Bontrager; Radiographic Positioning Chapter 4 and 5 Exam
Metacarpal phalanges joints
Ellipsoidal (condyloid)
Radiocarpal joint
Ellipsoidal (condyloid) - flexion, extension, abduction, adduction and circumduction
Fracture through the epiphyseal plate
Epiphyseal fracture
Most common type of primary malignant tumor occurring in bone
Ewing's sarcoma
Which routine projection of the shoulder requires that the humeral epicondyles be parallel to the IR?
External rotation
T/F A posteroanterior (PA) axial projection of the clavicle requires a 35-45 degree caudal central ray angle
False
T/F Radiography is more sensitive than nuclear medicine for demonstrating physiologic aspects of the shoulder girdle
False
T/F The hand(s) are placed in a true PA position when using the Norgaard method
False
T/F The male clavicle is shorter and less curved than the female clavicle
False
True/False: Lead (protective) shielding is only required for upper limb studies performed on patients who are child-bearing age or younger
False A good practice is to provide shielding for all patients
T/F 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.
T/F Anterior and posterior fat pads of the elbow are best seen on correctly positioned and correctly exposed anteroposterior (AP) elbow projections?
False, lateral projections
T/F If the posterior fat pad of the elbow id not visible radiographically, it suggests that a non obvious radial head or neck fracture is present
False, suggest negative exam
Which preferred lateral position of the hand best demonstrates the phalanges without excessive superimposition?
Fan lateral
Where is the CR centered for an AP projection of the thumb?
First metacarpophalangeal (MCP) joint
bursitis
Fluid filled joint space with possible calcification
Bennett's fracture
Fracture of the base of the first metacarpal
What type of injury must be ruled out before the weight-bearing phase of an AC joint study?
Fractured clavicle
A patient with a possible shoulder dislocation enters the emergency room. A neutral AP projection of the shoulder has been taken, confirming a dislocation. What additional projection should be taken?
Garth method
Elbow joint humeroulnar and humeroradial
Ginglymus ( hinge )
Interphalangeal joints
Ginglymus (hinge)
Elbow joint
Ginglymus (hinge) - flexion and extension
Interphalangeal joint
Ginglymus (hinge) - flexion and extension
Which carpal contains a hooklike process
Hamate
Internal rotation
Hand and arm are rotated internally. Epicondyles are perpendicular to the IR. Greater tubercle is anterior the lesser tubercle is profiled medially. (joint space)
In and direct atomic positioning, which one of the following structures is considered to be the most inferior or distal
Head of ulna
Compression fracture of humeral head
Hill-Sachs defect
Compression fracture of the articular surface of the humeral head
Hill-Sachs defect
Disability of the shoulder joint caused by chronic inflammation in and around the joint
Idiopathic chronic adhesive capsulitis
Compression between the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch. Subacromial spurs.
Impingement syndrome
Supinated
In what position should the hand be for an AP elbow projection
Pronated
In what position should the hand be for an AP medial rotation oblique elbow position
Fracture does not transverse through entire bone (the bone is not broken into two pieces)
Incomplete (partial) fracture
What is the major disadvantage of performing a PA projection of the thumb rather than an AP?
Increased OID
What are the angles found on the scapula?
Inferior angle Lateral angle Superior angle
Bursitis
Inflammation of the fluid filled sac's enclosing The joints
What are the names of the two fossae located on the posterior scapula?
Infraspinus process Supraspinus process
A radiograph of an AP oblique-medial rotation reveals 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
Which position of the shoulder and proximal humerus projects the lesser tubercle in profile medially?
Internal rotation
Accumulated fluid within the joint cavity
Joint effusion
Which two bony landmarks are palpated to assist with positioning of the upper limb
Lateral and medial epicondyles
Which two bony landmarks are palpated to assist with positioning of the upper limb?
Lateral and medial epicondyles
This projection of the elbow best demonstrates the olecranon process in profile:
Lateral elbow
This projection of the elbow best demonstrates the trochlear notch in profile:
Lateral elbow
Which lateral projection of the hand best demonstrates a possible foreign body in the palm of the hand?
Lateral in extension
Which routine projection best demonstrates the pronator fat stripe?
Lateral wrist
Osteomyelitis
Local or generalized infection of the bone or bone marrow
Where is the coronoid tubercle located
Medial aspect of coronoid process
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
Which special positioning method can be performed to demonstrate a Bennett's fracture?
Modified Robert's method
Fracture of the proximal half of the ulna, along with dislocation of the radial head
Monteggia's fracture
osteoarthritis
Narrowing of joint space with periosteal growths on the joint margins
What is the exposure factor adjustment for Joint effusion
None
What is the proper name for the position referred to as the "ball-catcher's position"?
Norgaard method
A patient comes to the radiology department for a hand series to evaluate early evidence of rheumatoid arthritis. Which special projection can be used in addition to the routine hand projections to evaluate this patient
Norgaard method ( ball catcher's position)
Which imaging procedure best demonstrates osteomyelitis?
Nuclear medicine
Partial dislocation of the radial head of a child
Nursemaid's elbow
The deep depression located on the posterior aspect of the distal humerus is the
Olecranon fossa
What is a radiographic procedure that uses contrast media injected into the joint capsule to visualize soft tissue pathology of the wrist, elbow, and shoulder joints?
Arthrography
Lateral elbow projection
Olecranon process in profile and Trochlear notch in profile
Which pathologic condition often produces a narrowing of the joint space?
Osteoarthritis
Local or generalized infection of bone or bone marrow. Soft tissue swelling and loss of fat pad detail visibility.
Osteomyelitis
Hereditary disease marked by abnormally dense bone. Reduction in the quantity of bone or atrophy of skeletal tissue. Decrease exposure factor
Osteoporosis
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 the carpal canal (inferosuperior) projection reveals that the pisiform and humans are superimposed. What can be done to correct this positioning error on the repeat exposure?
Rotate wrist laterally 5-10 degrees
Traumatic injury to one or more muscles of the shoulder joint
Rotator cuff tear
Where is the central ray placed for a PA projection of the hand?
Third MCP joint
A PA axial scaphoid projection of the wrist using a 15 degree distal CR angle and ulnar flexion was performed. The resultant radiograph reveals 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
T/F Even though the amount of radiation exposure is minimal for most shoulder projections, gonadal shielding should be used for children and adults of childbearing age.
True
T/F Nuclear medicine bone scans can demonstrate signs of osteomyelitis and cellulitis
True
T/F Sonography (ultrasound) can provide a functional (dynamic) evaluation of joint movement that MRI cannot
True
T/F The entire metacarpal and trapezium must be demonstrated on all projections of the thumb
True
T/F The greatest technological concern during a pediatric shoulder study is voluntary motion
True
T/F The use of a grid is not required for shoulder studies that measure less than 10cm
True
T/F The use of breathing technique can be performed for the transthoracic lateral humerus projection
True
T/F To visualize fat pads surrounding the elbow, exposure factors must be adjusted to see both bony and soft tissue structures.
True
True/False: Slight superimposition of the distal third, fourth, and fifth metacarpals may occur with a well-positioned PA projection of the hand.
True
True/False: The entire metacarpal and trapezium must be demonstrated on all projections of the thumb
True
True/False: Guardians of young pediatric patients who are having upper limb studies can be asked to hold their child during the radiographic study
True Given proper shielding
True
True or false to visualize fat pads surrounding the elbow, exposure factors must be adjusted to see both bone me and soft tissue structures
False
True or false, anterior and posterior are fat pads of the elbow our best seen on correctly positioned and correctly exposed anteroposterior AP elbow projection
False
True or false, placing multiple images on the same digital IP is recommended as long as close collimation is applied for each projection.
Comminuted fracture of the distal phalanx.
Tuft fracture
Which bone of the upper limb contains the trochlear notch?
Ulna
Turning position of the wrist most commonly used to detect scaphoid fracture
Ulnar Deviation
What special turning or bending position of the hand and wrist are commonly performed to detect a fracture of the scaphoid bone?
Ulnar deviation
Which imaging procedure provides a functional , or dynamic, study of the shoulder joint?
Ultrasound
A three projection study of the hand was taken using the following analog exposure factors: 64kV, 1000 mA, 1/100 second, large focal spot, 36 inch SID, and high speed screens. Which of these factors should be changed on future hand studies to produce more optimal images
Use a small focal spot, minimum 40 inch SID, and detail screens to produce a higher quality study
To best demonstrate Hill-Sachs defect on the inferosuperior axial projection, which additional positioning maneuver must be used?
Use exaggerated external rotation
Anterior surface of the scapula is referred to as the _________ surface
Ventral (costal)
increased OID
What is the major disadvantage of performing a PA projection of the thumb rather then and AP
Lateral rotation, the radius and ulna are separated
What rotation of the elbow is this?
Medial rotation, the radius and ulna are superimposed
What rotation of the elbow is this?
Bennett's fracture
What type of fracture is best demonstrated with a modified Roberts method
Affected PIP joint
Where is the central ray centered for a PA projection of the second digit
Third MCP joint
Where is the central ray placed for a P a projection of the hand
Advanced osteoporosis
Which one of the following clinical indication requires a decrease in manual exposure factors
A patient with possible Barton fracture enters the emergency room. Which positioning routine should be performed to confirm this diagnosis?
Wrist
A patient with possible Smith fracture enters the emergency room. Which positioning routine should be performed to confirm this diagnosis?
Wrist/forearm
list the three parts of each metacarpal ,starting proximally:
a.base b.body c.head
the three part of each phalanx ,starting distally ,are the
a.head b.body. c.base
the two portions of the thumb (first digit) are the
a.proximal phalanx b.distal phalanx
the portion of each finger(second through fifth digits)are
a.proximal phalanx. b. medial phalanx c.distal phalanx
the intermediate double arc,consisting of the outer ridges of
a.the smallest arc: capitulum b.the larger arc :trachea
The general rule for collimation for upper limb radiography states
collimation borders should be visible on all four sides if the IR is large enough to allow for this with out cutting off essential anatomy
What is the exposure factor adjustment for Advanced Rheumatoid Arthritis
decrease
What is the exposure factor adjustment for Osteoporosis
decrease
type of intensification screens most commonly used for analog imaging in upper limb radiography
detail-intensifying
ellipsoidal joints are classified as freely movable ,or _________,and allow movement in ______directions
diarthrodial,4
How much of the metacarpals should be included for a PA projection of the digits?
distal aspect of metacarpals
list the two radiographic criteria used to determine whether rotation is present on the PA projection of the digits symmetric appearance of both sides of the shafts of phalanges and distal metacarpals
equal amounts of tissue on each side of the phalanges
A radiograph of a PA oblique projection of the hand reveals that the fourth and fifth metacarpals are superimposed. Which specific positioning error is involved
excessive lateral rotation
Which positioning error is involved if a majority of the carpal bones are superimposed in a PA oblique wrist projection?
excessive lateral rotation from PA
T/F Trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph.
false
What is the exposure factor adjustment for Advanced Paget's Disease
increase
What is the exposure factor adjustment for Osteopetrosis
increase
how would you change the technical factors for upper limb radiography if the patient had a fiberglass cast
increase 3-4 kV
how would you change the technical factors for upper limb radiography if the patient had a small to medium dry plaster cast
increase 5-7 kV
how would you change the technical factors for upper limb radiography if the patient had a large plaster cast
increase 8-10 kV
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
the name of the joint between the proximal and distal phalanges of the digits is the
interphalangeal joint
which routine projection best demonstrates the pronator fat stripe
lateral wrist
A sesamoid bone is frequently found adjacent to the _________ joint of the thumb.
metacarpophalangeal (MCP)
the joint between the metacarpals and the phalanges are the
metacarpophalangeal (MCP)
osteopetrosis
mixed areas of sclerotic and cortical thickening along with radiolucent lesions
What is the exposure factor adjustment for bursitis
none
Reduction in the quantity of bone or atrophy of skeletal tissue
osteoporosis
Hereditary condition marked by abnormally dense bone
osterpetrosis
which positioning modifications should be used for a study of the second digit to reduce distortion for a lateral position
perform a thumb-down lateral (mediolateral projection) to decrease OID
Which positioning modifications should be used for a study of the second digit to reduce distortion for a PA oblique projection
perform the medial oblique rather than lateral oblique
where is the CR centered fro a PA oblique projection of the second digit
proximal interphalangeal (PIP) joint
which ligament of the wrist extends from the styloid process of the lateral aspect to the scaphoid and trapezium bones?
radial collateral ligaments
Which ligament of the wrist extends from the styloid process of the radius to the lateral aspect of the scaphoid and trapezium bones?
Radial collateral ligament
What is the name of the two special turning or bending positions of the hand and wrist that demonstrate medial and lateral aspects of the carpal region?
Radial deviation (medial) Ulnar deviation (lateral)
AP lateral rotation oblique projection
Radial head and tuberosity without superimposition and Capitulum and lateral epicondyle in profile
Which carpal is most commonly fractured
Scaphoid
Which two carpal bones are located most anteriorly as seen on a lateral wrist radiography
Scaphoid and trapezium
Which projection is best for demonstrating a possible dislocation of the proximal humerus?
Scapular Y projection
Which bony structure separates the supraspinus and infraspinus fuss?
Scapular spine
What clinical indication is best demonstrated with the Garth method?
Scapulohumeral dislocations
The term that correctly describe the shoulder joint
Scapulohumeral joint or Glenohumeral joint
Which anatomy of the shoulder is best demonstrated with a PA transaxillary projection (Hobbs modification)?
Scapulohumeral joint space
First metacarpopmetacarpal joint
Sellar (saddle) - flexion, extension, abduction, adduction circumduction, opposition and some degree of rotation
A _______ bone is frequently found adjacent to the metacarpophalangeal (MCP) joint of the thumb
Sesamoid bone
Taylor goes into the ER with an injury to his elbow. Alicia is working as the technologist that day. Taylor is complaining of severe pain in his elbow, he is unable to move it and the physician on staff believes it may be dislocated. What does Alicia do?
She tells Taylor "awe man.... this is really going to hurt" as she laughs evilly and rubs her hands together. Then she performs two acute flexion projections of the elbow. One for distal humerus, CR perpendicular to the humerus, and one for proximal forearm CR perpendicular to the forearm. Alicia then tells Taylor to suck it up and apologizes for forgetting to shield his gonads!
Fracture in which the bone does not break through the skin
Simple (closed) fracture
Sprain or tear of the ulnar collateral ligament
Skier's thumb
Fracture of the wrist with the distal fragment of the radius displaced anteriorly rather than posteriorly. Reverse of Colles' fracture
Smith fracture
Arthrography is a radiographic study of
Soft tissue structure within certain synovial joints
Arthrography is a radiographic study of:
Soft tissue structures within certain synovial joints
Osteomyelitis
Soft tissue swelling and loss of fat-pad detail visibility
What is the type of joint movement for the scapulohumeral joint?
Spheroidal movement - flexion, extension, abduction, adduction, circumduction, medial and lateral rotation
Rupture or tearing of supporting ligaments, without dislocation.
Sprain
Skiers thumb
Sprain or tear of the ulnar collateral ligament
Carpometacarpal joint, first digit thumb
Stellar (saddle)
Three aspects of the clavicle are:
Sternal extremity Body (shaft) Acromial extremity
Partial dislocation
Subluxation
What two positioning landmarks are aligned perpendicularly to the IR for the lateral scapula projection?
Superior angle of the scapula and AC joint
In what position should the hand be for an AP elbow projection?
Supinated
External rotation
Supination of the hand, epicondyles are parallel to the IR. Greater tubercle is located laterally and lesser tubercle is located anteriorly. Proximal humerus in position for an AP projection
Which special projection of the wrist helps rule out abnormal calcifications in the carpal sulcus ?
Tangential inferiosuperior or Gaynor-Hart projection
A patient comes to the radiology department with a history of tendonitis of the bicep tendon. Which projection will best demonstrate calcification of the tendon within the intertubercular groove?
Tangential projection (Fisk method)
Which projection best describes the supraspinatus outlet region?
Tangential projection (Neer method)
Which projection/position best demonstrates signs of impingement syndrome?
Tangential projection (Neer method)
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
Inflammatory condition of the tendon
Tendonitis
Why is the AP projection of the thumb recommended instead of PA
The AP position produces a decrease in OID and increased resolution
False
The Hands are placed and a true PA position when using the Norgaard method
Parallel to the long axis of the IR
The long axis of the anatomic part being imaged should be placed
What is the major advantage of the supine, tangential version of the intertubercular groove projection over the erect version?
Reduced OID
Osteoporosis
Reduction in the quality of bone or atrophy of skeletal tissue
Smith fracture
Reverse of a colles fracture
Chronic systemic disease with arthritic inflammatory changes throughout the body. Closed joint spaces with subluxation of MCP joints. Decrease exposure values.
Rheumatoid arthritis
Which pathologic condition may require a reduction in minimal exposure factors?
Rheumatoid arthritis
The "ball-catchers position" is commonly used to evaluate for early signs of
rheumatoid arthritis
A radiograph of a PA projection of the second digit reveals that the phalanges are not symmetric on both sides the of the bony shafts. Which specific positioning error is involved
rotation
What type of exposure time is more commonly used with upper limb radiography?
short
What type of focal spot is most commonly used with upper limb radiography?
small
correctly exposed radiographs visualize __________ margins and __________ markings of all bones
soft tissue fine trabecular
How many bones make up the phalanges of the hand
14
Which IR size should be used for a thumb projection?
18x24 cm (8x10 inch)
Appearance of the forearm when pronated for a PA projection
Proximal radius covers over the ulna
Where is the coronoid tubercle located?
Proximal ulna, the medial aspect of the coronoid process.
How much CR angulation from the long axis of the forearm is required for the carpal bridge (tangential) projection?
45 degrees
How much rotation is required for an oblique projection of the wrist?
45 degrees
During the PA axial scaphoid projection with CR angle and ulnar flexion, the CR must be angled
10-15 degrees proximally
Where is the central ray centered for an AP projection-external rotation of the shoulder?
1 inch (2.5 cm) inferior to coracoid process
a minimum of _____ inch(es) ______ cm of the forearm should be included radiographically for PA projection of the hand
1 inch, 2.5 cm
AP projection Thumb Fracture and dislocation of the distal ,middle, and proximal phalanges ,distal metacarpal and assorted joints, pathology (osteoporosis and osteoarthritis) also special AP modified Roberts projection For Bennett's fracture at base of first metacarpal
1. Internally rotate hand with fingers extended until posterior surface of thumb is in contact with IR .Immobilize other fingers with tape to isolate thump if necessary 2.CR to first MCP joint ,CR perpendicular to IR. 3.Exposure optimal density (brightness)and contrast with no motion demonstrate soft tissue margins and clear sharp bony trabecular markings . 4. distal phalanx,Proximal phalanx ,MCP joint (CR), 1st CMC joint Trapezium 5.SID 40,IR 8x10 landscape or portrait analog 55+_5kv digital 60+-5kv
The thumb oblique medial rotation Fracture and dislocation of the distal ,middle, and proximal phalanges ,distal metacarpal and assorted joints, pathology (osteoporosis and osteoarthritis
1.Abduct thumb slightly with palmar surface of hand in contact with IR(this is naturaly 45 oblique) 2.CR to first MCP joint ,CR perpendicular to IR. 3.Exposure optimal density (brightness)and contrast with no motion demonstrate soft tissue margins and clear sharp bony trabecular markings . 4. distal phalanx,Proximal phalanx ,MCP joint (CR), 1st CMC joint ,sesamoid bone 5.SID 40,IR 8x10 landscape or portrait analog 55+_5kv digital 60+-5kv
"FAN" LATERAL - LATEROMEDIAL PROJECTION: HAND Fractures and/or dislocations of the phalanges, anterior/posterior displaced fractures, and dislocations of the metacarpals are shown. Some pathologic processes, such as osteoporosis and osteoarthritis, also may be demonstrated in the phalanges.
1.Align long axis of hand with long axis of IR. Rotate hand and wrist into lateral position with thumb side up. Spread fingers and thumb into a "fan" position, and support each digit on radiolucent block as shown. Ensure all digits, including the thumb, are separated and parallel to IR, and that the metacarpals are not rotated but remain in a lateral position. 2.CR perpendicular to IR, directed to second MCP joint Minimum SID of 40 inches (100cm) 3.Entire hand and wrist and about 2.5cm (1inch) of distal forearm are visible. 4.Optimal density and contrast with no motion demonstrate soft tissue margins and clear, sharp bony trabecular markings. Outlines of individual metacarpals demonstrated are superimposed. Midphalanges and distal phalanges of both thumb and fingers should appear sharp but may be slightly overexposed.
PA OBLIQUE PROJECTION: HAND
1.Pronate hand on cassette; center and align long axis of hand with long axis of portion of IR that is being exposed. Rotate entire hand and wrist laterally 45 degrees and support with radiolucent wedge or step block, as shown, so that all digits are separated and parallel to IR (see exception below). 2 CR perpendicular to IR, directed to third MCP joint Minimum SID of 40 inches (100cm) 3.Exposure optimal density (brightness)and contrast with no motion demonstrate soft tissue margins and clear sharp bony trabecular markings . 4.45 degrees oblique is evidenced by the following: Midshafts of metacarpals should not overlap; some overlap of distal heads of third, fourth, and fifth, metacarpals but no overlap of distal second and third metacarpals should occur; excessive overlap of metacarpals indicates over rotation, and too much separation indicates underotation
PA PROJECTION HAND
1.Pronate hand with palmar surface in contact with cassette; spread fingers slightly. Align long axis of hand and forearm with long axis of portion of IR that is being exposed. Center hand ans wrist to unmasked half of IR. 2.PA projection of entire hand and wrist and about 2.5 cm (1 inch) of distal forearm are visible. Note that PA projection of hand demonstrates oblique view of the thumb. 3.CR to first MCP joint ,CR perpendicular to IR. 4.MCP and IP joints should appeat open, indicating correct CR location and that hand was fully pronated. Long axis of hand and wrist aligned with long axis of IR. No rotation of hand, as evidence by the following: symmetric appearance of both sides or concavities of shaft of metacarpals and phalanges of digits 2 though 5; the appearance of equal amounts of soft tissue on each side of phalanges 2 through 5. Digits should be separated slightly with soft tissues not overlapping.
The two (2) special turning or bending positions of the hand and wrist that demonstrate medial and lateral aspects of the carpal region
1.Ulnar Deviation 2.Radial Deviation
Finger PA projection ( routine PA,PA oblique ,Lateral) fracture and dislocation of the distal ,middle, and proximal phalanges ,distal metacarpal and assorted joints, pathology (osteoporosis and osteoarthritis)
1.pronate hand with fingers extended .Center and align long axis of affected finger with long axis of IR. 2.CR PIP joint ,CR perpendicular to IR. 3.Exposure optimal density (brightness)and contrast with no motion demonstrate soft tissue margins and clear sharp bony trabecular markings . 4. distal phalanx,distal IP joint Middle phalanx,Proximal IP joint (CR), Proximal Phalanx ,4th MCP joint 4th metacarpal. 5.SID 40,IR 8x10 landscape or portrait analog 55+_5kv digital 60+-5kv
Thumb Lateral position Fracture and dislocation of the distal ,middle, and proximal phalanges ,distal metacarpal and assorted joints, pathology (osteoporosis and osteoarthritis
1.start with hand pronated and thumb abducted ,with fingers and hand slightly arched,than rotate hand slightly medial until thumb in true lateral position.entire lateral aspect of the thumb must be in direct contact with IR. 2.CR to first MCP joint ,CR perpendicular to IR. 3.Exposure optimal density (brightness)and contrast with no motion demonstrate soft tissue margins and clear sharp bony trabecular markings . 4. distal phalanx,Proximal phalanx ,MCP joint (CR), 1st CMC joint ,sesamoid bone, trapezium 5.SID 40,IR 8x10 landscape or portrait analog 55+_5kv digital 60+-5kv
PA oblique projection MEDIAL OR LATERAL FINGERS fracture and dislocation of the distal ,middle, and proximal phalanges ,distal metacarpal and assorted joints, pathology (osteoporosis and osteoarthritis)
1.with fingers extended against 45 foam wedge block,place hand in 45 lateral oblique(thumb side up.Separate fingers against block 45 oblique and parallel to IR. 2.CR PIP joint ,CR perpendicular to IR. 3.Exposure optimal density (brightness)and contrast with no motion demonstrate soft tissue margins and clear sharp bony trabecular markings . 4. distal phalanx,distal IP joint Middle phalanx,Proximal IP joint (CR), Proximal Phalanx ,4th MCP joint 4th metacarpal. 5.SID 40,IR 8x10 landscape or portrait analog 55+_5kv digital 60+-5kv Lateral rotation is recommended to demonstrate 3rd,4th,5th digits
grids are used if the body part measures greater than
10 cm
For the erect version of the tangential projection for the intertubercular groove, the patient leans forward ________ from vertical
10-15 degrees
What central ray angulation is required for the tangential projection of the supraspinatus outlet (Neer method)?
10-15 degrees caudad
LATEROMEDIAL OR MEDIOLATERAL PROJECTIONS FINGERS Fracture and dislocation of the distal ,middle, and proximal phalanges ,distal metacarpal and assorted joints, pathology (osteoporosis and osteoarthritis)
1Place hand in lateral position (thumb side up)align and center finger to long axis of IR and to CR. 2.CR PIP joint ,CR perpendicular to IR. 3.Exposure optimal density (brightness)and contrast with no motion demonstrate soft tissue margins and clear sharp bony trabecular markings . 4. distal phalanx, Middle phalanx,Proximal IP joint (CR), Proximal Phalanx. 5.SID 40,IR 8x10 landscape or portrait analog 55+_5kv digital 60+-5kv
How much are the hand and wrist elevated from the IR for the modified Stecher method?
20 degrees
How much CR angulation to the long axis of the hand is required for the carpal canal (tunnel) projection?
25-30 degrees
What central ray angle should be used for the inferosuperior axial projection for the scapulohumeral joint space?
25-30 degrees medially
What is the total number of bones that make up the hand and wrist
27
What is the most common minimum SID for upper limb radiography?
40 inches
what factors help reduce image distortion during upper limb radiography?
40-44 inch SID Minimal OID Correct CR placement and angulation Use of small focal spot
If the patient cannot fully abduct the affect arm 90 degrees for the inferosuperior axial projection (Clements modification), the technologist can angle the CR ____________ degrees toward the axilla.
5-15 degrees toward the axilla
kV range for upper limb radiography
50-60 kV
Choosing the best set of exposure factors for upper limb radiography using and analog film-based system
60 4KV, 200 mA, 1/20 Second, small focal spot, 40 inch ( 102- cm) SID , detail speed screen
What is the kV range most commonly used for upper limb radiography?
60-70 analog 60-80 digital
kV range for shoulder series on an average adult
70-80 kV
How many bones make up the carpals region
8
What is the minimum amount of weight a large adult should have strapped to each wrist for the weight-bearing phase of an AC joint study?
8-10 lbs
The hand and wrist form a ________ angle to the forearm with the carpal bridge (tangential) projection.
90 degree
The elbow generally should be flexed ________ degrees for the routine positions of the wrist.
90 degrees
68 to 70 KV
A patient has a colles fracture reduced, and a large plaster cast and placed all the upper limb. The orthopedic surgeon orders a postreduction study. The original technique, used before the cast placement, involved 60 KV and 5 mAs analog system.how sure the exposure effect or be altered within a large plaster casts
wrist
A patient with a possible Barton fracture enter the emergency room. Which position routine should be performed to confirm this diagnosis
Wrist/forearm
A patient with possible Smith fracture enters the emergency room. Which position routine should best be performed to confirm this diagnosis.
Coyle method
A pediatric patient with a possible Radiohead fracture is brought into the emergency room. It is too painful for the patient to extend The elbow beyond 90° or rotate the hand.what type of special projection could be performed on this patient to confirm the diagnosis without causing further discomfort
Decrease oblique of the hand
A radiograph of a PA oblique of the hand reveals that the third, fourth, and fifth metacarpal's are superimposed what must be done to correct this positioning problem on the repeat exposure
Place humerus/forearm in same horizontal plane
A radiograph of a lateral projection of the elbow reveals that the epicondyles are not superimposed and the trochlear notch is not clearly seen. what must be done to correct this positioning error Doring the repeat exposure
Insufficient medial rotation
A radiograph of an AP oblique medial rotation reveals that the coronoid process is not in profile and the Radiohead is not superimposed over the Ulna. What a specific position error was involved
Rotate upper limb medially
A radiograph of an APO of a projection demonstrates total separation between the proximal radius and Ulna. What must be done to correct this positioning error on the repeat exposure
Rotate wrist laterally 5° to 10°
A redo a graph of the carpal canal ( inferosuperior ) projection videos that the pisiform and hamulus are superimposed. What can be done to correct this problem on the repeat exposure
In an erect position, which one of the following structures is considered to be most inferior or distal? A. Head of ulna B. Olecranon process C. Radial tuberosity D. Head of radius
A. Head of ulna
A patient with a possible right shoulder separation enters the emergency room. Which routine should be used?
AC joint series - non-weight bearing and weight bearing projections
What anatomy is best demonstrated with the Alexander method?
AC joints
A patient with a trauma injury enters the ER with an evident Colles' fracture. Which positioning routine should be used to demonstrate the extent of the injury
AP and lateral forearm projections to include the wrist
This projection of the elbow best demonstrates the coronoid tubercle:
AP elbow
This projection of the elbow best demonstrates the olecranon process seated in the olecranon fossa:
AP elbow
Which alternative projection to the routine PA wrist best demonstrates the intercarpal joint spaces and wrist joint?
AP projection with the hand slightly arched
This projection of the elbow best demonstrates the capitulum and lateral epicondyle in profile:
AP, lateral rotation oblique
This projection of the elbow best demonstrates the radial head and tuberosity without superimposition:
AP, lateral rotation oblique
This projection of the elbow best demonstrates the coronoid process in profile:
AP, medial rotation oblique
Joint effusion
Accumulating fluid within the joint cavity
Abnormality of cartilage affecting long bones
Achondroplasia
An abnormality of the cartilage affecting long bones
Achondroplasia
Which specific joint is found on the lateral end of the clavicle?
Acromioclavicular joint
Superior displacement of distal clavicle
Acromioclavicular joint dislocation
Where is the central ray centered for a PA projection of the second digit?
Affected PIP joint
1. Acromial extremity 2. Acromoclavicular joint 3. Greater tubercle 4. Intertubercular groove * lesser tubercle located medially 5. Surgical neck 6. Body 7. Head of humerus 8. Lateral angle Arrow - Scapulohumeral (glenohumeral) joint
Anatomy of proximal humerus:
Where are the coronoid and radial fossa located
Anterior aspect of the distal humerus
Where are the coronoid and radial fossae located
Anterior aspect of the distal humerus
Avulsion fracture of the glenoid rim
Bankart lesion
Fracture and dislocation of the posterior lip of the distal radius
Barton's fracture
A Bennett's fracture involves:
Base of first metacarpal
Fracture of the distal phalanx is caused by a ball striking the end of an extended finger. The distal interphalangeal (DIP) joint is partially flexed and an avulsion fracture is frequently present at the posterior base of the of the distal phalanx
Baseball fracture
Longitudinal fracture at the base of the first metacarpal, with the fracture line entering the carpometacarpal (CMC) joint, generally includes a posterior dislocation or subluxation
Bennett's fracture
What type of fracture is best demonstrated with a modified Robert's method?
Bennett's fracture
True
Both hands are examined with one single exposure when using the Norgaard method
Fracture usually involved with the 5th distal metacarpal. Results from punching someone or something
Boxer's fracture
Transverse fracture extending through the distal aspect of the metacarpal neck, most often the 5th metacarpal
Boxer's fracture
Inflammation of the fluid-filled joint spaces with possible calcification
Bursitis
Which one of the following structures is considered to be the most posterior? A. Scapular notch B. Coracoid process C. Acromion D. Glenoid process
C. Acromion
Which one of the following clinical indications requires a decrease in manual exposure factors? A. Paget's disease B. Advanced Osteopetrosis C. Advanced Osteoporosis D. Joint effusion
C. Advanced Osteoporosis
The articular portion of the lateral aspect of the distal humerus is called
Capitulum (articulates with the radius)
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 Tunnel position (Gaynor-Hart Method)
Painful disorder of hand and wrist from compression of the median resulting nerve
Carpal tunnel syndrome
Why should a forearm never be taken as a PA projection?
Causes proximal radius to cross over the ulna
Why should a farm never be taken as a PA projection
Causes the proximal radius to cross over the ulna
Transverse fracture of the distal radius with posterior displacement of the distal fragment
Colles' Fracture
Fracture of the wrist in which the distal radius is fracture with distal fragment displaced posteriorly.
Colles' fracture
Fracture in which the break is complete and the bone is broken into two pieces
Complete fracture
Fracture in which portion of the bone protrudes through the skin
Compound (open) fracture
Bruise type of injury without fracture
Contusion
AP medial rotation oblique projection
Coronoid process in profile
A P elbow projection
Coronoid tubercle and Olecranon process seeded in olecranon fossa
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 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
Which one of the following structures of the scapula extends most anteriorly? A. Glenoid cavity B. Acromion C. Scapular spine D. Coracoid process
D. Coracoid process
A radiograph of a PA oblique of the hand reveals that the third, fourth and fifth metacarpals are superimposed. What must be done to correct this positioning problem on the repeat exposure?
Decrease the obliquity of the hand
Displacement of bone from the joint
Dislocation
What is the type of joint movement for the Sternoclavicular joint?
Double plane (gliding) - sliding or gliding motion between articulating surfaces
The fat pads around the elbow joint are valuable diagnostic indicators if the following three technical/positioning requirements are met with the lateral position.
Elbow Flexed 90o Optimal exposure factors employed In a true lateral position
Wrist ( radio carpal) joint
Ellipsoidal ( condyloid)
A patient with a metallic foreign body in the palm of the hand enters the ER. Which specific projections should be used to locate the foreign body
PA and lateral-in-extension projection
Which routine projections best demonstrate the scaphoid fat pad?
PA and oblique wrist
In a radiographic 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 preferred rather than AP
Which projection of the thumb is achieved naturally by placing the palmar surface of the hand in contact with the cassette?
PA oblique
Which special projection of the wrist best demonstrates the interspaces on the ulnar side of the wrist between the lunate, triquetrum, pisiform, and hamate bones?
PA projection with radial deviation
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
What is the routine positioning routine for the second through fifth digits of the hand?
PA, PA oblique, and lateral
Chronic skeletal disease characterized by bone destruction followed by a reparative process of overproduction of very dense yet soft bones that tend to fracture easily
Paget's disease
Carpal tunnel syndrome
Painful disorder of hand and wrist from compression of the median resulting nerve
Neutral rotation
Palm of hand against thigh. Epicondyles are 45 degrees to IR. Proximal humerus in a lateral position. Greater tubercle anteriorly but still lateral to the lesser tubercle
The long axis of the anatomic part being imaged should be placed:
Parallel to the long axis of the IR
How are the humeral epicondyles aligned for a rotational lateromedial projection of the humerus?
Perpendicular to the IR
A radiograph of a lateral projection of the elbow reveals 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 the same horizontal plane
Carpometacarpal joint 2nd to 5th digits
Plane ( gliding)
Intercarpal joint
Plane ( gliding)
Third carpometacarpal joint
Plane (gliding) - least amount of movement
Acromiclavicular joint
Plane (gliding) - sliding or gliding motion between articulating surfaces
Carpal tunnel syndrome
Possible calcification in the carpal sulcus
What projection requires the CR to be centered 2 inches inferior and medial from the superolateral border of the shoulder?
Posterior oblique (Grashey method)
Which special projection of the shoulder places the glenoid cavity in profile for an "open" scapulohumeral joint?
Posterior oblique (Grashey method)
Which routine projection best demonstrates the scaphoid fat pad?
Posteroanterior (PA) and oblique wrists
Which one of the following fractures is not demonstrated in a wrist routine? Barton's Pott's Smith's Colles'
Pott's
In what position should the hand be in for an AP medial rotation oblique elbow position?
Pronated
Articulates with the scapula, making up the shoulder joint
Proximal humerus
Shoulder girdle consists of:
Proximal humerus, clavicle and scapula
Tiffany, Tim, and Vivianette walk into the ER. Tim expresses severe pain in is pokemon catching IP and MCP joints of his first digit. Tiffany has a possible fracture of her ulna after she and Vivianette chased down a man for taking her squirtle and Tiffany suffered a fall. Vivanette is experiencing pain across the 2nd thru 5th MCP joints for beating up the jerk that made Tiffany fall. What specific images can be taken to best demonstrate the IP and MCP of the first digit for Tim, the ulna for Tiffany and the 2nd thru 5th MCP for Vivianette
Tim: AP and PA oblique thumb Tiffany: AP and Lateral forearm Vivianette: PA Oblique Hand, "Fan" Lateral Hand, and Lateral in Extension and flexion - Lateromedial projections of the hand
Why is it important to keep the long axis of the digit parallel to the IR?
To reduce distortion of the phalanges To properly visualize joints To demonstrate small fractures
Why is it important to keep a long axis of the digit parallel to the IR
To reduce distortion of the phalanges, to probably visualize joints, to demonstrate small fractures.
What projection can a breathing technique be employed?
Transthoracic lateral for humerus and shoulder
Which carpal articulates with the base of thumb
Trapezium
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 corocoid process
The articular portion of the medial aspect of the distal humerus is called
Trochlea (articulates with the ulna)
The articular portion of the humeral condyle is divided into two parts:
Trochlea (medial condyle) and the capitulum (lateral condyle)
Proximal radioulnar
Trochoidal ( pivot )
Proximal radioulnar
Trochoidal ( pivot ) joint
T/F A 72'' SID is recommended for acromioclavicular joint studies
True
T/F Both hands are examined with one single exposure when using the Norgaard method
True
T/F CT arthrography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space.
True
A radiograph of an AP elbow projection reveals 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 reveals 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
Where is the CR centered for a PA projection of the hand?
third metacarpophalangeal MCP joint
Why is it important to keep the affected digit parallel to the IR for the PA oblique and lateral projections
to prevent distortion of the phalanx to prevent distortion of the joints to demonstrate small, non-displaced fractures near the joint
the third arc ,which is part of the ulna
trochlear notch
the first and smallest of the arcs
trochlear sulcus
T/F Excessive kV may obscure the visibility of a fat pad.
true
true /false in addition to the ulnar and radial collateral ligaments ,the following fife additional ligaments are also important in stabilizing the wrist joint:
true:1.dorsal radiocarpal,2.palmar radiocarpal,3.scapholunate,4.lunotriquetral.Triangular fibrocartilage complex (TFCC)
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 projections with acute flexion and lateral projection
Which bone of the upper limb contains the coronoid process
ulna
