Radiography Boards

Which of the following are the most common routine projections for demonstration of the sternum? a. AP and lateral b. PA and lateral c. RPO and lateral d. RAO and lateral

d. RAO and lateral These views are the most helpful when diagnosing the sternum because they get the spine out of the way/so it is not superimposing the sternum

Which of the following are alternate terms for the "jugular notch"? 1. Manubrial notch 2. Suprasternal notch 3. Cervical notch

1 & 2

Which of the following abnormalities would typically be found on a chest radiograph of a patient suffering from congestive heart failure? 1. Enlarged cardiac size 2. Pulmonary edema 3. Absence of lung markings

1 & 2 only Enlarged cardiac size & pulmonary edema Blood refluxes into pulmonary veins causing fluid to leak into lung airspaces.

Which of the following structures is/are best demonstrated on a PA chest radiograph? 1. Tracheal bifurcation 2. Retrosternal space 3. Manubrial extremity of clavicles

1 & 3 PA chest radiographs will demonstrate the apices and bases of the lungs, the costrophrenic angles and the mediastinum. The trachea and its bifurcation are demonstrated on a PA chest radiograph as well as the clavicles with their manubrial extremities. The retrosternal and retrocardiac spaces are not visible on a PA chest radiograph.

Which of the following are alternate terms for the "jugular notch"? 1. Manubrial notch 2. Suprasternal notch 3. Cervical notch

1 and 2

Which of the following is/are important positioning considerations when obtaining a lateral image of the forearm? 1. The hand is adjusted into a lateral position 2. The wrist and elbow should be included within the collimated field 3. The thumb should be tucked between the 2nd and 3rd fingers

1 and 2

Which of the following would be seen on a correctly positioned lateral forearm image? 1. The ulnar head superimposes the distal radius 2. The olecranon process in profile 3. Radial head free of superimposition

1 and 2

Which of the following landmarks could be considered a reliable indicator of the hypersthenic or obese patient's midsagittal plane (MSP) when performing abdomen images? 1. Xiphoid process 2. Umbilicus 3. Spinous process of L5

1 and 3

Which of the following is/are correct central ray angulation requirements for imaging the scaphoid bone? 1. PA wrist with ulnar deviation, perpendicular central ray 2. PA wrist elevated on 15-20 degree sponge, perpendicular central ray 3. PA wrist, central ray angled 15-20 degrees toward elbow

1, 2, and 3 There are several methods to examine the scaphoid bone. The patient might be positioned for a PA wrist with the hand placed in ulnar deviation and the central ray perpendicular; proximal or distal angulation of the central ray may be used with this positioning to better open the joint spaces surrounding the scaphoid. Stecher also describes a method utilizing a 15-20 degree angulation between the wrist and the x-ray beam. This can be accomplished by placing the wrist in a PA position on an image receptor resting on a 15-20 degree angle sponge or by resting the IR flat on the table and angling the central ray 15-20 degrees toward the elbow.

Which of the portions of the urinary system would normally be visible on a preliminary intravenous urogram image? 1. Lower poles of the kidneys 2. Ureters 3. Urinary bladder

1. Lower poles of the kidneys Without contrast enhancement, the ureters and the urinary bladder are not normally seen on an AP abdomen radiograph. The kidneys are surrounded by a layer of fat, called the perirenal fat which results in a significant difference in x-ray absorption. Because of this difference in tissue contrast, a faint shadow of the kidneys is commonly visible on abdomen images.

How much is the patient rotated for a posterior-anterior (PA) oblique projection of the sternum in a right anterior oblique (RAO) position? a. 5 degrees b. 15-20 degrees c. 25-30 degrees d. 35-45 degrees

15-20 degrees

A barium enema tip was incorrectly inserted, resulting in a tear of the rectum. Which of the following procedures would demonstrate the presence of free abdominal air that might be associated with this occurrence? 1. AP supine abdomen 2. Erect AP abdomen 3. Left lateral decub abdomen

2 and 3

A patient presents in the Emergency Department with a potential ileus. Which of the following projections would demonstrate the air-fluid levels associated with this pathology? 1. AP supine abdomen 2. Erect AP abdomen 3. Left lateral decub abdomen

2 and 3

From the statements below, choose the appropriate positioning guideline(s) for performing an oblique wrist radiograph. 1. Angle the central ray 10-15 degrees proximally 2. The axilla, elbow and wrist are resting on the table 3. Laterally (externally) rotate the wrist 45 degrees

2 and 3

An RPO projection of the ribs will best demonstrate: A. A fracture in the central part of the body of the right 5th rib B. A dislocation of the head of the right 5th rib C. The costal cartilage of the right 5th rib D. The costotransverse joint of the right 5th rib

A. A fracture in the central part of the body of the right 5th rib An RPO of the right ribs elongates the curve of the axillary ribs on the dependent side to best demonstrate that area. The vertebral ends of the elevated ribs are demonstrated on posterior obliques (RPO or LPO).

In order to optimally visualize ribs below the diaphragm, the central ray should be angled: A. 0 degrees B. 15 degrees cephalad C. 15 degrees caudad D. 30- 45 degrees cephalad, depending on body habitus

A. 0 degrees To avoid unwanted distortion, all rib radiographs are routinely obtained with a perpendicular central ray.

At what vertebral level is the anterior superior iliac spine (ASIS)? A. 2nd sacral segment B. L5 C. Junction of sacrum and coccyx D. Sacral promontory

A. 2nd sacral segment The ASIS is a prominent projection of bone on the anterior surface of the pelvis that corresponds to the 2nd vertebral segment of the sacrum. It can easily be found by palpating the iliac crest and following the curve of this landmark anteriorly until a prominent bony "bump" is felt.

Which of the following correctly describes the SID for a lateral projection of the sternum? A. 72 inches to reduce size distortion B. 40 inches to reduce size distortion C. 30 inches to blur surrounding structures D. 72 inches to utilize anode-heel effect

A. 72 inches to reduce size distortion Because the sternum is a midline structure, there will be an unavoidable amount of object-to-image receptor distance (OID). To reduce the resulting size distortion (magnification), a large SID is used if the patient is able to be placed in the erect position.

What correctly describes the SID for a lateral projection of the sternum? A. 72 inches to reduce size distortion B. 40 inches to reduce size distortion C. 30 inches to blur surrounding structures D. 72 inches to utilize anode-heel effect

A. 72 inches tp reduce size distortion

In order to minimize magnification of the ribs when performing an AP projection, what SID and patient position should be used? A. 72 inches, patient erect B. 72 inches, patient prone C. 40 inches, patient erect D. 40 inches, patient supine

A. 72 inches, patient erect In order to minimize magnification of the ribs on frontal or oblique radiographs, the largest SID possible should be used at 72 inches with the patient erect. Rarely is it feasible to use a 72 inch SID when the patient is recumbent.

Which of the following types of fractures are associated with the forearm? A. Colles B. Bennett C. Jones D. Boxer

A. Colles A Colles fracture is seen in the distal radius and usually occurs as a result of a fall on the outstretched hand. The distal fragment of the radius is posteriorly displaced and there is commonly an accompanying avulsion fracture of the ulnar styloid process.

Which of the following structures is commonly NOT seen on a correctly centered AP abdominal radiograph of a hyposthenic patient? A. Diaphragm B. Femoral head C. Ischial spines D. Transverse processes of L5

A. Diaphragm A correctly positioned and centered AP abdomen radiograph should normally include the kidney shadows, psoas muscles, and pelvic structures including the femoral heads and the symphysis pubis. On a hyposthenic (tall and thin) patient the image receptor may not be large enough in many cases to also include the diaphragm.

The sternoclavicular (SC) joint is classified as what type of joint? A. Diarthrodial, gliding B. Synovial, condyloid C. Fibrous D. Cartilaginous, slightly movable

A. Diarthrodial, gliding Diarthrodial and synovial are terms describing freely movable joints. The SC joints are freely movable and allow gliding motion for motions such as rolling and shrugging the shoulders.

It is important to abduct the patient's arm for an oblique rib projection in order to: A. Elevate the scapula and minimize superimposition of the arm over the ribs B. Allow for correct degree of rotation C. Elevate the clavicle superiorly and laterally to not superimpose the ribs D. Allow the patient to get closer to the image receptor

A. Elevate the scapula and minimize superimposition of the arm over the ribs

For which projection of the wrist is it most important for the elbow to be flexed 90 degrees? A. Lateral B. PA C. Oblique D. PA axial

A. Lateral

If an acute abdominal series is ordered for a patient who or sit upright, which projection should be included in place of the erect abdomen? A. Left lateral decubitus B. Right lateral decubitus C. AP supine D. Left lateral

A. Left lateral decubitus A horizontal beam is needed to demonstrate air-fluid layers and the presence of free intraabdominal air so neither an AP supine or lateral abdomen would be appropriate substitutes for an erect abdomen. A left lateral decubitus is preferred so that there is no confusion between free intraabdominal air and the air in the fundus of the stomach.

What is the appropriate term for the double-walled layer of peritoneum in which the small bowel is enveloped? A. Mesentery B. Greater omentum C. Lesser omentum D. Mesocolon

A. Mesentery The peritoneum is a double-walled membrane found in the abdomen. Many of the abdominal organs originate and develop by growing within some of the folds of the peritoneum. The small bowel is one such organ which develops within folds of peritoneum. These folds, called the mesentery, support and protect the small bowel and its vascular supply.

What is the central ray entrance point for a PA projection to demonstrate ribs above the diaphragm? A. Midsagittal plane at the level of T7 B. Midsagittal plane at the level of the sternal angle C. Midcoronal plane at the level of the mid-sternum D. Midcoronal plane at the level of T6

A. Midsagittal plane at the level of T7 PA radiographs to demonstrate ribs above the diaphragm bilaterally are positioned and centered like PA chest radiographs. The central ray should enter the posterior surface of the body at the midsagittal plane and the level of T7 (inferior angle of the scapula).

In order to obtain an oblique projection of the 1st digit (thumb), the hand should be in what position? A. PA B. AP C. Oblique D. Lateral

A. PA

Where should the central ray enter for PA radiographs of the 2nd-5th digits? A. PIP joint of affected digit B. DIP joint of affected digit C. MCP joint of affected digit D. 3rd MCP joint for PA radiographs of any digit

A. PIP joint of affected digit

What is the rationale for having the patient make a fist when positioning for a PA wrist? A. Reduces OID B. More comfortable for the patient C. Reduces risk of voluntary motion D. Spreads the carpals

A. Reduces OID

Breathing instructions for a routine AP abdominal radiographshould be: A. Suspended expiration B. Suspended inspiration C. Suspended respiration; either inspiration or expiration is acceptable D. Quiet breathing

A. Suspended expiration Suspended expiration will cause the diaphragm to rise, minimizing compression of the abdominal structures.

How does rotation for the oblique sternum differ between a patient with a deep, barrel-chested thorax and a patient with an asthenic body type? A. The deeper thorax requires less rotation B. The asthenic body type requires less rotation C. The deeper thorax requires no rotation D. The asthenic body type requires no rotation

A. The deeper thorax requires less rotation The larger the anterior-to-posterior dimension of the thorax, the less rotation is required to separate the sternum and spine on an RAO image. Therefore, hypersthenic body types generally require about 15 degrees of rotation while asthenic body types will require 20 degrees or more to achieve this separation.

Which of the following bones articulates with the 2nd metacarpal? A. Trapezoid B. Scaphoid C. Lunate D. Trapezium

A. Trapezoid The distal row of carpals articulates with the bases of the metacarpals. The trapezium with the 1st metacarpal, the trapezoid with the 2nd metacarpal, the capitate with the 3rd metacarpal, and the hamate with the 4th and 5th metacarpals.

Which of the following should be removed prior to performing a PA chest radiograph? 1. T-shirt with a large college logo 2. Hearing aids 3. Post-type pierced earrings

A: 1 only Prior to performing a PA chest radiograph, any item that could potentially cause an artifact on the image should be removed. This includes items such as necklaces, buttons or snaps on clothing, or brassieres. Pockets in the thoracic region should be checked and any items removed; shirts with thick or rubberized logos should also be removed.

How much is the patient rotated for a posterior-anterior (PA) oblique projection of the sternum in a right anterior oblique (RAO) position? A. 5 degrees B. 15-20 degrees C. 25-30 degrees D. 35-45 degrees

B. 15-20 degrees In order to image the sternum with minimal distortion, the patient is rotated 15-20 degrees in a right anterior oblique (RAO) position and a posterior-anterior (PA) oblique projection to move the sternum away from the spine.

What is the central ray entrance point for a PA projection of the hand? A. 3rd carpometacarpal joint B. 3rd metacarpophalangeal joint C. Body of the 3rd metacarpal D. Base of the 3rd metacarpal

B. 3rd metacarpophalangeal joint

The appropriate SID for a routine AP abdomen image is: A. 30 inches B. 40 inches C. 60 inches D. 72 inches

B. 40 inches

A boxer fracture is most commonly associated with which of the following bones? A. 1st metacarpal B. 5th metacarpal C. Scaphoid D. Distal phalanx of any finger

B. 5th metacarpal

Which of the following structures would most commonly be found in the right lower quadrant of the abdomen? A. Right kidney B. Cecum C. Tail of pancreas D. Descending colon

B. Cecum Structures located in the RLQ include: the cecum, appendix, terminal portion of the ileum, ileocecal valve, and the origin of the ascending colon.

What is the term for the joint between the head of the rib and the body of a thoracic vertebra, and what is the classification for this joint? A. Costovertebral, synarthroidal b. B. Costovertebral, plane (gliding) C. Costotransverse, synarthroidal D. Costotransverse, plane (gliding)

B. Costovertebral, plane (gliding) The joint formed between the head of the rib and the body of the thoracic vertebra is called a costovertebral joint; the joint between the tubercle of the rib and the transverse process of a thoracic vertebra is a costotransverse joint. Both of these types of joints are considered plane (gliding) joints that facilitate movement of the rib cage during respiration.

For an AP abdomen image the central ray should enter at what level for a sthenic patient? A. Anterior superior iliac spine (ASIS) B. Iliac crest C. Symphysis pubis D. Lower costal margin

B. Iliac crest For a survey abdomen x-ray examination (KUB) the central ray should enter the midsagittal plane at the level of the iliac crest to ensure that both kidneys and the bladder are included on the image. A hypersthenic patient might require more than one exposure to include all of the abdominal anatomy.

What anatomic landmark lies at the level of the interspace between L2 and L3? A. Xiphoid process B. Inferior margin of the ribs C. Umbilicus D. 7th costal cartilage

B. Inferior margin of the ribs The inferior costal (rib) margin lies at the L2/L3 interspace on the average patient. This positioning landmark is useful when centering for radiographs of the gallbladder, pyloric region of the stomach, or splenic flexure of the large intestine.

What is the central ray entrance point for an AP projection to demonstrate bilateral, below the diaphragm ribs? A. Midsagittal plane at level of xiphoid B. Midsagittal plane, midway between xiphoid and lower rib margin C. Midsagittal plane at level of the lower rib margin D. Midsagittal plane at level of the umbilicus

B. Midsagittal plane, midway between xiphoid and lower rib margin When radiographing lower ribs, a 14x17 inch image receptor is generally placed in the landscape orientation and the beam is centered to the midsagittal plane midway between the xiphoid and the lower rib margin so that all lower ribs are included. Some institutions may obtain unilateral images of the ribs in which case the image receptor and central ray are shifted toward the side of interest.

A patient with a history of trauma to the proximal interphalangeal (PIP) joint of the 5th finger comes to your facility with a request for hand radiographs. Which of the following would be the correct images for this patient? A. PA, oblique with hand and fingers resting on sponge, lateral with fingers stacked B. PA, oblique with hand and fingers resting on sponge, lateral with fingers fanned C. PA, oblique with hand and fingers relaxed on image receptor, lateral with fingers stacked D. PA, oblique with hand and fingers relaxed on image receptor, lateral with fingers fanned

B. PA, oblique with hand and fingers resting on sponge, lateral with fingers fanned

Which of the following conditions would demonstrate absence of the diaphragm contour and blunting of the costophrenic angle? A. Emphysema B. Pleural effusion C. Pneumothorax D. Atelectasis

B. Pleural effusion (Abnormal collection of fluid in the pleural space increases tissue density of the lung in that area, making it appear whiter on the image. This increased density obscures the diaphragm border and the heavier fluid sinks to the inferior portion of the thorax, blunting the costophrenic angle on the affected side.)

Which of the following correctly describes positioning for a lateral projection of the 4th digit? A. From the prone position, medially rotate hand to lateral position B. Rest the hand of the ulnar surface C. Make a fist and rest tip of 4th finger on image receptor D. Rest hand on lateral surface with 4th finger extended

B. Rest the hand of the ulnar surface Resting the hand on the ulnar surface rather than lateral surface of the hand ensures that the digit will be parallel with the IR

The jugular notch of the sternum corresponds to which of the following vertebral levels? A. C7 B. T2 C. T4 D. T6

B. T2

Which statement regarding the pancreas is true? A. The head of the pancreas lies in the left upper quadrant B. The tail of the pancreas lies near the hilum of the spleen C. Secretions of the pancreas empty into the jejunum D. The body of the pancreas lies anterior to the body of the stomach

B. The tail of the pancreas lies near the hilum of the spleen It lies posterior to the stomach; the head is encircled by the c-shaped loop of the duodenum and the tail lies near the hilum of the spleen. Secretions from the pancreas pass through the hepatopancreatic ampulla to empty into the 2nd (descending) portion of the duodenum.

When performing an oblique hand projection, how many degrees should the hand be rotated? A. 15 degrees B. 30 degrees C. 45 degrees D. 60 degrees

C. 45 degrees

When performing posterior oblique rib radiographs (RPO, LPO), the patient should routinely be rotated: a. 25 degrees toward side of interest b. 35 degrees away from side of interest c. 45 degrees toward side of interest d. 60 degrees away from side of interest

C. 45 degrees toward the side of interest This places the pathologic area closest to the image receptor and allows for the best spatial resolution. AP oblique rib positioning will demonstrate elongation of the dependent axillary ribs, and will also demonstrate the vertebral ends of the ribs on the side up.

Ideally, how long should a patient be in position for a lateral decubitus abdomen prior to exposing the image? A. The image can be exposed immediately B. 2 minutes C. 5 minutes D. 12 minutes

C. 5 minutes Ideally, the patient should be in the lateral position for at least 5 minutes prior to exposure to allow air to rise to the highest level in the abdomen.

Which of the following projections would best demonstrate the pisiform free of superimposition? A. PA B. PA oblique C. AP oblique D. Lateral

C. AP oblique The pisiform is the most medial bone of the proximal row of carpals (with the patient in anatomic position). In the PA and PA oblique projections the pisiform is superimposed on the triquetrum, however it is projected free of superimposition on an AP oblique of the wrist.

Which of the following structures can best be used to evaluate the degree of rotation on a PA chest radiograph? A. Symmetry of intercostal spaces B. Location of left ventricle C. Appearance of the sternoclavicular (SC) joints D. Shape of vertebral bodies

C. Appearance of the sternoclavicular (SC) joints On a properly positioned PA chest radiograph, the SC joints should appear symmetrical and should be equidistant from the spinous processes of the thoracic vertebrae. If a chest radiograph demonstrates the left SC joint superimposing the thoracic vertebra and the right SC joint superimposing the right lung, the patient was rotated with the left side closer to the image receptor than the right side.

Where should the central ray enter for a PA axial projection of the wrist, Stecher method? A. Mid-carpal region B. Radioulnar joint C. At the anatomic snuffbox D. ½ inch medial to the ulnar styloid

C. At the anatomic snuffbox The Stecher method is done to image the scaphoid bone of the wrist, and the central ray should pass through that bone. The scaphoid corresponds to a surface landmark called the anatomic snuffbox. The snuffbox is a triangular depression on the posterior wrist that is visible when the thumb is extended and abducted.

Which of the following is the correct breathing instructions for a lateral projection of the sternum? A. No instructions needed B. Deep expiration C. Deep inspiration D. Shallow breathing

C. Deep inspiration Deep inspiration is helpful to fully inflate the lungs and more clearly demonstrate the posterior surface of the sternum.

Which carpal bone contains the hook-like hamulus? A. Scaphoid B. Capitate C. Hamate D. Trapezium

C. Hamate

Dislocation of the lunate bone is best demonstrated on which of the following projections? A. PA wrist B. AP wrist C. Lateral wrist D. PA oblique wrist

C. Lateral wrist Dislocation of the lunate bone would mean that the bone is displaced either anteriorly or posteriorly in relation to the other carpals. The best image to demonstrate anterior/posterior displacement is a lateral projection.

What is the rationale for placing the shoulder, elbow, and wrist in the same plane when positioning for a lateral forearm image? A. More comfortable for the patient B. Decreases the need for a grid C. Minimizes distortion of the distal humerus D. Only 1 image is needed to include all of the required anatomy

C. Minimizes distortion of the distal humerus In order to minimize distortion of the elbow joint and the distal humerus, the patient should be positioned so that the shoulder, elbow, and wrist are all in the same plane when performing elbow and forearm imaging.

Your patient complains of pain in the left anterior ribs at about the level of her shoulder. Which of the following represents the best projections to take for this patient's rib exam? A. PA and LPO ribs centered over the left side B. AP and LPO ribs centered over the left side C. PA and RAO ribs centered over the left side D. PA and LAO ribs centered over the left side

C. PA and RAO ribs centered over the left side Since the patient is having pain anteriorly, a PA projection results in better spatial resolution by placing this area closer to the image receptor (IR) than an AP projection would. The patient's complaint also indicates that pain is near the shoulder, which would correspond to the axillary region of the ribs. An RAO centered over the left side will elongate the right ribs to best demonstrate the axillary ribs.

A patient presents in the emergency room after being hit on the left side, just inferior to the sternum. What radiographs would most commonly be obtained for this type of injury? A. PA upper ribs, LAO lower ribs B. PA upper ribs, LAO upper and lower ribs C. PA upper and lower ribs, RAO upper and lower ribs, PA chest D. PA upper and lower ribs, LAO upper and lower ribs, PA and lateral chest, localized image of area of injury

C. PA upper and lower ribs, RAO upper and lower ribs, PA chest Because the injury was on the anterior side of the body, PA images should be obtained. The injury is near the location of the diaphragm so both upper and lower rib images would most likely be needed to adequately demonstrate the injured ribs. PA chest radiographs are also commonly needed to make sure the patient did not sustain an additional injury to the lung. Generally a PA chest radiograph is adequate.

Which of the following abdominal organs is classified as retroperitoneal? A. Stomach B. Bladder C. Right kidney D. Transverse colon

C. Right kidney

The Stecher method is used to specifically demonstrate which carpal bone? A. Trapezium B. Pisiform C. Scaphoid D. Triquetrum

C. Scaphoid

A patient with cholelithiasis is suffering from: A. Gastritis B. Portal hypertension C. Stones in the gallbladder D. Fatty liver

C. Stones in the gallbladder Chole- is a medical term meaning bile; lithiasis is the medical term for the formation of stones. Cholelithiasis is the formation of stones in the gallbladder.

Which of the following statements is an accurate guideline to follow when determining the appropriate rib projections to be obtained? A. A routine rib series should include both AP and PA projections of the affected side B. Better images will be obtained if the patient can be positioned on the x-ray table C. The affected or injured ribs should be placed closest to the image receptor for a posterior oblique image D. Because it is difficult for patients to breath if there is a rib fracture, images should be obtained on full expiration

C. The affected or injured ribs should be placed closest to the image receptor for a posterior oblique image Placing the affected side closest to the IR for posterior oblique projections will best demonstrate that side by decreasing magnification and improving spatial resolution of those ribs. Respiration will be based on whether upper or lower ribs are being examined, and ribs are most frequently completed with the patient erect, because it is less painful for the patient and because breathing is easier in the erect position.

If the clavicles superimpose the apices of the lungs and the first rib on a PA chest radiograph, what can be stated regarding the patient positioning? A. The patient was positioned correctly B. The patient was leaning forward with the shoulders too close to the image receptor (IR) C. The patient's back was arched with shoulders too far from the image receptor (IR) D. The patient's head was turned to the side

C. The patient's back was arched with shoulders too far from the image receptor (IR) A properly positioned PA chest radiograph will demonstrate the clavicles approximately 1 inch inferior to the lung apices and first ribs. If the patient is leaning forward, the clavicles will be projected lower in relation to the apices and ribs on a PA projection; if the patient is arch backward, the clavicles will be projected higher in relation to the lung apices and will have an appearance similar to a lordotic chest radiograph.

When performing an erect AP abdomen projection, the central ray should enter the midsagittal plane: A. At the level of the iliac crests B. At the level of the ASIS C. Two inches above the iliac crest D. Two inches below the iliac crest

C. Two inches above the iliac crest Erect images of the abdomen are performed primarily to demonstrate air-fluid levels and the presence of free intra-abdominal air. In the erect position, air will rise to the highest possible point, the inferior surface of the diaphragm. Centering above the crest is critical so that the diaphragm can be included on the image.

What is the central entrance point for a lateral projection of the 1st digit? A. Center of hand; 3rd metacarpophalangeal joint B. 1st carpometacarpal (CMC) joint C. 1st interphalangeal (IP) joint D. 1st metacarpophalangeal (MCP) joint

D. 1st metacarpophalangeal (MCP) joint

Which of the following projections of the hand would be most beneficial in evaluating early changes associated with rheumatoid arthritis? A. PA B. PA oblique C. Lateral D. AP oblique

D. AP oblique Early changes of the bases of the proximal phalanges associated with rheumatoid arthritis are commonly evaluated with an AP oblique projection, Norgaard method. This is commonly referred to as the "ball-catcher's projection".

A patient who has ascites is suffering from: A. Liver enlargement B. Gallstones C. Renal hyperplasia D. An accumulation of fluid in the peritoneal cavity

D. An accumulation of fluid in the peritoneal cavity Ascites is an abnormal accumulation of fluid in the peritoneal cavity. It can be caused by many pathologic processes. Two of the most common causes are cirrhosis of the liver and metastatic disease of the peritoneum.

To correctly position the forearm for an AP projection, the patient should be adjusted so that the: A. Elbow is flexed 90 degrees and the hand pronated B. Elbow is flexed 90 degrees and the hand supinated C. Elbow is extended and the hand pronated D. Elbow is extended and the hand supinated

D. Elbow is extended and the hand supinated

Which of the following represents the correct central ray entrance point for a routine oblique image of the sternum? A. midway between the midsagittal plane and mid coronal plane at the level of T7 B. Enters dependent side 1 inch lateral to spine at the level of T6 C. Midsagittal plane at the level of T7 D. Enters elevated side 1 inch lateral to spine at the level of T7

D. Enters elevated side 1 inch lateral to spine at the level of T7 The RAO projection of the sternum is a shallow oblique, so the central ray enters the elevated side of the body approximately 1 inch lateral to the spine. The midpoint of the sternum is approximately the level of T7 which corresponds to the level of the inferior angle of the scapula.

Which of the following would be seen on an appropriately positioned PA projection of the hand? A. Partial superimposition of the 4th and 5th metacarpal heads B. Fingernails in profile C. Pisiform free of superimposition D. Equal concavity of the metacarpal bodies

D. Equal concavity of the metacarpal bodies

What is the rationale for including a PA chest x-ray as part of a routine rib series of radiographs? A. This is standard protocol for geriatric patients B. Examination of lungs for pulmonary edema C. Best way to evaluate the diaphragm D. Evaluation of the lungs for presence of a pneumothorax

D. Evaluation of the lungs for presence of a pneumothorax The chest radiograph is helpful in determining if there is pathology to the lungs as a result of rib injury. A common respiratory system injury is a pneumothorax caused by jagged ends of fractured ribs puncturing the pleura.

What are the correct breathing instructions for radiographs of the ribs? A. Full inspiration for both the upper and lower rib projections B. Full expiration for both the upper and lower rib projections C. Full inspiration for the lower ribs and Full expiration for the upper ribs D. Full inspiration for the upper ribs and Full expiration for the lower ribs

D. Full inspiration for the upper ribs and Full expiration for the lower ribs

The most superior portion of the stomach is called the: A. Antrum B. Pylorus C. Cardiac incisura D. Fundus

D. Fundus

Which of the following anatomic structures are found on the distal end of the ulna? A. Tuberosity B. Trochlear notch C. Coronoid fossa D. Head

D. Head

The most distal portion of the small bowel is termed the: A. Jejunum B. Cecum C. Duodenum D. Ileum

D. Ileum The small intestine is a portion of the digestive system that occupies most of the central abdominal cavity. This tubular structure is normally around 18-22 feet in length and about 1 inch in diameter. It is divided into three sections from proximal to distal: duodenum, jejunum, and ileum.

Which of the following statements is TRUE of the retrocardiac space? A. Its appearance can indicate pneumonia B. It is found between the sternum and the heart C. It is only visible if the patient has pulmonary edema D. It is best evaluated on a lateral chest radiograph

D. It is best evaluated on a lateral chest radiograph The retrocardiac space is found between the posterior border of the heart and the spine. This anatomic region is only visible on a lateral chest radiograph. The retrocardiac space can be an indicator of heart disease if it is decreased in size or obscured by an enlarged heart.

Pneumonitis is another term for which of the following pathologic conditions? A. Pneumothorax B. Pleural effusion C. Pulmonary edema D. Pneumonia

D. Pneumonia Pneumonitis refers to an inflammation of the lung and is generally considered synonymous with pneumonia. The inflammation can be caused by bacterial, viral, of fungal agents.

Which of the following are the most common routine projections for demonstration of the sternum? A. AP and lateral B. PA and lateral C. RPO and lateral D. RAO and lateral

D. RAO and lateral In AP or PA projections, the spine superimposes the sternum. A slightly oblique projection allows the sternum to be seen without superimposition. RAO position shows the sternum with minimal distortion and it is projected over the somewhat homogeneous density of the heart.

When evaluating an AP image of the forearm, the technologists sees that the radius and ulna are crossed. Which of the following would be the correct action for the technologist to take? A. No further action is needed, this demonstrates correct AP forearm positioning B. Repeat the image because the humerus was not resting on the image receptor C. Repeat the image because the patient was leaning too far laterally D. Repeat the image because the hand was pronated

D. Repeat the image because the hand was pronated

Which of the following would most likely require an erect AP abdomen radiograph to demonstrate the layering of air and fluid associated with the patient's pathology? A. Longstanding gastritis B. Acute abdominal aortic aneurysm C. Metastatic adrenal tumor D. Severe, chronic Crohn's disease

D. Severe, chronic Crohn's disease Crohn's disease is a chronic condition that most commonly affects the terminal portion of the ileum. This disease is an inflammatory condition that may also lead to ulceration of the bowel wall and formation of fistulous tracts. Inflammation and dilation of the bowel can be associated with the layering of air and fluid.

Which of the following would indicate that an erect abdomen image is correctly positioned? A. Lower margin of the liver is symmetrical B. Kidneys are demonstrated in profile C. Psoas muscles are foreshortened D. Spinous processes of the lumbar vertebrae are centered to the vertebral bodies

D. Spinous processes of the lumbar vertebrae are centered to the vertebral bodies

Which of the following is TRUE of a properly positioned AP forearm radiograph? A. The radial head will be free of superimposition B. The distal humerus will be foreshortened C. The coronoid process will be demonstrated in profile D. The radial tubercle will superimpose the proximal ulna

D. The radial tubercle will superimpose the proximal ulna

Where is the correct central ray entrance point for a routine oblique image of the sternum? A. midway between the midsagittal plane and mid coronal plane at the level of T7 B. Enters dependent side 1 inch lateral to spine at the level of T6 C. Midsagittal plane at the level of T7 D. Enters elevated side 1 inch lateral to spine at the level of T7

D. enters elevated side 1 inch lateral to spine at the level of T7

What area should be included on a soft tissue neck projection?

From the pharynx to the mid-thoracic region (just above the heart)

How should the clavicles appear on a lordotic AP Chest x-ray?

Horizontal straight line

What is the SID on a lateral soft tissue neck? SID on AP soft tissue neck?

Lateral - 72" AP - 40" The SID is increased when the part is further away from the IR to decrease magnification. In a lateral, you have the shoulder creating distance between the IR and neck. In AP, the neck is right up against the IR.

A pathological condition in which air or gas enters the pleural space is called: a. pneumothorax b. emphyema c. pleural effusion d. congestive heart failure

Pneumothorax

What are the breathing instructions for a soft tissue neck?

Slow breathing

The gallbladder of a sthenic patient would normally be found in which of the following quadrants? a. RUQ b. LUQ c. RLQ d. LLQ

a. RUQ The major portion of the liver, the gallbladder, hepatic flexure, c-loop of the duodenum, and the head of the pancreas lie within this portion of the abdomen.

The carina is associated with: a. bifurcation of trachea b. superior wall of aortic arch c. horizontal fissure of right lung d. hilum of left lung

a. bifurcation of trachea

How many pairs of ribs articulate directly with the sternum? a. 5 b. 7 c. 10 d. 12

b. 7

When evaluating a PA chest radiograph a radiologist notes an absence of lung markings and a pleural line on the patient's right side. Which of the following pathologies is the most likely cause for this appearance? a. pneumonia b. pneumothorax c. pleurisy d. Croup

b. Pneumothorax

The jugular notch of the sternum corresponds to which of the following vertebral levels? a. C7 b. T2 c. T4 d. T6

b. T2

On a PA chest radiograph, which of the following is an accurate statement in reference to the lung's vascular markings? A. Vascular markings are only visible when there is pulmonary pathology B. Vascular markings appear thinner in the superior portions of the lungs C. The caliber of vascular markings should be the same from superior to inferior lung D. Vascular markings are only visible in the hilar regions near the heart

b. vascular markings appear thinner in the superior portions of the lungs

On an AP projection of the upper ribs, how many ribs should be visible above the diaphragm? a. 7 b. 8 c. 10 d. 12

c. 10

To best visualize the apices of the lungs, which chest positioning method should be used? a. PA with horizontal beam b. AP with horizontal beam c. AP Lordotic with horizontal beam d. PA with cephalic angulation

c. AP Lordotic with horizontal beam