Imaging Procedures- Extremities

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Which of the following projections will best demonstrate acromioclavicular separation? AP erect, both shoulders

Acromioclavicular (AC) joints usually are examined when separation or dislocation is suspected. They must be examined in the erect position because in the recumbent position a separation appears to reduce itself. Both AC joints are examined simultaneously for comparison because separations may be minimal.

Adult orthoroentgenography, or radiographic measurement of long bones of an upper or lower extremity, requires which of the following accessories? 1. Bell-Thompson scale 2. Bucky tray

Adult orthoroentgenography is the radiographic measurement of long-bone length. It can be required on adults or children having extremity length (especially leg) discrepancies. This can be performed most easily with the use of the metallic Bell-Thompson scale secured to the x-ray tabletop adjacent to the limb being examined (or between both limbs for simultaneous bilateral examination). A 14 × 17 inch cassette is in the Bucky tray (to permit movement of the cassette between exposures), and three well-collimated exposures are made—at the hip joint, the knee joint, and the ankle joint. A cannula is a tube placed in a cavity to introduce or withdraw material and is unrelated to orthoroentgenography.

AP stress studies of the ankle may be performed 1. following inversion or eversion injuries 2. to demonstrate a ligament tear

After forceful eversion or inversion injuries of the ankle, AP stress studies are valuable to confirm the presence of a ligament tear. Keeping the ankle in an AP position, the physician guides the ankle into inversion and eversion maneuvers. Characteristic changes in the relationship of the talus, tibia, and fibula will indicate ligament injury. Inversion stress demonstrates the lateral ligament, whereas eversion stress demonstrates the medial ligament. A fractured ankle would not be manipulated in this manner.

Identify the structure labeled 1 in the AP projection of the knee shown in Figure 2-16. https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f090.jpg Medial epicondyle

Figure 2-16 shows an AP projection of the knee. The distal femur and proximal tibia and fibula are seen. The femorotibial joint space is open, and the tibial articular facets of the tibial plateau (number 4) are demonstrated. The intercondylar eminence (number 3) is seen. Number 2 is the medial femoral condyle; number 1 is the medial femoral epicondyle; and number 5 is the medial tibial condyle.

In Figure 2-29, which of the following is represented by the number 7? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f166.gif Lateral border

Figure 2-29 depicts a posterior view of the right scapula and its articulation with the humerus (number 4). The scapula presents two borders—the lateral or axillary border (number 7) and the medial or vertebral border (number 9). It also presents three angles—the inferior angle (number 8), the superior angle (number 12), and the lateral angle (number 6). The processes of the scapula are the coracoid (number 2), the acromion (number 3), and the scapular spine (number 13). The scapula has a (supra) scapular notch (number 1), a supraspinatus fossa (number 11), and an infraspinatus fossa (number 10). Number 5 identifies the glenoid fossa—the articular surface for the humeral head, forming the glenohumeral articulation.

A spontaneous fracture most likely would be associated with pathology

Spontaneous fractures most often affect bone weakened by a pathologic condition, for example, metastatic bone disease. The spontaneous fracture occurs suddenly, without trauma. One measure of a good radiographer is his or her ability to be cautious and resourceful when examining injured or debilitated patients having pathologic or traumatic conditions such as metastatic bone disease, arthritis, or bone fractures. Crepitus refers to a crackling sound made by a body part—such as the sound of fractured ends of bones rubbing together. Metabolism refers to the numerous energy and material transformations that take place in the body and is not associated with spontaneous fractures.

Which of the following can be used to demonstrate the intercondyloid fossa? 1. Prone, knee flexed 40 degrees, CR directed caudad 40 degrees to the popliteal fossa 2. Supine, IR under flexed knee, CR directed cephalad to knee, perpendicular to tibia

Statement number 1 describes the PA axial projection (Camp-Coventry method) for demonstration of the intercondyloid fossa. Statement number 2 describes the AP axial projection (Béclère method) for demonstration of the intercondyloid fossa. The positions are actually the reverse of each other. Statement number 3 describes the method of obtaining a PA projection of the patella.

What portion of the humerus articulates with the ulna to help form the elbow joint? Trochlea

he distal humerus articulates with the proximal radius and ulna to form the elbow joint. Specifically, the semilunar/trochlear notch of the proximal ulna articulates with the trochlea of the distal medial humerus. The capitulum is lateral to the trochlea and articulates with the radial head (Figure 2-50). https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f067.gif

To demonstrate the glenoid fossa in profile, the patient is positioned 45 degrees oblique, affected side down

When viewing the glenoid fossa from the anterior, it is seen to angle posteriorly and laterally approximately 45 degrees. To view it in profile, then, it must be placed so that its surface is perpendicular to the IR. The patient is positioned in a 45-degree oblique, affected-side-down position, which places the glenoid fossa approximately perpendicular to the IR. The arm is abducted slightly, the elbow is flexed, and the hand and forearm are placed over the abdomen. The CR is directed perpendicular to the glenohumeral joint.

With the patient and the x-ray tube positioned as illustrated in Figure 2-2, which of the following will be visualized? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f007.gif 1. Patellofemoral articulation 2. Tangential patella

Note the relationship between the thigh, lower leg, patella, and CR. The CR is directed parallel to the plane of the patella, thereby providing a tangential projection of the patella (i.e., patella in profile) and an unobstructed view of the patellofemoral articulation (Figure 2-42). A tunnel view is required to demonstrate the intercondyloid fossa and the articulating surfaces of the tibia and femur. https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f007a.gif

Which of the following is (are) associated with a Colles' fracture? 1. Chip fracture of the ulnar styloid 2. Posterior or backward displacement

A Colles fracture usually is caused by a fall onto an outstretched (extended) hand to "brake" a fall. The wrist then suffers an impacted transverse fracture of the distal inch of the radius with an accompanying chip fracture of the ulnar styloid process. Because of the hand position at the time of the fall, the fracture usually is displaced backward approximately 30 degrees.

A compression fracture of the posterolateral humeral head and associated with an anterior dislocation of the glenohumeral joint is called a(an) Hill-Sachs defect

A Hill-Sachs defect is a compression fracture of the posterolateral humeral head, usually associated with anterior dislocation of the shoulder joint. It can involve the cartilage of the humeral head, causing instability and predisposing the shoulder to subsequent dislocations. A Bankart lesion is a fracture of the anteroinferior portion of the rim of the glenoid fossa. A rotator cuff tear involves injury to one or more of the muscles participating in formation of that muscular structure. The supraspinatus, infraspinatus, subscapularis, and teres minor are the major muscles of the rotator cuff. Adhesive capsulitis, or "frozen shoulder," causes very diminished shoulder movement as a result of chronic joint inflammation.

Which of the following is most useful for bone age evaluation? PA hand

A PA projection of the left hand and wrist is obtained most often to evaluate skeletal maturation. These images are compared with standard normal images for the age and sex of the child. Additional supplemental images may be requested.

Posterior displacement of a tibial fracture would be best demonstrated in the lateral projection

A frontal projection (AP or PA) demonstrates the medial and lateral relationship of structures. A lateral projection demonstrates the anterior and posterior relationship of structures. Two views, at right angles to each other, are generally taken of most structures.

Medial displacement of a tibial fracture would be best demonstrated in the AP projection

A frontal projection (AP or PA) demonstrates the medial and lateral relationships of structures. A lateral projection demonstrates the anterior and posterior relationships of structures. Two views, at right angles to each other, generally are taken of most structures.

Which surface of the forearm must be adjacent to the IR to obtain a lateral projection of the fourth finger with optimal recorded detail? Medial

A lateral projection of the fourth finger is best obtained if the finger is positioned so that there is as little OID as possible. Therefore, with only the fourth finger extended in the lateral position, the arm is positioned on the ulnar (medial) surface. This places the finger closer to the IR than if it were positioned radial side down. Excessive magnification distortion is avoided, and better recorded detail is obtained.

In the lateral projection of the scapula, the vertebral and axillary borders are superimposed.

A lateral projection of the scapula superimposes its medial and lateral borders (vertebral and axillary, respectively). The coracoid and acromion processes should be readily identified separately (not superimposed) in the lateral projection. The entire scapula should be free of superimposition with the ribs. The erect position is probably the most comfortable position for a patient with scapular pain.

Which of the following statements is (are) true regarding the radiograph in Figure 2-12? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f071.jpg 1. The patient is placed in an RAO position. 2. The midcoronal plane is about 60 degrees to the IR. 3. The acromion process is free of superimposition.

A right scapular Y is illustrated; this refers to the characteristic Y formed by the clearly visible humerus, acromion, and coracoid. The patient is positioned in a PA oblique position—in this case, an RAO projection to demonstrate the right side. The MCP is adjusted to approximately 60 degrees to the IR, and the affected arm is left relaxed at the patient's side. The scapular Y position is employed to demonstrate anterior or posterior humeral dislocation. The humerus is superimposed on the scapula in this position; any deviation from this may indicate dislocation.

Which of the following is used to obtain a lateral projection of the upper humerus on patients who are unable to abduct their arm? Transthoracic lateral

A transthoracic projection is used to obtain a lateral projection of the upper half to two-thirds of the humerus when the arm cannot be abducted. The affected arm is placed next to the upright Bucky, the unaffected arm rests on the head, and the CR is directed horizontally through the thorax, exiting the upper humerus. The superoinferior and inferosuperior projections of the shoulder both require abduction of the arm.

Which of the following are components of a trimalleolar fracture? 1. Fractured lateral malleolus 2. Fractured medial malleolus 3. Fractured posterior tibia

A trimalleolar fracture involves three separate fractures. The lateral malleolus is fractured in the "typical" fashion, but the medial malleolus is fractured on both its medial and posterior aspects. The trimalleolar fracture frequently is associated with subluxation of the articular surfaces.

Important considerations for radiographic examinations of traumatic injuries to the upper extremity include 1. both joints must be included in long bone studies. 2. two views, at 90 degrees to each other, are required.

All traumatic injuries require the radiographer to be particularly alert and observant. Patient status must be observed and monitored continually. The radiographer must speak calmly to the patient, explaining the procedure even if the patient appears unconscious or unresponsive. In the case of an injured limb, both joints must be supported if any movement is required. Both joints also must be included when examining long bones. The injured limb need not be placed in exact AP and lateral positions, but any two views of the part at right angles to each other must be obtained.

To demonstrate the entire circumference of the radial head, the required exposure(s) must include 1. epicondyles perpendicular to the IP 2. hand pronated 3. hand supinated as much as possible

Although routine elbow projections may be essentially negative, conditions may exist (such as an elevated fat pad) that seem to indicate the presence of a small fracture of the radial head. To demonstrate the entire circumference of the radial head, four exposures are made with the elbow flexed 90 degrees and with the humeral epicondyles superimposed and perpendicular to the IP—one with the hand supinated as much as possible, one with the hand lateral, one with the hand pronated, and one with the hand in internal rotation, thumb down. Each maneuver changes the position of the radial head, and a different surface is presented for inspection.

The structure labeled number 4 in Figure 2-41 is the https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f295.jpg coracoid process

An AP, external rotation, projection of the shoulder is pictured. The hand is supinated, and the arm is in the anatomical position. Therefore, the greater tubercle (number 3) is well visualized. The greater portion of the clavicle is seen, the acromioclavicular joint (number 1), the acromion process (number 2), the coracoid process (number 4), and the glenohumeral joint (number 5). The coronoid process is located on the ulna.

The structure labeled number 5 in Figure 2-41 is the https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f295.jpg glenohumeral joint

What projection was used to obtain the image seen in Figure 2-41? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f295.jpg AP, external rotation

Which of the labeled bones in Figure A identifies the tarsal navicular? https://s3.amazonaws.com/content-d/mghqa/qimport/RadiographicProcedures_image017.jpg Number 6

An anterior view of the foot and ankle bones is illustrated. The ankle joint is formed by the articulation of the tibia, fibula, and talus (7). The tibial (medial) malleolus is labeled 8; the fibular (lateral) malleolus is labeled 1. The talus articulates with the calcaneus (2) inferiorly and with the navicular (6) anteriorly. The cuboid (3) is seen anterior to the calcaneus, and the three cuneiforms (5) are anterior to the navicular.

What does the number 8 in Figure 6-14 identify? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c006f119.gif Medial malleolus

An anterior view of the foot and ankle bones is shown. The ankle joint is formed by the articulation of the tibia, fibula, and talus (number 7). The tibial (medial) malleolus is labeled 8; the fibular (lateral) malleolus is labeled 1. The talus articulates with the calcaneus (number 2) inferiorly and with the navicular (number 6) anteriorly. The cuboid (number 3) is seen anterior to the calcaneus, and the three cuneiforms (number 5) are anterior to the navicular.

Which of the labeled bones in Figure 6-14 identifies the tarsal navicular? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c006f119.gif Number 6

Which of the following correctly identifies the radial styloid process in the illustration in Figure A? https://s3.amazonaws.com/content-d/mghqa/qimport/RadiographicProcedures_image025.jpg Number 11

An anterior view of the forearm is pictured. The proximal anterior surface of the ulna (number 8) presents a rather large pointed process at the anterior margin of the semilunar (trochlear) notch (5) called the coronoid process (6). The olecranon process is identified as number 4, and the radial notch of the ulna is number 7. Distally, the ulnar head is number 9, and the styloid process is labeled 10. The radius (number 12) is the lateral bone of the forearm. The radial head is number 3, the radial neck is number 2, and the radial tuberosity is number 1. Distally, the radial styloid process is labeled 11.

What is the anatomic structure indicated by the number 7 in Figure 6-22? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c006f164.gif Radial notch

An anterior view of the forearm is shown. The proximal anterior surface of the ulna (number 8) presents a rather large pointed process at the anterior margin of the semilunar (trochlear) notch (number 5) called the coronoid process (number 6). The olecranon process is identified as number 4, and the radial notch of the ulna is number 7. Distally, the ulnar head is number 9, and the styloid process is labeled 10. The radius (number 12) is the lateral bone of the forearm. The radial head is number 3, the radial neck is number 2, and the radial tuberosity is number 1. Distally, the radial styloid process is labeled 11.

Which of the following correctly identifies the head of the ulna in the illustration in Figure 6-22? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c006f164.gif Number 9

Which of the following fracture classifications describes a small bony fragment pulled from a bony process? Avulsion fracture

An avulsion fracture is a small bony fragment pulled from a bony process as a result of a forceful pull of the attached ligament or tendon. A comminuted fracture is one in which the bone is broken or splintered into pieces. A torus fracture is a greenstick fracture with one cortex buckled and the other intact. A compound fracture is an open fracture in which the fractured ends have perforated the skin.

Which of the following views would best demonstrate arthritic changes in the knees? AP erect

Arthritic changes in the knee result in changes in the joint bony relationships. These bony relationships are best evaluated in the AP position. Narrowing of the joint spaces is readily detected more on AP weight-bearing projections than on recumbent projections.

Which of the following statements regarding the Norgaard method, "Ball-Catcher's position," is (are) correct? 1. Bilateral AP oblique hands are obtained. 2. It is used for early detection of rheumatoid arthritis. 3. The hands are obliqued about 45 degrees, palm up.

Bilateral AP oblique hands are obtained using the Norgaard method or "Ball-Catcher position." The method is used to detect early rheumatoid arthritis changes or fracture to the base of the fifth metacarpal. The hands are positioned and supported in a 45-degree oblique, palm-up position. The CR is directed to the level of the fifth metacarpophalangeal joint (MPJ) midway between the hands—both hands are exposed simultaneously.

The secondary center of ossification in long bones is the epiphysis

Bones are classified as long, short, flat, and irregular. Many of the bones making up the extremities are long bones. Long bones have a shaft and two extremities (ends). The shaft (or diaphysis) of long bones is the primary ossification center during bone development. It is composed of compact tissue and covered with a membrane called periosteum. Within the shaft is the medullary cavity, which contains bone marrow and is lined by the membrane called endosteum. In the adult, yellow marrow occupies the shaft, and red marrow is found within the proximal and distal extremities of long bones. The secondary ossification center, the epiphysis, is separated from the diaphysis in early life by a layer of cartilage, the epiphyseal plate. As bone growth takes place, the epiphysis becomes part of the larger portion of bone and the epiphyseal plate disappears, but a characteristic line remains and is thereafter recognizable as the epiphyseal line.

Impingement on the wrist's median nerve causing pain and disability of the affected hand and wrist is known as carpal tunnel syndrome

Carpal tunnel syndrome involves pain and numbness to some parts of the median nerve distribution (i.e., palmar surface of the thumb, index finger, and radial half of the fourth finger and palm). Carpal tunnel syndrome occurs frequently in those who continually use vibrating tools or machinery. Carpopedal spasm is spasm of the hands and feet, commonly encountered during hyperventilation. Carpal boss is a bony growth on the dorsal surface of the third metacarpophalangeal joint.

Which of the following articulations may be described as diarthrotic? 1. Knee 2. Temporomandibular joint (TMJ)

Diarthrotic, or synovial, joints, such as the knee and the TMJ, are freely movable. Most diarthrotic joints are associated with a joint capsule containing synovial fluid. Diarthrotic joints are the most numerous in the body and are subdivided according to type of movement. Amphiarthrotic joints are partially movable joints whose articular surfaces are connected by cartilage, such as intervertebral joints. Synarthrotic joints, such as the cranial sutures, are immovable.

Which of the following is (are) true regarding radiographic examination of the acromioclavicular joints? 1. The procedure is performed in the erect position. 2. Use of weights can improve demonstration of the joints.

Evaluation of the acromioclavicular joints requires bilateral AP or PA erect projections with and without the use of weights. Weights are used to emphasize the minute changes within a joint caused by separation or dislocation. Weights should be anchored from the patient's wrists rather than held in the patient's hands because this encourages tightening of the shoulder muscles and obliteration of any small separation.

In Figure 2-29, which of the following is represented by the number 3? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f166.gif Acromion process

In the lateral projection of the knee, the central ray is angled 5° cephalad to prevent superimposition of which of the following structures on the joint space? Medial femoral condyle

For the lateral projection of the knee, the patient is turned onto the affected side. This places the lateral femoral condyle closest to the IR and the medial femoral condyle remote from the IR. Consequently, there is significant magnification of the medial femoral condyle and, unless the central ray is angled slightly cephalad, subsequent obliteration of the joint space.

In the lateral projection of the ankle, the 1. talotibial joint is visualized. 2. ibia and fibula are superimposed.

In a lateral projection of the ankle, the tibia and fibula are superimposed, and the foot is somewhat dorsiflexed to better demonstrate the talotibial joint. The talofibular joint is not visualized because of superimposition with other bony structures. It may be well visualized in the medial oblique projection of the ankle.

To demonstrate a profile view of the glenoid fossa, the patient is AP recumbent and obliqued 45 degrees toward the affected side

In an AP projection of the shoulder, there is superimposition of the humeral head and glenoid fossa. With the patient obliqued 45 degrees toward the affected side, the glenohumeral joint is open, and the glenoid fossa is seen in profile. The patient's arm is abducted somewhat and placed in internal rotation.

Which of the following positions will separate the radial head, neck, and tuberosity from superimposition on the ulna? Lateral oblique

In the AP projection of the elbow, the proximal radius and ulna are partially superimposed. In the lateral projection, the radial head is partially superimposed on the coronoid process, facing anteriorly. In the medial oblique projection, there is even greater superimposition. The lateral oblique projection completely separates the proximal radius and ulna, projecting the radial head, neck, and tuberosity free of superimposition with the proximal ulna.

In the AP projection of an asthenic patient whose knee measures less than 19 cm from the anterior superior iliac spine (ASIS) to tabletop, the CR should be directed 5 degrees caudad

In the AP projection of the knee, the position of the joint space is significantly affected by the patient's overall body habitus and the distance between the ASIS and tabletop. When the patient is of sthenic habitus with a distance of 19 to 24 cm between the ASIS and tabletop, the CR is directed perpendicularly. When the patient is of asthenic habitus with a distance of less than 19 cm between the ASIS and tabletop, the CR is directed 5 degrees caudad. With a patient with a hypersthenic habitus and an ASIS-to-table measurement of greater than 24 cm, the CR is directed 5 degrees cephalad.

Which of the following is (are) accurate positioning or evaluation criteria for an AP projection of the normal knee? Femorotibial interspaces equal bilaterally.

In the AP projection of the normal knee, the space between the tibial plateau and the femoral condyles is equal bilaterally. It is, therefore, important that there be no pelvic rotation that could change the appearance of an otherwise normal relationship. The AP projection of the knee superimposes the patella and femur. The CR should enter at the knee joint, located ½ in. distal to the patellar apex.

Which of the following positions would best demonstrate the proximal tibiofibular articulation? 45-degree internal rotation

In the AP projection, the proximal fibula is at least partially superimposed on the lateral tibial condyle. Medial rotation of 45 degrees will "open" the proximal tibiofibular articulation. Lateral rotation will obscure the articulation even more.

Which of the following projections is most likely to demonstrate the carpal pisiform free of superimposition? AP (medial) oblique

In the direct PA projection of the wrist, the carpal pisiform is superimposed on the carpal triquetrum. The AP oblique projection (medial surface adjacent to the IR) separates the pisiform and triquetrum and projects the pisiform as a separate structure. The pisiform is the smallest and most palpable carpal.

Which of the following is recommended to better demonstrate the tarsometatarsal joints in a dorsoplantar projection of the foot? Angle the CR 10 degrees posteriorly

In the dorsoplantar projection of the foot, the CR may be directed perpendicularly or angled 10 degrees posteriorly. Angulation serves to "open" the tarsometatarsal joints that are not well visualized on the dorsoplantar projection with perpendicular ray. Inversion and eversion of the foot do not affect the tarsometatarsal joints.

To better visualize the knee-joint space in the radiograph in Figure 2-31, the radiographer should https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f178.jpg angle the CR 5 to 7 degrees cephalad

In the lateral projection of the knee, the joint space is obscured by the magnified medial femoral condyle unless the CR is angled 5 to 7 degrees cephalad. The degree of flexion of the knee is important when evaluating the knee for possible transverse patellar fracture. In such a case, the knee should not be flexed more than 10 degrees. The knee normally should be flexed 20 to 30 degrees in the lateral position.

Which of the following positions is used to demonstrate vertical patellar fractures and the patellofemoral articulation? Tangential patella

In the tangential (sunrise) projection of the patella, the CR is directed parallel to the longitudinal plane of the patella, thereby demonstrating a vertical fracture and providing the best view of the patellofemoral articulation. The AP knee projection could demonstrate a vertical fracture through the superimposed femur, but it does not demonstrate the patellofemoral articulation. The tunnel view of the knee is used to demonstrate the intercondyloid fossa.

What is the most superior structure of the scapula? Acromion process

It is easy to determine the highest point of the scapula when it is viewed laterally. The coracoid process projects anteriorly and is quite superior. However, the acromion process, which is an anterior extension of the scapular spine, projects considerably more superior than the coracoid.

Knee arthrography may be performed to demonstrate a 1. torn meniscus. 2. Baker's cyst.

Knee arthrography may be performed to demonstrate torn meniscus (cartilage), Baker's cyst, loose bodies, and ligament damage. A torn rotator cuff would be demonstrated on a shoulder, not a knee arthrogram.

The primary center of ossification in long bones is the diaphysis

Long bones are composed of a shaft, or diaphysis, and two extremities. The diaphysis is referred to as the primary ossification center. In the growing bone, the cartilaginous epiphyseal plate (located at the extremities of long bones) is gradually replaced by bone. For this reason, the epiphyses are referred to as the secondary ossification centers. The ossified growth area of long bones is the metaphysis. Apophysis refers to vertebral joints formed by articulation of superjacent articular facets.

The secondary center of ossification in long bones is the epiphysis

Which of the following projections of the elbow should demonstrate the coronoid process free of superimposition and the olecranon process within the olecranon fossa? Medial oblique

On the AP projection of the elbow, the radial head and ulna are normally somewhat superimposed. The lateral oblique demonstrates the radial head free of ulnar superimposition. The lateral projection demonstrates the olecranon process in profile. The medial oblique demonstrates considerable overlap of the proximal radius and ulna, but should clearly demonstrate the coronoid process free of superimposition and the olecranon process within the olecranon fossa.

Which of the following projections of the elbow should demonstrate the radial head free of ulnar superimposition? Lateral oblique

On the AP projection of the elbow, the radial head and ulna normally are somewhat superimposed. The lateral oblique projection demonstrates the radial head free of ulnar superimposition. The lateral projection demonstrates the olecranon process in profile. The medial oblique projection demonstrates considerable overlap of the proximal radius and ulna but should clearly demonstrate the coronoid process free of superimposition and the olecranon process within the olecranon fossa.

Which of the following conditions is limited specifically to the tibial tuberosity? Osgood-Schlatter disease

Osgood-Schlatter disease is most common in adolescent boys, involving osteochondritis of the tibial tuberosity epiphysis. The large patellar tendon actually will pull the tibial tuberosity away from the tibia. Immobilization generally will resolve the issue. Ewing sarcoma is a malignant bone tumor most common in young children. It attacks long bones and presents a characteristic "onion peel" appearance. Gout is a type of arthritis that most commonly attacks the knee and first metatarsophalangeal joint, although other joints also can be involved. High levels of uric acid in the blood are deposited in the joint. Exostosis is a bony growth arising from the surface of a bone and growing away from the joint. It is a benign and sometimes painful condition.

Cells concerned with the formation and repair of bone are osteoblasts

Osteoblasts are cells of mesodermal origin that are concerned with formation and repair of bone. Osteoclasts are cells concerned with the breakdown and resorption of old or dead bone. An osteoma is a benign bony tumor. An osteon is the microscopic unit of compact bone, consisting of a haversian canal and its surrounding lamellae.

Skeletal conditions characterized by faulty bone calcification include 1. osteomalacia. 2. rickets.

Rickets and osteomalacia are skeletal disorders characterized by abnormal calcification processes. In osteomalacia, bones become soft and are easily misshapen. Rickets affects the growing bones of children and is also characterized by soft, misshapened bones—as a result of calcium salts not being deposited in bone matrix. Osteoarthritis is a degeneration of articular cartilage; when these surfaces then attempt to articulate and move, bone friction and pain occur.

An autoclave is used for steam sterilization.

Sterilization is the complete elimination of all living microorganisms, and it can be accomplished by several methods. Pressurized steam, in an autoclave, is probably the most familiar means of sterilization; the pressure allows higher temperatures to be achieved. Gas or chemical sterilization is used for items that are unable to withstand moisture and/or high temperatures. Other methods of sterilization include dry heat, ionizing radiation, and microwaves (nonionizing radiation).

Synovial fluid is associated with the bony articulations

Synovial fluid is associated with diarthrotic (freely movable) bony articulations. Other types of bony articulations are fibrous (synarthrotic/immovable) and cartilaginous (amphiarthrotic/partially movable). Fluid associated with the brain and spinal canal is cerebrospinal fluid (CSF). The peritoneal and pleural cavities are associated with a lubricating serous fluid.

Examples of synovial pivot articulations include the 1. atlantoaxial joint 2. radioulnar joint

Synovial pivot joints are diarthrotic, that is, freely movable. Pivot joints permit rotation motion. Examples include the proximal radioulnar joint that permits supination and pronation of the hand. The atlantoaxial joint is the articulation between C1 and C2 and permits rotation of the head. The temporomandibular joint is diarthrotic, having both hinge and planar movements.

Which of the following projections of the ankle would best demonstrate the mortise? Medial oblique 15 to 20 degrees

The 15-degree medial oblique projection is used to demonstrate the ankle mortise (joint). Although the joint is well demonstrated in the 15-degree medial oblique projection, there is some superimposition of the distal tibia and fibula, and greater obliquity is required to separate the bones. To best demonstrate the distal tibiofibular articulation, a 45-degree medial oblique projection of the ankle is required.

The AP oblique projection (medial rotation) of the elbow demonstrates which of the following? 1. Olecranon process within the olecranon fossa 2. Coronoid process free of superimposition

The AP oblique projection (medial rotation) of the elbow superimposes the radial head and neck on the proximal ulna. It demonstrates the olecranon process within the olecranon fossa, and it projects the coronoid process free of superimposition. The radial head is projected free of superimposition in the AP oblique projection (lateral rotation) of the elbow.

In which of the following projections is the talofibular joint best demonstrated? Medial oblique

The AP projection demonstrates superimposition of the distal fibula on the talus; the joint space is not well seen. The 15- to 20-degree medial oblique position shows the entire mortise joint; the talofibular joint is well visualized, as well as the talotibial joint. There is considerable superimposition of the talus and fibula in the lateral and lateral oblique projections.

Which of the following should be demonstrated in a true AP projection of the clavicle? 1. Clavicular body 2. Acromioclavicular joint

The AP projection of the clavicle should demonstrate the clavicular body/shaft and its two extremities: the sternal extremity and its associated sternoclavicular articulation, and the acromial extremity and its associated acromioclavicular articulation. The sternocostal joint is the articulation between the sternum and rib and is not delineated in the AP clavicle image.

Which of the following positions would be the best choice for a right shoulder examination to rule out fracture? AP and scapular Y

The AP projection will give a general survey and show mediolateral and inferosuperior joint relationships. The scapular Y position (LAO or RAO) is employed to demonstrate anterior (subcoracoid) or posterior (subacromial) humeral dislocation. The humerus normally is superimposed on the scapula in this position; any deviation from this may indicate dislocation. Rotational views must be avoided in cases of suspected fracture. The AP and scapular Y combination is the closest to two views at right angles to each other.

With the patient positioned as illustrated in Figure 2-20, which of the following structures is best demonstrated? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f112.gif Intercondyloid fossa

The PA axial projection (Camp-Coventry method) of the intercondyloid fossa (tunnel view) is shown. The knee is flexed about 40 degrees, and the CR is directed caudally 40 degrees and perpendicular to the tibia (Figure 2-57). The patella and patellofemoral articulation are demonstrated in the axial/tangential view of the patella. https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f112.gif

With which of the following does the lateral extremity of the clavicle articulate? Acromion process

The S-shaped clavicle ("collar bone") is usually the last bone to completely ossify, at about age 21, and is one of the most commonly fractured bones in young people. Its medial end articulates with the sternum to form the sternoclavicular joint; the clavicle articulates laterally with the scapula's acromion process, forming the acromioclavicular joint. Superior dislocation of the acromioclavicular joint is a common athletic injury.

Which of the following articulations participate(s) in formation of the ankle mortise? 1. Talotibial 2. Talofibular

The ankle mortise, or ankle joint, is formed by the articulation of the tibia, fibula, and talus (Figure 2-45). Two articulations form the ankle mortise: the talotibial and talofibular articulations. The calcaneus is not associated with formation of the ankle mortise. https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f016.jpg

With the patient seated at the end of the x-ray table, elbow flexed 80 degrees, and the CR directed 45 degrees laterally from the shoulder to the elbow joint, which of the following structures will be demonstrated best? Coronoid process

The axial trauma lateral (Coyle) position is described. If routine elbow projections in extension are not possible because of limited part movement, these positions can be used to demonstrate the coronoid process and/or radial head. With the elbow flexed 90 degrees and the CR directed to the elbow joint at an angle of 45 degrees medially (i.e., toward the shoulder), the joint space between the radial head and capitulum should be revealed. With the elbow flexed 80 degrees and the CR directed to the elbow joint at an angle of 45 degrees laterally (i.e., from the shoulder toward the elbow), the elongated coronoid process will be visualized.

A patient unable to extend his or her arm is seated at the end of the x-ray table, elbow flexed 90 degrees. The CR is directed 45 degrees medially. Which of the following structures will be demonstrated best? 1. Radial head 2. Capitulum

The axial trauma lateral (Coyle) position is described. If routine elbow projections in extension are not possible because of limited part movement, this position can be used to demonstrate the coronoid process and/or radial head. With the elbow flexed 90 degrees and the CR directed to the elbow joint at an angle of 45 degrees medially (i.e., toward the shoulder), the joint space between the radial head and capitulum should be revealed. With the elbow flexed 80 degrees and the CR directed to the elbow joint at an angle of 45 degrees laterally (i.e., from the shoulder toward the elbow), the elongated coronoid process will be visualized.

Which of the following articulates with the base of the first metatarsal? First cuneiform

The base of the first metatarsal articulates with the first (medial) cuneiform. The base of the second metatarsal articulates with the second (intermediate) cuneiform; the third base of the metatarsal articulates with the third (lateral) cuneiform. The bases of the fourth and fifth metatarsals articulate with the cuboid. The navicular articulates with the first and second cuneiforms anteriorly and the talus posteriorly.

The first carpometacarpal joint is formed by the articulation of the base of the first metacarpal and the trapezium

The bases of the proximal row of phalanges articulate with the heads of the metacarpals to form the (condyloid) metacarpophalangeal joints, which permit flexion and extension, abduction and adduction, and circumduction. The bases of the metacarpals articulate with each other and the distal row of carpals at the carpometacarpal joints. The first carpometacarpal joint (thumb) is a saddle joint, permitting flexion and extension, abduction and adduction, and circumduction; it is formed by the articulation of the base of the first metacarpal and the trapezium.

Which projection of the foot will best demonstrate the longitudinal arch? Lateral weight-bearing

The bones of the foot are arranged to form a number of longitudinal and transverse arches. The longitudinal arch facilitates walking and is evaluated radiographically in lateral weight-bearing (erect) projections. Recumbent laterals would not demonstrate any structural change that occurs when the individual is weight-bearing erect.

The bone labeled number 3 in Figure 7-15 is the https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c007f155.jpg cuboid

The bones of the foot include the 7 tarsal bones, 5 metatarsal bones, and 14 phalanges. The calcaneus (os calsis), or heel bone, is the largest tarsal (numbers 6 and 7). It serves as attachment for the Achilles tendon posteriorly, articulates anteriorly with the cuboid bone (number 3), presents three articular surfaces superiorly for its articulation with the talus (number 1), and has a prominent shelf on its anteromedial edge called the sustentaculum tali. The inferior surface of the talus (astragalus) articulates with the superior calcaneus to form the three-faceted subtalar joint. The talus also articulates anteriorly with the navicular (number 2). Articulating anteriorly with the navicular are the three cuneiform bones—medial/first, intermediate/second, and lateral/third. The navicular articulates laterally with the cuboid.

Which of the following articulates with the base of the fifth metatarsal? Cuboid

The bones of the foot include the seven tarsal bones, five metatarsal bones, and 14 phalanges. The calcaneus (os calsis) serves as the attachment for the Achilles tendon and articulates anteriorly with the cuboid bone. Articulating anteriorly with the navicular are the three cuneiform bones: medial/first, intermediate/second, and lateral/third. The navicular articulates laterally with the cuboid. The bases of the fourth and fifth metatarsals articulate with the cuboid. The fifth (most lateral) metatarsal projects laterally and presents a large tuberosity at its base making it very susceptible to fracture.

The following procedure can be employed to better demonstrate the carpal scaphoid: 1. elevate hand and wrist 20°. 2. place wrist in ulnar deviation.

The carpal scaphoid is a curved, boat-shaped, bone, and is therefore superimposed on itself ("self-superimposition") in a routine PA projection. Since the scaphoid is the most frequently fractured carpal, special projections have been developed to help overcome self-superimposition. Stecher (in 1937) recommended elevating the hand and wrist 20° and using a perpendicular CR directed to the scaphoid. Effective variations of this position include employing ulnar deviation and angling the CR 20° proximally (toward the elbow). The 20° tube angulation would be used in place of the elevated hand/wrist.

Ulnar deviation will best demonstrate which carpal(s)? 1. Lateral carpals 2. Scaphoid

The carpal scaphoid is somewhat curved and consequently foreshortened radiographically in the PA position. To better separate it from the adjacent carpals, the ulnar deviation maneuver is employed frequently. In addition to correcting foreshortening of the scaphoid, ulnar deviation opens the interspaces between adjacent lateral carpals. Radial deviation is used to better demonstrate medial carpals.

Which of the following projections will best demonstrate the carpal scaphoid? Ulnar flexion/deviation

The carpal scaphoid is somewhat curved and consequently foreshortened radiographically in the PA position. To better separate it from the adjacent carpals, the ulnar flexion (ulnar deviation) maneuver is frequently employed. In addition to correcting foreshortening of the scaphoid, ulnar flexion/deviation opens the interspaces between adjacent lateral carpals. Radial flexion/deviation is used to better demonstrate medial carpals.

All of the following bones are associated with condyles 1. femur 2. tibia 3. mandible

The distal femur is associated with two large condyles; the deep depression separating them is the intercondyloid fossa (Fig. A). The proximal tibia has two condyles; their superior surfaces are smooth, forming the tibial plateau. The mandible has a condyle that articulates with the mandibular fossa of the temporal bone, forming the temporomandibular joint. The fibula has a proximal styloid process and a distal malleolus, but no condyle. https://s3.amazonaws.com/content-d/mghqa/qimport/02_173_193_image003.gif

Which of the following articulations participate in the formation of the elbow joint? 1. Between the humeral trochlea and the semilunar/trochlear notch 2. Between the capitulum and the radial head 3. The proximal radioulnar joint

The distal humerus articulates with the radius and ulna to form a part of the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, that articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar notch of the ulna. All three articulations are enclosed in a common capsule to form the elbow joint proper.

Which of the following is (are) located on the distal aspect of the humerus? 1. Capitulum 2. Coronoid fossa

The distal humerus articulates with the radius and ulna to form the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, that articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar notch of the ulna. Just proximal to the capitulum and the trochlea are the lateral and medial epicondyles; the medial is more prominent and palpable. The coronoid fossa is found on the anterior distal humerus and functions to accommodate the coronoid process with the elbow in flexion. The intertubercular (bicipital) groove is located on the proximal humerus.

All the following can be associated with the elbow joint 1. the capitulum 2. the trochlea 3. the epicondyles

The distal humerus articulates with the radius and ulna to form the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, that articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar/trochlear notch of the ulna. Just proximal to the capitulum and trochlea are the lateral and medial epicondyles; the medial is more prominent and palpable. Lateral epicondylitis ("tennis elbow") is a painful condition caused by prolonged rotary motion of the forearm. The tubercles are prominences located at the proximal humerus and are anatomically remote from the elbow joint.

All the following can be associated with the distal radius 1. styloid process 2.ulnar notch 3. radioulnar joint

The distal radius presents a styloid process laterally; the ulnar notch is located medially, helping to form the distal radioulnar articulation. The distal surface of the radius (carpal articular surface) is smooth for accommodating the scaphoid and lunate to form the radiocarpal (wrist) joint. The proximal radius has a cylindrical head with a medial surface that participates in the proximal radioulnar joint; its superior surface articulates with the capitulum of the humerus. Fracture of the distal radius is one of the most common skeletal fractures. Fractures of the radial head and neck frequently result from a fall onto an outstretched hand with the elbow partially flexed. Severe fractures often are accompanied by posterior dislocation of the elbow joint. Colles' fractures of the distal radius usually result from a fall onto an outstretched hand with the arm extended.

ll the following can be associated with the distal ulna 1. head 2. radioulnar joint 3. styloid process

The distal ulna presents a head and styloid process and articulates with the distal radius to form the distal radioulnar joint. The ulna is slender distally but enlarges proximally and becomes the larger of the two bones of the forearm. At its proximal end, the ulna presents the olecranon process (posteriorly) and coronoid process (anteriorly) that are joined by a large articular cavity, the semilunar, or trochlear notch. The coronoid process fits into the humeral coronoid fossa during flexion, and the olecranon process fits into the humeral olecranon fossa during extension. Just distal and lateral to the semilunar/trochlear notch is the radial notch, which provides articulation for the radial head to form the proximal radioulnar articulation. The ulna is the principal bone of the elbow joint, and the radius is the principal bone of the wrist joint.

Which of the following correctly identifies the letter L in the radiograph shown in Figure 7-13? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c007f117.jpg Lunate

The eight carpal bones are well visualized in this PA projection of the hand and wrist. The letters E (scaphoid) and L (lunate) are in the proximal carpal row. The capitate (I) is seen in the distal carpal row; just lateral to the capitate is the carpal trapezium, seen articulating with the base of the first metacarpal. The PA projection of the hand provides an oblique projection of the first finger (thumb).

To obtain an exact axial projection of the clavicle, place the patient in a lordotic position and direct the central ray at right angles to the coronal plane of the clavicle

The exact axial projection is performed by placing the patient in a lordotic position, leaning against the vertical grid device. This places the clavicle at right angles, or nearly so, to the plane of the IR. The central ray is directed to enter the inferior border of the clavicle, at right angles to its coronal plane. Other axial projections may include a prone position with a 25° to 30° caudal angle. However, none of these produce an exact axial projection of the clavicle.

In which position of the shoulder is the greater tubercle seen superimposed on the humeral head? Internal rotation

The external rotation position is the true AP position and places the greater tubercle in profile laterally and places the lesser tubercle anteriorly. The internal rotation position demonstrates the lesser tubercle in profile medially and places the humerus in a true lateral position; the greater tubercle is seen superimposed on the humeral head. The epicondyles should be superimposed and perpendicular to the IR. The neutral position places the epicondyles about 45 degrees to the IR and places the greater tubercle anteriorly but still lateral to the lesser tubercle.

Which position of the shoulder demonstrates the lesser tubercle in profile medially? Internal rotation

All the following structures are associated with the posterior femur 1. popliteal surface 2. intercondyloid fossa 3. linea aspera

The femur is the longest and strongest bone in the body. The femoral shaft is bowed slightly anteriorly and presents a long, narrow ridge posteriorly called the linea aspera. The distal femur is associated with two large condyles; the deep depression separating them posteriorly is the intercondyloid fossa (Figure 2-49). Just superior to the large condyles are the smaller medial and lateral epicondyles. The posterior distal femoral surface presents the popliteal surface, whereas the distal anterior surface presents the patellar surface. Proximally, the femur presents a head, neck, and greater and lesser trochanters. The intertrochanteric crest is a prominent ridge of bone between the trochanters posteriorly; anteriorly the intertrochanteric line is seen. The femoral head presents a roughened prominence, the fovea capitis femoris—ligaments attached here secure the femoral head to the acetabulum. https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f056.gif

Which of the following is (are) located on the anterior aspect of the femur? Patellar surface

The femur is the longest and strongest bone in the body. The femoral shaft is bowed slightly anteriorly and presents a long, narrow ridge posteriorly called the linea aspera. The proximal femur consists of a head that is received by the pelvic acetabulum. The femoral neck, which joins the head and shaft, normally angles upward about 120 degrees and forward (in anteversion) about 15 degrees. The greater and lesser trochanters are large processes on the posterior proximal femur. The intertrochanteric crest runs obliquely between the trochanters; the intertrochanteric line parallels the intertrochanteric crest on the anterior femoral surface. The intercondyloid fossa, a deep notch, is found on the distal posterior femur between the large femoral condyles, and the popliteal surface is a smooth surface just superior to the intercondyloid fossa. Just opposite the popliteal surface, on the distal anterior femur is the patellar surface—a smooth surface for patellar motion during flexion and extension of the knee.

All the following are posterior structures 1. the linea aspera 2. the popliteal surface 3. the intercondyloid fossa

The femur is the longest and strongest bone in the body. The femoral shaft is bowed slightly anteriorly. The proximal end of the femur consists of a head, which is received by the acetabulum of the pelvis. The femoral head has a small notch, the fovea capitis femoris, for ligament attachment. The femoral neck, which joins the head and shaft, angles upward approximately 120 degrees and forward (in anteversion) approximately 15 degrees. The greater (lateral) and lesser (medial) trochanters are large processes on the posterior proximal femur. The greater trochanter is a prominent positioning landmark that lies in the same transverse plane as the public symphysis and coccyx. The intertrochanteric crest runs obliquely between the trochanters; the intertrochanteric line runs anteriorly parallel to the crest. The femoral shaft presents a long, narrow ridge posteriorly called the linea aspera. Its distal anterior portion presents the patellar surface—a triangular depression over which the patella glides during flexion. The distal posterior surface presents the popliteal surface—a depression that houses the popliteal artery. The medial and lateral femoral condyles are very prominent posterior structures, and between them is the deep intercondyloid fossa. Just above the condyles are the medial and lateral femoral epicondyles.

The fifth metacarpal is located on which aspect of the hand? Medial

The fifth metacarpal is located on the medial aspect of the hand. Remember to always view a part in its anatomic position. With the arm in the anatomic position, the fifth metacarpal and the ulna lie medially.

What could be done to improve the mediolateral projection of the knee seen in Figure 2-3? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f010.jpg Rotate the pelvis slightly backward/posteriorly

The figure illustrates a mediolateral projection of the knee. The femoral condyles are not superimposed posteriorly, indicating incorrect degree of forward (anterior)/backward (posterior) rotation. Because the magnified medial femoral condyle is obscuring the femoropatellar articulation, the radiographer should rotation the pelvis backward, i.e. posteriorly, a bit. This will superimpose the femoral condyles, place the patella perpendicular to the tabletop, and open the femoropatellar joint space.

What is the name of the structure indicated as number 5 in Figure 7-7? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c007f069.gif Olecranon fossa

The figure shows a posterior view of the elbow. The distal posterior humerus (number 1) is seen, as well as the proximal posterior radius (number 4) and ulna (number 3). Additional structures identified are the medial epicondyle (number 2), the olecranon fossa (number 5), olecranon process (number 6), lateral epicondyle (number 7), and radial head (number 8) The olecranon process (number 6) can best be demonstrated in the lateral projection; it can also be demonstrated in the acute flexion position. The AP internal oblique will demonstrate the coronoid process; the AP external oblique will demonstrate the radial head free of superimposition.

Which of the following projections/positions would best demonstrate structure number 6 seen in Figure 7-7? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c007f069.gif Lateral projection

What should be done to better demonstrate the coracoid process shown in Figure 2-22? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f116.jpg Angle the CR about 30 degrees cephalad

The figure shows an AP projection of the shoulder. A plane passing through the epicondyles is parallel to the IR (and perpendicular to the CR). To project the coracoid process with less self-superimposition, the CR must be angled cephalad 15 degrees. The amount of cephalad angulation depends on the degree of thoracic kyphosis; the greater the degree of kyphosis, the greater is the degree of cephalad angulation required. A 30-degree angle is used for the average patient.

To evaluate the interphalangeal joints in the oblique and lateral positions, the fingers must be supported parallel to the IR

The fingers must be supported parallel to the IR (e.g., on a finger sponge) in order that the joint spaces parallel the x-ray beam. When the fingers are flexed or resting on the cassette, the relationship between the joint spaces and the IR changes, and the joints appear "closed."

With which of the following does the trapezium articulate? First metacarpal

The first metacarpal, on the lateral side of the hand, articulates with the most lateral carpal of the distal carpal row, the greater multangular/trapezium. This articulation forms a rather unique and very versatile saddle joint named for the shape of its articulating surfaces.

Which of the following articulate(s) with the bases of the metatarsals? 1. The cuboid 2. The cuneiforms

The foot is composed of the 7 tarsal bones, 5 metatarsals, and 14 phalanges. The metatarsals and phalanges are miniature long bones; each has a shaft, base (proximal), and head (distal). The bases of the first to third metatarsals articulate with the three cuneiforms. The bases of the fourth and fifth metatarsals articulate with the cuboid. The heads of the metatarsals articulate with the bases of the first row of phalanges.

Which of the following criteria is (are) required for visualization of the greater tubercle in profile? 1. Epicondyles parallel to the IR 2. Arm in external rotation 3. Humerus in AP position

The greater and lesser tubercles are prominences on the proximal humerus separated by the intertubercular (bicipital) groove. The AP projection of the humerus/shoulder places the epicondyles parallel to the IR and the shoulder in external rotation, and demonstrates the greater tubercle in profile. The lateral projection of the humerus places the shoulder in extreme internal rotation with the epicondyles perpendicular to the IR and demonstrates the lesser tubercle in profile.

Evaluation criteria for a lateral projection of the humerus include 1. lesser tubercle in profile 2. superimposed epicondyles

The greater and lesser tubercles are prominences on the proximal humerus separated by the intertubercular (bicipital) groove. The lateral projection of the humerus places the shoulder in extreme internal rotation with the epicondyles perpendicular to the IR and superimposed. The lateral projection of the humerus should demonstrate the lesser tubercle in profile. The AP projection of the humerus/shoulder places the epicondyles parallel to the IR and the shoulder in external rotation and demonstrates the greater tubercle in profile.

The greater tubercle should be visualized in profile in which of the following? AP shoulder, external rotation

The greater and lesser tubercles are prominences on the proximal humerus, separated by the bicipital groove. The AP projection of the humerus in external rotation demonstrates the greater tubercle in profile. With the arm placed in internal rotation, the humerus is placed in a true lateral position and the lesser tubercle is demonstrated.

Which of the following anatomic structures is indicated by the number 2 in Figure 2-7? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f037.jpg olecranon process

The image illustrates a medial oblique (internal rotation) projection of the elbow with epicondyles 45 degrees to the IR. An oblique view of the proximal radius and ulna and the distal humerus is obtained. This projection is particularly useful to demonstrate the coronoid process in profile (number 4), the trochlea (number 3), and the medial epicondyle (number 1). The olecranon process (number 2) fits into the olecranon fossa during extension of the elbow. A small portion of the radial head (number 5) not superimposed on the ulna can be seen. The external oblique (lateral rotation) projection demonstrates the entire radial head free of superimposition as well as the radial neck and the humeral capitulum.

In which of the following projections was the image in Figure 2-7 made? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f037.jpg medial oblique

The image illustrates a medial oblique (internal rotation) projection of the elbow with epicondyles 45 degrees to the IR. An oblique view of the proximal radius and ulna and the distal humerus is obtained. This projection is particularly useful to demonstrate the coronoid process in profile, the trochlea, and the medial epicondyle. The external oblique (lateral rotation) projection demonstrates the radial head free of superimposition as well as the radial neck and the humeral capitulum. The acute flexion projection (Jones Method) of the elbow is a two-projection method demonstrating the elbow anatomy when the part cannot be extended for an AP projection.

What is the structure labeled number 2 in Figure 2-37? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f255.jpg Trapezium

The image illustrates a semipronation oblique of the wrist. This projection best demonstrates the lateral carpals. An oblique of the proximal metacarpals and distal radius and ulna are also visualized. The base of the second metacarpal is number 1. Just lateral, is seen the first carpometacarpal joint—the trapezium (lateral carpal, distal row) is labeled number 2. The scaphoid (lateral carpal, proximal row) is number 3. The pisiform is labeled number 4. The radial styloid process is number 5 and the ulnar styloid process is number 6.

What is the structure labeled number 5 in Figure 2-37? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f255.jpg Radial styloid

All of the following statements regarding the inferosuperior axial (nontrauma, Lawrence method) projection of the shoulder are true 1. the coracoid process and lesser tubercle are seen in profile. 2. the arm is abducted about 90° from the body. 3. the CR is directed medially 25° to 30° through the axilla.

The inferosuperior axial (nontrauma, Lawrence method) projection of the shoulder demonstrates the glenohumeral joint and adjacent structures. The patient is supine with arm abducted 90°, and in external rotation. The (horizontal) CR is directed medially 25° to 30° through the axilla. The coracoid process and lesser tubercle are seen in profile.

Which of the following shoulder projections can be used to evaluate the lesser tubercle in profile? Internal rotation position

The internal rotation position places the humeral epicondyles perpendicular to the IR, the humerus in a true lateral position, and the lesser tubercle in profile. The external rotation position places the humeral epicondyles parallel to the IR, the humerus in a true AP position, and the greater tubercle in profile. The neutral position is used often for the evaluation of calcium deposits in the shoulder joint.

Which of the following is (are) located on the proximal aspect of the humerus? Intertubercular groove

The intertubercular (bicipital) groove is located on the proximal humerus, distal to the head, between the greater and lesser tubercles. The distal humerus articulates with the radius and ulna to form the elbow joint. The lateral aspect of the distal humerus presents a raised, smooth, rounded surface, the capitulum, which articulates with the superior surface of the radial head. The trochlea is on the medial aspect of the distal humerus and articulates with the semilunar notch of the ulna. Just proximal to the capitulum and the trochlea are the lateral and medial epicondyles; the medial is more prominent and palpable. The coronoid fossa is found on the anterior distal humerus and functions to accommodate the coronoid process with the elbow in flexion.

Which of the following bones participate(s) in the formation of the knee joint? 1. Femur 2. Tibia

The knee (tibiofemoral joint) is the largest joint of the body, formed by the articulation of the femur and tibia. However, it actually consists of three articulations—the patellofemoral joint, the lateral tibiofemoral joint (lateral femoral condyle with tibial plateau), and the medial tibiofemoral joint (medial femoral condyle with tibial plateau). Although the knee is classified as a synovial (diarthrotic) hinge-type joint, the patellofemoral joint actually is a gliding joint, and the medial and lateral tibiofemoral joints are hinge type.

For an AP projection of the knee on a patient whose measurement from ASIS to tabletop is 21 cm, which CR direction will best demonstrate the knee joint? 0 degrees (perpendicular)

The knee is formed by the proximal tibia, the patella, and the distal femur, which articulate to form the femorotibial and femoropatellar joints. Body habitus will change the relationship of the knee-joint space with the tabletop/IR considerably. The CR should be directed to ½ inch below patellar apex (knee joint). The direction of CR depends on distance between the ASIS and tabletop/IR. When this distance is up to 19 cm (thin pelvis), the CR should be directed 3 to 5 degrees caudad; when the distance is between 19 to 24 cm, the CR is directed vertically/perpendicular (0 degrees); when the distance is greater than 24 cm (thick pelvis), the CR is directed 3 to 5 degrees cephalad.

The mediolateral projection of the knee shown in Figure 6-1 could best be improved by https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c006f007.jpg angling the CR about 5 degrees cephalad

The knee is formed by the proximal tibia, the patella, and the distal femur, which articulate to form the femorotibial and femoropatellar joints. The distal posterior femur presents two large medial and lateral condyles separated by the deep intercondyloid fossa. Because the medial femoral condyle is further from the IR, it is magnified and will obscure the femorotibial joint space, as seen in the figure. If the CR is angled about 5 degrees cephalad, the medial femoral condyle will be projected superiorly and superimposed on the lateral femoral condyle, thus opening the joint space. The patient should lie on the affected side with the patella perpendicular to the tabletop and the knee flexed 20 to 30 degrees. Rotating the part forward or backward will affect visualization of the femoropatellar joint.

Which of the following is (are) distal to the tibial plateau? 1. Tibial condyles 2. Tibial tuberosity

The knee joint is formed by the femur, tibia, and patella. The most superior aspect of the tibia is the tibial plateau—formed by the tibial condyles just distal to it. The proximal tibia also presents the tibial tuberosity on its anterior surface, just distal to the condyles. Proximal to the tibial plateau, and articulating with it, are the femoral condyles—the deep notch separating them is the intercondyloid fossa. The term proximal refers to a part located closer to the point of attachment; the term distal refers to a part located farther away from the point of attachment.

A lateral projection of the hand in extension is often recommended to evaluate 1. a foreign body 2. soft tissue

The lateral hand in extension, with appropriate technique adjustment, is recommended to evaluate foreign-body location in soft tissue. A small lead marker frequently is taped to the spot thought to be the point of entry. The physician then uses this external marker and the radiograph to determine the exact foreign-body location. Extension of the hand in the presence of a fracture would cause additional and unnecessary pain and possibly additional injury.

In which projection of the foot are the interspaces between the first and second cuneiforms best demonstrated? Lateral oblique foot

The lateral oblique demonstrates the interspaces between the first and second metatarsals and between the first and second cuneiforms. To best demonstrate most of the tarsals and intertarsal spaces (including the cuboid, sinus tarsi, and tuberosity of the fifth metatarsal), a medial oblique projection is required (plantar surface and IR form a 30-degree angle). A weight-bearing lateral projection of the feet is used to demonstrate the longitudinal arches.

In the 45-degree medial oblique projection of the ankle, the 1. tibiofibular joint is visualized 2. plantar surface should be vertical

The medial oblique projection of the ankle can be performed either as a 15- to 20-degree oblique or as a 45-degree oblique. The 15- to 20-degree oblique projection demonstrates the ankle mortise, that is, the articulations between the talus, tibia, and fibula. The 45-degree oblique opens the distal tibiofibular joint. In all three cases, although the MSP can change the plantar surface must be vertical.

In the 15° medial oblique projection of the ankle, the 1. talotibial joint is visualized. 2. malleoli demonstrated in profile.

The medial oblique projection of the ankle can be performed either as a 15° to 20° oblique or as a 45° oblique. The 15° to 20° oblique demonstrates the ankle mortise, that is, the articulations between the talus, tibia, and fibula. The 45° oblique opens the distal tibiofibular joint. In all three cases, it is often recommended that the plantar surface be vertical.

Which of the following projections will best demonstrate the tarsal navicular free of superimposition? AP oblique, medial rotation

The medial oblique projection requires that the leg be rotated medially until the plantar surface of the foot forms a 30-degree angle with the cassette. This position demonstrates the navicular with minimal bony superimposition. The lateral oblique projection of the foot superimposes much of the navicular on the cuboid. The navicular is also superimposed on the cuboid in lateral projections.

Which of the following is an important consideration to avoid excessive metacarpal joint overlap in the oblique projection of the hand? Oblique the hand no more than 45 degrees.

The oblique projection of the hand should demonstrate minimal overlap of the third, fourth, and fifth metacarpals. Excessive overlap of these metacarpals is caused by obliquing the hand more than 45 degrees. The use of a 45-degree foam wedge ensures that the fingers will be extended and parallel to the IR, thus permitting visualization of the interphalangeal joints and avoiding foreshortening of the phalanges. Clenching of the fist and ulnar flexion are maneuvers used to better demonstrate the carpal scaphoid.

Which of the following statements regarding the radiograph in Figure A is (are) true? https://s3.amazonaws.com/content-d/mghqa/qimport/02_131_151_image007.jpg 1. The tibial eminences are well visualized. 2. The femorotibial articulation is well demonstrated.

The pictured radiograph is an AP projection of the knee with the knee extended. The tibial intercondylar eminences are well demonstrated on the tibial plateau, and the femorotibial joint is well visualized. The intercondyloid fossa is not demonstrated here. A "tunnel" view of the knee is required to demonstrate the intercondyloid fossa.

What projection of the os calsis is obtained with the leg extended, the plantar surface of the foot vertical and perpendicular to the IR, and the CR directed 40 degrees cephalad? Axial plantodorsal projection

The plantodorsal projection of the os calsis/calcaneus is described. It is performed supine and requires cephalad angulation. The CR enters the plantar surface and exits the dorsal surface. The axial dorsoplantar projection requires that the CR enter the dorsal surface of the foot and exit the plantar surface.

An AP oblique (lateral rotation) of the elbow demonstrates which of the following? 1. Radial head free of superimposition 2. Capitulum of the humerus

The radial head and neck are projected free of superimposition in the AP oblique projection (lateral rotation) of the elbow. The humeral capitulum is also well demonstrated in this external oblique position. The AP oblique projection (medial rotation) of the elbow superimposes the radial head and neck on the proximal ulna. It demonstrates the olecranon process within the olecranon fossa, and it projects the coronoid process free of superimposition.

The radiograph shown in Figure 7-12 can be produced with the https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c007f110.jpg 1. long axis of the plantar surface perpendicular to the IR 2. CR 40 degrees cephalad to the base of the third metatarsal

The radiograph illustrates a plantodorsal projection of the calcaneus. The patient usually is positioned with the leg extended and the long axis of the plantar surface perpendicular to the tabletop/IR. The CR is directed 40 degrees cephalad to the base of the third metatarsal. Structures that should be visualized include the sustentaculum tali, trochlear process, and calcaneal tuberosity.

What is the structure indicated by the letter A in Figure 7-3? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c007f015.jpg acromion process

The radiograph illustrates an AP projection of the scapula; abduction of the arm moves the scapula away from the rib cage, revealing a greater portion of the scapula than would be visualized with the arm at the side. A number of bony structures are identified: the acromion process (A), the humeral head (B), glenoid fossa (C), scapular spine (D), clavicle (E), supraspinatus fossa (F), acromioclavicular joint (G), scapular notch (H), coracoid process (I), inferior angle/apex (j), body/costal surface (K), lateral/axillary border (L).

Which of the following indicates the scapular costal surface seen in Figure 7-3? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c007f015.jpg K

Which of the following statements is (are) true with respect to the radiograph shown in Figure 2-26? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f155.jpg This projection is performed to evaluate the scapula.

The radiograph in Figure 2-26 illustrates a lateral projection of the scapula. The axillary and vertebral borders are superimposed. The acromion and coracoid process are visualized; the coracoid process is partially superimposed on the axillary portion of the third rib. A scapular Y projection is often performed to demonstrate shoulder dislocation, but the affected arm is left to rest at the patient's side; the arm in this radiograph is abducted somewhat to better view the body of the scapula.

Which of the following correctly identifies the letter T in the radiograph shown in Figure 7-13? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c007f117.jpg Diarthrotic joint

The radiograph is a PA projection of the hand and wrist; an oblique projection of the thumb is obtained. The letter T is pointing out the first carpometacarpal joint, formed by the base of the first metacarpal and the trapezium. This is classified as a saddle-type diarthrotic joint. Diarthrotic joints are freely movable joints and the most plentiful type of joint in the human body. Amphiarthrotic joints are partially movable; synarthrotic joints are immovable.

Figure A was made in which of the following positions? https://s3.amazonaws.com/content-d/mghqa/qimport/02_152_172_image001.jpg Lateral oblique

The radiograph is a lateral oblique (external rotation) projection of the elbow, removing the proximal radius from superimposition with the ulna and demonstrating its articulation with the ulna at the radial notch, that is, the proximal radioulnar articulation. An AP projection of the elbow would demonstrate partial overlap of the proximal radius and ulna. A medial oblique would demonstrate complete overlap of the proximal radius and ulna; this position is used to demonstrate the coronoid process in profile and the olecranon process within the olecranon fossa.

The radiograph shown in Figure 2-15 demonstrates the articulation between the https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f089.jpg 1. calcaneus and the cuboid 2. talus and the navicular

The radiograph shown is that of a medial oblique foot. With the foot rotated medially so that the plantar surface forms a 30-degree oblique with the IR, the sinus tarsi, the tuberosity of the fifth metatarsal, and several articulations should be demonstrated—the articulations between the talus and the navicular, between the calcaneus and the cuboid, between the cuboid and the bases of the fourth and fifth metarsals, and between the cuboid and the lateral (third) cuneiform.

Muscles that contribute to the formation of the rotator cuff include the 1. subscapularis. 2. infraspinatus. 3. teres minor.

The rotator cuff is a musculotendinous structure that includes the supraspinatus, infraspinatus subscapularis, and teres minor muscles. The muscles function to stabilize the humeral head in all arm motions and, together with the deltoid, function to abduct and rotate the arm. Weakness of the rotator cuff can lead to impingement syndrome and/or tendonitis. A tear of the cuff can result in subluxation; calcification can lead to shoulder immobilization.

The carpal scaphoid can be demonstrated in which of the following projection(s) of the wrist? PA oblique

The scaphoid can be difficult to image because its curved shape lends itself to foreshortening and self-superimposition. The lateral carpals, especially the scaphoid, are well demonstrated in the PA oblique projection. The ulnar flexion maneuver helps to overcome the scaphoid's self-superimposition. The scaphoid may also be demonstrated with less foreshortening with the wrist PA and elevated 20 degrees. The CR is directed perpendicular to the carpal scaphoid. The medial carpals, especially the pisiform, are well demonstrated in the AP oblique projection with the radial flexion maneuver.

Which of the following may be used to evaluate the glenohumeral joint? 1. Scapular Y projection 2. Inferosuperior axial 3. Transthoracic lateral

The scapular Y projection is an oblique projection of the shoulder and is used to demonstrate anterior or posterior shoulder dislocation. The inferosuperior axial projection may be used to evaluate the glenohumeral joint when the patient is able to abduct the arm. The transthoracic lateral projection is used to evaluate the glenohumeral joint and upper humerus when the patient is unable to abduct the arm.

Which of the following may be used to evaluate the glenohumeral joint? 1. Scapular Y projection 2. Inferosuperior axial 3. Transthoracic lateral

The scapular Y projection is an oblique projection of the shoulder that is used to demonstrate anterior or posterior shoulder dislocation. The inferosuperior axial projection may be used to evaluate the glenohumeral joint when the patient is able to abduct the arm. The transthoracic lateral projection is used to evaluate the glenohumeral joint and upper humerus when the patient is unable to abduct the arm.

Which of the following statements regarding the scapular Y projection of the shoulder is (are) true? 1. The scapular borders should be superimposed on the humeral shaft. 2. An oblique projection of the shoulder is obtained.

The scapular Y projection requires that the coronal plane be about 60 degrees to the IR (MSP is about 30 degrees), thus resulting in an oblique projection of the shoulder. The vertebral and axillary borders of the scapula are superimposed on the humeral shaft, and the resulting relationship between the glenoid fossa and humeral head will demonstrate anterior or posterior dislocation. Lateral or medial dislocation is evaluated on the AP projection.

Which of the following projections or positions will best demonstrate subacromial or subcoracoid dislocation? PA oblique scapular Y

The scapular Y refers to the characteristic Y formed by the humerus, acromion, and coracoid processes. The patient is placed in a PA oblique position—an RAO or LAO position depending on which is the affected side. The midcoronal plane is adjusted approximately 60 degrees to the IR, and the affected arm remains relaxed at the patient's side. The scapular Y position is employed to demonstrate anterior (subcoracoid) or posterior (subacromial) humeral dislocation. The humerus normally is superimposed on the scapula in this position; any deviation from this may indicate dislocation.

The functions of which body system include mineral homeostasis, protection, and triglyceride storage? Skeletal

The skeleton's design functions to protect vital internal organs such as the heart and lungs. Bone stores important minerals (e.g., calcium and phosphorus) and releases them into the blood as needed. Yellow bone marrow is composed mainly of fat cells and stores triglycerides for use as an energy reserve. The endocrine system is associated with hormone production; the integumentary system includes the skin that is important in protection and excretion; the muscular system is responsible for movement and heat production.

In which of the following positions/projections will the talocalcaneal joint be visualized? Plantodorsal projection of the os calcis

The talocalcaneal, or subtalar, joint is a three-faceted articulation formed by the talus and the os calcis (calcaneus). The plantodorsal and dorsoplantar projections of the os calcis should exhibit sufficient density to visualize the talocalcaneal joint (Figure 2-60). This is the only "routine" projection that will demonstrate the talocalcaneal joint. If evaluation of the talocalcaneal joint is desired, special views (such as the Broden and Isherwood methods) are required. https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f160.jpg

The best projection to demonstrate the articular surfaces of the femoropatellar articulation is the tangential ("sunrise") projection

The tangential ("sunrise") projection is used to demonstrate the articular surfaces of the femur and patella. It is also used to demonstrate vertical fractures of the patella. The AP, PA, and oblique projections of the knee are used primarily to evaluate the joint space and articulating structures. The tunnel view is used to demonstrate the intercondyloid fossa.

Tangential axial projections of the patella can be obtained in which of the following positions? 1. supine flexion 45° (Merchant) 2. prone flexion 90° (Settegast) 3. prone flexion 55° (Hughston)

The tangential axial projections of the patella are also often referred to as "sunrise" or "skyline" views. The supine flexion 45° (Merchant) position requires a special apparatus, and the patellae can be examined bilaterally. This position also requires patient comfort without muscle tension—muscle tension can cause a subluxed patella to be pulled into the intercondyler sulcus, giving the appearance of a normal patella. The two prone positions differ according to the degree of flexion employed. The 90° flexion (Settegast) position must not be employed with suspected patellar fracture.

In which of the following tangential axial projections of the patella is complete relaxation of the quadriceps femoris required for an accurate diagnosis? Supine flexion 45 degrees (Merchant)

The tangential axial projections of the patella are also often referred to as sunrise or skyline views. The supine flexion 45-degree (Merchant) position requires a special apparatus, and the patellae can be examined bilaterally. This position also requires patient comfort without muscle tension—muscle tension can cause a subluxed patella to be pulled into the intercondyler sulcus, giving the appearance of a normal patella. The two prone positions differ according to the degree of flexion employed. The 90-degree flexion (Settegast) position must not be employed with suspected patellar fracture.

Which of the following is (are) valid criteria for a lateral projection of the forearm? 1. The coronoid process and radial head should be superimposed. 2. The radial tuberosity should face anteriorly.

To accurately position a lateral forearm, the elbow must form a 90° angle with the humeral epicondyles superimposed. The radius and ulna are superimposed only distally. Proximally, the coronoid process and radial head are superimposed, and the radial head faces anteriorly. Failure of the elbow to form a 90° angle or the hand to be lateral results in a less than satisfactory lateral projection of the forearm.

In which of the following positions can the sesamoid bones of the foot be demonstrated to be free of superimposition with the metatarsals or phalanges? Tangential metatarsals/toes

The tangential projection projects the sesamoid bones separate from adjacent structures. The patient is best examined in the prone position because this places the parts of interest closest to the IR. The affected foot is dorsiflexed so as to place its plantar surface 15 to 20 degrees with the vertical. The CR is directed perpendicular to the posterior surface of the foot (near the metatarsophalangeal joints). The dorsoplantar and oblique projections of the foot will demonstrate the sesamoid bones superimposed on adjacent bony structures.

The tarsals and metatarsals are arranged to form the 1. transverse arch. 2. longitudinal arch

The tarsals and metatarsals of the foot are arranged so as to form two arches: the transverse and the longitudinal (which has two parts—lateral and medial). The arches function to support and distribute the body's weight over the body. The ball of the foot usually accommodates about 40 percent of the body's weight, and the heel about 60 percent.

Which of the following is proximal to the carpal bones? Radial styloid process

The term proximal refers to structures closer to the point of attachment. For example, the elbow is described as being proximal to the wrist; that is, the elbow is closer to the point of attachment (the shoulder) than is the wrist. Referring to the question, then, the interphalangeal joints (both proximal and distal) and the metacarpals are both distal to the carpal bones. The radial styloid process is proximal to the carpals.

The term varus refers to turned inward

The term varus refers to bent or turned inward. In genu varus, the tibia or femur turns inward causing bowlegged deformity; in talipes varus, the foot turns inward (clubfoot deformity). The term valgus refers to a part turned/deformed outward—as in hallux valgus and talipes valgus. Hallux valgus is angulation of the great toe away from the midline; talipes valgus is a foot deformity with the heel turned outward—a component of clubfoot.

In which type of fracture are the splintered ends of bone forced through the skin? Compound

The type of fracture in which the splintered ends of bone are forced through the skin is a compound fracture. In a closed fracture, no bone protrudes through the skin. Compression fractures are seen in stressed areas, such as the vertebrae. A depressed fracture would not protrude but rather would be pushed in.

The term that refers to parts away from the source or beginning is distal

There are many terms (with which the radiographer must be familiar) that are used to describe radiographic positioning techniques. Cephalad refers to that which is toward the head, and caudad refers to that which is toward the feet. Structures close to the source or beginning are said to be proximal, whereas those lying away from the source or origin are distal. Parts close to the midline are said to be medial, and those away from the midline are lateral.

Demonstration of the posterior fat pad on the lateral projection of the adult elbow can be caused by 1. trauma or other pathology 2. less than 90-degree flexion

There are three important fat pads associated with the elbow, best demonstrated in the true lateral projection. They cannot be demonstrated in the AP projection because of their superimposition on bony structures. The anterior fat pad is located just anterior to the distal humerus. The posterior fat pad is located within the olecranon fossa at the distal posterior humerus. The supinator fat pad/stripe is located at the proximal radius just anterior to the head, neck, and tuberosity. The posterior fat pad is not visible radiographically in the normal elbow. The posterior fat pad is visible in cases or trauma or other pathology and when the elbow is insufficiently flexed.

All elbow fat pads are best demonstrated in which position? Lateral

There are three important fat pads associated with the elbow. The anterior fat pad is located just anterior to the distal humerus. The posterior fat pad is located within the olecranon fossa at the distal posterior humerus. The supinator fat pad/stripe is located at the proximal radius just anterior to the head, neck, and tuberosity. The posterior fat pad is not visible radiographically in the normal elbow. All three fat pads can be demonstrated only in the lateral projection of the elbow.

Valid evaluation criteria for a lateral projection of the forearm requires that 1. the radius and ulna be superimposed distally. 2. the radial tuberosity should face anteriorly.

To accurately position a lateral forearm, the elbow must form a 90-degree angle with the humeral epicondyles perpendicular to the IR and superimposed. The radius and ulna are superimposed distally. Proximally, the coronoid process and radial head are superimposed, and the radial head faces anteriorly. Failure of the elbow to form a 90-degree angle or the hand to be lateral results in a less than satisfactory lateral projection of the forearm.

Which of the following is (are) valid evaluation criteria for a lateral projection of the forearm? 1. The radius and the ulna should be superimposed distally. 2. The coronoid process and the radial head should be partially superimposed. 3. The humeral epicondyles should be superimposed.

To accurately position a lateral forearm, the elbow must form a 90-degree angle with the humeral epicondyles superimposed. The radius and ulna are superimposed distally. Proximally, the coronoid process and radial head are partially superimposed. Failure of the elbow to form a 90-degree angle or the hand to be lateral results in a less than satisfactory lateral projection of the forearm.

In which projection of the foot are the sinus tarsi, cuboid, and tuberosity of the fifth metatarsal best demonstrated? Medial oblique foot

To best demonstrate most of the tarsals and intertarsal spaces (including the cuboid, sinus tarsi, and tuberosity of the fifth metatarsal), a medial oblique is required (plantar surface and IR form a 30° angle). The lateral oblique demonstrates the interspaces between the first and second metatarsals and between the first and second cuneiforms. Weight-bearing lateral feet are used to demonstrate the longitudinal arches.

Which of the following projections of the ankle would best demonstrate the distal tibiofibular joint? Medial oblique 45°

To best demonstrate the distal tibiofibular articulation, a 45° medial oblique projection of the ankle is required. The 15° medial oblique is used to demonstrate the ankle mortise (joint). Although the joint is well demonstrated in the 15° medial oblique, there is some superimposition of the distal tibia and fibula, and greater obliquity is required to separate the bones.

In a lateral projection of the normal knee, the 1. fibular head should be somewhat superimposed on the proximal tibia. 2. patellofemoral joint should be visualized. 3. femoral condyles should be superimposed.

To better visualize the joint space in the lateral projection of the knee, 20 to 30 degrees of flexion is recommended. The femoral condyles are superimposed so as to demonstrate the patellofemoral joint and the articulation between the femur and the tibia. The head of the fibula will be slightly superimposed on the proximal tibia. The correct degree of forward or backward body rotation is responsible for visualization of the patellofemoral joint. Cephalad tube angulation of 5 to 7 degrees is responsible for demonstrating the articulation between the femur and the tibia (by removing the magnified medial femoral condyle from superimposition on the joint space).

In the AP projection of the ankle, the 1. plantar surface of the foot is vertical. 2. fibula projects more distally than the tibia.

To demonstrate the ankle joint space to best advantage, the plantar surface of the foot should be vertical in the AP projection of the ankle. Note that the fibula is the more distal of the two long bones of the lower leg and forms the lateral malleolus. The calcaneus is not well visualized in this projection because of superimposition with other tarsals.

With the patient positioned as shown in Figure 6-13, how should the CR be directed to best demonstrate the intercondyloid fossa? https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c006f113.gif 40 degrees caudad to the popliteal depression

To demonstrate the intercondyloid fossa, the CR must be directed perpendicular to the long axis of the tibia (Figure 6-25). Because the knee is flexed so that the tibia forms a 40-degree angle with the IR, the CR must be directed 40 degrees caudad to place the CR perpendicular to the long axis of the tibia. Directing the CR to the popliteal depression aligns the CR parallel with the knee joint space. https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c006f113a.gif

Which of the following is most likely to be the correct routine for a radiographic examination of the forearm? AP and lateral

To demonstrate the radius and ulna free of superimposition, the forearm must be radiographed in the AP position, with the hand supinated. Pronation of the hand causes overlapping of the proximal radius and ulna. Two views, at right angles to each other, are generally required for each examination. Therefore, AP and lateral is the usual routine for an examination of the forearm.

An axiolateral inferosuperior projection of the femoral neck is particularly useful 1. when the "cross-table" axiolateral is contraindicated. 2. for patients with bilateral hip fractures. 3. for patients with limited movement of the unaffected leg.

Typically, traumatic injury to the hip requires a cross-table (axiolateral) lateral projection. Occasionally, this projection may be contraindicated, for example, a patient with suspected bilateral hip fractures, or one who is unable to move the unaffected hip out of the way as required by the axiolateral. In these instances, the axiolateral inferosuperior trauma projection (Clements-Nakayama method) can be employed. The patient is recumbent with lateral surface of affected side close to table/stretcher edge. The CR is directed almost horizontally to the affected femoral neck (inferosuperior), with a 15° posterior angulation. Correct placement and angulation of the grid cassette is essential to avoid grid cutoff.

The scapula shown in Figure 2-29 demonstrates 1. its posterior aspect https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f166.gif

Visualization of the scapular spine (number 13) indicates that this is a view of the posterior aspect of the scapula. The scapula's anterior, or costal, surface is that which is adjacent to the ribs. The scapula has no sternal articulation.

What is the best position/projection to demonstrate the longitudinal arch of the foot? Lateromedial weight-bearing lateral

Weight-bearing lateral projections of the foot are requested often to evaluate the longitudinal arch structure of the foot. The patient stands on a small platform. The x-ray cassette is placed between the feet, in a slot provided on the platform, with the top of the cassette against the medial aspect of the foot. The CR is directed to enter the lateral aspect of the foot perpendicular to the base of the fifth metatarsal and to exit the medial side of the foot.

When examining a patient whose elbow is in partial flexion, the AP projection requires two separate positions and exposures

When a patient's elbow needs to be examined in partial flexion, the lateral projection offers little difficulty, but the AP projection requires special attention. If the AP projection is made with a perpendicular CR and the olecranon process resting on the table-top, the articulating surfaces are obscured. With the elbow in partial flexion, two exposures are necessary to achieve an AP projection of the elbow joint articular surfaces. One is made with the forearm parallel to the IR (humerus elevated), which demonstrates the proximal forearm. The other is made with the humerus parallel to the IR (forearm elevated), which demonstrates the distal humerus. In both cases, the CR is perpendicular if the degree of flexion is not too great or angled slightly into the joint space with greater degrees of flexion.

When examining a patient whose elbow is in partial flexion, how should an AP projection be obtained? 1. With humerus parallel to IR, CR perpendicular 2. With forearm parallel to IR, CR perpendicular

When a patient's elbow needs to be examined in partial flexion, the lateral projection offers little difficulty, but the AP projection requires special attention. If the AP radiograph is made with a perpendicular CR and the olecranon process resting on the tabletop, the articulating surfaces are obscured. With the elbow in partial flexion, two exposures are necessary. One is made with the forearm parallel to the IR (humerus elevated), which demonstrates the proximal forearm. The other is made with the humerus parallel to the IR (forearm elevated), which demonstrates the distal humerus. In both cases, the CR is perpendicular if the degree of flexion is not too great or is angled slightly into the joint space with greater degrees of flexion.

Which of the following projections require(s) that the humeral epicondyles be perpendicular to the IR? 1. Lateral forearm 2. Internal rotation shoulder

When the arm is placed in the AP position, the epicondyles are parallel to the plane of the IR, and the shoulder is placed in external rotation. In this position, an AP projection of the humerus, elbow, and forearm can be obtained; it places the greater tubercle of the humerus in profile. For the lateral projection of the humerus and the internal rotation projection of the shoulder, the arm is internally rotated, elbow somewhat flexed, with the back of the hand against the thigh, and the epicondyles are superimposed and perpendicular to the IR. The lateral projections of the humerus, elbow, and forearm all require that the epicondyles be perpendicular to the plane of the cassette.

Which of the following projection(s) require(s) that the shoulder be placed in internal rotation? Lateral humerus

When the arm is placed in the AP position, the epicondyles are parallel to the plane of the cassette and the shoulder is placed in external rotation. In this position, an AP projection of the humerus, elbow, and forearm can be obtained; it places the greater tubercle of the humerus in profile. For the lateral projection of the humerus, the arm is internally rotated, elbow somewhat flexed, with the back of the hand against the thigh and the epicondyles superimposed and perpendicular to the IR. The lateral projections of the humerus, elbow, and forearm all require that the epicondyles be perpendicular to the plane of the cassette.

Which of the following projections require(s) that the shoulder be placed in external rotation? AP humerus

When the arm is placed in the AP position, the epicondyles are parallel to the plane of the cassette, and the shoulder is placed in external rotation. In this position, an AP projection of the humerus, elbow, and forearm can be obtained. For the lateral projection of the humerus, elbow, or forearm, the epicondyles must be perpendicular to the plane of the cassette.

What process is best seen using a perpendicular CR with the elbow in acute flexion and with the posterior aspect of the humerus adjacent to the image receptor? Olecranon

When the elbow is placed in acute flexion with the posterior aspect of the humerus adjacent to the image receptor and a perpendicular CR is used, the olecranon process of the ulna is seen in profile. The coronoid process is best visualized in the medial oblique position. The coracoid and glenoid are associated with the scapula.

In the lateral projection of the foot, the 1. plantar surface should be perpendicular to the IR. 2. metatarsals are superimposed.

When the foot is positioned for a lateral projection, the plantar surface should be perpendicular to the IR so as to superimpose the metatarsals. This may be accomplished with the patient lying on either the affected or the unaffected side (usually the affected), that is, mediolateral or lateromedial. The talofibular articulation is best demonstrated in the medial oblique projection of the ankle.

How can OID be reduced for a PA projection of the wrist? Flex the metacarpophalangeal joint

When the hand is pronated and the fingers are extended for a PA projection of the wrist, the wrist arches, and an OID is introduced between the wrist and the cassette. To reduce this OID, the metacarpophalangeal joints should be flexed slightly. This maneuver will bring the anterior surface of the wrist into contact with the cassette.

Which of the following statements is (are) true regarding the images shown in Figure 2-33? 1. Image B is positioned in internal rotation. 2. The greater tubercle is better demonstrated in image A. https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f218a.jpg https://s3.amazonaws.com/content-d/mghqa/qimport/saia8_c002f218b.jpg

When the shoulder is placed in internal rotation, a greater portion of the glenoid fossa is superimposed by the humeral head, and the lesser tubercle is visualized, as in image B. The external rotation position (image A) removes the humeral head from a large portion of the glenoid fossa and better demonstrates the greater tubercle.

For the AP projection of the scapula, the 1. patient's arm is abducted at right angles to the body. 2. patient's elbow is flexed. 3. exposure is made during quiet breathing.

With the patient in the AP position, the scapula and upper thorax are normally superimposed. With the arm abducted, the elbow flexed, and the hand usually supinated, much of the scapula is drawn away from the ribs. The patient should not be rotated toward the affected side because this causes superimposition of ribs on the scapula. The exposure is made during quiet breathing to obliterate pulmonary vascular markings.

Imaging Procedures- Extremities

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