration is demonstrated by the visualization of 10 posterior ribs projected above the diaphragm. Rotation of the chest is detected by asymmetry in the distance between the medial ends of the clavicles and the vertebral column. The scapulae should be free of superimposition with the lung fields; this is accomplished by rolling the shoulders forward while positioning for the PA projection.

The manubrial notch is at approximately the same level as the A. fifth thoracic vertebra. B. T2-3 interspace. C. T4-5 interspace. D. costal margin.

The Correct Answer is: B Surface landmarks, prominences, and depressions are very useful to the radiographer in locating anatomic structures that are not visible externally. The fifth thoracic vertebra is at approximately the same level as the sternal angle. The T2-3 interspace is about at the same level as the manubrial (suprasternal) notch. The costal margin is about the same level as L3.

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

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

The sternoclavicular joints will be best demonstrated in which of the following positions? A. Apical lordotic B. Anterior oblique C. Lateral D. Weight-bearing

The Correct Answer is: B The (diarthrotic) sternoclavicular joints are formed by the medial (sternal) extremities of the clavicles and the clavicular notches of the manubrium (of the sternum). They can be demonstrated in the LAO and RAO positions. The LAO projection demonstrates the left sternoclavicular joint, whereas the RAO projection demonstrates the joint on the right. The patient is obliqued about 15 degrees with the side of interest adjacent to the IR.

The lumbar transverse process is represented by what part of the "Scotty dog" seen in a correctly positioned oblique lumbar spine? A. Eye B. Nose C. Body D. Ear

The Correct Answer is: B The 45-degree oblique projection of the lumbar spine generally is performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated (Figures 2-53 and 2-54 ). The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process.

The AP projection of the coccyx requires that the CR be directed 1. 15 degrees cephalad 2. 2 inches superior to the pubic symphysis 3. to a level midway between the ASIS and pubic symphysis A. 1 only B. 2 only C. 1 and 2 only D. 1 and 3 only

The Correct Answer is: B The AP projection of the coccyx requires the CR to be directed 10 degrees caudally and centered 2 inches superior to the pubic symphysis. The AP projection of the sacrum requires a 15-degree cephalad angle centered at a point midway between the pubic symphysis and the ASIS.

The AP projection of the coccyx requires that the CR be directed 1. 15 degrees cephalad 2. 2 inches superior to the pubic symphysis 3. at a level 1 inch medial to the ASIS A. 1 only B. 2 only C. 1 and 2 only D. 1 and 3 only

The Correct Answer is: B The AP projection of the coccyx requires the CR to be directed 10 degrees caudally and centered 2 inches superior to the pubic symphysis. The AP projection of the sacrum requires a 15-degree cephalad angle, also centered 2 inches superior to the pubic symphysis. A centering point of 1 inch medial to the elevated ASIS is used for posterior oblique positions of the sacroiliac joints.

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

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

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

The Correct Answer is: B The ankle mortise, or ankle joint, is formed by the articulation of the tibia, fibula, and talus (Figure 2-45). Two articulations form the ankle mortise: the talotibial and talofibular articulations. The calcaneus is not associated with formation of the ankle mortise.

The auditory, or eustachian, tube extends from the nasopharynx to the A. external ear. B. middle ear. C. inner ear. D. oropharynx.

The Correct Answer is: B The auditory, or eustachian, tube extends from the middle ear to the nasopharynx. It is 3-4 cm in length and is lined with mucous membrane. Otitis media can result when the auditory tube becomes occluded during inflammatory processes. The middle ear contains the auditory ossicles (i.e., malleus, incus, and stapes). The inner ear contains the cochlea, semicircular canals, and vestibule.

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

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

The following procedure can be employed to better demonstrate the carpal scaphoid: 1. elevate hand and wrist 20°. 2. place wrist in ulnar deviation. 3. angle CR 20° distally (toward fingers). A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: B The carpal scaphoid is a curved, boat-shaped, bone, and is therefore superimposed on itself ("self-superimposition") in a routine PA projection. Since the scaphoid is the most frequently fractured carpal, special projections have been developed to help overcome self-superimposition. Stecher (in 1937) recommended elevating the hand and wrist 20° and using a perpendicular CR directed to the scaphoid. Effective variations of this position include employing ulnar deviation and angling the CR 20° proximally (toward the elbow). The 20° tube angulation would be used in place of the elevated hand/wrist.

Which of the following projections will best demonstrate the carpal scaphoid? A. Lateral wrist B. Ulnar deviation C. Radial deviation D. Carpal tunnel

The Correct Answer is: B The carpal scaphoid is somewhat curved and consequently foreshortened radiographically in the PA projection/position. To better separate it from the adjacent carpals, the ulnar deviation maneuver is frequently employed. In addition to correcting foreshortening of the scaphoid, ulnar deviation opens the interspaces between adjacent lateral carpals. Radial deviation is used to better demonstrate medial carpals.

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

The Correct Answer is: B The central nervous system (brain and spinal cord) is located within three protective membranes, the meninges. The inner membrane is the pia mater, the middle membrane is the arachnoid, and the outer membrane is the dura mater. The subarachnoid space is located between the pia and arachnoid mater and contains cerebrospinal fluid (CSF). During myelography, the needle is introduced into the subarachnoid space (L3-4 or L4-5), a small amount of CSF is removed, and the contrast medium is introduced (Figure 2-51). The subdural space is located between the arachnoid and dura mater. The epidural space is located between the two layers of the dura mater.

Which of the following procedures will best demonstrate the cephalic, basilic, and subclavian veins? A. Aortofemoral arteriogram B. Upper-limb venogram C. Lower-limb venogram D. Renal venogram

The Correct Answer is: B The cephalic, basilic, and subclavian veins should be demonstrated on an upper limb venogram. Venography of the upper limb usually is performed to rule out venous obstruction or thrombosis. The injection site is usually in the hand or wrist, and images should be obtained up to the area of the superior vena cava.

The RPO position of the cervical spine requires which of the following combinations of tube angle and direction? A. 15 to 20 degrees caudad B. 15 to 20 degrees cephalad C. 25 to 30 degrees caudad D. 25 to 30 degrees cephalad

The Correct Answer is: B The cervical intervertebral foramina lie 45 degrees to the midsagittal plane (MSP) and 15 to 20 degrees to the transverse plane. When the posterior oblique position (i.e., LPO or RPO) is used, the CR is directed 15 to 20 degrees cephalad, and the cervical intervertebral foramina demonstrated are those farther from the IR. There is, therefore, some magnification of the foramina (because of the OID). In the anterior oblique position (i.e., LAO or RAO), the CR is directed 15 to 20 degrees caudad, and the foramina disclosed are those closer to the IR.

The act of inspiration will cause elevation of the 1. sternum. 2. ribs. 3. diaphragm. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

Which of the following correctly identifies the letter L in the radiograph shown in Figure 7-13? A. Hamate B. Lunate C. Scaphoid D. Trapezium

The Correct Answer is: B The eight carpal bones are well visualized in this PA projection of the hand and wrist. The letters E (scaphoid) and L (lunate) are in the proximal carpal row. The capitate (I) is seen in the distal carpal row; just lateral to the capitate is the carpal trapezium, seen articulating with the base of the first metacarpal. The PA projection of the hand provides an oblique projection of the first finger (thumb).

The esophagus commences at about the level of A. C3. B. C6. C. T1. D. T11.

The Correct Answer is: B The esophagus is a musculomembranous tube commencing (begin, start) at about the level of the cricoid cartilage, that is, C5-6. It is located posterior to the larynx and trachea and extends to about the level of T11, where it joins with the proximal stomach.

All the following are posterior structures except A. the linea aspera. B. the intertrochanteric line. C. the popliteal surface. D. the intercondyloid fossa.

The Correct Answer is: B The femur is the longest and strongest bone in the body. The femoral shaft is bowed slightly anteriorly. The proximal end of the femur consists of a head, which is received by the acetabulum of the pelvis. The femoral head has a small notch, the fovea capitis femoris, for ligament attachment. The femoral neck, which joins the head and shaft, angles upward approximately 120 degrees and forward (in anteversion) approximately 15 degrees. The greater (lateral) and lesser (medial) trochanters are large processes on the posterior proximal femur. The greater trochanter is a prominent positioning landmark that lies in the same transverse plane as the public symphysis and coccyx. The intertrochanteric crest runs obliquely between the trochanters; the intertrochanteric line runs anteriorly parallel to the crest. The femoral shaft presents a long, narrow ridge posteriorly called the linea aspera. Its distal anterior portion presents the patellar surface—a triangular depression over which the patella glides during flexion. The distal posterior surface presents the popliteal surface—a depression that houses the popliteal artery. The medial and lateral femoral condyles are very prominent posterior structures, and between them is the deep intercondyloid fossa. Just above the condyles are the medial and lateral femoral epicondyles.

Which of the following projections/positions would best demonstrate structure number 6 (Olecranon process seen in Figure 7-7? A. PA projection B. Lateral projection C. AP external oblique D. AP internal oblique

The Correct Answer is: B The figure shows a posterior view of the elbow. The distal posterior humerus (number 1) is seen, as well as the proximal posterior radius (number 4) and ulna (number 3). Additional structures identified are the medial epicondyle (number 2), the olecranon fossa (number 5), olecranon process (number 6), lateral epicondyle (number 7), and radial head (number 8) The olecranon process (number 6) can best be demonstrated in the lateral projection; it can also be demonstrated in the acute flexion position. The AP internal oblique will demonstrate the coronoid process; the AP external oblique will demonstrate the radial head free of superimposition.

In a posteroanterior (PA) projection of the chest being used for cardiac evaluation, the heart measures 14.7 cm between its widest points. If the magnification factor is known to be 1.2, what is the actual diameter of the heart? A. 10.4 cm B. 12.25 cm C. 13.5 cm D. 17.64 cm

The Correct Answer is: B The formula for magnification factor (MF) = image size/object size. In the stated problem, the anatomic measurement is 14.7 cm, and the magnification factor is known to be 1.2. Substituting the known factors in the appropriate equation:

Compared with that of the hypersthenic and sthenic body types, the gallbladder of an asthenic patient is most likely to be located A. higher and more medial B. lower and more medial C. higher and more lateral D. lower and more lateral

The Correct Answer is: B The four types of body habitus describe differences in visceral shape, position, tone, and motility. One body type is hypersthenic, the very large individual with short, wide heart and lungs, high transverse stomach and gallbladder, and peripheral colon. The sthenic individual is the average, athletic, most predominant type. The hyposthenic patient is somewhat thinner and a little more frail, with organs positioned somewhat lower. The asthenic type is smaller in the extreme, with a long thorax, a very long, almost pelvic stomach, and a low medial gallbladder. The asthenic colon is medial and redundant.

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

The Correct Answer is: B The gallbladder is located on the posterior surface of the liver in the right upper quadrant (RUQ). The hepatic (right colic) flexure, so named because of its close proximity to the liver, is also in the RUQ. The cecum, located in the right lower quadrant (RLQ), is continuous with the terminal ileum—forming the ileocecal valve.

The lesser tubercle of the humerus will be visualized in profile in the A. AP shoulder external rotation radiograph. B. AP shoulder internal rotation radiograph. C. AP elbow radiograph. D. Lateral elbow radiograph.

The Correct Answer is: B The greater and lesser tubercles are prominences on the proximal humerus, separated by the bicipital groove. The AP projection of the humerus in external rotation demonstrates the greater tubercle in profile. With the arm placed in internal rotation, the humerus is placed in a true lateral position, and the lesser tubercle is demonstrated.

Which of the following shoulder projections can be used to evaluate the lesser tubercle in profile? A. External rotation position B. Internal rotation position C. Neutral rotation position D. Inferosuperior axial position

The Correct Answer is: B The internal rotation position places the humeral epicondyles perpendicular to the IR, the humerus in a true lateral position, and the lesser tubercle in profile. The external rotation position places the humeral epicondyles parallel to the IR, the humerus in a true AP position, and the greater tubercle in profile. The neutral position is used often for the evaluation of calcium deposits in the shoulder joint.

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

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

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

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

Which of the following bony landmarks is in the same transverse plane as the symphysis pubis? A. Ischial tuberosity B. Prominence of the greater trochanter C. Anterosuperior iliac spine D. Anteroinferior iliac spine

The Correct Answer is: B The most prominent part of the greater trochanter is at the same level as the pubic symphysis—both are valuable positioning landmarks. The ASIS is in the same transverse plane as S2. The ASIS and the pubic symphysis are the bony landmarks used to locate the hip joint, which is located midway between the two points.

The lateral aspect of the obturator foramen is formed by the A. ilium. B. ischium. C. pubis. D. sacrum.

The Correct Answer is: B The obturator foramen is the largest foramen in the human skeleton. Blood vessels and nerves pass through this large pelvic foramen. Whereas the ilium, ischium, and pubis make up the pelvis—only two of those bones, the ischium and pubis, make up the obturator foramen. The lateral aspect of the foramen is comprised of the ischium and its rami, while its medial aspect is formed by the pubis and its rami.

Which of the following positions is/are most frequently used to demonstrate the sphenoid sinuses? 1. Modified Waters (mouth open) 2. Lateral 3. PA axial A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

The radiograph: right lateral decubitus position may be used to evaluate 1. polypoid lesions. 2. the lateral wall of the descending colon. 3. the posterior wall of the rectum. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

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

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

The right posterior oblique position (Judet method) of the right acetabulum will demonstrate the 1. anterior rim of the right acetabulum 2. right iliac wing 3. right anterior iliopubic column A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B The posterior oblique projection of the acetabulum (Judet method) requires a 45-degree obliquity of the entire MSP. In the RPO position, the down side (the right side in this case) will demonstrate the anterior rim of the right acetabulum, the right posterior ilioischial column, and the right iliac wing. When centered to the up side (left in this case), the structures demonstrated are the posterior rim of the left acetabulum, left anterior iliopubic column, and the left obturator foramen.

The right posterior oblique (RPO) position of the left acetabulum will demonstrate the 1. posterior rim of the left acetabulum. 2. left anterior iliopubic column. 3. left iliac wing. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B The posterior oblique projection of the acetabulum (Judet method) requires a 45-degree obliquity of the entire midsagittal plane (MSP). In the RPO position, the down side (the right side in this case) will demonstrate the anterior rim of the right acetabulum, the right posterior ilioischial column, and the right iliac wing. When centered to the up side (the left side in this case), the structures demonstrated are the posterior rim of the left acetabulum, the left anterior iliopubic column, and the left obturator foramen. The right iliac wing will be demonstrated in this position.

An AP oblique (lateral rotation) of the elbow demonstrates which of the following? 1. Radial head free of superimposition 2. Capitulum of the humerus 3. Olecranon process within the olecranon fossa A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B The radial head and neck are projected free of superimposition in the AP oblique projection (lateral /external rotation) of the elbow. The humeral capitulum is also well demonstrated in this external oblique position. The AP oblique projection (medial /internal rotation) of the elbow superimposes the radial head and neck on the proximal ulna. The medial rotation demonstrates the olecranon process within the olecranon fossa, and it projects the coronoid process free of superimposition.

An aspirated foreign body is more likely to enter the lower respiratory tract via the A. left main stem bronchus. B. right main stem bronchus. C. bronchioles. D. alveoli.

The Correct Answer is: B The right and left main stem (primary) bronchi branch from the distal trachea; the right branch supplies air to the right lung, and the left branch supplies air to the left lung. The right main stem bronchus is shorter, wider, and more vertical than the left—making it the most likely route for aspirated foreign bodies to enter the right lung.

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

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

Which of the following is the most likely site for a lumbar puncture? A. S1-2 B. L3-4 C. L1-2 D. C6-7

The Correct Answer is: B The spinal cord is a column of nervous tissue about 17 in. (44 cm) in length. It is somewhat flattened anteroposteriorly and extends from the medulla oblongata of the brain to the level of L2 within the spinal canal. Because the adult spinal cord ends at the level of L2, a lumbar puncture usually is performed below that level—generally at the level of L3 to L4. A lumbar puncture may be performed for the removal of spinal fluid for diagnostic purposes or for the injection of medications.

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

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

In which of the following positions can the sesamoid bones of the foot be demonstrated to be free of superimposition with the metatarsals or phalanges? A. Dorsoplantar metatarsals/toes B. Tangential metatarsals/toes C. 30-degree medial oblique foot D. 30-degree lateral oblique foot

The Correct Answer is: B The tangential projection projects the sesamoid bones separate from adjacent structures. The patient is best examined in the prone position because this places the parts of interest closest to the IR. The affected foot is dorsiflexed so as to place its plantar surface 15 to 20 degrees with the vertical. The CR is directed perpendicular to the posterior surface of the foot (near the metatarsophalangeal joints). The dorsoplantar and oblique projections of the foot will demonstrate the sesamoid bones superimposed on adjacent bony structures.

The tarsals and metatarsals are arranged to form the 1. transverse arch. 2. longitudinal arch. 3. oblique arch. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B The tarsals and metatarsals of the foot are arranged so as to form two arches: the transverse and the longitudinal (which has two parts—lateral and medial). The arches function to support and distribute the body's weight over the body. The ball of the foot usually accommodates about 40 percent of the body's weight, and the heel about 60 percent.

All the following statements regarding respiratory structures are true except A. the right lung has three lobes. B. the inferior portion of the lung is the apex. C. each lung is enclosed in serous membrane. D. the main stem bronchi enter the lung hilum.

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

Types of inflammatory bowel disease include 1. ulcerative colitis. 2. Crohn's disease. 3. intussusception. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: B The two most common types of chronic inflammation of the intestines are ulcerative colitis and Crohn's disease. The latter can attack any part of the GI tract and extends through all layers of the intestinal wall (therefore the possibility of forming fistulous tracks to contiguous structures). Ulcerative colitis attacks only the large bowel and only the mucosal layer of the intestinal wall. Curiously, cigarette smoking increases the risk for Crohn's disease and decreases the risk for ulcerative colitis. Intussusception is an obstructive disorder.

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

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

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

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

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

The Correct Answer is: B There are several surface landmarks and localization points that can help the radiographer in positioning various body structures. The jugular notch, located at the superior aspect of the manubrium, is approximately opposite the T2-3 interspace. The sternal angle is located opposite the T4-5 interspace. The xiphoid (or ensiform) process is located opposite T10.

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

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

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

The Correct Answer is: B Thoracic and sacrococcygeal vertebrae exhibit kyphotic curves. The cervical and lumbar vertebrae exhibit lordotic curves. The lordotic curves are secondary curves; that is, they develop sometime after birth. The thoracic and sacral vertebrae exhibit the primary curves, those that are present at birth.

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

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

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

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

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

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

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

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

A lateral projection of the larynx is occasionally required to rule out foreign body, polyps, or tumor. The CR should be directed A. just below the EAM B. to the level of the mandibular angles C. to the level of the laryngeal prominence D. to the level of C7

The Correct Answer is: C AP and lateral projections of the airway and larynx are required occasionally to rule out foreign body, polyps, tumors, or any other condition suspected of causing some airway obstruction. The AP projection is positioned as for an AP cervical spine projection with the CR perpendicular to the laryngeal prominence. The lateral projection is positioned as for a lateral cervical spine projection and is centered to the coronal plane passing through the trachea (anterior to the cervical spine) at the level of the laryngeal prominence. Centering just below the EAM would demonstrate the nasopharynx. Centering at the mandibular angles would demonstrate the oropharynx. Exposures are made on slow inspiration to visualize air-filled structures.

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

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

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

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

How can OID be reduced for a PA projection of the wrist? A. Extend the fingers. B. Flex the metacarpophalangeal joints. C. Extend the forearm. D. Oblique the metacarpals 45 degrees.

The Correct Answer is: B When the hand is pronated and the fingers are extended for a PA projection of the wrist, the wrist arches, and an OID is introduced between the wrist and the cassette. To reduce this OID, the metacarpophalangeal joints should be flexed slightly. This maneuver will bring the anterior surface of the wrist into contact with the cassette.

To demonstrate the glenoid fossa in profile, the patient is positioned A. 45 degrees oblique, affected side up. B. 45 degrees oblique, affected side down. C. 25 degrees oblique, affected side up. D. 25 degrees oblique, affected side down.

The Correct Answer is: B When viewing the glenoid fossa from the anterior, it is seen to angle posteriorly and laterally approximately 45 degrees. To view it in profile, then, it must be placed so that its surface is perpendicular to the IR. The patient is positioned in a 45-degree oblique, affected-side-down position, which places the glenoid fossa approximately perpendicular to the IR. The arm is abducted slightly, the elbow is flexed, and the hand and forearm are placed over the abdomen. The CR is directed perpendicular to the glenohumeral joint.

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

The Correct Answer is: B With the patient in the PA position, the rami are well visualized with a perpendicular ray or with 20 to 25 degrees of cephalad angulation. A portion of the mandibular body is demonstrated in this position, but most of it is superimposed over the cervical spine.

Which of the following would best evaluate Maxillary Sinus? A. PA axial projection (Caldwell method) B. Parietoacanthal projection (Waters method) C. Lateral projection D. Submentovertical projection

The Correct Answer is: B the maxillary sinuses, which are best demonstrated using the parietoacanthal projection (Waters method). The lateral projection demonstrates the four pairs of paranasal sinuses superimposed on each other.

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

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

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

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

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

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

Which surface of the forearm must be adjacent to the IR to obtain a lateral projection of the fourth finger with optimal spatial resolution? A. Anterior B. Posterior C. Medial D. Lateral

The Correct Answer is: C A lateral projection of the fourth finger is best obtained if the finger is positioned so that there is as little OID as possible. Therefore, with only the fourth finger extended in the lateral position, the arm is positioned on the ulnar (medial) surface. This places the finger closer to the IR than if it were positioned radial side down. Excessive magnification distortion is avoided, and better spatial resolution is obtained.

Which of the following positions/projections of the skull will result in the most shape distortion? A. 0° PA B. 23° Caldwell C. 37° Towne D. 25° Haas

The Correct Answer is: C Accurate positioning skills include a knowledge of anatomy (the position of the structure with respect to the image receptor) and geometric principles (how the x-ray tube angle will project or distort the anatomic structure). Shape distortion is related to the alignment of the x-ray tube, the object being examined, and the image receptor. When all three are parallel to one another, shape distortion is minimal. If one or more are out of alignment, shape distortion occurs. The two types of shape distortion are foreshortening and elongation. Foreshortening occurs as a result of the anatomic structure within the body being at an angle with the image receptor. For example, in the supine position, the kidneys are not parallel to the image receptor: Their lower pole is anterior to their upper pole. Another example is the curved carpal scaphoid: Its full length will not be appreciated in the PA projection, as because of its curve, it will be self-superimposed and foreshortened. Elongation occurs as a result of x-ray tube angulation. Elongation is often used intentionally to see structures better. The axial projection of the sigmoid colon during BE "opens" the S-shaped sigmoid to allow visualization of its entire length. The AP axial skull (Towne) projects the facial bones inferiorly to better see the occipital bone. The greater the tube angulation, the greater the elongation (distortion) produced.

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

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

To radiograph an infant for suspected free air within the abdominal cavity, which of the following projections of the abdomen will demonstrate the condition with the least patient exposure? A. PA erect with grid B. Left lateral decubitus with grid C. Left lateral decubitus without grid D. Recumbent AP without grid

The Correct Answer is: C Air-fluid levels are demonstrated in the erect or decubitus position. Grid radiography requires about a 3 to 4 times greater dose than nongrid radiography. A left lateral decubitus projection without a grid, then, would demonstrate fluid levels with a considerably smaller dose to the infant. PA erect with grid would be the next-best choice - the PA position reduces dose to radiosensitive future reproductive cells. A recumbent AP projection would not demonstrate air-fluid levels. Left lateral decubitus is preferred to right lateral decubitus because the liver moves down slightly in this position, creating a space between the liver and right hemidiaphragm (right subphrenic space). Any abdominal free air would then be visualized below the right hemidiaphragm in the subphrenic space along the lateral aspect of the liver.

Which projection(s) of the abdomen would be used to demonstrate pneumoperitoneum? 1. Right lateral decubitus 2. Left lateral decubitus 3. Upright A. 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: C An erect abdomen or left lateral decubitus should be performed for demonstration of air-fluid levels in the abdomen. The right lateral decubitus position is used to demonstrate the layering of gallstones. It will not show free air within the peritoneum because of the overlying gastric bubble on the elevated left side of the body.

The pain experienced by an individual whose coronary arteries are not conveying sufficient blood to the heart is called A. tachycardia. B. bradycardia. C. angina pectoris. D. syncope.

The Correct Answer is: C An individual whose coronary arteries are not carrying enough blood to the heart muscle (myocardium) as a result of partial or complete blockage of a cardiac vessel experiences crushing pain in the chest, frequently radiating to the left jaw and arm. This is termed angina pectoris. It may be relieved by the drug nitroglycerin, which dilates the coronary arteries, thus facilitating circulation. Tachycardia refers to rapid heart rate, and bradycardia, to slow heart rate. Syncope is fainting.

The radiograph in Figure 6-12 could be improved in which of the following ways? A. The MSP should be 45 degrees to the plane of the IR. B. The MSP should be 90 degrees to the plane of the cassette. C. The chin should be elevated slightly. D. The head should be flexed slightly.

The Correct Answer is: C An oblique projection of the cervical spine is shown. The first two cervical vertebrae are poorly visualized because of superimposition with the mandible; the chin should be elevated to correct this problem. Otherwise, the positioning is satisfactory, with good demonstration of the remainder of the cervical intervertebral foramina. The patient has been accurately rotated 45 degrees, and a 15- to 20-degree tube angle was used.

Which of the following views would best demonstrate arthritic changes in the knees? A. AP recumbent B. Lateral recumbent C. AP erect D. Medial oblique

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

A near-frontal (AP/PA) view of the sternum is best accomplished in which of the following positions? A. AP B. PA C. RAO D. LAO

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

The secondary center of ossification in long bones is the A. periosteum. B. endosteum. C. epiphysis. D. diaphysis.

The Correct Answer is: C Bones are classified as long, short, flat, and irregular. Many of the bones making up the extremities are long bones. Long bones have a shaft and two extremities (ends). The shaft (or diaphysis) of long bones is the primary ossification center during bone development. It is composed of compact tissue and covered with a membrane called periosteum. Within the shaft is the medullary cavity, which contains bone marrow and is lined by the membrane called endosteum. In the adult, yellow marrow occupies the shaft, and red marrow is found within the proximal and distal extremities of long bones. The secondary ossification center, the epiphysis, is separated from the diaphysis in early life by a layer of cartilage, the epiphyseal plate. As bone growth takes place, the epiphysis becomes part of the larger portion of bone and the epiphyseal plate disappears, but a characteristic line remains and is thereafter recognizable as the epiphyseal line.

Which cholangiographic procedure uses an indwelling drainage tube for contrast medium administration? A. Endoscopic retrograde cholangiographic pancreatography (ERCP) B. Operative cholangiography C. T-tube cholangiography D. Percutaneous transhepatic cholangiography

The Correct Answer is: C Contrast media may be administered in a variety of manners in cholangiography, including (1) an endoscope with a cannula placed in the hepatopancreatic ampulla (of Vater) for an ERCP, (2) a needle or small catheter placed directly in the common bile duct for an operative cholangiogram, (3) a very fine needle through the patient's side and into the liver for a percutaneous transhepatic cholangiogram, and (4) via an indwelling T-tube for a postoperative or T-tube cholangiogram.

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

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

Blood is returned to the left atrium, from the lungs, via the A. aorta. B. superior vena cava. C. pulmonary veins. D. pulmonary artery.

The Correct Answer is: C Deoxygenated blood is collected by the superior and inferior vena cava and emptied into the right atrium. Pulmonary circulation conveys deoxygenated blood from the right ventricle, through the pulmonary semilunar valve, into the pulmonary artery (the only artery that carries deoxygenated blood), and into the lungs where the blood becomes oxygenated. The oxygenated blood from the lungs is carried via the four pulmonary veins (the only veins that carry oxygenated blood) and emptied into the left atrium.

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

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

Which of the following articulations may be described as diarthrotic? 1. Knee 2. Intervertebral joints 3. Temporomandibular joint (TMJ) A. 1 only B. 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: C Diarthrotic, or synovial, joints, such as the knee and the TMJ, are freely movable. Most diarthrotic joints are associated with a joint capsule containing synovial fluid. Diarthrotic joints are the most numerous in the body and are subdivided according to type of movement. Amphiarthrotic joints are partially movable joints whose articular surfaces are connected by cartilage, such as intervertebral joints. Synarthrotic joints, such as the cranial sutures, are immovable.

The condition in which pulmonary alveoli lose their elasticity and become permanently inflated, causing the patient to consciously exhale, is A. bronchial asthma B. bronchitis C. emphysema D. tuberculosis

The Correct Answer is: C Emphysema is a progressive disorder caused by long-term irritation of the bronchial passages, such as by air pollution or cigarette smoking. Emphysema patients are unable to exhale normally because of the loss of elasticity of the alveolar walls. If emphysema patients receive oxygen, it is usually administered at a very slow rate because their respirations are controlled by the level of carbon dioxide in the blood

The instrument that is used frequently in quality-control programs to measure varying degrees of x-ray exposure is the A. aluminum step wedge. B. spinning top. C. densitometer. D. sensitometer.

The Correct Answer is: C Every radiographic image is composed of a number of different densities. These densities may be measured and given a numeric value with a device called a densitometer. A sensitometer is another device used in QA programs; it is used to give a precise exposure to a film emulsion. An aluminum step wedge (penetrometer) may be used to show the effect of kilovoltage on contrast. A spinning top is used to test the accuracy of the x-ray machine's timer or rectifiers.

The AP projection of the sacrum requires the central ray to be directed A. perpendicular to the midline midway between the anterior superior iliac spine (ASIS) and the pubis. B. to the midline approximately 2 inches superior to the pubis. C. 15° cephalad to a point approximately 2 inches superior to the pubis. D. 15° caudad to a point approximately 2 inches superior to the pubis.

The Correct Answer is: C For the AP projection of the sacrum, the patient is AP supine with the MSP perpendicular to the x-ray tabletop. The central ray is directed 15° cephalad to a point 2 inches superior to the pubis (approximately midway between the ASIS and the pubic symphysis). In this projection, the central ray angulation parallels the sacral curve and provides less distorted visualization of the sacrum and its foramina.

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

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

To best visualize the lower ribs, the exposure should be made A. on normal inspiration B. on inspiration, second breath C. on expiration D. during shallow breathing

The Correct Answer is: C Full or forced expiration is used to elevate the diaphragm and demonstrate the ribs below the diaphragm to best advantage (with exposure adjustment). Deep inspiration is used to depress the diaphragm and demonstrate as many ribs above the diaphragm as possible. Shallow breathing is used occasionally to visualize the ribs above the diaphragm while obliterating pulmonary vascular markings.

Another name for Hirschsprung's disease, the most common cause of lower GI obstruction in neonates, is A. intussusception. B. volvulus. C. congenital megacolon. D. pyloric stenosis.

The Correct Answer is: C Hirschsprung disease, or congenital megacolon, is caused by the absence of some or all of the bowel ganglion cells—usually in the rectosigmoid area but occasionally more extensively. Hirschsprung disease is the most common cause of lower GI obstruction in neonates and is treated surgically by excision of the affected area followed by reanastomosis with the normal, healthy bowel. Hirschsprung disease is diagnosed by BE or, in mild cares, by rectal biopsy. Intussusception is "telescoping" of the bowel, causing (mechanical) obstruction. Volvulus is twisting of the bowel on itself causing (mechanical) obstruction. Pyloric stenosis is a condition of the upper GI tract.

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

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

Which of the following positions would best demonstrate the proximal tibiofibular articulation? A. AP B. 90 degrees mediolateral C. 45-degree internal rotation D. 45-degree external rotation

The Correct Answer is: C In the AP projection, the proximal fibula is at least partially superimposed on the lateral tibial condyle. Medial rotation of 45 degrees will "open" the proximal tibiofibular articulation. Lateral rotation will obscure the articulation even more.

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

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

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

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

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

The Correct Answer is: C In the dorsoplantar projection of the foot, the CR may be directed perpendicularly or angled 10 degrees posteriorly. Angulation serves to "open" the tarsometatarsal joints that are not well visualized on the dorsoplantar projection with perpendicular ray. Inversion and eversion of the foot do not affect the tarsometatarsal joints.

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

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

Glossitis refers to inflammation of the A. epiglottis B. salivary glands C. tongue D. ossicles

The Correct Answer is: C Inflammation of the tongue is called glossitis. Inflamed salivary glands are usually referred to with reference to the affected gland, as in parotitis (inflammation of the parotid gland). Inflammation of the epiglottis is termed epiglottitis.

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

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

Which of the following statements regarding myelography is (are) correct? 1. Spinal puncture may be performed in the prone or flexed lateral position. 2. Contrast medium distribution is regulated through x-ray tube angulation. 3. The patient's neck must be in extension during Trendelenburg positions. A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: C Myelography is radiologic examination of the structures within the spinal canal. Opaque contrast medium is usually used. Following injection, the contrast medium is distributed to the vertebral region of interest by gravity; the table is angled Trendelenburg for visualization of the cervical region and in the Fowler position for visualization of the thoracic and lumbar regions. Although the table is Trendelenburg, care must be taken that the patient's neck is kept in acute extension to compress the cisterna magna and keep contrast medium from traveling into the ventricles of the brain.

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

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

Which of the following equipment is mandatory for performance of a myelogram? A. Cine camera B. 105-mm spot film C. Tilting x-ray table D. Tomography

The Correct Answer is: C Myelography requires that contrast medium be instilled into the lumbar subarachnoid space and distributed via gravity to various levels of the subarachnoid space. This gravitational distribution is accomplished through the use of an x-ray table that is capable of angling or tilting during the procedure.

Which of the following projections of the elbow should demonstrate the coronoid process free of superimposition and the olecranon process within the olecranon fossa? A. AP B. Lateral C. Medial oblique D. Lateral oblique

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

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

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

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

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

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

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

An acute infection of the lungs is called A. atelectasis. B. pneumothorax. C. pneumonia. D. COPD.

The Correct Answer is: C Pneumonia is an acute infection of the lung parenchyma characterized by productive cough, chest pain, fever, and chills and frequently accompanied by rales. Atelectasis is partial or complete collapse of a lung or lobe of a lung. Pneumothorax is the condition of air or gas in the pleural space. COPD (chronic obstructive pulmonary disease) is the name given to a number of disease processes that decrease the lung's ability to perform its function of ventilation.

High-kilovoltage exposure factors are usually required for radiographic examinations using 1. water-soluble, iodinated media. 2. a negative contrast agent. 3. barium sulfate. A. 1 only B. 2 only C. 3 only D. 1 and 3 only

The Correct Answer is: C Positive-contrast medium is radiopaque; negative-contrast material is radioparent. Barium sulfate (radiopaque, positive-contrast material) is most frequently used for examinations of the intestinal tract, and high-kVp exposure factors are used to penetrate (to see through and behind) the barium. Water-based iodinated contrast media (Conray, Amipaque) are also positive-contrast agents. However, the K-edge binding energy of iodine prohibits the use of much greater than 70 kVp with these materials. Higher kVp values will obviate the effect of the contrast agent. Air is an example of a negative-contrast agent, and high-kVp factors are clearly not indicated.

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

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

If your patient is unable to stay erect for a paranasal sinus examination, which of the following alternatives should be chosen? A. Recumbent AP B. Lateral recumbent C. Lateral cross-table recumbent D. Recumbent Waters'

The Correct Answer is: C Radiography of the paranasal sinuses should be performed in the erect position whenever possible to demonstrate the presence of an air-fluid level. The only way air-fluid levels can be demonstrated is to have the central ray parallel the floor, as in erect, decubitus, and cross-table projections. Therefore, of the choices provided, the cross-table lateral is the only one that will demonstrate air-fluid levels.

All the following procedures demonstrate renal function except A. IVP. B. descending urography. C. retrograde urography. D. infusion nephrotomography.

The Correct Answer is: C Retrograde urography is not considered a functional study of the urinary system. IVP, descending urography, and infusion nephrotomography are all considered functional urinary tract studies because the contrast medium is introduced intravenously and excreted by the kidneys. Retrograde urography involves introduction of contrast medium into the kidneys via catheter, thereby demonstrating their structure but not their function.

Skeletal conditions characterized by faulty bone calcification include 1. osteoarthritis. 2. osteomalacia. 3. rickets. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: C Rickets and osteomalacia are skeletal disorders characterized by abnormal calcification processes. In osteomalacia, bones become soft and are easily misshapen. Rickets affects the growing bones of children and is also characterized by soft, misshapened bones—as a result of calcium salts not being deposited in bone matrix. Osteoarthritis is a degeneration of articular cartilage; when these surfaces then attempt to articulate and move, bone friction and pain occur.

To visualize or "open" the right sacroiliac joint, the patient is positioned A. 30 to 40 degrees LPO B. 30 to 40 degrees RPO C. 25 to 30 degrees LPO D. 25 to 30 degrees RPO.

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

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

The Correct Answer is: C Shoulder arthrograms (Figure 2-64) are used to evaluate rotator cuff tear, glenoid labrum (a ring of fibrocartilaginous tissue around the glenoid fossa), and frozen shoulder. Routine radiographs demonstrate arthritis, and the addition of a transthoracic humerus or scapular Y projection would be used to demonstrate luxation (dislocation).

The sternal angle is at approximately the same level as the A. T2-3 interspace B. T9-10 interspace C. T5 D. costal margin

The Correct Answer is: C Surface landmarks, prominences, and depressions are very useful to the radiographer in locating anatomic structures that are not visible externally. The fifth thoracic vertebra is at approximately the same level as the sternal angle. The T2-3 interspace is about at the same level as the manubrial (suprasternal) notch. The costal margin is about the same level as L3.

The medical term for congenital clubfoot is A. coxa plana. B. osteochondritis. C. talipes. D. muscular dystrophy.

The Correct Answer is: C Talipes is the term used to describe congenital clubfoot. There are several types of talipes, generally characterized by a deformed talus and a shortened Achilles tendon, giving the foot a clubfoot appearance. Osteochondritis (Osgood-Schlatter disease) is a painful incomplete separation of the tibial tuberosity from the tibial shaft. It is often seen in active adolescent boys. Coxa plana (Legg-Calvé-Perthes disease) is ischemic necrosis leading to flattening of the femoral head. Muscular dystrophy is a congenital disorder characterized by wasting of skeletal muscles.

The lumbar lamina is represented by what part of the "Scotty dog" seen in a correctly positioned oblique lumbar spine view? A. Eye B. Nose C. Body D. Neck

The Correct Answer is: C The 45-degree oblique projection of the lumbar spine generally is performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated. The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis (that small portion of the lamina between the superior and inferior articular processes), his body to the largest portion of the lamina, and his front foot to the inferior articular process

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

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

The AP axial projection of the chest for pulmonary apices 1. requires 15 to 20 degrees of cephalad angulation 2. projects the apices above the clavicles 3. should demonstrate the medial ends of the clavicles equidistant from the vertebral column A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: C The AP axial projection is used to prevent the clavicles from superimposition on the pulmonary apices. A 15- to 20-degree cephalad angle projects the clavicles above the apices. The routine PA chest radiograph is evaluated for rotation by checking the distance between the medial ends of the clavicles and the lateral border of the vertebral column.

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

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

The AP oblique projection (medial rotation) of the elbow demonstrates which of the following? 1. Radial head free of superimposition 2. Olecranon process within the olecranon fossa 3. Coronoid process free of superimposition A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: C The AP oblique projection (medial rotation) of the elbow superimposes the radial head and neck on the proximal ulna. It demonstrates the olecranon process within the olecranon fossa, and it projects the coronoid process free of superimposition. The radial head is projected free of superimposition in the AP oblique projection (lateral rotation) of the elbow.

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

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

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

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

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

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

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

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

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

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

Which of the following positions will demonstrate the right axillary ribs? 1. RAO 2. LAO 3. RPO A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

Which projection of the foot will best demonstrate the longitudinal arch? A. Mediolateral B. Lateromedial C. Lateral weight-bearing D. 30-degree medial oblique

The Correct Answer is: C The bones of the foot are arranged to form a number of longitudinal and transverse arches. The longitudinal arch facilitates walking and is evaluated radiographically in lateral weight-bearing (erect) projections. Recumbent laterals would not demonstrate any structural change that occurs when the individual is weight-bearing erect.

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

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

The ridge that marks the bifurcation of the trachea into the right and left primary bronchi is the A. root. B. hilus. C. carina. D. epiglottis.

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

Ulnar deviation will best demonstrate which carpal(s)? 1. Medial carpals 2. Lateral carpals 3. Scaphoid A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

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

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

At approximately what level do the carotid arteries bifurcate? A. Foramen magnum B. Trachea C. laryngopharynx D. nasopharynx

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

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

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

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

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

All of the following bones are associated with condyles except the A. femur. B. tibia. C. fibula. D. mandible.

The Correct Answer is: C The distal femur is associated with two large condyles; the deep depression separating them is the intercondyloid fossa (Fig. A). The proximal tibia has two condyles; their superior surfaces are smooth, forming the tibial plateau. The mandible has a condyle that articulates with the mandibular fossa of the temporal bone, forming the temporomandibular joint. The fibula has a proximal styloid process and a distal malleolus, but no condyle.

Which of the following is (are) located on the distal aspect of the humerus? 1. Capitulum 2. Intertubercular groove 3. Coronoid fossa A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: C The distal humerus articulates with the radius and ulna to form the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, that articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar notch of the ulna. Just proximal to the capitulum and the trochlea are the lateral and medial epicondyles; the medial is more prominent and palpable. The coronoid fossa is found on the anterior distal humerus and functions to accommodate the coronoid process with the elbow in flexion. The intertubercular (bicipital) groove is located on the proximal humerus.

All the following can be associated with the elbow joint except A. the capitulum. B. the trochlea. C. the tubercles. D. the epicondyles.

The Correct Answer is: C The distal humerus articulates with the radius and ulna to form the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, that articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar/trochlear notch of the ulna. Just proximal to the capitulum and trochlea are the lateral and medial epicondyles; the medial is more prominent and palpable. Lateral epicondylitis ("tennis elbow") is a painful condition caused by prolonged rotary motion of the forearm. The tubercles are prominences located at the proximal humerus and are anatomically remote from the elbow joint

When the erect position is requested as part of an IVU, it is used to demonstrate A. the adrenal glands. B. the renal surfaces. C. kidney mobility. D. the bladder neck.

The Correct Answer is: C The erect position in IV urography may be part of the departmental routine, but more often than not it is requested as a supplemental view to rule out nephroptosis. With the patient erect, the kidneys normally change position, dropping no more than 2 inches. More marked dropping of the kidney is termed nephroptosis, a condition that is actually due to loss of the surrounding perinephric fat.

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

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

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

The Correct Answer is: C The external rotation position is the true AP position and places the greater tubercle in profile laterally and places the lesser tubercle anteriorly. The internal rotation position demonstrates the lesser tubercle in profile medially and places the humerus in a true lateral position; the greater tubercle is seen superimposed on the humeral head. The epicondyles should be superimposed and perpendicular to the IR. The neutral position places the epicondyles about 45 degrees to the IR and the outline of the greater tubercle superimposed on the humeral head

All the following structures are associated with the posterior femur except A. popliteal surface B. intercondyloid fossa C. intertrochanteric line D. linea aspera

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

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

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

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

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

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

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

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

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

Which of the following positions may be used to effectively demonstrate the hepatic flexure during radiographic examination of the large bowel? 1. RAO 2. LAO 3. LPO A. 1 only B. 1 and 2 only C. 1 and 3 only D. 2 and 3 only

The Correct Answer is: C The hepatic and splenic flexures are not generally well 0demonstrated in the AP and PA projections. To "open" the flexures, oblique projections are required. The hepatic flexure is usually well demonstrated in the RAO (right PA oblique) and LPO (left AP oblique) positions. The LAO and RPO positions are used to demonstrate the splenic flexure.

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

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

Fluoroscopic imaging of the ileocecal valve is generally part of a(n) A. esophagram. B. upper GI series. C. small-bowel series. D. ERCP.

The Correct Answer is: C The ileocecal valve is located at the terminal ileum, where it meets the first portion of the large bowel, the cecum. Most small-bowel examinations are performed following oral administration of barium sulfate suspension. The first small-bowel radiograph is taken 15 minutes after the first swallow of barium, with subsequent radiographs made every 15 to 30 minutes, depending on how quickly the barium is moving through the small bowel. Each image is shown to the radiologist, and a decision is made regarding the time of the next image. When the barium reaches the terminal ileum, fluoroscopy may be performed and compression spot images taken of the ileocecal valve.

The position shown in Figure A is known as A. ventral decubitus. B. dorsal decubitus. C. left lateral decubitus. D. right lateral decubitus.

The Correct Answer is: C The illustration shows the patient positioned on his left side, with the cassette behind his back. This is a left lateral decubitus position. The x-ray beam is directed horizontally in decubitus positions to demonstrate air-fluid levels. Air or fluid levels will be clearly delineated only if the central ray is directed parallel to them. If the patient were lying on the right side, it would be a right lateral decubitus position. If the patient were lying on his or her back with a horizontal x-ray beam, it would be a dorsal decubitus position. Lying prone with a horizontal x-ray beam is termed a ventral decubitus position.

All of the following statements regarding the inferosuperior axial (nontrauma, Lawrence method) projection of the shoulder are true, except A. the coracoid process and lesser tubercle are seen in profile. B. the arm is abducted about 90° from the body. C. the arm should be in internal rotation. D. the CR is directed medially 25° to 30° through the axilla.

The Correct Answer is: C The inferosuperior axial (nontrauma, Lawrence method) projection of the shoulder demonstrates the glenohumeral joint and adjacent structures. The patient is supine with arm abducted 90°, and in external rotation. The (horizontal) CR is directed medially 25° to 30° through the axilla. The coracoid process and lesser tubercle are seen in profile.

Which of the four baselines illustrated in Figure 6-15 should be used for a lateral projection of facial bones? A. Baseline 1 (GML) B. Baseline 2 (OML) C. Baseline 3 (IOML) D. Baseline 4 (AML)

The Correct Answer is: C The infraorbitomeatal line (IOML) is an imaginary line extending from the infraorbital margin to the external auditory meatus and is represented by number 3. The IOML is used for most lateral skull projections, including lateral projections of facial bones. The skull is positioned so that the MSP is parallel to the cassette, the interpupillary line is perpendicular to the cassette, and the IOML is parallel to the long (transverse) axis of the cassette. Number 1 is the glabellomeatal line, number 2 is the OML (orbitomeatal line), and number 4 is the acanthomeatal line. These baselines are used to obtain accurate positioning in skull radiography.

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

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

The femoral neck can be located A. parallel to the femoral shaft. B. perpendicular to the femoral shaft. C. perpendicular to a line drawn from the ASIS to the pubic symphysis. D. perpendicular to a line from the iliac crest to the pubic symphysis.

The Correct Answer is: C The landmarks that can be used in radiography of the bony pelvis are the iliac crest, the ASIS, the pubic symphysis, the greater trochanter, the ishchial tuberosity, and the tip of the coccyx. With the patient in the anatomic position, the femoral neck is located 2½ in. distal on a line drawn perpendicular to the midpoint of a line drawn between the ASIS and the pubic symphysis. It is recommended to rotate the legs inward about 15 degrees, whenever possible, to place the femoral neck parallel to the IR.

Which of the following positions would best demonstrate the lumbar intervertebral joints and foramina? A. LPO B. RPO C. Lateral D. PA

The Correct Answer is: C The lateral lumbar position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes. The posterior oblique positions (i.e., LPO and RPO) of the lumbar vertebrae demonstrate the apophyseal articulations closer to the IR. The left apophyseal articulations are demonstrated in the LPO position, whereas the right apophyseal articulations are demonstrated in the RPO position.

In Figure A, which of the localization lines is used for the lateral projection of the skull? A. Line 1 GML B. Line 2 OML C. Line 3 IOML D. Line 4 AML

The Correct Answer is: C The lateral projection of the skull requires that the patient be in the prone oblique position with the MSP parallel to the IR and the interpupillary line perpendicular to the IR. The IOML (line 3) must be parallel to the long axis of the IR. The supraorbital margins, anterior clinoid processes, and posterior clinoid processes should be superimposed.

The male bony pelvis differs from the female bony pelvis in which of the following way(s)? 1. The male pelvis has a larger pelvic inlet. 2. The female pubic arch is greater than 90 degrees. 3. The male ilium is more vertical. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: C The male and female bony pelves have several differing characteristics. An overview of comparisons is listed below. Male pelvis The general structure is heavy and thick. The greater, or false, pelvis is deep. The pelvic brim, or inlet, is small and heart-shaped. The acetabulum is large and faces laterally. The pubic angle is less than 90 degrees. The ilium is more vertical. Female pelvis The general structure is light and thin. The greater, or false, pelvis is shallow. The pelvic brim, or inlet, is large and oval. The acetabulum is small and faces anteriorly. The pubic angle is more than 90 degrees. The ilium is more horizontal.

The hard palate is formed by the 1. ethmoid bone. 2. maxillary bone. 3. palatine bone. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: C The maxillae are the second largest of the facial bones. They articulate with each other to form most of the upper jaw (hard palate). The palatine bones are small bones, forming the posterior one-third of the hard palate. They are L-shaped, and have vertical and horizontal processes. The horizontal parts articulate with the palatine processes of the maxillae to complete the hard palate. The vertical parts project superiorly from the horizontal part to articulate with the sphenoid bones

In the 45-degree medial oblique projection of the ankle, the 1. talotibial joint is visualized 2. tibiofibular joint is visualized 3. plantar surface should be vertical A. 1 only B. 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: C The medial oblique projection of the ankle can be performed either as a 15- to 20-degree oblique or as a 45-degree oblique. The 15- to 20-degree oblique projection demonstrates the ankle mortise, that is, the articulations between the talus, tibia, and fibula. The 45-degree oblique opens the distal tibiofibular joint. In all three cases, although the MSP can change, the plantar surface must be vertical.

Which of the following bones participate(s) in the formation of the obturator foramen? 1. Ilium 2. Ischium 3. Pubis A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

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

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

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

Which of the following positions demonstrates all the paranasal sinuses? A. Parietoacanthial B. PA axial C. Lateral D. True PA

The Correct Answer is: C The parietoacanthial (Waters' method) projection demonstrates the maxillary sinuses. The PA axial with a caudal central ray (Caldwell) demonstrates the frontal and ethmoidal sinus groups. The lateral projection, with the central ray entering 1 inch posterior to the outer canthus, demonstrates all the paranasal sinuses. X-ray examinations of the sinuses should always be performed erect, to demonstrate leveling of any fluid present.

Which of the following statements is (are) correct regarding the parietoacanthial projection (Waters' method) of the skull? 1. The head is rested on the extended chin. 2. The orbitomeatal line (OML) is perpendicular to the (IR). 3. The maxillary antra should be projected above the petrosa. A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: C The parietoacanthial projection (Waters' position) of the skull is valuable for the demonstration of facial bones or maxillary sinuses. The head is rested on the extended chin so that the OML forms a 37° angle with the IR. This projects the petrous pyramids below the floor of the maxillary sinuses and provides an oblique frontal view of the facial bones.

In a lateral projection of the nasal bones, the CR is directed A. 1/2 inch posterior to the anterior nasal spine B. 3/4 inch posterior to the glabella C. 1/2 inch distal to the nasion D. 1/2 inch anterior to the EAM

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

What is the position of the gallbladder in an asthenic patient? A. Superior and medial B. Superior and lateral C. Inferior and medial D. Inferior and lateral

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

Which of the following methods was used to obtain the image seen in Figure 2-6? A. erect PA, chin extended, OML forming 37 degrees to IR B. erect PA, OML, and CR perpendicular to IR C. erect PA, chin extended, OML 15 degree from horizontal D. erect PA, chin extended, OML 30 degree from horizontal

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

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

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

The oblique foot (internal rotation) demonstrates the articulation between the 1. talus and the calcaneus 2. calcaneus and the cuboid 3. talus and the navicular A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

Place the following anatomic structures in order from anterior to posterior: 1. Trachea 2. Apex of heart 3. Esophagus A. Trachea, esophagus, apex of heart B. Esophagus, trachea, apex of heart C. Apex of heart, trachea, esophagus D. Apex of heart, esophagus, trachea

The Correct Answer is: C The relationship of these three structures can be appreciated in a lateral projection of the chest. The heart is seen in the anterior half of the thoracic cavity, with its apex extending inferior and anterior. The air-filled trachea can be seen in about the center of the chest, and the air-filled esophagus just posterior to the trachea

Which of the anatomic structures listed below is seen most anteriorly in a lateral projection of the chest? A. Esophagus B. Trachea C. Cardiac apex D. Superimposed scapular borders

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

Below-diaphragm ribs are better demonstrated when A. respiration is suspended at the end of full inhalation. B. exposed using shallow breathing technique. C. the patient is in the recumbent position. D. the patient is in the AP erect position.

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

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

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

The functions of which body system include mineral homeostasis, protection, and triglyceride storage? A. Endocrine B. Integumentary C. Skeletal D. Muscular

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

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

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

The image shown in Figure 7-4 was made in the following recumbent position A. RAO B. Lateral C. LPO D. PA

The Correct Answer is: C The stomach is generally not parallel with the long axis of the body—its fundus/superior portion lies more posterior, and the pylorus/inferior portion lies more anterior. Consequently, in the recumbent position, barium will gravitate to the fundus when the patient is supine and to the pylorus when the patient is prone. Since the image shows a barium-filled fundus, it must have been made in the AP projection or LPO position. A look at the vertebrae indicates that the body is somewhat obliqued, indicating an LPO position. Note the double-contrast demonstration of rugal folds in the body of the stomach and double-contrast delineation of the pylorus and duodenal bulb.

The best projection to demonstrate the articular surfaces of the femoropatellar articulation is the A. AP knee. B. PA knee. C. tangential ("sunrise") projection. D. tunnel view.

The Correct Answer is: C The tangential ("sunrise") projection is used to demonstrate the articular surfaces of the femur and patella. It is also used to demonstrate vertical fractures of the patella. The AP, PA, and oblique projections of the knee are used primarily to evaluate the joint space and articulating structures. The tunnel view is used to demonstrate the intercondyloid fossa.

Which of the following radiographic examinations require(s) the patient to be NPO 8-10 hours prior to examination for proper patient preparation? 1. Abdominal survey 2. Upper GI series 3. BE A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: C There is no preparation required for an abdominal survey. For an upper GI series and a lower GI series (BE), the patient should be NPO, or have nothing by mouth, for 8 to 10 hours prior to the examination. In addition, a low-residue diet may be imposed, fluid intake may be increased, and cleansing enemas and laxatives may be prescribed to rid the colon of fecal matter.

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

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

Which of the following is (are) valid criteria for a lateral projection of the forearm? 1. The radius and ulna should be superimposed proximally and distally. 2. The coronoid process and radial head should be superimposed. 3. The radial tuberosity should face anteriorly. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

Which of the following projections of the ankle would best demonstrate the distal tibiofibular joint? A. Medial oblique 15° to 20° B. Lateral oblique 15° to 20° C. Medial oblique 45° D. Lateral oblique 45°

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

Which of the following radiologic examinations requires preparation consisting of a low-residue diet, cathartics, and enemas? A. Upper GI series B. Small bowel series C. Barium enema (BE) D. Intravenous (IV) cystogram

The Correct Answer is: C To have high diagnostic quality, a barium enema (BE) examination requires rigorous and complete patient preparation. This usually consists of a modified low-residue diet for a few days before the examination, cathartics the day before, and cleansing enemas the morning of the examination. Instructions for a upper GI series, small bowel series, and IV cystogram are usually to be NPO after midnight.

Which of the following positions may be used to effectively demonstrate the right posterior axillary ribs? A. LAO B. RAO C. RPO D. LPO

The Correct Answer is: C To place the right posterior axillary ribs parallel to the IR, an RPO position is required. The LAO will also demonstrate the right axillary ribs, but primarily the anterior portion. The RAO position will demonstrate the left anterior axillary ribs, and the LPO will demonstrate the left posterior axillary ribs

Which of the following radiologic examinations can demonstrate ureteral reflux? A. IV urogram B. Retrograde pyelogram C. Voiding cystourethrogram D. Nephrotomogram

The Correct Answer is: C Ureteral reflux is best demonstrated during voiding. It can occur even when the bladder is only partially filled with a contrast medium. The vesicourethral orifice, as well as other sphincter muscles, relaxes during urination; however, the vesicoureteral orifices may also relax and cause reflux.

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

The Correct Answer is: C When a cervical spine radiograph is requested to rule out subluxation or fracture, the patient will arrive in the radiology area on a stretcher. The patient should not be moved before a subluxation is ruled out. Any movement of the head and neck could cause serious damage to the spinal cord. A horizontal beam lateral projection is performed and evaluated. The physician then will decide what further images are required. Flexion and extension laterals are generally performed in cases of whiplash, to demonstrate degree of anterior/posterior motion.

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

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

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

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

What process is best seen using a perpendicular CR with the elbow in acute flexion and with the posterior aspect of the humerus adjacent to the image receptor? A. Coracoid B. Coronoid C. Olecranon D. Glenoid

The Correct Answer is: C When the elbow is placed in acute flexion with the posterior aspect of the humerus adjacent to the image receptor and a perpendicular CR is used, the olecranon process of the ulna is seen in profile. The coronoid process is best visualized in the medial oblique position. The coracoid and glenoid are associated with the scapula.

When a GI series has been requested on a patient with a suspected perforated ulcer, the type of contrast medium that should be used is A. a thin barium sulfate suspension. B. a thick barium sulfate suspension. C. water-soluble iodinated media. D. oil-based iodinated media.

The Correct Answer is: C Whenever a perforation of the GI tract is suspected, a water-soluble contrast agent (such as Gastrografin or oral Hypaque) should be used because it is easily absorbed from within the peritoneal cavity. Leakage of barium sulfate into the peritoneal cavity can have serious consequences. Water-soluble contrast agents also may be used in place of barium sulfate when the possibility of barium impaction exists. Oil-based contrast agents are used rarely today.

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

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

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

The Correct Answer is: C With inspiration, the diaphragm moves inferiorly and depresses the abdominal viscera. The ribs and sternum are elevated. As the ribs are elevated, their angle is decreased. Receptor exposure can vary considerably in appearance depending on the phase of respiration during which the exposure is mad

During an upper gastrointestinal (GI) examination, the AP recumbent projection of a stomach of average shape will usually demonstrate 1. anterior and posterior aspects of the stomach. 2. barium-filled fundus. 3. double-contrast body and antral portions. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: C With the body in the AP recumbent position, barium flows easily into the fundus of the stomach, displacing the stomach somewhat superiorly. The fundus, then, is filled with barium, while the air that had been in the fundus is displaced into the gastric body, pylorus, and duodenum, illustrating them in double-contrast fashion. Air-contrast delineation of these structures allows us to see through the stomach to the retrogastric areas and structures. Anterior and posterior aspects of the stomach are visualized in the lateral position; medial and lateral aspects of the stomach are visualized in the AP projection.

The position illustrated in the figure below (RAO position) can be used successfully to demonstrate the 1. PA oblique sternum 2. barium-filled pylorus and duodenum 3. left anterior axillary ribs A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The RAO position is shown. The barium-filled pylorus and duodenum are well demonstrated in this position, and the esophagus can be projected between the vertebrae and heart in this position. This RAO position is also used to superimpose the sternum onto the heart shadow to provide uniform receptor exposure throughout the sternum. The degree of obliquity depends on the patient's body habitus—greater obliquity is required for thinner chests. The RAO position is also used to see left anterior (axillary) ribs; in the anterior oblique positions, the affected side is away from the IR

When evaluating a PA axial projection of the skull with a 15-degree caudal angle, the radiographer should see 1. petrous pyramids in the lower third of the orbits 2. equal distance from the lateral border of the skull to the lateral rim of the orbit bilaterally 3. symmetrical petrous pyramids A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

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

Which of the following positions is obtained with the patient lying supine on the radiographic table with the CR directed horizontally to the iliac crest? A. Left lateral decubitus position B. Right lateral decubitus position C. Ventral decubitus position D. Dorsal decubitus position

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

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

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

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

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

All of the following statements regarding the RAO position of the sternum are true, except A. the sternum is generally projected to the left of the vertebral column. B. shallow breathing during the exposure can obliterate prominent pulmonary markings. C. it is helpful to project the sternum over the heart. D. a thin thorax requires a lesser degree of obliquity than a thicker thorax.

The Correct Answer is: D A thin chest would require a greater degree of obliquity to separate the vertebrae and sternum from superimposition than would a thick chest. With the patient in the RAO position, the sternum is projected to the left of the vertebral column and superimposed on the heart. This superimposition promotes more uniform tissue density and therefore more uniform receptor exposure. Prominent pulmonary vascular markings may be obliterated by allowing the patient to breathe (shallow breaths only) during a long exposure (with a very low mA).

Which of the following is used to obtain a lateral projection of the upper humerus on patients who are unable to abduct their arm? A. Bicipital groove projection B. Superoinferior lateral C. Inferosuperior axial D. Transthoracic lateral

The Correct Answer is: D A transthoracic projection is used to obtain a lateral projection of the upper half to two-thirds of the humerus when the arm cannot be abducted. The affected arm is placed next to the upright Bucky, the unaffected arm rests on the head, and the CR is directed horizontally through the thorax, exiting the upper humerus. The superoinferior and inferosuperior projections of the shoulder both require abduction of the arm.

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

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

Which of the following projections will best demonstrate acromioclavicular separation? A. AP recumbent, affected shoulder B. AP recumbent, both shoulders C. AP erect, affected shoulder D. AP erect, both shoulders

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

Which of the following positions is required to demonstrate small amounts of air in the pleural cavity? A. AP supine B. AP Trendelenburg C. Lateral decubitus, affected side down D. Lateral decubitus, affected side up

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

An increase in exposure factors usually is required in which of the following circumstances? 1. Edema 2. Ascites 3. Acromegaly A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: D An increase in exposure factors will be required when imaging pathologic conditions that cause greater attenuation of the x-ray beam. The x-ray beam suffers more attenuation as the thickness and/or density of the tissues increases. Examples include conditions involving an increase in part size as a result of fluid accumulation (edema) following trauma, an accumulation of fluid in the abdomen (ascites), or an increase in bone size and density (acromegaly) as a result of an endocrine disorder. The radiographer needs a good working knowledge of pathologic conditions, their effect on the body, and the resulting modifications in technical factors required.

What instructions might a patient be given following an upper GI examination? 1. Drink plenty of fluids. 2. Take a mild laxative. 3. Increase dietary fiber. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D Barium can dry and harden in the large bowel, causing symptoms ranging from mild constipation to bowel obstruction. It is therefore essential that the radiographer provide clear instructions, especially to outpatients, for follow-up care, along with the rationale for this care. To avoid the possibility of fecal impaction, patients should drink plenty of fluids for the next few days, increase their dietary fiber, and take a mild laxative such as milk of magnesia.

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

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

Which of the following pathologic conditions would require an increase in exposure factors? A. Pneumoperitoneum B. Obstructed bowel C. Renal colic D. Ascites

The Correct Answer is: D Because pneumoperitoneum is an abnormal accumulation of air or gas in the peritoneal cavity, it would require a decrease in exposure factors. Obstructed bowel usually involves distended, air- or gas-filled bowel loops, again requiring a decrease in exposure factors. With ascites, there is an abnormal accumulation of fluid in the abdominal cavity, necessitating an increase in exposure factors. Renal colic is the pain associated with the passage of renal calculi; no change from the normal exposure factors is usually required.

To better demonstrate the interphalangeal joints of the toes, which of the following procedures may be employed? 1. Angle the CR 15 degrees caudad. 2. Angle the CR 15 degrees cephalad. 3. Place a sponge wedge under the foot with the toes elevated 15 degrees. A. 1 only B. 1 and 2 only C. 1 and 3 only D. 2 and 3 only

The Correct Answer is: D Because the toes curve naturally downward, the interphalangeal joints are not well demonstrated in the AP (dorsoplantar) projection. To "open" the interphalangeal joints, the CR should be directed 15 degrees cephalad. Another method is to place a 15-degree foam sponge wedge under the foot, elevating the toes 15 degrees from the IR; the CR then would be directed perpendicularly.

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

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

Which of the following is (are) essential to high-quality mammographic examinations? 1. Small-focal-spot x-ray tube 2. Short-scale contrast 3. Use of a compression device A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: D Breast tissue has very low subject contrast, but it is imperative to visualize micro-calcifications and subtle tissue density differences. Fine detail is necessary to visualize any micro-calcifications; therefore, a small-focal-spot tube is essential. High, short-scale contrast (and, therefore, low kilovoltage) is needed to accentuate minute differences in tissue density. A compression device serves to even out differences in tissue thickness (thicker at the chest wall, thinner at the nipple) and decrease OID and helps to decrease the production of scattered radiation.

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

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

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

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

Angulation of the central ray may be required 1. to avoid superimposition of overlying structures. 2. to avoid foreshortening or self-superimposition. 3. to project through certain articulations. A. 1 only B. 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: D If structures are overlying or underlying the area to be demonstrated (eg, the medial femoral condyle obscuring the joint space in the lateral knee projection), central ray angulation is employed (eg, 5° cephalad angulation to see the joint space in the lateral knee). If structures would be foreshortened or self-superimposed (eg, the scaphoid in a PA wrist), central ray angulation may be employed to place the structure more closely parallel with the IR. Another example is the oblique cervical spine, where cephalad or caudad angulation is required to "open" the intervertebral foramina.

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

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

During endoscopic retrograde cholangiopancreatography (ERCP) examination, contrast medium is injected into the A. hepatic duct B. cystic duct C pancreatic duct D. common bile duct

The Correct Answer is: D Endoscopic retrograde cholangiopancreatography (ERCP) is performed to diagnose disease of the biliary and/or pancreatic organs. Fluoroscopic control is used to introduce the fiber-optic endoscope through the mouth and into the duodenum. The hepatopancreatic ampulla (of Vater) then is located and cannulated, and contrast medium is injected into the common bile duct.

Identify the structure labeled 1 in the AP projection of the knee shown in Figure 2-16. A. Lateral condyle B. Lateral epicondyle C. Medial condyle D. Medial epicondyle

The Correct Answer is: D Figure 2-16 shows an AP projection of the knee. The distal femur and proximal tibia and fibula are seen. The femorotibial joint space is open, and the tibial articular facets of the tibial plateau (number 4) are demonstrated. The intercondylar eminence (number 3) is seen. Number 2 is the medial femoral condyle; number 1 is the medial femoral epicondyle; and number 5 is the medial tibial condyle.

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

The Correct Answer is: D Generally, contrast medium is injected into the subarachnoid space between the third and fourth lumbar vertebrae (Figure 2-62). Because the spinal cord ends at the level of the first or second lumbar vertebra, this is considered to be a relatively safe injection site. The cisterna magna can be used, but the risk of contrast medium entering the ventricles and causing side effects increases. Diskography requires injection of contrast medium into the individual intervertebral disks.

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

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

Which of the following examinations might require the use of 120 kVp? 1. AP abdomen 2. Chest radiograph 3. Barium-filled stomach A. 1 only B. 2 only C. 1 and 2 only D. 2 and 3 only

The Correct Answer is: D High-kilovoltage factors are frequently used to even out densities in anatomic parts with high tissue contrast (eg, the chest). However, as high kilovoltage produces added scattered radiation, it generally must be used with a grid. It would be inappropriate to perform an AP abdomen with high kilovoltage because it has such low subject contrast. Barium-filled structures are frequently radiographed using 120 kV or more to penetrate the barium—to see through to structures behind.

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

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

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

The Correct Answer is: D In the AP projection of the elbow, the proximal radius and ulna are partially superimposed. In the lateral projection, the radial head is partially superimposed on the coronoid process, facing anteriorly. In the medial oblique projection, there is even greater superimposition. The lateral oblique projection completely separates the proximal radius and ulna, projecting the radial head, neck, and tuberosity free of superimposition with the proximal ulna.

In the AP knee projection of an asthenic patient who measures less than 19 cm from the anterior superior iliac spine (ASIS) to tabletop, the CR should be directed A. perpendicularly B. 5 degrees medially C. 5 degrees cephalad D. 5 degrees caudad

The Correct Answer is: D In the AP projection of the knee, the position of the joint space is significantly affected by the patient's overall body habitus and the distance between the ASIS and tabletop. When the patient is of sthenic habitus with a distance of 19 to 24 cm between the ASIS and tabletop, the CR is directed perpendicularly. When the patient is of asthenic habitus with a distance of less than 19 cm between the ASIS and tabletop, the CR is directed 5 degrees caudad. With a patient with a hypersthenic habitus and an ASIS-to-table measurement of greater than 24 cm, the CR is directed 5 degrees cephalad.

Which of the following will best demonstrate the lumbosacral junction in the AP position? A. CR perpendicular to L3 B. CR perpendicular to L5-S1 C. CR caudad 30-35 degrees D. CR cephalad 30-35 degrees

The Correct Answer is: D In the AP projection of the lumbar spine, the disk spaces of L1 to L4 are perpendicular to the IR and well visualized, but the L5 to S1 disk space is angled 30 to 35 degrees cephalad to the perpendicular. If the CR is directed 30 to 35 degrees cephalad midway between the ASIS and the publis symphysis, the L5 to S1 interspace will be well demonstrated.

Moderate hypertension can produce damage to which of the following organ(s) 1. Lungs 2. Kidneys 3. Brain A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

Moderate hypertension can produce damage to which of the following organs? 1. Lungs 2. Kidneys 3. Brain A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

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

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

Operative cholangiography may be performed to 1. visualize biliary stones or a neoplasm. 2. determine function of the hepatopancreatic ampulla. 3. examine the patency of the biliary tract. A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D Operative cholangiography may be performed to visualize biliary stones or a neoplasm, determine the function of the hepatopancreatic ampulla, and examine the patency of the biliary tract. Any strictures or obstructions may be localized when contrast medium is introduced into the catheter and images are obtained. It is important that no air bubbles are introduced into the biliary tract because they can imitate radiolucent stones. The radiographer can coordinate the time of exposure with the anesthesiologist to obtain the radiographs during suspended respiration.

A patient suffering from orthopnea would experience the least discomfort in which body position? A. Fowler B. Trendelenburg C. Recumbent D. Erect

The Correct Answer is: D Orthopnea is a respiratory condition in which the patient has difficulty breathing (dyspnea) in any position other than erect. The patient is usually comfortable in the erect, standing, or seated position. The Trendelenburg position places the patient's head lower than the rest of the body, the Fowler position is a semierect position, and the recumbent position is lying down.

Involuntary motion can be caused by 1. peristalsis. 2. severe pain. 3. heart muscle contraction. A. 1 only B. 2 only C. 1 and 2 only D. 1, 2, and 3

The Correct Answer is: D Patients who are able to cooperate are usually able to control voluntary motion. However, certain body functions and responses create involuntary motion that is not controllable by the patient. Severe pain, muscle spasm, and chills all cause involuntary movements. Peristaltic activity of the intestinal tract and motion caused by contraction of the heart muscle are other sources of involuntary motion.

The following instructions should be given to a patient following a barium sulfate contrast examination: 1. Increase fluid and fiber intake for several days. 2. Changes in stool color will occur until all barium has been evacuated. 3. Contact a physician if no bowel movement occurs in 24 hours. A. 1 only B. 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: D Physicians often prescribe a mild laxative to aid in the elimination of barium sulfate. If a laxative is not given, the patient should be instructed to increase dietary fluid and fiber and to monitor bowel movements (the patient should have at least one within 24 hours). Patients should also be aware of the white appearance of their stool that will be present until all barium is expelled.

Particulate matter entering the respiratory bronchi can cause A. emphysema. B. empyema. C. pneumothorax. D. pneumoconiosis.

The Correct Answer is: D Pneumoconiosis is a condition of the lungs characterized by particulate matter having been deposited in lung tissue; it sometimes results in emphysema. Overdistension of the alveoli with air is emphysema. The condition is often a result of many years of smoking and is characterized by dyspnea, especially when recumbent. Empyema is pus in the thoracic cavity; pneumothorax is air or gas in the pleural cavity.

Which of the following statements is (are) correct with respect to postoperative cholangiography? 1. A T-tube is in place in the common bile duct. 2. Water-soluble contrast material is injected. 3. The patency of biliary ducts is evaluated. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D Postoperative, or T-tube, cholangiography frequently is performed to evaluate the patency of the biliary ducts and to identify any previously undetected stones. Following surgery, a T-tube is left in place within the common bile duct, with the vertical portion of the T extending outside the body. Water-soluble iodinated contrast medium is injected, and fluoroscopic examination is carried out.

In which of the following procedures is quiet, shallow breathing recommended during the exposure to obliterate prominent pulmonary vascular markings? 1. RAO sternum 2. Lateral thoracic spine 3. AP scapula A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D Pulmonary vascular markings often are prominent in the elderly and in smokers. Quiet, shallow breathing may be used during a long exposure (with a compensating low milliamperage) to blur them out. Oblique sternum, AP scapula, and lateral thoracic spine projections are examinations in which this technique is useful.

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

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

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

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

During an intravenous urogram (IVU), the RPO position is used to demonstrate the 1. left kidney parallel to the IR 2. right kidney parallel to the IR 3. right kidney perpendicular to the IR A. 1 only B. 2 only C. 1 and 2 only D. 1 and 3 only

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

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

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

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

The Correct Answer is: D Surface landmarks, prominences, and depressions are very useful to the radiographer in locating anatomic structures that are not visible externally. The costal margin is at about the same level as L3. The umbilicus is at approximately the same level as the L3-4 interspace; its location can be variable especially as body habitus varies. Bony landmarks are generally more reliable than soft tissue landmarks. The xiphoid tip is at about the same level as T10. The fourth lumbar vertebra is at approximately the same level as the iliac crest.

Synovial fluid is associated with the A. brain. B. spinal canal. C. peritoneal cavity. D. bony articulations.

The Correct Answer is: D Synovial fluid is associated with diarthrotic (freely movable) bony articulations. Other types of bony articulations are fibrous (synarthrotic/immovable) and cartilaginous (amphiarthrotic/partially movable). Fluid associated with the brain and spinal canal is cerebrospinal fluid (CSF). The peritoneal and pleural cavities are associated with a lubricating serous fluid.

An accurately positioned oblique projection of the first through fourth lumbar vertebrae will demonstrate the classic "Scotty dog." What bony structure does the Scotty dog's neck represent? A. Superior articular process B. Pedicle C. Transverse process D. Pars interarticularis

The Correct Answer is: D The 45-degree oblique position of the lumbar spine generally is performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated. The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process.

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

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

Which of the following statements is (are) true regarding the PA axial projection of the cranium? 1. The central ray is directed caudally to the OML. 2. The petrous pyramids are projected into the lower third of the orbits. 3. The frontal sinuses are visualized. A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The Correct Answer is: D The PA axial (Caldwell) projection of the cranium can be used to demonstrate the frontal and ethmoid bones and the frontal and ethmoidal sinuses. The central ray is angled caudally 15° to the OML. This projects the petrous pyramids into the lower one third of the orbits, thus permitting optimal visualization of the frontal and ethmoidal sinuses. If the paranasal sinuses are being investigated, the OML forms a 15° angle with the horizontal CR. Additionally, the vertical grid should be angled 15°, or the patient's neck extended and forehead moved away from the IR. This is done to avoid tube angulation which could distort any sinus air/fluid levels.

The position RAO can be used successfully to demonstrate the 1. PA oblique sternum 2. barium-filled pylorus and duodenum 3. left anterior ribs A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The RAO position is shown. The barium-filled pylorus and duodenum are well demonstrated in this position, and the esophagus can be projected between the vertebrae and heart in this position. This RAO position is also used to superimpose the sternum onto the heart shadow to provide uniform receptor exposure throughout the sternum. The degree of obliquity depends on the patient's body habitus—greater obliquity is required for thinner chests. The RAO position is also used to see left anterior ribs; in the anterior oblique positions, the affected side is away from the IR

With which of the following does the lateral extremity of the clavicle articulate? A. Manubrium B. Coracoid process C. Coronoid process D. Acromion process

The Correct Answer is: D The S-shaped clavicle ("collar bone") is usually the last bone to completely ossify, at about age 21, and is one of the most commonly fractured bones in young people. Its medial end articulates with the sternum to form the sternoclavicular joint; the clavicle articulates laterally with the scapula's acromion process, forming the acromioclavicular joint. Superior dislocation of the acromioclavicular joint is a common athletic injury.

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

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

Which of the following skull positions will demonstrate the cranial base, sphenoidal sinuses, atlas, and odontoid process? A. AP axial B. Lateral C. Parietoacanthial D. Submentovertical (SMV)

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

Which of the following bones participate in the formation of the acetabulum? 1. Ilium 2. Ischium 3. Pubis A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The acetabulum is the bony socket that receives the head of the femur to form the hip joint. The upper two fifths of the acetabulum is formed by the ilium, the lower anterior one fifth is formed by the pubis, and the lower posterior two-fifths is formed by the ischium. Thus, the acetabulum is formed by all three of the bones that form the pelvis: the ilium, the ischium, and the pubis.

In the anterior oblique position of the cervical spine, the CR should be directed A. parallel to C4 B. perpendicular to C4 C. 15 degrees cephalad to C4 D. 15 degrees caudad to C4.

The Correct Answer is: D The anterior oblique positions (LAO and RAO) of the cervical spine require a 15-degree caudal angulation and demonstrate the intervertebral foramina closest to the IR. The posterior oblique positions (LPO and RPO) require that the CR be directed cephalad 15 degrees to C4. The posterior oblique positions demonstrate the intervertebral foramina farther away from the IR.

The first carpometacarpal joint is formed by the articulation of the base of the first metacarpal and the A. distal radius. B. distal ulna. C. scaphoid. D. trapezium.

The Correct Answer is: D The bases of the proximal row of phalanges articulate with the heads of the metacarpals to form the (condyloid) metacarpophalangeal joints, which permit flexion and extension, abduction and adduction, and circumduction. The bases of the metacarpals articulate with each other and the distal row of carpals at the carpometacarpal joints. The first carpometacarpal joint (thumb) is a saddle joint, permitting flexion and extension, abduction and adduction, and circumduction; it is formed by the articulation of the base of the first metacarpal and the trapezium.

Which of the following articulates with the base of the fifth metatarsal? A. First cuneiform B. Third cuneiform C. Navicular D. Cuboid

The Correct Answer is: D The bones of the foot include the seven tarsal bones, five metatarsal bones, and 14 phalanges. The calcaneus (os calsis) serves as the attachment for the Achilles tendon and articulates anteriorly with the cuboid bone. Articulating anteriorly with the navicular are the three cuneiform bones: medial/first, intermediate/second, and lateral/third. The navicular articulates laterally with the cuboid. The bases of the fourth and fifth metatarsals articulate with the cuboid. The fifth (most lateral) metatarsal projects laterally and presents a large tuberosity at its base making it very susceptible to fracture.

The structures forming the brain stem include 1. the pons 2. the medulla oblongata 3. the midbrain A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The brain generally is described as having three divisions. The forebrain is composed of the cerebrum, the thalamus, and the hypothalamus. The midbrain is a short, constricted portion connecting the forebrain to the hindbrain and containing the corpora quadrigemina and the aqueduct of Sylvius. The hindbrain is composed of the pons, medulla oblongata, and cerebellum. The brain stem is defined as the midbrain, pons, and medulla oblongata.

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

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

What portion of the humerus articulates with the ulna to help form the elbow joint? A. Semilunar/trochlear notch B. Radial head C. Capitulum D. Trochlea

The Correct Answer is: D The distal humerus articulates with the proximal radius and ulna to form the elbow joint. Specifically, the semilunar/trochlear notch of the proximal ulna articulates with the trochlea of the distal medial humerus. The capitulum is lateral to the trochlea and articulates with the radial head

Which of the following articulations participate in the formation of the elbow joint? 1. Between the humeral trochlea and the semilunar/trochlear notch 2. Between the capitulum and the radial head 3. The proximal radioulnar joint A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The distal humerus articulates with the radius and ulna to form a part of the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, that articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar notch of the ulna. All three articulations are enclosed in a common capsule to form the elbow joint proper.

To obtain an exact axial projection of the clavicle, place the patient A. supine and angle the central ray 30° caudally. B. prone and angle the central ray 30° cephalad. C. supine and angle the central ray 15° cephalad. D. in a lordotic position and direct the central ray at right angles to the coronal plane of the clavicle.

The Correct Answer is: D The exact axial projection is performed by placing the patient in a lordotic position, leaning against the vertical grid device. This places the clavicle at right angles, or nearly so, to the plane of the IR. The central ray is directed to enter the inferior border of the clavicle, at right angles to its coronal plane. Other axial projections may include a prone position with a 25° to 30° caudal angle. However, none of these produce an exact axial projection of the clavicle.

The stomach of an asthenic patient is most likely to be located A. high, transverse, and lateral. B. low, transverse, and lateral. C. high, vertical, and toward the midline. D. low, vertical, and toward the midline.

The Correct Answer is: D The four body types (from largest to smallest) are hypersthenic, sthenic, hyposthenic, and asthenic. The abdominal viscera of the asthenic person are generally located quite low, vertical, and toward the midline. The opposite is true of the hypersthenic individual: Organs are located high, transverse, and lateral.

Differences between body habitus types are likely to affect all the following except A. the size and shape of an organ. B. the position of an organ. C. the position of the diaphragm. D. the degree of bone porosity.

The Correct Answer is: D The four types of body habitus are (from upper extreme to lower extreme) hypersthenic, sthenic, hyposthenic, and asthenic. The gallbladder and stomach are higher and more lateral and the large bowel more peripheral in the hypersthenic individual. The diaphragm is in a higher position in the hypersthenic individual. Recognition of a patient's body habitus and its characteristics is an important part of accurate radiography. Bone porosity generally is unrelated to body habitus.

Which of the following criteria is (are) required for visualization of the greater tubercle in profile? 1. Epicondyles parallel to the IR 2. Arm in external rotation 3. Humerus in AP position A. 1 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The greater and lesser tubercles are prominences on the proximal humerus separated by the intertubercular (bicipital) groove. The AP projection of the humerus/shoulder places the epicondyles parallel to the IR and the shoulder in external rotation, and demonstrates the greater tubercle in profile. The lateral projection of the humerus places the shoulder in extreme internal rotation with the epicondyles perpendicular to the IR and demonstrates the lesser tubercle in profile.

Which of the following positions can be used to effectively demonstrate the left colic flexure during radiographic examination of the large bowel? 1. RAO 2. LAO 3. RPO A. 1 only B. 1 and 2 only C. 1 and 3 only D. 2 and 3 only

The Correct Answer is: D The hepatic (right colic) and splenic (left colic) flexures are not generally well demonstrated in the AP and PA projections. To "open" the flexures, oblique projections are required. The left anterior oblique (LAO, left PA oblique) and right posterior oblique (RPO, right AP oblique) positions are used to demonstrate the splenic flexure. The hepatic flexure is usually well demonstrated in the RAO and LPO positions.

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

The Correct Answer is: D The knee is formed by the proximal tibia, the patella, and the distal femur, which articulate to form the femorotibial and femoropatellar joints. Body habitus will change the relationship of the knee-joint space with the tabletop/IR considerably. The CR should be directed to ½ inch below patellar apex (knee joint). The direction of CR depends on distance between the ASIS and tabletop/IR. When this distance is up to 19 cm (thin pelvis), the CR should be directed 3 to 5 degrees caudad; when the distance is between 19 to 24 cm, the CR is directed vertically/perpendicular (0 degrees); when the distance is greater than 24 cm (thick pelvis), the CR is directed 3 to 5 degrees cephalad.

The mediolateral projection of the knee shown in Figure 6-1 could best be improved by A. rotating the patient forward B. rotating the patient backward C. angling the central ray (CR) about 5 degrees caudad D. angling the CR about 5 degrees cephalad

The Correct Answer is: D The knee is formed by the proximal tibia, the patella, and the distal femur, which articulate to form the femorotibial and femoropatellar joints. The distal posterior femur presents two large medial and lateral condyles separated by the deep intercondyloid fossa. Because the medial femoral condyle is further from the IR, it is magnified and will obscure the femorotibial joint space, as seen in the figure. If the CR is angled about 5 degrees cephalad, the medial femoral condyle will be projected superiorly and superimposed on the lateral femoral condyle, thus opening the joint space. The patient should lie on the affected side with the patella perpendicular to the tabletop and the knee flexed 20 to 30 degrees. Rotating the part forward or backward will affect visualization of the femoropatellar joint.

The lateral coccyx image shown in the figure below was made using AEC but is overexposed. This is most likely a result of A. incorrect selection of the small focal spot B. insufficient backup time C. selection of the center photocell D. incorrect centering of the part

The Correct Answer is: D The lateral projection of the coccyx seen in the figure is markedly overexposed. Although a small focal spot would not be a practical selection for a lateral coccyx, focal spot size is unrelated to receptor exposure. If insufficient backup time had been selected, the image would be underexposed. The center photocell is the appropriate photocell to select because the part of interest, the coccyx, should be in the center of the image. Because the coccyx was not centered to the IR (but rather the thicker hip portion of the body was centered), the AEC correctly exposed the thicker portion—thus overexposing the less dense coccyx area. Accurate positioning/centering is particularly important when using AEC.

Which of the following procedures requires that the patient be placed in the lithotomy position? A. Myelography B. Venography C. T-tube cholangiography D. Hysterosalpingography

The Correct Answer is: D The lithotomy position is generally employed for hysterosalpingography. The lithotomy position requires that the patient lie on the back with buttocks at the edge of the table. The hips are flexed, the knees are flexed and resting on leg supports, and the feet rest in stirrups

Which of the following vertebral groups form(s) lordotic curve(s)? 1. Cervical 2. Thoracic 3. Lumbar A. 1 only B. 2 only C. 1 and 2 only D. 1 and 3 only

The Correct Answer is: D The lordotic curves are secondary curves; that is, they develop sometime after birth. The cervical and lumbar vertebrae form lordotic curves. The thoracic and sacral vertebrae exhibit the primary kyphotic curves, those that are present at birth.

When comparing the male and female bony pelves, it is noted that the 1. male pelvis is deeper. 2. female pubic arch is greater than 90°. 3. female greater sciatic notch is wider. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The male and female bony pelves have several differing characteristics. Male pelvis • Heavy and thick general structure • Greater, or false, pelvis is deep • Pelvis brim, or inlet, is small and heart-shaped • Acetabulum is large and faces laterally • Pubic angle is less than 90° • Ilium is more vertical Female pelvis • Light and thin general structure • Greater, or false, pelvis is shallow • Pelvis brim, or inlet, is large and oval • Acetabulum is small and faces anteriorly • Pubic angle is more than 90° • Ilium is more horizontal

In the 15° medial oblique projection of the ankle, demonstrates the entire 1. talofibular joint. 2. tibiotalar joint. 3. ankle mortise. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The medial oblique projection of the ankle can be performed either as a 15° to 20° oblique or as a 45° oblique. The 15° to 20° oblique demonstrates the entire ankle mortise, that is, the articulations between the talus, tibia, and fibula. The talofibular articulation is open, the tibiotalar articulation is open, and the entire mortise is visible. The 45° oblique opens the distal tibiofibular joint. It is often recommended that the plantar surface be vertical.

The AP axial projection, or "frog leg" position, of the femoral neck places the patient in a supine position with the affected thigh A. adducted 25 degrees from the horizontal B. abducted 25 degrees from the vertical C. adducted 40 degrees from the horizontal D. abducted 40 degrees from the vertical

The Correct Answer is: D The patient is supine with the leg abducted (drawn away from the midline) approximately 40 degrees. This 40-degree abduction from the vertical places the long axis of the femoral neck parallel to the IR. Adduction is drawing the extremity closer to the midline of the body.

With which of the following does the femoral head articulate? 1. Ilium 2. Ischium 3. Pubis A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The pelvic girdle consists of two innominate bones, one on each side of the sacrum. Each innominate bone consists of three fused bones: the ilium, ischium, and pubis. Parts of these three bones contribute to the formation of the acetabulum—the socket articulation for the femoral head. (

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

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

Which of the following positions is most likely to offer the best visualization of the pulmonary apices? A. Lateral decubitus B. Dorsal decubitus C. Erect lateral D. AP axial lordotic

The Correct Answer is: D The pulmonary apices are often at least partially obscured by the clavicles. To visualize the entire lung apex and any suspicious areas, the clavicles must be "removed." This can be accomplished with the AP axial lordotic position. Through the arching of the patient's back and the cephalad angulation, the clavicles are projected upward and out of the pulmonary apices. Decubitus positions are used primarily to see air-fluid levels. Lateral and dorsal decubitus positions show fluid in the side that is down and air in the side that is up.

The structure labeled 5 in Figure 2-32 is the A. body of C1 B. body of C2 C. odontoid process D. anterior arch of C1

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

Muscles that contribute to the formation of the rotator cuff include the 1. subscapularis. 2. infraspinatus. 3. teres minor. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D The rotator cuff is a musculotendinous structure that includes the supraspinatus, infraspinatus subscapularis, and teres minor muscles. The muscles function to stabilize the humeral head in all arm motions and, together with the deltoid, function to abduct and rotate the arm. Weakness of the rotator cuff can lead to impingement syndrome and/or tendonitis. A tear of the cuff can result in subluxation; calcification can lead to shoulder immobilization.

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

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

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

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

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

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

Which of the following structures will be filled with barium in the AP recumbent position of a sthenic patient during an upper GI examination? A. Duodenal bulb B. Descending duodenum C. Pyloric vestibule D. Gastric fundus

The Correct Answer is: D The stomach is normally angled with the fundus lying posteriorly and the body, pylorus, and duodenum inferior to the fundus and angling anteriorly. Therefore, when the patient ingests barium and lies AP recumbent, the heavy barium gravitates easily to the fundus and fills it. With the patient PA recumbent, barium gravitates inferiorly to the body, pylorus, and duodenum, displacing air into the fundus.

Which of the following structures will usually contain air, in the PA recumbent position on a sthenic patient, during a double-contrast upper GI (UGI) examination? A. Duodenal bulb B. Descending duodenum C. Pyloric vestibule D. Gastric fundus

The Correct Answer is: D The stomach is normally angled with the fundus lying posteriorly and the body, pylorus, and duodenum inferior to the fundus and angling anteriorly. Therefore, when the patient ingests barium and lies AP recumbent, the heavy barium gravitates easily to the fundus and fills it. With the patient PA recumbent, barium gravitates inferiorly to the body, pylorus, and duodenum, displacing air into the fundus.

Tangential axial projections of the patella can be obtained in which of the following positions? 1. supine flexion 45° (Merchant) 2. prone flexion 90° (Settegast) 3. prone flexion 55° (Hughston) A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3 only

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

Which of the following is proximal to the carpal bones? A. Distal interphalangeal joints B Proximal interphalangeal joints C. Metacarpals D. Radial styloid process

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

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

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

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

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

Which of the following is (are) valid evaluation criteria for a lateral projection of the forearm? 1. The radius and the ulna should be superimposed distally. 2. The coronoid process and the radial head should be partially superimposed. 3. The humeral epicondyles should be superimposed. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D To accurately position a lateral forearm, the elbow must form a 90-degree angle with the humeral epicondyles superimposed. The radius and ulna are superimposed distally. Proximally, the coronoid process and radial head are partially superimposed. Failure of the elbow to form a 90-degree angle or the hand to be lateral results in a less than satisfactory lateral projection of the forearm.

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

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

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

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

Which of the following is most likely to be the correct routine for a radiographic examination of the forearm? A. PA and medial oblique B. AP and lateral oblique C. PA and lateral D. AP and lateral

The Correct Answer is: D To demonstrate the radius and ulna free of superimposition, the forearm must be radiographed in the AP position, with the hand supinated. Pronation of the hand causes overlapping of the proximal radius and ulna. Two views, at right angles to each other, are generally required for each examination. Therefore, AP and lateral is the usual routine for an examination of the forearm.

Which of the following criteria are used to evaluate a PA projection of the chest? 1. Ten posterior ribs should be visualized. 2. Sternoclavicular joints should be symmetrical. 3. The scapulae should be lateral to the lung fields. A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D To evaluate sufficient inspiration and lung expansion, 10 posterior ribs should be visualized. The sternoclavicular joints should be symmetrical; any loss of symmetry indicates rotation. To visualize maximum lung area, the shoulders are rolled forward to move the scapulae laterally from the lung fields.

Routine excretory urography usually includes a postmicturition radiograph of the bladder. This is done to demonstrate 1. tumor masses. 2. residual urine. 3. prostatic enlargement. A. 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

The Correct Answer is: D Variance from the normal bladder contour will be noted while the bladder is full of contrast medium. However, a postmicturition (postvoiding) radiograph is also an essential part of an IVU/IVP. The presence of residual urine may be an indication of small tumor masses or, in male patients, enlargement of the prostate gland.

The condition that allows blood to shunt between the right and left ventricles is called A. patent ductus arteriosus. B. coarctation of the aorta. C. atrial septal defect. D. ventricular septal defect.

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

What is the best position/projection to demonstrate the longitudinal arch of the foot? A. Mediolateral B. Lateromedial C. Mediolateral weight-bearing lateral D. Lateromedial weight-bearing lateral

The Correct Answer is: D Weight-bearing lateral projections of the foot are requested often to evaluate the longitudinal arch structure of the foot. The patient stands on a small platform. The x-ray cassette is placed between the feet, in a slot provided on the platform, with the top of the cassette against the medial aspect of the foot. The CR is directed to enter the lateral aspect of the foot perpendicular to the base of the fifth metatarsal and to exit the medial side of the foot.

Free air in the abdominal cavity is demonstrated in which of the following? 1. Lateral recumbent abdomen 2. Erect AP abdomen 3. Left lateral decubitus abdomen A. 1 only B. 2 only C. 1 and 2 only D. 2 and 3 only

The Correct Answer is: D When air-fluid levels are to be demonstrated, it is important to direct the central ray horizontally. If the central ray is angled or directed vertically, the air or fluid level will be distorted or entirely obliterated. Free air in the abdominal cavity is best visualized when the patient is left lateral decubitus or erect AP. The decubitus allows the air to accumulate around the homogeneous liver.

In what order should the following examinations be scheduled? 1. Upper GI 2. Intravenous pyelogram (IVP) 3. Barium enema (BE) A. 3, 1, 2 B. 1, 3, 2 C. 2, 1, 3 D. 2, 3, 1

The Correct Answer is: D When scheduling patient examinations, it is important to avoid the possibility of residual contrast medium covering areas of interest on later examinations. The IVP should be scheduled first because the contrast medium used is excreted rapidly. The BE should be scheduled next. Finally, the upper GI series is scheduled. Any barium remaining from the previous BE should not be enough to interfere with the stomach or duodenum (a preliminary scout image should be taken in each case).

Using the PA projection, which of the following tube angle and direction combinations is correct for an axial projection of the clavicle? A. 5 to 15 degrees caudad B. 5 to 15 degrees cephalad C. 15 to 30 degrees cephalad D 15 to 30 degrees caudad

The Correct Answer is: D When the clavicle is examined in the PA axial projection, the CR must be directed 15 to 30 degrees caudad to project most of the clavicle's length above the ribs. The direction of the CR is reversed when examining the patient in the AP position.

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

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

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

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

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

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

Which of the following are demonstrated in the oblique position of the cervical spine? 1. Intervertebral foramina 2. Zygapophyseal joints 3. Intervertebral joints A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The correct answer is (A). Intervertebral joints are well visualized in the lateral projection of all the vertebral groups. Cervical articular facets (forming zygapophyseal joints) are 90° to the midsagittal plane and are therefore well demonstrated in the lateral projection. The cervical intervertebral foramina lie 45° to the midsagittal plane (and 15° to 20° to a transverse plane) and are therefore demonstrated in the oblique position.

Which of the following is (are) well demonstrated in the oblique position of the cervical vertebrae? 1. Intervertebral foramina 2. Disk spaces 3. Zygapophyseal joints A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The correct answer is (A). The cervical intervertebral foramina form a 45-degree angle with the MSP and, therefore, are well visualized in a 45-degree oblique position. Zygapophyseal joints are formed by articulating surfaces of the inferior articular facet of one vertebra with the superior articular facet of the vertebra below; they are well demonstrated in the lateral position of the cervical spine. The intervertebral disk spaces are best demonstrated in the lateral position.

Which of the following positions would best demonstrate the left zygapophyseal articulations of the lumbar vertebrae? A. LPO B. RPO C. Left lateral D. PA

The correct answer is (A). The posterior oblique positions (LPO, RPO) of the lumbar vertebrae demonstrate the zygapophyseal articulations closer to the image receptor. The left zygapophyseal articulations are demonstrated in the LPO position, while the right zygapophyseal articulations are demonstrated in the RPO position. The lateral position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes.

Which of the following is (are) demonstrated in the AP projection of the thoracic spine? 1. Intervertebral spaces 2. Zygapophyseal joints 3. Intervertebral foramina A. 1 only B. 2 only C. 1 and 3 D. 1, 2, and 3

The correct answer is (A). The thoracic intervertebral (disk) spaces are demonstrated in the AP and lateral projections, although they are probably best demonstrated in the lateral. The thoracic zygapophyseal joints are 70° to the MSP and are demonstrated in a steep (70°) oblique position. The thoracic intervertebral foramina, formed by the vertebral notches of the pedicles, are 90° to the MSP. They are therefore well demonstrated in the lateral position.

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

The correct answer is (B). Intervertebral joints (include: intervertebral disc and facet joints/zygapophyseal) are well visualized in the lateral projection of all the vertebral groups. Cervical articular facets (forming zygapophyseal joints) are 90 degrees to the MSP and, therefore, are well demonstrated in the lateral projection. The cervical intervertebral foramina lie 45 degrees to the MSP (and 15-20 degrees to a transverse plane) and, therefore, are demonstrated in the oblique position.

Which of the following is (are) demonstrated in an AP axial projection of the cervical spine? 1. Intervertebral disk spaces 2. C3-7 cervical bodies 3. Zygapophyseal joints A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The correct answer is (B). The AP axial projection of the cervical spine demonstrates the bodies and intervertebral spaces of the last five vertebrae (C3-7). The cervical zygapophyseal joints are 90 degrees to the MSP and, therefore, are demonstrated in the lateral projection.

The term varus refers to A. turned outward B. turned inward C. rotated medially D. rotated laterally

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

An axial projection of the clavicle is often helpful in demonstrating a fracture that is not visualized using a perpendicular CR. When examining the clavicle in the PA axial projection, how should the Central Ray directed? A. Cephalad B. Caudad C. Medially D. Laterally

The correct answer is (B). With the patient positioned erect or supine, the CR is directed cephalad 25 to 30°. This serves to project the clavicle away from the pulmonary apices and ribs, projecting most of the clavicle above the thorax. The reverse is true when the patient is examined for the PA axial projection, i.e. the CR is directed caudally. The PA and PA axial projections can be useful for better resolution because of the reduced OID.

Which of the following is (are) well demonstrated in the lateral lumbar spine pictured in Figure 2-8? 1. Zygapophyseal articulations 2. Intervertebral foramina 3. Pedicles A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The correct answer is (C). A lateral projection of the lumbar spine is illustrated. The intervertebral articulations (disk spaces) are well demonstrated. Because the intervertebral foramina, which are formed by the pedicles, are 90 degrees to the MSP, they are also well demonstrated in the lateral projection. The articular facets, forming the zygapophyseal joints, lie 30 to 50 degrees to the MSP and are visualized in the oblique position.

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

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

Which of the following positions will demonstrate the lumbosacral zygapophyseal articulation? A. AP B. Lateral C. 30-degree RPO D. 45-degree LPO

The correct answer is (C). The articular facets (zygapophyseal joints) of the L5-S1 articulation form a 30-degree angle with the MSP; they are, therefore, well demonstrated in a 30-degree oblique position. The 45-degree oblique position demonstrates the zygapophyseal joints of L1-4.

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

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

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

The correct answer is (C). The thoracic intervertebral (disk) spaces are demonstrated in the AP and lateral projections, although they are probably best demonstrated in the lateral projection. The thoracic zygapophyseal joints are 70 degrees to the MSP and are demonstrated in a steep (70-degree) oblique position. The thoracic intervertebral foramina, formed by the vertebral notches of the pedicles, are 90 degrees to the MSP. They are, therefore, well demonstrated in the lateral position.

The zygapophyseal articulations of the thoracic spine are demonstrated with the A. coronal plane 45° to the IR. B. midsagittal plane 45° to the IR. C. coronal plane 70° to the IR. D. midsagittal plane 70° to the IR.

The correct answer is (C). The thoracic zygapophyseal joints are demonstrated by placing the patient in an oblique position with the coronal plane 70° to the IR (MSP 20° to the IR). This may be accomplished by first placing the patient lateral, then obliquing the patient 20° "off lateral." The zygapophyseal joints closest to the IR are demonstrated in the PA oblique, and those remote from the IR in the AP oblique. Comparable resolution is obtained using either method, because the OID is about the same.

To demonstrate the entire circumference of the radial head, the required exposure(s) must include 1. epicondyles perpendicular to the IP 2. hand pronated 3. hand supinated as much as possible A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

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

Which of the following positions would demonstrate the right lumbar zygapophyseal articulations closest to the IR? A. LAO B. RAO C. LPO D. RPO

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

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

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

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

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

What is the anatomic structure indicated by number 3 in the radiograph in Figure 6-20? A. Mandibular angle B. Coronoid process C. Zygomatic arch D. Maxillary sinus

The correct answer is: (B) A parietoacanthal projection (Waters position) of the skull is shown. The chin is elevated sufficiently to project the petrous ridges below the maxillary sinuses (number 4). Note that the foramen rotundum is seen near the upper margin of the maxillary sinuses. Other paranasal sinus groups are not well visualized in this position, although a modification with the mouth open may be taken to demonstrate the sphenoidal sinuses. This is also the single best projection to demonstrate the facial bones. The zygomatic arch (number 2) is well demonstrated; the mandible, its angle (number 1), and the coronoid process (number 3) are also well demonstrated. The odontoid process is seen projected through the foramen magnum. The mastoid air cells are seen adjacent to the mandibular angle as multiple small, air-filled, bony spaces.

What is the anatomic structure indicated by number 4 (scotty dog leg) in the radiograph in Figure 6-21? A. Superior articular process B. Inferior articular process C. Pedicle D. Lamina

The correct answer is: (B) An LPO position of the lumbar spine is shown. The patient is positioned so that the lumbar spine forms a 45-degree angle with the IR. The apophyseal joints (those closest to the IR) are well demonstrated in this position. The typical "Scotty dog" image is depicted. The "ear" of the Scotty is the superior articular process (number 1), and the front foot is the inferior articular process (number 4). The Scotty's eye is the pedicle (number 2), its body is the lamina (number 3), its nose is the transverse process (number 5), and it's "neck" is the pars interarticularis (number 6).

Which of the following may be used as landmark(s) for an AP projection of the hip? 1. 2 inches medial to the ASIS 2. Prominence of the greater trochanter 3. Midway between the iliac crest and the pubic symphysis A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The correct answer is: (B) For an AP projection of the hip, two bony landmarks are used. The CR is directed perpendicular to a point located 2 inches medial to the ASIS at the level of the greater trochanter. A point midway between the iliac crest and the pubic symphysis is too superior and medial to coincide with the hip articulation.

A patient is usually required to drink barium sulfate suspension to demonstrate which of the following structures? 1. Esophagus 2. Pylorus 3. Ilium A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The correct answer is: (B) Oral administration of barium sulfate is used to demonstrate the upper digestive tract: the esophagus; the fundus, body, and pylorus of the stomach; and the small bowel, consisting of duodenum, jejunum, and ileum (i.e. small bowel..not ilium). Consistent care must be taken to read and record patient information accurately and correctly. The large bowel is usually demonstrated via rectal administration of barium.

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

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

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

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

Which of the following will be demonstrated best in the 45-degree right anterior oblique (RAO) position? A. Right axillary ribs B. Left axillary ribs C. Sternum in the heart shadow D. Left scapular Y

The correct answer is: (B) The axillary portions of ribs are demonstrated in a 45-degree oblique position. In order to place the axillary portions parallel to the image receptor (IR), the affected side is away from the IR in the PA oblique (RAO and LAO) positions and toward the IR in the AP oblique (RPO and LPO) positions. Radiography of the sternum, in the slight RAO position, requires greater obliquity for thinner patients and lesser obliquity for thicker patients. The scapular Y position of the shoulder is performed to demonstrate dislocation and requires a rotation of 45-60 degrees, with the affected side closest to the IR.

Which of the following is a vessel that does not carry oxygenated blood? A. Pulmonary vein B. Pulmonary artery C. Coronary artery D. Chordae tendineae

The correct answer is: (B) Venous blood is returned to the right atrium of the heart via the superior (from the upper part of the body) and inferior (from the lower body) venae cavae and the coronary sinus (from the heart substance). During atrial systole, the blood passes through the tricuspid valve into the right ventricle. During ventricular systole, the blood is pumped through the pulmonary semilunar valve into the pulmonary artery (the only artery to carry unoxygenated blood) to the lungs for oxygenation. Blood is returned via the pulmonary veins (the only veins to carry oxygenated blood) to the left atrium. During atrial systole, blood passes through the mitral (bicuspid) valve into the left ventricle. During ventricular systole, the oxygenated blood is pumped through the aortic semilunar valve into the aorta. The coronary arteries supply oxygenated blood to the myocardium. The chordae tendineae are connective tissue fibers that help to limit the movement of valve flaps, preventing backflow of blood.

During studies of the soft tissue of the neck, the exposure can be made 1. during phonation before/after opacification. 2. during Valsalva maneuver. 3. at the height of swallowing motion with opacification. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The correct answer is: (D) Soft tissue neck studies can be performed for a number of reasons including to determine presence of foreign body or to evaluate the swallowing mechanism following a stroke event. Phonation of various vowel sounds, with or without contrast media opacification, can help demonstrate the vocal cords. Performance of the Valsalva maneuver fills the larynx and trachea with air, which is then well demonstrated on soft tissue study. Pharyngeal structures are demonstrated during swallowing motion.

A flat and upright abdomen is requested on an acutely ill patient, to demonstrate the presence of air-fluid levels. Because of the patient's condition, the x-ray table can be tilted upright only 70° (rather than the desired 90°). How should the central ray be directed? A. Perpendicular to the IR B. Parallel to the floor C. 20° caudad D. 20° cephalad

The correct answer is: (B) Whenever a part is being radiographed for demonstration of air-fluid levels, the central ray must be directed parallel to the floor; horizontal beam is necessary for visualization of a air fluid levels. In this example, the patient was unable to tolerate the 90° tilt of the x-ray table. If the radiographer were to compensate for this by directing the central ray perpendicular to the IR (angling 20° caudad), it is very possible that any air-fluid level would be blurred and indistinct, and would go unrecognized. Remember that air or fluid always levels out parallel to the floor. Thus, if the air-fluid level needs to be demonstrated, the central ray must also be parallel to the floor.

Intervertebral foramina will be demonstrated in which of the following projections? 1. Lateral cervical spine 2. Lateral thoracic spine 3. Lateral lumbar spine A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The correct answer is: (C) The intervertebral foramina of the thoracic and lumbar vertebrae are best demonstrated in the lateral projection. The cervical intervertebral foramina are well demonstrated when placed 45 degrees to the IR and CR.

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

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

Which of the positions illustrated below would best demonstrate the cervical pedicles? 1. A (PA oblique). 2. B (Lateral). 3. C (AP oblique). A. 1 only B. 2 only C. 1 and 3 only D. 2 and 3 only

The correct answer is: (C) Three positions of the cervical spine are illustrated. Figure B shows the left lateral position. Lateral projections of the cervical spine are done to demonstrate the intervertebral disk spaces, apophyseal joints, and spinous processes. Apophyseal joints are formed by adjacent superior and inferior articular processes and their facets. Spinous processes are formed by the union of the laminae. Figure A is an RAO with caudal angulation; Figure C is an LPO with cephalad angulation. Anterior oblique positions (LAO, RAO) of the cervical spine demonstrate the intervertebral foramina closer to the IR, while posterior oblique positions (LPO, RPO) demonstrate the intervertebral foramina farther from the IR. Intervertebral foramina are formed by the vertebral notches of the pedicles.

Which of the following projection(s) require(s) that the shoulder be placed in internal rotation? 1. AP humerus 2. AP thumb 3. Lateral humerus A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

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

Which of the following statements is (are) true regarding the lateral projection of the lumbar spine? 1. The MSP is parallel to the tabletop. 2. The vertebral foramina are well visualized. 3. The pedicles are well visualized. A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The correct answer is: (C) With the patient in the lateral position, the MSP is parallel to the x-ray tabletop. Because the intervertebral foramina, which are formed by the pedicles, are 90 degrees to the MSP, they are well demonstrated in the lateral projection. The intervertebral joints (i.e., disk spaces) are also well demonstrated. The spinal cord passes through the vertebral foramina, which would not be visualized in conventional radiography of the lumbar spine.

Which of the positions will best demonstrate the lumbar intervertebral foramina? 1. RPO 2. LAO 3. AP Supine 4. Left Lateral A. Number 1 B. Number 2 C. Number 3 D. Number 4

The correct answer is: (D) Four positions for the lumbar spine are illustrated. Number 1 is an RPO, and number 2 an LAO. The posterior oblique positions (LPO and RPO) demonstrate the apophyseal joints closer to the IR, while the anterior oblique positions (LAO and RAO) demonstrate the apophyseal joints further from the IR. Number 3 is the AP projection, which demonstrates the lumbar bodies and disk spaces and the transverse and spinous processes. Number 4 is the lateral position, which provides the best demonstration of the lumbar bodies, intervertebral disk spaces, spinous processes, pedicles, and intervertebral foramina.

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

The correct answer is: (D) Spinal column studies often are required for evaluation of adolescent scoliosis, thus presenting a twofold problem—radiation exposure to youthful gonadal and breast tissues and significantly differing tissue densities/thicknesses. Exposure-dose concerns also addressed with the use of a compensating filter (for uniform density) that incorporates lead shielding for the breasts and gonads

Abdominal viscera located in the retroperitoneum include the 1. kidneys. 2. duodenum. 3. ascending and descending colon. A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1, 2, and 3

The correct answer is: (D) Structures located behind the parietal peritoneum are referred to as retroperitoneal. Retroperitoneal structures include the kidneys, adrenal glands, pancreas, duodenum, ascending and descending colon, portions of the aorta, and the inferior vena cava.

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

The correct answer is: (D) The thoracic cavity contains the lungs and heart and is separated from the abdominal cavity by the diaphragm. The mediastinum is the space between the lungs which contains the heart and great vessels, trachea, esophagus, thymus, lymph nodes, and connective tissue.

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

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

A modified axiolateral inferosuperior projection of the femoral neck is particularly useful 1. when the "cross-table" axiolateral is contraindicated. 2. for patients with bilateral hip fractures. 3. for patients with limited movement of the unaffected leg. A. 1 only B. 1 and 2 only C. 1 and 3 only D. 1, 2, and 3

The correct answer is: (D) Typically, traumatic injury to the hip requires a cross-table (axiolateral) lateral projection. Occasionally, this projection may be contraindicated, for example, a patient with suspected bilateral hip fractures, or one who is unable to move the unaffected hip out of the way as required by the axiolateral. In these instances, the axiolateral inferosuperior trauma projection (Clements-Nakayama method) can be employed. The patient is recumbent with lateral surface of affected side close to table/stretcher edge. The CR is directed almost horizontally to the affected femoral neck (inferosuperior), with a 15° posterior angulation. Correct placement and angulation of the grid cassette is essential to avoid grid cutoff.

The type of ileus characterized by cessation of peristalsis is termed A. mechanical B. paralytic C. asymptomatic D. sterile

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

In which projection of the foot are the sinus tarsi, cuboid, and tuberosity of the fifth metatarsal best demonstrated? A. Lateral oblique foot B. Medial oblique fooT C. Lateral foot D. Weight-bearing foot

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