Procedures

In the posterior oblique projection of the pelvis - Judet method, placing the affected side down will demonstrate: (1) Anterior acetabular rim (2) Posterior acetabular rim (3) Posterior ilioischial column A

(1)(3)

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

A

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

A

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

A

To position a patient for a Danelius-Miller axiolateral cross-table projection of the hip: A The knee and the hip of the unaffected leg is flexed and elevated. B The knee and the hip of the affected leg is flexed and elevated. C Both legs are left extended, and the central ray is directed 15 degrees posterior from the horizontal plane. D The knee of the affected leg is flexed, the thigh is drawn up to a near right angle and abducted, and the tube is angled cephalad 20 to 25 degrees.

A

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

A

For the lateral thoracic spine breathing technique, how long of an exposure is needed to adequately blur out overlying ribs and lung markings? A 2-3 seconds B 4-5 seconds C 6-8 seconds D 9-10 seconds

A Breathing technique for the lateral thoracic spine can be useful in demonstrating pathology of the vertebrae by blurring out lung markings and overlying ribs. This technique, if a patient can cooperate, only requires a 2-3 minute (A) exposure time. The technique also requires a low mA setting due to the longer exposure.

Centering for the posterior oblique positions of the lumbar spine is: A Lower costal margin B 1 inch distal to iliac crest C L2 D 2 inches medial to downside ASIS

A Lower costal margin (cetnered @ L3) (2 inches above the iliac crest)(2 inches medial to the upside ASIS)

A properly positioned PA axial (Caldwell) projection of the skull directs the central ray: A 15 - 20 degrees cephalad, exiting the acanthion. B 10 - 15 degrees caudal, exiting the nasion. C 10 - 15 degrees caudal, exiting the glabella. D 30 degrees caudal, entering the nasion.

B

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

B

When performing the lateral hyperflexion and hyperextension lumbar series, which of the following is true: A The SID is increased to 72 inches to account for air gap B The pelvis should act as a fulcrum during the series C Images are taken on suspended inspiration for consistent density D The bottom of the IR should reach the coccyx

B During this series, the pelvis should act as a fulcrum, or pivot-point, for the spine (B). When performing the series standing, it is imperative that the flexion and extension come from the spine rather than the hips, the pivot should not extend to the hip joints. The SID will remain at 48 inches (A); no significant airgap is present. All images in this series are taken at suspended expiration (C), inspiration would have the lung fields expand and create differences in receptor exposure. The bottom of the IR should allow for 1-2 inches of the iliac crest in the series; the coccyx is not needed (D). (Lampignano & Kendrick, 9th edition, 346)

An AP axial projection of the cervical spine is performed with a central ray angle directed 15 to 20 degrees cephalad. This will result in: A Visualization of intervertebral foramina on the resulting radiograph. B Visualization of intervertebral disk spaces on the resulting radiograph. C A non-diagnostic image, as the central ray should be directed caudal for the AP axial projection. D Visualization of the zygapophyseal joint spaces on the resulting radiograph.

B The AP axial projection is performed with a 15-20 degree cephalad angle, which aligns the direction of the central ray with the plane of the intervertebral disk spaces. The intervertebral foramina appear on oblique projections, while zygapophyseal joints of the cervical spine can be seen on a lateral projection. It is strongly recommended that a student preparing for the credentialing exam construct a table of which anatomy appears on which projections for the entire spine, as this is common material from which comprehensive assessment derives.

Which of the following are benefits of providing waist support for the recumbent lateral thoracic spine: (1) The support helps bring the lower and upper thoracic vertebrae to the same distance from the table (2) Using a support reduces vertebral tilt (3) Scatter reduction A 2 only B 1 and 2 only C 1 and 3 only D 1, 2 and 3

B 1 and 2 only When imaging the lateral thoracic spine in a recumbent position, adding a support sponge below the waist can help even out the OID between both the upper and lower vertebrae and the table (1). In bringing the vertebrae to the same level, tilt is also reduced (2). The sponge will not, however, supply a reduction in scatter (3); a lead mat placed posteriorly to the spine can help in scatter reduction.

Which of the following is an advantage of imaging the lumbar spine in the PA position: A Reduction of lordotic curvature B The intervertebral spaces are positioned more parallel to the divergent rays C Reduced OID D Reduced rotation

By replacing the AP lumbar spine projection with the PA lumbar spine projection, the intervertebral spaces are aligned more parallel to the divergent rays (B). This positioning difference will not reduce the lordotic curve (A) and will increase the OID (C) between the vertebrae and the IP. The positioning change should not impact rotation (D). (Lampignano & Kendrick, 9th edition, 337)

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.

C

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

C

Which of the following is (are) well demonstrated in the LATERAL lumbar spine Zygapophyseal articulations Intervertebral foramina Pedicles

C 2 and 3 only

Which of the following are required for the AP axial projection of L5-S1: (1) 25° cephalic tilt for females (2) Centering at the ASIS (3) Support under the knees for comfort and reduction of pelvic tilt A 2 only B 1 and 2 only C 2 and 3 only D 1, 2 and 3

C For the AP axial projection of the lumbar spine, the goal is to open the joint space between L5 and S1. The CR is centered at the ASIS (2) with the patient's knees bent to reduce pelvic tilt and provide comfort. Alternatively, a support cushion can be provided (3). A cephalic angulation of 30° for males and 35° for females (1) is needed for adequate joint space opening.

When imaging the cervical spine in extension, as shown in the image below, patients should be instructed with which breathing instructions: (1) Full exhalation (2) Suspended respiration (3) Full inspiration A 1 only B 3 only C 1 and 2 only D 2 and 3 only Mark for Review

C When imaging the cervical spine flexion/extension series, the images should be taken with suspended respiration (2) and full exhalation (3). The suspended respiration indicates that the patient is holding their breath, while the full expiration ensures that the patient's shoulders remain depressed to avoid obstruction of anatomy. If the image is taken on full inspiration (3), the shoulders can raise into the levels of C6-C7 and block essential anatomy.

To radiographically demonstrate the lumbar spine and sacrum in an AP projection, the radiographer should center the spine at the level of the iliac crest, which corresponds with the level of which lumbar vertebra? A L-1 B L-2 C L-3 D L-4

D

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

D

Which of the following refers to parts nearer the point of attachment, point of reference, origin, or beginning? A Distal B Lateral C Medial D Proximal

D

Which projection of the pelvis is also referred to as the Modified Cleaves method: A AP axial outlet B Posterior oblique C AP axial inlet D AP bilateral frog-leg

D

While positioning a patient for a lateral projection of the sternum, the technologist should: A Instruct the patient to oblique their torso to the image receptor, as if they were "listening at a door" to reduce OID. B Instruct the patient to raise their arms over their head, with fingers laced behind their head. C Bring the arm closest to the image receptor superior and anterior, while the arm furthest from the image receptor reaches inferior and posterior. D Arch the shoulders backwards, with fingers interlaced behind the patients back.

D A well prepared radiography student will recognize that each of these positioning instructions is appropriate for various lateral projections of the head, thorax, and spine, but only one correctly describes ideal positioning for a lateral sternum. While it is true that there is ample OID between the sternum and the IR on a lateral projection, a longer SID is recommended to compensate. Choice A is a good strategy to reduce OID for a lateral skull, but will oblique the sternum out of a true lateral alignment. Choice B is an appropriate position for a lateral projection of the chest, but will obscure visualization of the manubrium, along with choice C. Choice C is a appropriate for a swimmer's projection of the C7-T1 intervertebral space. With the shoulders arched backwards, the manubrium displays free of superimposition on full inspiration.

In the image below of the lateral sacrum and coccyx projection, where is the CR directed: A 2 inches above ASIS B At the level of the greater trochanter C 1 inch below iliac crest D At the level of ASIS

D For adequate visualization of both the sacrum and coccyx in the lateral projection, the CR is directed 3-4 inches posterior and at the level of the ASIS (D). Centering 2 inches above the ASIS (A) and 1 inch below the iliac crest (C) would be too high, risking cutoff of the coccyx. Centering at the level of the grater trochanter would be too low, resulting in poor image quality and substantial anatomy cutoff (B).

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.

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). (Frank, Long, and Smith, 11th ed., vol. 1, p. 393)

Which of the following does not apply to the posterior oblique pelvis, Judet method: A To visualize the downside acetabulum, the CR is centered 2 inches distal and 2 inches medial to downside ASIS B The patient is rotated 45°° in a posterior oblique position C Downside demonstrates the anterior rim and posterior ischial column D Upside shows the anterior rim and posterior ischial column

D When the area of interest is the downside acetabulum, the CR will be directed 2 inches distal and 2 inches medial to the downside ASIS (A); this will place the acetabulum at the center of the radiograph. The patient will be rotated 45°° in a posterior oblique whether the area of interest is the downside or upside (B). When the area of interest is the downside acetabulum, the anterior rim and posterior ischial column are demonstrated (C). When the area of interest is the upside acetabulum, the posterior rim and anterior iliopubic column are demonstrated (D).

In the RPO of the cervical spine, which anatomy is demonstrated: (1) Left intervertebral foramina (2) Right pedicles (3) Right intervertebral foramina (4) Left pedicles A 1 and 2 only B 1 and 4 only C 2 and 3 only D 2 and 4 only

For the posterior oblique positions of the cervical spine, the anatomy of interest is that furthest from the IR. For the RPO, the anatomy of interest would be the left intervertebral foramina (1) and the left pedicles (4). For a right anterior oblique, or an RAO, the anatomy of interest would be the right intervertebral foramina (3) and the right pedicles (2). (Lampignano & Kendrick, 9th edition, 312)

From the following list of 6 choices, which 3 are potential benefits to performing a PA projection of the Lumbar spine, with the patient prone, as an alternative to an AP supine projection? A Decreased OID yields greater spatial resolution. B Intervertebral spaces are better aligned to the divergence of the beam. C Contrast resolution is improved with soft tissue compression. D Zygapophyseal joint spaces are opened on the PA projection. E Intervertebral foramina are visualized on the PA projection. F Gonadal dose for female patients will be reduced.

PA projections of the lumbar spine, with the patient prone, yield several benefits as an alternative to an AP supine view. The lordotic curvature of the lumbar spine aligns the planes of intervertebral spaces with the divergence of the beam. The soft tissue structures of the anterior abdomen will be compressed and spread out when the patient lays prone. The part thickness will be reduced, and so also the production of Compton scatter. Less Compton production within the patient will yield less scatter reaching the image receptor, and contrast resolution will improve. Finally, in a prone position, the ala and the sacrum will attenuate much of the beam before it reaches the ovaries, reducing the dose to those organs. Zygopophyseal joints and intervertebral foramina do not appear open on either the AP or the PA projections. The vertebral bodies may have increased OID in a PA projection, depending on patient habitus.

Developmental dysplasia of hip (DDH) utilizes which radiographic view for diagnosis: A AP Bilateral frog-leg projection of the pelvis B AP axial outlet projection of the pelvis C Posterior oblique pelvis: Judet method D AP axial inlet projection of the pelvis

The AP bilateral frog-leg projection of the pelvis demonstrates both femoral heads, necks, and acetabulum side by side. This allows for the comparison of the hips at the same time which aids in the diagnosis of DDH (A). The AP axial outlet projection (B) is used to evaluate the bilateral pubis and ischium for malalignment and fractures, while the AP axial inlet projection (D) assess the pelvic inlet, upper body of ischium, and ischial spine for trauma. The posterior oblique pelvis: Judet method (C) visualizes the acetabulum.

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.

When modifying the PA axial projection of the skull to demonstrate superior orbital fissures, the central ray is directed A 20° to 25° caudad. B 20° to 25° cephalad. C 30° to 35° caudad. D 30° to 35° cephalad.

The Correct Answer is: A The PA projection can be easily modified by redirecting the central ray to demonstrate a variety of structures. The central ray can be directed (1) 25° to 30° caudad for the rotundum foramina, (2) 20° to 25° caudad for the superior orbital fissures, or (3) 20° to 25° cephalad for the inferior orbital fissures.

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.

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.

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.

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. (Frank, Long, and Smith, 11th ed., vol. 2, p. 44)

Which of the following positions will provide an AP axial 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.

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.

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.

With an adult patient in the PA position and the OML perpendicular to the IR, a 15- to 20-degree caudal angulation places the petrous ridges in the lower third of the orbit. To achieve the same result a small child, the CR is directed A perpendicular to the nasion B 25 to 30 degrees caudal C 15 to 20 degrees cephalic D 3 to 5 degrees caudal

The Correct Answer is: A With an adult patient in the PA position and the OML perpendicular to the IR, a 15- to 20-degree caudal angulation places the petrous ridges in the lower third of the orbit. To achieve the same result in a small child, whose skull bones are undergoing complex ossification processes, the CR is simply directed perpendicular to the nasion.

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: AThe 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. (Frank, Long, and Smith, 11th ed., vol. 2, p. 316)

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: AThe 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 examinations require(s) restriction of a patient's diet?Barium enemaPyelogramMetastatic 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.

An esophagram would most likely be requested for patients with which of the following esophageal disorders/symptoms? Varices Achalasia 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?PolypsColitisDiverticulosis 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 diverticulosis/diverticulitis.

What should be done to better demonstrate the mandibular rami seen in PA projection in Figure A? Figure A. Courtesy of Stamford Hospital, Department of Radiology. 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.

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.

Which of the following would best evaluate paranasal sinuses? A PA axial projection (Caldwell method) B Parietoacanthial projection (Waters method) C Lateral projection D Submentovertical projection

The Correct Answer is: B The frontal sinuses and the ethmoidal sinuses can be visualized using the PA axial projection (Caldwell method). sphenoidal sinuses 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.

During IV urography, the prone position generally is recommended to demonstratethe filling of the uretersthe renal pelvisthe 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.

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.

The right posterior oblique position (Judet method) of the right acetabulum will demonstrate theanterior rim of the right acetabulumright iliac wingright 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.

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. (Tortora and Derrickson, 11th ed., pp. 856-857)

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 precautions should be observed when radiographing a patient who has sustained a traumatic injury to the hip?When a fracture is suspected, any required manipulation of the affected extremity must be performed by a physician.The axiolateral projection should be avoided.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.

A radiolucent sponge can be placed under the patient's waist for a lateral projection of the lumbosacral spine principally tomake the vertebral column parallel with the IRplace the intervertebral disk spaces perpendicular to the IRdecrease 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.

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.

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: BA 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. (Bontrager and Lampignano, 6th ed., p. 499)

Which of the following statements regarding myelography is (are) correct? Spinal puncture may be performed in the prone or flexed lateral position. Contrast medium distribution is regulated through x-ray tube angulation. 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.

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.

Which of the following statements is (are) true regarding a PA axial projection of the paranasal sinuses?The OML is elevated 15 degrees from the horizontal.The petrous pyramids completely fill the orbits.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.

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.

BASELINE USED FOR FACIAL BONE

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.

The male bony pelvis differs from the female bony pelvis in which of the following way(s)?The male pelvis has a larger pelvic inlet.The female pubic arch is greater than 90 degrees.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.

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.

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.

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: CFor 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.

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

The Correct Answer is: CThe degree of anterior and posterior motion is occasionally diminished with a whiplash-type injury. Anterior (forward, flexion) and posterior (backward, extension) motion is evaluated in the lateral position with the patient assuming flexion and extension as best as he or she can. Left and right bending images of the thoracic and lumbar vertebrae are obtained frequently when evaluating scoliosis. The AP open-mouth projection is used to evaluate the first two cervical vertebrae. The moving mandible AP projection is used to demonstrate the entire cervical spine while blurring out the superimposed mandible.

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: CThe 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.

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.

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.

Which of the following statements is (are) true regarding the PA axial projection of the paranasal sinuses?OML forms a 15 degree angle with the horizontal beam.The petrous pyramids are projected into the lower third of the orbits.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 paranasal sinuses is used to demonstrate the frontal and ethmoidal sinuses. The patient is positioned with the OML 15° to the horizontal CR (ie, with the chin elevated a bit). 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 bones participate in the formation of the acetabulum?1.Ilium2.Ischium3.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.

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

The Correct Answer is: D The illustration shows the patient positioned on his left side with the IR behind his back. This is a left lateral decubitus position. The x-ray beam is directed horizontally (not vertically) in decubitus positions to demonstrate air-fluid levels. Air or fluid levels will be clearly delineated only if the CR is directed parallel to them. Fluid levels will be best detected on the down side (in this case, left); air levels will be best detected on the up side (in this case, right). If the patient were lying on the right side, it would be a right lateral decubitus position. If the patient were lying on his or her back with a horizontal x-ray beam, it would be a dorsal decubitus position. Lying prone with a horizontal x-ray beam is termed a ventral decubitus position.

When comparing the male and female bony pelves, it is noted that the1.male pelvis is deeper.2.female pubic arch is greater than 90°.3.female ilium is more horizontal. 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. An overview of comparisons is listed below. 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

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 demonstratepartial or complete collapse of pulmonary lobe(s)air in the pleural cavityforeign 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.

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.

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

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. A foreshortened view of the maxillary sinuses is obtained. The frontal and ethmoidal sinuses are best visualized in the PA axial position (modified Caldwell method).

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.

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: DThe 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.

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: DThe 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.

Single contrast BE studies are likely to demonstrateanatomy/tonusmucosaintraluminal lesions A 1 only B 1 and 2 only C 2 and 3 only D 1, 2, and 3

The answer is A. Single contrast barium examinations fill hollow viscera with barium and are most useful to demonstrate anatomy, tonus, size, and shape (1). Diverticula are easily identified in a single contrast study because they are outward extensions of weakened intestinal walls. To demonstrate intestinal mucosa and intraluminal lesions such as polyps, a double contrast study is required (2 and 3). A small amount of barium is introduced to coat the mucosa, then air is insufflated to distend the bowel. Mucosal pathology such as polyps is best demonstrated in this manner.

Which of the following projections can be used to demonstrate pathology of the zygomatic arch? Submentovertical (SMV) projection Oblique inferosuperior tangential projection PA axial caldwell projection A 1 and 2 only B 1 and 3 only C 2 and 3 only D 1, 2, and 3

The answer is A. The zygomatic arches can be difficult anatomical structures to capture on radiographs. Typical positioning utilized for projections of the zygoma is uncomfortable for patients, especially after trauma. Views to obtain the zygomatic arches include the submentovertical (SMV) projection (1) and oblique inferosuperior projections (2)—both require patients to hyperextend their necks until the IOML is parallel to the IR, thus projecting the zygomatic arches free of superimposition. Additional and less uncomfortable projections include the AP axial Towne method and parietocanthial (Waters) projections. The PA axial Caldwell projection closes off the zygomatic arches and therefore would not be recommended (3).

For the modified bilateral Cleaves method, what movements of the patient's lower extremities are necessary? (select the four that apply) A Knees extended B Knees flexed C Thighs abducted D Thighs adducted E Hips flexed F Hips extended G Feet inverted H Feet everted

The answer is B, C, E, and G. The modified bilateral Cleaves method (sometimes referred as the "frog leg" method) demonstrates an AP oblique projection of the femoral heads, necks, and trochanteric areas onto one radiographic image for comparison. The CR is directed perpendicular to the IR entering 1-inch superior to the symphysis pubis in the mid-sagittal plane. In this method, the patient's hips and knees are flexed as much as possible. The feet are inverted to place the plantar surfaces of both in contact. The thighs are abducted as much as possible (B, C, E, and G). Extension refers to increasing the angle between two bony structures at a freely movable joint. Adduction refers to moving an extremity toward the midline of the body. Eversion of the foot refers to an outward turning of the foot at the ankle

Although they are defined as fibrous joints, sutures are ______ while sacroiliac joints are ______. A diarthrotic; amphiarthrotic B amphiarthrotic; synarthrotic C synarthrotic; diarthrotic D synarthrotic; amphiarthrotic

The answer is D. Fibrous joints lack a joint cavity and are connected by fibrous tissue. Even though sutures and sacroiliac joints are in the fibrous joint category, they differ in their degree of movement. Sutures are the joints between cranial bones, and once the skull is fully formed, the joints are synarthrotic, or immovable. Distal tibiofibular, sacroiliac, and tarsal joints are syndesmoses type of fibrous joints, classified as having amphiarthrodial/ slightly movable mobility. Diarthrotic joints are freely moveable, such as the synovial joints.

The medial extension of the descending colon is the A transverse colon. B descending colon. C ascending colon. D sigmoid colon.

The answer is D. The most proximal portion of the large intestine/colon is the cecum, from which the vermiform appendix projects. The ascending colon is continuous with the cecum and is located along the right side of the abdominal cavity (C). It bends medially and anteriorly in the right hypochondrium, forming the right colic (hepatic) flexure. The colon traverses the abdomen as the transverse colon and bends posteriorly and inferiorly in the left hypochondrium, forming the left colic (splenic) flexure (A). The descending colon continues down the left side of the abdominal cavity and, at about the level of the pelvic brim, the colon moves medially to form the S-shaped sigmoid colon (B and D). The rectum is that part of the large intestine, approximately 5 inches in length, between the sigmoid and the anal canal.

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. (Saia, p 131)

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?Intervertebral spacesZygapophyseal jointsIntervertebral 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.

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.

A patient is usually required to drink barium sulfate suspension to demonstrate which of the following structures?1.Esophagus2.Pylorus3.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 positions will move the fundus of the gallbladder shown in Figure 7-6 away from the superimposed transverse process? Courtesy of Stamford Hospital, Department of Radiology. A RAO B LAO C LPO D Left lateral decubitus

The correct answer is: (B) The image shown is an erect PA projection of a patient of hyposthenic body habitus. Note the low position of the gallbladder. It is a result of body habitus and position (viscera assume a lower position in the erect position). The gallbladder may be moved away from the spine by using the LAO position. The right lateral decubitus position also will move the gallbladder away from the spine.

Which of the following may be used as localizer(s) for an AP projection of the hip? the ASIS Prominence of the greater trochanter 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 localizers can used. The CR is directed perpendicular to a point located 1 1/2 inches perpendicular and distal to the midpoint between the ASIS and pubic symphysis (1and 2). A point midway between the iliac crest and the pubic symphysis (3) is too superior and medial to coincide with the hip articulation.

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. (Frank, Long, and Smith, vol. 1, pp. 494-495)

The cross-table view of the hip and proximal femur is known as the: A Modified Cleaves method B Danelius-Miller method C Teufel method D Judet method

The cross-table view of the hip and proximal femur is referred to as the Danelius-Miller method (B). The Modified Cleaves method is a frog-leg lateral of the hip (A). The Teufel method is a PA axial oblique of the acetabulum (C), and the Judet method is a posterior oblique of the pelvis (D).

For a properly positioned AP Upright Abdomen, the central ray is directed to A The mid-sagittal plane at the level of the iliac crests B The mid-sagittal plane at the umbilicus. C The mid coronal plane at the level of the iliac crests. D The mid-sagittal plane and two inches superior to the iliac crests.

The upright AP projection of the abdomen is primarily obtained in order to visualize the diaphragm and the surrounding tissues to evaluate for free air in the peritoneum. In order to ensure that all of the diaphragm is included in the FOV, the central ray should be directed to the intersection of the mid-sagittal plane and a transverse plane that is two inches superior to the iliac crests. Centering at the crests, as described in choice A, is sufficient for a supine AP abdomen. The mid coronal plane is used to center lateral projections of the torso, and soft tissue landmarks, such as the umbilicus, are not reliable landmarks for centering radiographs. (Long, Rollins, and Smith, 13th edition, Volume 2)