Scenarios for IMG 111

The ER physician suspects a patient has a kidney stone. the patient is sent to the radiology department to confirm the diagnosis. what specific positioning routine would be used to rule out the presence of a kidney stone?

A KUB would be performed with the correct exposure factors to visualize the possible stone

A patient in intensive care may have developed intro-abdominal bleeding. The patient is in critical condition and cannot go to the radiology department. the physician has ordered a portable study of the abdomen. which specific position or projection can be used to determine the extent of the bleeding?

A bedside portable left decubitus projection could be performed to demonstrate any fluid levels in the abdomen

A routine chest series indicates a possible mass beneath a patients right clavicle. The PA and lateral projections are inconclusive. Which additional projection(s) could be taken to rule out this condition?

AP Lordotic

a patient with a possible perforated duodenal ulcer enter the ER. The ER physician is concerned about the presence of free air in the abdomen. the patient is in severe pain and can not stand. what positioning routine should be used to diagnose this condition?

AP Supine and Left Lateral Decubitus

a patient with a trauma injury enters the ER with an evident Colles fracture/ which positioning routine should be used to determine the extent of the injury

AP and lateral forearm projections to include the wrist

A young child enters the ER with a possible foreign body in one of the bronchi of the lung. The foreign body, a peanut< cannot be seen on the PA and lateral projections of the chest. Which additional projection(s) could the technologist perform to locate the foreign body?

AP and lateral upper airway projections

A patient with a possible neoplasm in the right lung apex comes to the radiology department for a chest xray. The PA and lateral projections do not clearly demonstrate the neoplasm because of superimposition of the clavicle over the apex. The patient is unable to stand or sit erect. Which additional projection can be taken to demonstrate the neoplasm clearly and to eliminate the superimposition of the clavicle and the left lung apex?

Ap semiaxial projection: CR is angled 15-20 degrees cephalad to project the clavicles above the apices and to demonstrate clearly the possible tumor.

PA and left lateral projections demonstrate a suspicious region in the left lung. The radiologist orders an oblique projection that will best demonstrate or "elongate" the left lung. Which specific oblique projections will best elongate the left lung?

Both the LPO and RAO positions

a patient with a possible fracture of the radial head enters the ER. When the technologist attempts to place the arm in the AP oblique-lateral rotation position, the patient is unable to extend or rotate the elbow laterally. which other positions can be used to demonstrate the radial head and neck without superimposition on the proximal ulna?

Coyle method for radial head (lateral elbow; CR 45 degrees toward shoulder

A patient with a clinical history of advanced emphysema comes to the radiology department for a chest x-ray. AEC will not be used. How should the technologist alter the manual exposure settings for this patient?

Decrease the kV moderately

A radiograph of a lateral projection of the chest shows the posterior ribs and costophrenic angles are separated more than 1/2 inch indicating excessive rotation. Describe a possible method for determining the direction of rotaion

Determine which hemidiaphragm (right or left) is more posterior/anterior. The left hemidiaphragm can frequently be identified by visualization of the gastric air bubble or the inferior heart shadow

A patient with a history of ascites comes to the radiology department. which position best demonstrates this condition?

Erect AP abdomen

A patient with a history of pleurisy comes to the radiology department. which of the following radiographic series should be performed>

Erect PA and Lateral

A radiograph of a PA oblique projection of the hand shows that the fourth and fifth metacarpals are superimposed. Which specific positioning error is involved?

Excessive Lateral rotation

A routine radiograph of an AP oblique elbow with lateral rotation reveals that the radial tuberosity is superimposed on the ulna. in what way must this position be modified during the repeat exposure?

Increase lateral rotation of the elbow to separate the radius from the ulna

A patient with severe pleural effusion comes to the radiology department for a chest xray. AEC will not be used. How should the technologist alter the manual exposure for this patient?

Increase the kV slightly

A patient with a possible small pneumothorax. Routine chest projections fail to show the pneumothorax conclusively. Which additional projections could be taken to rule out this condition?

Inspiration and expiration PA projections and/or a lateral decubitus AP chest with affected side up

A child goes to radiology for an abdomen study. It is possible that he swallowed a coin. the ER doc believes it may be in the upper GI tract. which of the following routines would best identify the location of the coin?

KUB and lateral abdomen

A KUB radiograph reveals that the symphysis pubis was cut off along the bottom of the image. Is this an acceptable image?

No. A KUB must include the pubis symphysis

a patient with a metallic foreign body in the palm of the hand enters the ER. Which specific positions should be used to locate the foreign body?

PA and lateral-in-extension projection

A patient with a possible ileus enters the emergency room the patient is able to stand , the physician has ordered an acute abdominal series. what specific positioning routine should be used?

PA chest, AP Supine and erect abdomen

In a radiograph study of the forearm, the proximal radius crossed over the ulna in the frontal projection. which specific positioning error led to this radiographic outcome?

PA forearm projection was performed rather than AP

KUB radiograph reveals that the gonadal shielding is superior to the upper margin of the symphysis pubis. the female patient has a history of kidney stones. What is the next step the tech should take?

Repeat the exposure without using gonadal shielding

A patient enters the ER with a possible hemothorax in the right lung caused by a motor vehicle accident. The patient is unable to stand or sit erect. Which specific projection would best demonstrate this condition, and why?

Right lateral decubitus: in a patient with hemothorax (fluid), the side of interest should be down

A radiograph of a PA projection of the second digit reveals that the phalanges are not symmetric on both sides of the bony shafts. Which specific positioning error is involved?

Rotation

A radiographic image of an AP projection of the abdomen demonstrates the motion, the following exposure factors ere selected: 78 kV, 200 mA, 2/10 sec,grid, and 40 SID the tech is sure that the patient did not breathe or move during the exposure. what may have caused this blurriness? What can be done to correct this problem on the repeat exposure?

The blurriness may be caused by involuntary motion. to control this motion the tech needs to increase the mA and decrease the exposure. for example 400mA at 1/10 sec

a patient comes for the ER with a large distended abdomen caused by an ileus. The physician suspects that the distention is caused by a large amount of bowel gas that is trapped in the small intestine, the standard analog technique for a KUB on and adult is 76 kV, 30 mAs. should the tech change any of these exposure factors for this patient? (AEC is not being used)

Yes decrease the mAs

A patient comes to the radiology department for a pre-surgical chest examination. The clinical history indicates a possible situs inversus of the thorax. Which positioning step or action must be taken to perform a successful chest examination?

ensure placement of the correct R or L anatomic side marker on the IR, because the heart and other thoracic structures may be transposed from right to left

an obese patient comes to the radiology department for a KUB, The radiograph reveals that the symphysis pubis is included on the image, but the next step the technologist should take?

repeat the exposure. Use two landscape aligned 14x17 IR to include the entire abdomen

A radiograph of an AP abdomen reveals the left illiac wing is more narrowed than the right . What specific positioning error caused this

rotated into a slight right posterior oblique position the downside ilium will appear wider

A PA axial scaphoid projection of the wrist using a 15 degree distal CR angle and ulnar flexion was performed. the resultant radiograph shows that the scaphoid bone is foreshortened. How must this projection be modified to produce a more diagnostic image of the scaphoid?

the CR needs to be angled 15 degrees proximally toward the elbow

a radiograph of an AP elbow projection shows considerable superimposition between the proximal radius and ulna. which specific positioning error is involved?

the elbow is rotated medially

a radiograph of a lateral projection of the elbow shows that the humeral epicondyles are not superimposed and the trochlear notch is not clearly demonstrated. Which specific type of positioning error is involved?

the forearm and humerus are not on the same horizontal plane

A radiograph of an AP projection of an average size adult abdomen was produced using the following exposure factors: 90 kV, 400mA, 1/10 second, grid, and 40 inch SID using film/screen analog imaging system. the overall density of the radiograph was acceptable but the soft tissue structures, such as the psoas muscles and kidneys were not visible. which adjustment to the technical considerations will enhance the visibility of these structures on the repeat exposure?

the selected kV 90 kVp was too high and the tech needs to lower the kVp to between 70 and 80. the mA and exposure time can be altered to maintain the density

a patient with a dislocated elbow enters the ER. the patient has the elbow tightly flexed and is careful not to move it. which specific positioning routine can be used to determine the extent of the injury?

two AP projections with acute flexion and a lateral projection