A&P 120: Ch 3-4 Exam 2
six organs of the digestive system
-Oral cavity -Pharynx -esophagus -Stomach -Small intestine -Large intestine
Condition or disease where the Erect Chest or Erect Abdomen are the most common Radiographic Exams
-Pneumoperitoneum
Exposure factors for KUB Analog/Digital kVp
70-80
Liver
8
Inferior Costal Rib Margin
B (Level of L2-L3) Used to locate upper abdominal organs, such as the gallbladder and stomach
Type of fracture is best demonstrated with a modified Robert method
Bennett Fracture
The process that the Coronoid fossa accommodates
Coronoid process of ulna when flexed
anterior superior iliac spine
D -found by locating the iliac crest, then palpating anteriorly and inferiorly until a prominent projection or "bump" is felt
kind of joint the wrist is
Ellipsoid
Type of joint that the radiocarpal joint is
Ellipsoidal
Nine regions of Abdomen Central Plane 2, 5, and 8
Epigastric, Umbilical, and Pubic (hypogastric)
Symphysis pubis:
F -the fibrocartilaginous union of the anterior pubic bones
True/False: The hand(s) is(are) placed in a true PA position when using the Brewerton method.
False
guidelines that should be followed with digital imaging of the abdomen
Four-sided collimation, Exposure factors, post-processing evaluation of exposure indicator
level that the top of the 14- × 17-inch (35- × 43-cm) IR is at on an erect abdomen projection
Level of the axils
level that thw central ray (CR) is centered to dor a supine AP projection of the abdomen
Level of the iliace crest, perpendicular to and directed to center of IR
double-walled membrane lining the abdominal cavity
Peritoneum
Proximal Radioulnar articulation location
Radial notch of ulna and head of radius
Proximal radioulnar location
Radial notch on ulna and head of radius
three fossa's of distal humerus
Radial, coronoid, and olecranon
Has styloid process and the ulnar notch articulates with the head of the ulna
Radius (thumb side)
Bones that separate with supination and cross with hand rotation
Radius and ulna
articulates directly with scaphoid and lunate only
Radius directly
Most commonly fractured carpal bone
Scaphoid
xiphoid process corresponds with this vertebral level
T9-T10
this often proves to be an inaccurate landmark on a bariatric patient
The umbilicus ("belly button")
Situation: A patient with a possible Barton fracture enters the emergency room. Which positioning routine should be performed to confirm the diagnosis?
Wrist
Osteomyelitis
a local or generalized infection of the bone and bone marrow, resulting from a bacterial infection that has spread to the bone tissue through the blood
Radiographic Appearance of Intussusception and exposure factor
air filled coiled spring appearance - decrease (-)
capitulum of humerus
articulates with head of radius (lateral)
Infraperitoneal Organs
bladder, male reproductive organs, lower rectum
Middle Phalanx 2nd digit
bone or joint of the right hand: H
PIP of digit 2
bone or joint of the right hand: I
Separates abdominal cavity from thoracic cavity
diaphragm
medical prefix for stomach
gastro
The most important muscles in abdominal radiography
hemidiaphragm and psoa's
Kind of joint that the finger is
hinge
The 3 articulations of the elbow joint
humeroulnar, humeroradial, proximal radioulnar
junction of the small and large intestine
ileocecal valve
longest part of the small intestine
ileum
condition that is demonstrated radiographically as distended, air-filled loops of the small bowel
ileus
the reason why a PA projection of a KUB is generally less desirable than the AP projection
increased object-image receptor distance (OID) if kidneys are of primary interest
Elbow Fat Pads and Stripes
indicates a radial head fracture; seen on lateral view
structures that connects the small intestine to the posterior abdominal wall
mesentery
Radoiocarpal Joint
- major joint of the wrist - lies between proximal carpals and radius/ulna
technical considerations that are essential when performing abdomen studies on a young pediatric patient
- motion prevention - short exposure times - reduction in kVp and mAs based on measured part thickness.
The 5th CMC joint
-A
disease or conditions that the acute abdomen series is most commonly used for:
-Ascites -Fibrous Adhesions - Crohn's Disease -Intussusception -Volvulus -Ileus
Proximal Phalanx of 2nd Digit
-B
Head of the 5th metatacarpal
-C
Iliac Crest (lateral)
-C -Level of L4-L5, Vertebral Interspace
4th metacarpophalangeal joint
-D
ASIS (lateral)
-D -found by locating Iliace Crest, then palpating anterior Lt and inferiority until prominent projection of "bump" feel. -landmark commonly used for positioning of pelvic and vertebral structures, secondary landmark for general abdominal positioning
Head of proximal phalanx of fifth digit
-E
greater trochanter (lateral)
-E - A bony prominence on the proximal lateral side of the thigh, just below the hip joint.
Important factors to consider for geriatric abdomen
-Extra radiolucent padding under -blankets to keep patients warm - careful breathing instructions - possible assistance when helping patient move to required position
Base of middle phalanx of digit 4
-F
symphysis pubis (lateral)
-F - anterior junction of two pelvic bones - can be palpated with patient in supine position -corresponds to inferior margin of abdomen
DIP of 4th digit
-G
ischial tuberosity (lateral)
-G - can be used to determine lower margin on PA abdomen with patient in prone -bears most of the weight of the trunk when one is seated
organs that would be found on an average sthenic patient in the left upper quadrant (LUQ)
-spleen -stomach -left colic (splenic) fixture -tail of pancreas -left kidney -leftsuprarenal gland
Oral Cavity
1
What is the recommended overlap when using two landscape-placed image receptors for an AP projection of a supine abdomen of an obese patient?
1-2 inches
Grids are used if the body part measures greater than:
10 cm
Number of phalanges
14 total in each hand -3 each finger -2 in thumb
Number of phalanges in both hands
14 total in each hand -3 each finger -2 in thumb
small intestine length
15-18 ft
Pharynx
2
Thumb has this number of phalanges
2
Number of bones in hand and wrist
27
Esophagus
3
Number of fossa in the Distal Humerus
3
Stomach
4
Number of metacarpals in palm
5
Small Intestine
5
minimum time frame that a patient should be placed in the decubitus position
5 minutes
What is the minimum amount of time a patient should be upright before taking a projection to demonstrate intra-abdominal free air?
5-10 minutes
Large Intestine
6
best set of exposure factors for upper limb radiography
64 kVp. 200 mA, 1/20 second, small focal spot, and 40 inch (100 cm) SID
Situation: A patient with a possible Smith fracture enters the emergency room. Which positioning routine should be performed to confirm this diagnosis?
Wrist and forearm
Acute Abdominal Series
XRAY w/ 3 different types of images -supine KUB -upright AP or decubitus abdomen -PA or AP chest
Topographical landmarks of abdomen
Xiphoid Tip, inferior costal margin, Iliac Crest, ASIS, Greater Trochanter, symphysis pubis, ischial tuberosity
Central Ray should be at this level to ensure the diaphragm is included on an erect abdomen projection,
Approximately 2 inches above level of iliac crest
Inferior Costal Margin (Lateral)
B - Level of L2-L3 -landmark used for locate upper abdominal organs like the Gallbladder and stomach
A KUB radiograph shows 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 technologist should take?
Because the patient may have renal calculi in the distal ureters and urinary bladder, gonadal shielding cannot be used.
A patient comes into the ER with the history of Crohn disease. An acute abdomen series is ordered on this patient. Which of the following is the reason for this order?
Bowel Obstruction -aka: regional enteritis, chronic inflammation of intestinal wall that results in bowel obstruction.
Iliac Crest
C -level of L4-L5 Verterbra interspace
used to evaluate patients with acute appendicitis
CT is considered the ideal imaging modality to demonstrate an abscess or thickened wall surrounding the inflamed appendix
Largest of the carpal bones
Capitate
Located on distal humerus
Capitulum
CMC is located between these two structures
Carpal and metacarpal
Situation: A patient with a history of carpal tunnel syndrome comes to the radiology department. The orthopedic physician suspects that bony changes in the carpal sulcus may be causing compression of the median nerve. Which special projection best demonstrates this region of the wrist?
Carpal canal position (Gaynor-Hart method)
The base of phalanges articulates with this
Carpals
Steve Left The Party
Carpals of the proximal Row: Scaphoid, lunate, triquetrum, pisiform
Exams that the diaphragm must be motionless during exposure of
Chest or abdomen
Which of the following technical factors is essential when using computed radiography to ensure a high-quality image is produced?
Close collimation
collimation margin for an adult abdomen
Collimation on the top and bottom for adults should be adjusted directly to the margins of the IR, allowing for divergence of the x-ray beam.
Situation: A pediatric patient with a possible radial head fracture is brought into the emergency room. It is too painful for the patient to extend the elbow beyond 90° or to rotate the hand. What type of special (i.e., optional) projection could be performed on this patient to confirm the diagnosis without causing further discomfort?
Coyle Method
This is located between distal and Middle phalanx
DIP
Joints in fingers from distal to proximal
DIP, PIP, MCP, and CMC
A patient comes from 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 exposure factors for a KUB on an average, healthy adult is 76 kVp, 30 mAs. Should the technologist change any of these exposure factors for this patient? (Automatic exposure control [AEC] is not being used.)
Decrease the mAs. Because trapped air is easier to penetrate than soft tissue with x-rays, reducing the mAs will prevent overexposing the radiograph.
exposure considerations that would be most ideal for an AP abdomen of an average-sized adult using a digital radiographic system
Faintly demonstrate the lateral borders of the psoas muscles, lower liver margin, kidney outlines, and the transverse processes of the lumbar vertebrae.
Reason why for a KUB, that it is not accepted practice to not place a marker on the IR, even though the liver is always on the right side.
due to conditions such as situs inversus/visceral inversion where the organs are on opposite sides of the body
Because the liver margin is visible in the right upper quadrant of the abdomen, it is not necessary to place a right or left anatomic side marker on the cassette before exposure
False
True/False: Placing multiple images on the same digital IP is recommended as long as close collimation is applied for each projection.
False. It is recommended that only one projection be placed on a digital IP. The anatomy should be centered on the IP.
Has three joints
Fingers
PIP joint for
Fingers
A patient comes to the radiology department with a clinical history of ascites. The patient is unable to stand or sit erect. Which of the following projections best demonstrates this condition?
LLD: left lateral decubitus
begins in the right lower quadrant at the junction of the small intestine and the ileocecal valve
Large Intestine
Mesentary
Large folds formed by peritoneum that bind abdominal organs
Peritoneum
Large serous double wallets sac like membrane
the decubitus position of the abdomen that best demonstrates intraperitoneal air in the abdomen
Lateral Decubitus (Ap Projection)
positioning routine that should be used for an acute abdominal series if the patient is too ill to stand
Lateral Decubitus replaces erect
Two Way KUB Decubitus Positions
Lateral Decubitus, Dorsal Decubitus
Nine regions of abdomen Left Lateral Plane 3,6 & 9
Left Hypochondriac, Left Lateral, and Left Inguinal
Situation: A patient with a possible perforated bowel caused by trauma enters the ER. The patient is unable to stand. Best projection that demonstrates any possible free air within the abdomen:
Left lateral decubitus
Which specific decubitus position of the abdomen should be used in an acute abdomen series if the patient cannot stand?
Left lateral decubitus
Accessory Organs of Abdominal Cavity
Liver, Gallbladder, pancreas, spleen
Intraperitoneal Organs
Liver, gallbladder, stomach, jejum, ileum, cecum, transverse and sigmoid colon
Metacarpals
Makes up the palm
MCP is located between which two structures
Metacarpal and proximal phalanx
Situation: A patient with a possible fracture of the trapezium enters the ER. The routine projections do not clearly demonstrate a possible fracture. Which other special projection can be taken?
Modified Robert's method
Number of abdominal regions
Nine
Situation: A patient comes to the radiology department for a hand series to evaluate early evidence of rheumatoid arthritis. Which special position can be used in addition to the routine hand projections to evaluate this patient?
Norgaard method - ball catcher's position
Alternative name for the mesentery
Omentum
Distal radioulnar location
On the ulnar notch on radius and head of ulna
projection of the three-way acute abdominal series that best demonstrates free air under the diaphragm
PA chest
Modified Stecher Method
PA scaphoid- ulnar deviation (toward ulna), scaphoid is shown, palm down on 20 degree sponge, CR at scaphoid( 3/4 inch distal and medial to styloid process)
Elbow projection that best demonstrates: Olecranon process seated in olecranon fossa
Pronated (palm down)
How the diaphragm remains motionless during exams
Proper breathing instructions on inspiration or expiration
Structure that is formed by the Olecranon process and trochlear notch that allows for a hinge like movement
Proximal Ulna Correlation
name of abdominal region that contains the rectum
Pubic (Hypogastric)
abdominal quadrants
RUQ, LUQ, RLQ, LLQ
Accommodates radial head when flexed
Radial Fossa
Proximal portion of duodenum
duodenal bulb or cap
First portion of the small intestine
duodenum
the three parts of the small intestine
duodenum, jejunum, ileum
Specific position for a patient with a possible dynamic ileus, the patient is able to stand. The physician has ordered an acute abdominal series.
erect images of PA chest or erect AP Abdomen
this is located in the mediastinum of the thoracic cavity
esophagus
structures seen on a properly exposed KUB of a average sized patient
faint lateral borders of the psoas muscles, lower liver margin, kidney outlines, and the transverse processes of the lumbar vertebrae
Gonadal shielding may be impossible for studies of the lower abdominopelvic region for this type of person
females
An important anatomic landmark that is commonly used to locate the center of the abdomen is the:
iliac crest
symmetric loss of this structure determines rotation on a kidney, ureter, and bladder (KUB) radiograph
iliac wings, obturator foramina, ischial spines, and outer rib margins
Bariatric patient second projection location
image lower abdomen, IR will slightly overlap of 1-2 inches (3-5 m), with the bottom of the IR placed at Symphysis Pubis
Bariatric patient first projection location
image the upper abdomen (top of IR at the level of the xiphoid process)
Bursitis
inflammation of a fluid-filled sac in a joint (bursa)
what CT uses to distinguish between a simple cyst and a tumor of the liver
iodinated contrast media
Radiographic Appearance of ileus and exposure factor
large amounts of air in entire dilated small and large intestine with air fluid levels visualized - decrease, depending on severity of distention (- or - - )
Radiographic Appearance of volvulus and exposure factor adjustment
larger amounts of air tapered or "corkscrew" appearance, with air-filled distended region of intestine - slight decrease (-)
projection that best demonstrates a possible aortic aneurysm in the prevertebral region of the abdomen
lateral
this is located near the first intercostal space
left hemi-diaphragm
Region of the abdomen that contains the spleen
left hypochondriac
Lesser Omentum
lesser curvature of stomach to liver
scale of contrast that is recommended for visualization of the abdominal structures on an abdominal x-ray
long scale
Automatic exposure control (AEC) systems are designed to optimize
mAs
structure that helps stabilize and support the small intestine
mesentery
Location of olecranon process
near end of the ulna, the bone in the forearm, and it forms the pointed portion of the elbow.
Which of the following alternative imaging modalities is most effectively used to evaluate GI motility and reflux?
nuclear medicine
time when gonadal shielding should not be used during abdomen radiography
obscures essential anatomy
The two beak-like processes on the proximal ulna
olecranon and coronoid process
What is a fat pad?
pad of fat located around joints for protection and cushion
Three accessory organs
pancreas, liver, gallbladder
abdominal structures not visible on a properly exposed KUB
pancrease
Placement of long axis of the anatomic part being imaged
parallel to the long axis of the IR
Another term describing a nonmechanical bowel obstruction is:
paralytic ileus
The double-walled membrane that lines the abdominopelvic cavity
parietal peritoneum
KUB Clinical Indications: AP Supine Abdomen
pathology of bowel obstruction, neoplasms, calcifications, ascites, and scout image for contrast media studies of abdomen
the primary cause for involuntary motion in the abdomen
perisaltic action of the bowel
The double-walled membrane lining the abdominal cavity is called the:
peritoneum
Mesocolon
peritoneum that attaches the colon to the posterior abdominal wall
An obese patient comes to the radiology department for a KUB. The radiograph shows that the symphysis pubis is included on the image, but the upper abdomen, including the kidneys, is cut off. Next step for the technologist:
Repeat the exposure -use: two 35 × 43 cm IR's placed in landscape orientation.
Type of structure pancreas is classified as
Retroperitoneal
terms for organ relationship
Retroperitoneal, Infraperitoneal, Intraperitoneal
Right lateral Plane of Abdomen Regions 1, 4, and 7
Right Hypochondriac, Right Lateral, Right Inguinal
Retroperitoneal Organs
Right adrenal gland, right kidney, Pancreas, Duodenum, Ascending Colon, IVC, Aorta, Descending Colon, Ureter
A radiograph of an AP elbow projection demonstrates total separation between the proximal radius and ulna. What must be done to correct this positioning error on the repeat exposure?
Rotate upper limb medially
A radiograph of an AP projection of the abdomen shows that the right iliac wing is wider than the left. Name the positioning error.
Rotation toward the right
To Take Carolyn Home
Rt Carpals Distal Row: Trapezium, Trapezoid, Capitate, Hamate
Thumb joint
Saddle
Arthrography is a radiographic study of:
Soft-tissue structures within certain synovial joints
Skier's Thumb
Sprain or tear of the ulnar collateral ligament
Retroperitoneal
Structures closely attach to posterior abdomen, behind peritoneum
Infrapertioneal
Structures located under or beneath the peritoneum
Elbow projection that best demonstrates: Capitulum and lateral epicondyle in profile
Supinated (palm up)
Forearm rotational movements
Supination of hand and pronation of hand
Elbow fat pads become visibility when trauma cause this to push fat pads out of normal position
Synovial fluid
Triquetrum
Third carpal bone on the proximal row (from lateral aspect of wrist)
Number of phalanges one digits 2 through 5
Three
First MCP for
Thumb
First Metacarpal
Thumb
CMC joint
carpometacarpal joint
saclike portion of the large intestine below the ileocecal valve
cecum
acute abdomen series is most commonly performed to evaluate and diagnose:
conditions or diseases related to bowel obstruction or perforation
what the duodenum is filled with when it looks like the letter C
contrast medium
Parietal Peritoneum
covers the walls of the abdominal cavity
A radiograph of a PA oblique of the hand shows that the third, fourth, and fifth metacarpals are superimposed. Correction for this positioning problem on the repeat exposure:
decrease obliquity of the hand
Forms the first Carpometacarpal joint
Trapezium & first metacarpal (thumb)
Situation: A patient has a routine elbow series performed. The AP projection indicates a possible deformity or fracture of the coronoid process. However, the patient is unable to pronate the upper limb for the AP oblique-medial rotation projection because of an arthritic condition. What other projection could be performed to demonstrate the coronoid process?
Trauma axial lateral projection - Coyle method for coronoid process
Has a styloid process and the head articulates with the ulnar notch on radius to form a distal radioulnar joint
Ulna (little finger side)
the correct name for the abdominal region found directly in the middle of the abdomen
Umbilical
ileocecal valve
Valve at the junction of the small and large intestines
A pathologic condition in which twisting of a loop of intestine creates an obstruction is termed:
Volvulus
Free air in the intra-abdominal cavity rises to this level in a patient who is in the erect position for an erect abdomen projection
diaphragm
If the PA chest projection is not performed for the acute abdomen series, centering for the erect abdomen projection must include the:
diaphragm
Radiographic Appearance of fibrous adhesions
distended loops of air filled small intestine
Radiographic Appearance of Crohn's Disease
distended loops of air filled small intestine (cobblestone appearance)
Shape of Diaphragm
dome shaped/umbrella
Omentum
double fold peritoneum that extends from the stomach to another organ, connects organs
Free air or gas in the peritoneal cavity is:
pneumoperitoneum
Cecum
portion of the large intestine below the ileocecal valve
location of pancreas to the stomach
posterior to the stomach and near the posterior abdominal wall, between the duodenum and the spleen
Digits 2-5 have 3 phalanges
proximal, middle, distal
muscles that are located laterally to the lumbar vertebrae
psoas major muscles
Osteoporosis
reduction in the quantity of bone or atrophy of skeletal tissue
name of group of organs that are located posteriorly to the serous membrane lining of the abdominopelvic cavity
retroperitoneal
A patient comes in the ER with possible gallstones. The patient is in severe pain. Which of the following imaging modalities or projections provides the quickest method for confirming the presence of gallstones?
sonography
preferred imaging modality for examining the gallbladder quickly
sonography/ultrasound
Peritoneal Cavity
space between visceral and parietal peritoneum
abdominal organ not associated with digestive system
spleen
organs of the lymphatic system
spleen, thymus, tonsils
expandable reservoir for swallowed food and fluids
stomach
three digestive organs within the abdominal cavity
stomach, small intestine, and large intestine
structure that is at about the same level as the prominence of the greater trochanter
superior border of the symphysis
Visceral Peritoneum
the inner layer of the peritoneum that surrounds the organs of the abdominal cavity
Radiographic Appearance of Pneumoperitoneum
thin, crest shaped, radiolucency under dome of right hemidiaphragm on erect abdomen
area of shielding for females where the top of the gonadal shield is placed at or slightly above
top of an ovarian shield should be at or slightly above the level of ASIS, and the lower border should be at the symphysis pubis
Greater Omentum
transverse colon to greater curvature of stomach
Image receptor alignment for an abdomen study on an obese patient
two exposures of the abdomen with a landscape alignment
lateral borders of these two muscles should be faintly visible on a diagnostic abdominal image of a small to average-sized patient when correct exposure factors are used
two psoas major and minor muscles faintly visible
endocrine glands that are superomedial to each kidney
two suprarenal (adrenal) glands
A chronic disease involving inflammation of the large intestine is:
ulcerative colitis
Most abdominal projections are taken:
upon expiration
The kidneys are connected to the bladder by way of the:
ureters
Intraperitoneal
within the peritoneal/abdominal cavity
principal exposure factors for abdominal images
• Medium kVp of 70 to 85 • Short exposure time • Adequate mAs based on part thickness
A child goes to radiology for an abdomen study. It is possible that he swallowed a coin. The ER physician believes it may be in the upper GI tract. Identify the routines would best identify the location of the coin.
KUB and lateral abdomen. With any foreign body study, two projections 90 degrees opposite are recommended to pinpoint the location of the foreign body.
KUB must include this to ensure the bladder is seen
KUB must include the symphysis pubis
A radiograph of an AP projection of an average-size adult abdomen was produced using the following exposure factors: 100 kVp, 400 mA, 1/10 second, grid, and 40-inch (100-cm) SID. 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 enhances the visibility of these structures on the repeat exposure?
-KV too high -lower it o 70 and 80 kV (analog) or 80 +/− 5 (for digital systems). -The milliamperage and exposure time can be altered to maintain the density
A radiographic image of an AP projection of the abdomen demonstrates motion. The following exposure factors were selected: 78 kVp, 200 mA, 2/10 second, grid, and 40-inch (100-cm) SID. The technologist is sure that the patient did not breathe or move during the exposure. Cause of blurriness and correction needed for repeat exposure:
-May be caused by involuntary motion. -Increase the milliamperage and decrease the exposure time (e.g., 400 mA at 1/10 second).
organ(s) that would be found on an average sthenic patient in the right lower quadrant (RLQ)
-ascending colon -appendix -cecum -2/3 of ileum -ileoceccal valce
reason it is recommended to take abdominal radiographs at the end of patient expiration
-better visualization of abdominal structures -prevent potential voluntary motion - diaphragm must rbe perfectly motionless
organ(s) that would be found on an average sthenic patient in the left lower quadrant (LLQ)
-descending colon -sigmoid colon -2/3 of jejunum
Organs that would be found on an average sthenic patient in the right upper quadrant (RUQ)
-liver -gallbladder -right (hepatic) fixture -duodenum (c-loop) -head of pancreas -right kidney -right suprarenal gland
Three accessory organs of digestion located in the abdominal cavity
-pancreas -liver -gallbladder
reason the right kidney is found in a more inferior position than the left kidney
-presence of the liver occupying the majority of the right upper quadrant of the abdomen
Situation: A patient has a Colles fracture reduced, and a large plaster cast is placed on the upper limb. The orthopedic surgeon orders a postreduction study. The original technique, used before the cast placement, involved 60 kVp and 5 mAs. How should the exposure factors be altered with a large plaster cast?
68-70kVp
Pancrease
7
Number of Carpal Bones
8
Number of carpals in wrist
8
Spleen
9
Xiphoid Process
A
Xiphoid process of sternum (lateral)
A (lateral) - Level of T10 Midline marker for superior level of liver
The ER physician suspects that a patient has a kidney stone. The patient is sent to the radiology department to confirm the diagnosis. Specific routine to rule out kidney stone is:
A KUB would be performed with the correct exposure factors to visualize the possible stone.
Exam that demonstrates borders of psoas major muscles
AP Abdomen (KUB)
markers seen
AP KUB Description of possible error of Anatomic side markers:
Most common exam of abdomen
AP Supine
Three way KUB: acute abdomen series
AP Supine Abdomen, AP Erect Abdomen, PA erect Chest
symphysis pubis is cut off from image
AP Supine KUB Description of possible error of Anatomy demonstrated:
indicate psoas muscles
AP abdomen (KUB)
Situation: 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 patient comes to the radiology department with a clinical history of pneumoperitoneum. The patient is able to stand. Projections that best demonstrates this condition:
AP erect abdomen
A patient with a possible ileus enters the emergency room. The physician orders an acute abdominal series. The patient can stand. Which specific position best demonstrates air/fluid levels in the abdomen?
AP erect abdomen
projections commonly performed for an acute abdominal series or three-way abdomen series
AP supine abdomen, AP erect abdomen, and a PA chest projection
Location of digestive tract
Abdominal cavity
Joint Effusion
Accumulated fluid in the joint cavity
Clinical indications that require a decrease in manual exposure factors
Advanced Osteoperosis
CR location for a PA projection of digit 2
Affected PIP joint
free intraperitoneal air
Air outside the digestive tract
Reason it is important to keep long axis of digit parallel to IR
All of the above
3 muscles visualized during abdomen x ray
Diaphgram, right PSOAS muscle, and left PSOAS muscle
3 important muscles of abdominal cavity
Diaphragm and the two PSOAS muscles
Fingers and thumbs are called
Digits
Called numeral condyle
Distal Humerus
Finger Joints names
Distal Interphalangeal Joint, Proximal Interphalangeal Joint, Metacarpalphalangeal Joint, and Carpometacarpal Joint
decubitus position that best demonstrates possible aneurysms, calcifications of the aorta, or umbilical hernias
Dorsal Decubitus (Rt or Lt Lateral)
Situation: A patient with a clinical history of a possible umbilical hernia comes to the radiology department. The KUB is inconclusive. Additional projection that can be undertaken to help confirm the diagnosis:
Dorsal decubitus
Intestine that is the shortest and widest
Duodenum
first portion of the small intestine
Duodenum
greater trochanter
E -A bony prominence on the proximal lateral side of the thigh, just below the hip joint.
appearance of this indicates non visible fracture and joint effusion
Elbow fat pad
term for the radiographic study of the entire urinary system
Excretory or Intravenous Urogram
Ulnar Deviation or Ulnar Flexion
Flexion toward ulna
Radial deviation or radial flexion
Flexion towards radius
Bennett Fracture
Fracture at base of first metacarpal
ischial tuberosity (lateral)
G -receives the weight of the body when sitting
structure that stores and releases bile
Gallbladder
Kind of joints the IP joints are
Ginglymus
Hooklike process extending anteriorly from the hamate
Hamulus (hamular process)
Distal radius crosses over the ulna when this is pronated
Hand
Bones of upper limb are divided into 4 groups
Hand and wrist, forearm, arm, shoulder girdle
All phalanx have 3 parts
Head, body, and base
iliac crest of ilium
Identify the structures labeled on this (AP) KUB radiograph: A
thoracic vertebrae (12)
Identify the structures labeled on this (AP) KUB radiograph: B
PSOAS left
Identify the structures labeled on this (AP) KUB radiograph: C
cocyx
Identify the structures labeled on this (AP) KUB radiograph: D
pubic symphysis
Identify the structures labeled on this (AP) KUB radiograph: E
ischial tuberosity of ischium
Identify the structures labeled on this (AP) KUB radiograph: F
topographic landmark found at L4-L5 vertebral interspace
Iliac Crest
Major disadvantage of performing a PA projection of the thumb rather than an AP
Increased OID (to include base of first metacarpal, thumb must be raised)
topographic landmark that is found at the level of L2-L3
Inferior costal (rib) margin
A radiograph of an AP oblique-medial rotation shows that the coronoid process is not in profile and the radial head is not superimposed over the ulna. What specific positioning error was involved?
Insufficient medial rotation
The telescoping of a section of bowel into another loop is called:
Intussusception
Situation: A patient is referred to radiology with a possible injury to the ulnar collateral ligament. The patient complains of pain near the first MCP joint. Initial radiographs of the hand do not indicate any fracture or dislocation. Which special projection can be performed to rule out an injury to the ulnar collateral ligament?
PA stress (Folio method) projection
projection that requires a kVp setting of 110 to 125 for acute abdomen series
PA, erect chest for free air under diaphragm
This is located between prox and middle phalanx
PIP
Posterior wall of abdomen is formed by these muscles
PSOAS
Two large abdominal muscles that extend parallel to lumbar spine and arte indicators of a well exposed KUB
PSOAs
two large muscles found in the posterior abdomen adjacent to the lumbar vertebra that are usually visible on an anteroposterior (AP) radiograph
PSOAs major and minor
Abdomen Radiography Image should demonstrate optimal density and include:
PSOAs muscles, Lower Liver border, and Transverse Process of Lumbar Spine
Carpal Tunnel Synrdrom
Painful disorder of hand and wrist from compression of the median resulting nerve
Explanation of how exam went wrong: error on radiograph of an AP abdomen shows the left iliac wing is more narrowed than the right.
Patient was rotated into a slight right posterior oblique (RPO) position. (The downside ilium will appear wider.)
3 parts of metacarpals are similar to this
Phalanges
2 or more fingers are named
Phalanges (pleural)
A digit consists of separate bones that are called this
Phalanx
A radiograph of a lateral projection of the elbow shows that the epicondyles are not superimposed and the trochlear notch is not clearly seen. What must be done to correct this positioning error during the repeat exposure?
Place humerus/forearm in same horizontal plane.
Situation: A patient enters the ER with a possible foreign body in the dorsal aspect of the wrist. Initial wrist radiographs are inconclusive in demonstrating the location of the foreign body. What additional projection can be performed to demonstrate this region of the wrist?
Tangential projection - carpal bridge projection
two parts of the body common to the respiratory system and the digestive system
The oral cavity (mouth) and the pharynx (oropharynx and laryngopharynx)
Situation: A patient with a possible perforated duodenal ulcer enters the emergency room. The ER physician is concerned about the presence of free air in the abdomen. The patient is in severe pain and cannot stand. Name the positioning routine that should be used to diagnose this condition.
The two-way acute abdomen series: AP supine abdomen and left lateral decubitus
Smith Fracture
The volar displacement of the distal fragment of the radius; sometimes called a reversed Colles fracture.
CR location placed for a PA projection of hand
Third MCP joint
Large concave depression that articulates with the trochlea of humerus
Trochlear Notch
Elbow joint itself is a hinge but the prox radioulnar joint is
Trochoidal (pivot
True/False: The Brewerton method requires a CR angle of 15º proximal
True
Situation: 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
Number of exposures a hypersthenic patient may require
Two Exposures, IR is CW, and Images overlap (2 in above and 2 in below)
Number of exposures that may be needed for an extremely tall hyposthenic patient
Two, IR is LW, and images over lap (2 in above and 2 in below)
number of inches that the lower margins of the ischial tuberosities are below or distal to the symphysis pubis.
about 0.4 to 1.5 inches (1 to 4 cm)
Positions that best demonstrate patient with a history of ascites
acute abdomen series: AP supine abdomen, AP erect abdomen, and a PA chest projection
An abnormal accumulation of fluid in the abdominal cavity is called:
ascites
conditions that is demonstrated radiographically as general abdominal haziness
ascites
respiration when the exposure for an AP projection of the abdomen should be taken
at the end of the expiration (about 1 second delay after to allow involuntary motion of bowel to cease)
Distal Phalanx of 1st digit
bone or joint of the right hand: J
IP of 1st digit
bone or joint of the right hand: K
1st MCP joint
bone or joint of the right hand: L
Two causes of voluntary motion
breathing and movement
type of body habitus might require two landscape-aligned image receptors to be taken so the entire abdomen is included
broad hypersthenic patient
Carpal Canal
formed by anterior concave surface of carpals where major nerves and tendons pass through it
Radiographic Appearance of Ascites
general abdomen haziness
structure that is a double fold of peritoneum that connects the transverse colon to the greater curvature of the stomach
greater omenteum
To identify the inferior margin of the abdomen, the technologist can palpate the symphysis pubis or:
greater trochanter
In an erect anatomic position, structure of the upper limb is considered most inferior or distal
head of ulna
attached anteriorly to the fifth rib and posteriorly at the level of the tenth rib
right hemi-diaphragm
quadrant that the large intestine begins in
right lower quadrant
A radiograph of the carpal canal (inferosuperior) projection shows that the pisiform and hamulus are superimposed. What can be done to correct this problem on the repeat exposure?
rotate wrist laterally 5-10 degrees
elongation of iliac wing indication
rotation in that direction
Carpal Bones Names
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate
Which of the following factors best controls the involuntary motion of a young, pediatric patient during abdominal radiography?
short exposure time
True/False: The patient best controls peristalsis by holding his or her breath during exposure.
short exposure time best controls peristalsis
best mechanism to control involuntary motion
shortest exposure time possible
trapped air is easier to penetrate than
soft tissue with x-rays
topographic landmark that corresponds to the inferior margin of the abdomen and is formed by the anterior junction of the two pelvic bones
symphysis pubis
type of patient that may require two 14- × 17-inch (35- × 43-cm) image receptors placed portrait so the entire abdomen is included.
tall hyposthenic or asthenic
Intussusception
telescoping of the intestines