Ch 09 02

Question 1

39. What CR angle should be used for a lateral sacrum/coccyx projection?

a. 15-degree cephalad
b. 30-degree cephalad
c. None. CR is perpendicular to the image receptor
d. 10-degree cephalad

Answer 1

c. None. CR is perpendicular to the image receptor

Question 2

40. A radiograph of a left posterior oblique (LPO) projection of the lumbar spine reveals that the downside pedicle is projected too far posterior on the vertebral body. What specific positioning error is present on this radiograph?

a. Excessive rotation of the spine
b. Insufficient rotation of the spine
c. Tilt of the spine
d. Incorrect CR placement

Answer 2

a. Excessive rotation of the spine

Question 3

41. A radiograph of a lateral projection of the lumbar spine reveals that the mid- to lower-intervertebral joint spaces are not open. The patient’s waist was supported and the CR was perpendicular to the IR. Which of the following modifications will help open these joint spaces during the repeat exposure?

a. Increase the SID for less divergence of the x-ray beam.
b. Decrease waist support and/or angle the CR 5- to 8-degree cephalad.
c. Have the patient hold her breath on a deeper inspiration to expand the thorax and straighten the spine.
d. Increase waist support and/or angle the CR 5- to 8-degree caudad.

Answer 3

d. Increase waist support and/or angle the CR 5- to 8-degree caudad.

Question 4

42. A radiograph of an AP axial sacrum reveals that it is foreshortened and the sacral foramina are not clearly seen. The patient was in an AP supine position, and the technologist angled the CR 5- to 7-degree cephalad. What specific positioning error is present on this radiograph?

a. Excessive CR angulation
b. Rotation of the sacrum
c. Insufficient CR angulation
d. Wrong direction of the CR angle

Answer 4

c. Insufficient CR angulation

Question 5

43. A radiograph of an AP axial coccyx reveals that the symphysis pubis is superimposed over the distal end of the coccyx. Which of the following modifications will correct this problem during the repeat exposure?

a. Decrease the CR angulation.
b. Increase the CR angulation.
c. Slightly oblique the patient.
d. Ask the patient to empty her bladder.

Answer 5

b. Increase the CR angulation.

Question 6

44. A radiograph of an AP axial L5-S1 projection reveals that the joint space is not open. The following factors were used on this female patient: 80 kVp, 40-inch (100-cm) SID, grid, 35-degree caudad angle, and CR centered to the ASIS. Which of the following factors needs to be modified to produce a more diagnostic image?

a. Increase the CR angulation.
b. Decrease the CR angulation.
c. Change the direction of the CR angulation.
d. Center the CR higher to place it parallel to the joint space.

Answer 6

d. Center the CR higher to place it parallel to the joint space.

Question 7

45. A radiograph of an AP projection of the lumbar spine on an average-size patient reveals that the psoas major muscles and transverse processes are not visible. The following analog factors were used for this projection: automatic exposure control (AEC) with center ionization chamber, 95 kVp, 40-inch (100-cm) SID, grid, and 14 × 17-inch (35 × 43-cm) image receptor. Which of the following modifications will be most effective in demonstrating these structures?

a. Decrease the kVp.
b. Activate all three ionization chambers.
c. Decrease the mAs.
d. Increase the kVp.

Answer 7

a. Decrease the kVp.

Question 8

46. A patient comes to radiology for a study of the lumbar spine. The initial radiographs demonstrate potential pathology involving the L5-S1 zygapophyseal joint. Which of the following positions and/or projections would best demonstrate this joint space?

a. Lateral L5-S1 position
b. Right and left 30-degree oblique projections
c. Right and left 50-degree oblique projections
d. Closely collimated and lateral position of L5-S1 region

Answer 8

b. Right and left 30-degree oblique projections

Question 9

47. A patient comes to radiology for a study of the lumbar spine. He has a clinical history of spondylolisthesis of L5. Which of the following projections will best demonstrate the severity of this condition?

a. 30-degree oblique projections
b. 50-degree oblique projections
c. Lateral L5-S1 projection
d. AP axial L5-S1 projection

Answer 9

c. Lateral L5-S1 projection

Question 10

48. A patient comes to radiology for a follow-up study of the lumbar spine. The patient had a spinal fusion performed at the L3-4 level 4 months earlier. Which of the following would best demonstrate the degree of movement at the fusion site?

a. Lateral hyperextension and hyperflexion projections
b. Ferguson method
c. AP and lateral erect projections
d. Right and left 45-degree oblique projections

Answer 10

a. Lateral hyperextension and hyperflexion projections

Question 11

49. A young female patient comes to radiology for a scoliosis study. The patient has had this series performed frequently. How much will the breast dose be decreased if a PA rather than an AP projection is taken?

a. 15%
b. 90%
c. 35%
d. It will not make a significant difference with good collimation.

Answer 11

b. 90%

Question 12

50. A patient comes in with a possible compression fracture of L3. Which one of the following positioning routines would best demonstrate the body of L3 and the intervertebral joint spaces above and below it?

a. Collimated R and L posterior oblique and AP projections
b. Collimated PA and lateral projections
c. Erect AP and lateral projections
d. Collimated LPO and RPO positions

Answer 12

b. Collimated PA and lateral projections

Question 13

51. A geriatric patient comes to radiology for a lumbar spine series. She has severe kyphosis of the thoracolumbar spine. Which one of the following modifications should be applied to this patient?

a. Perform all positions erect.
b. Perform all positions recumbent, include flexion and extension projections.
c. Include the entire spine for all projections regardless of what was ordered by the physician.
d. Use high (90 kVp) for all projections.

Answer 13

b. Perform all positions recumbent, include flexion and extension projections.

Question 14

52. A female patient is brought to the emergency department (ED) because of a motor vehicle accident (MVA). Her chief complaint is pain in the lower lumbar region. The ED physician orders a lumbar series. Upon questioning, the technologist learns that the patient is pregnant. The ED physician is made aware of the pregnancy but still wants the lumbar spine series performed. What can the technologist do to minimize dose to the fetus and mother?

a. Use higher kVp than normal; reduce mAs accordingly.
b. Use smallest IR possible.
c. Collimate as much as feasible.
d. All of the options.

Answer 14

d. All of the options.

Question 15

53. Which of the following fractures is due to a hyperflexion force injury?

a. Compression
b. Burst
c. Chance
d. Metastatic

Answer 15

c. Chance

Question 16

54. For a lateral L5-S1 projection, the CR must be parallel to the:

a. midsagittal plane.
b. midcoronal plane.
c. interiliac line.
d. transverse plane.

Answer 16

c. interiliac line

Question 17

55. How much obliquity of the body is required for posterior oblique (LPO/RPO) positions for the sacroiliac joints?

a. 45 degrees
b. 10 to 15 degrees
c. 60 to 70 degrees
d. 25 to 30 degrees

Answer 17

d. 25 to 30 degrees

Question 18

56. A radiograph of the left sacroiliac joint demonstrates it open and clearly seen. Which of the following positions was performed?

a. LPO
b. RPO
c. RAO
d. AP

Answer 18

b. RPO

Question 19

57. Radiographs of oblique projections of the SI joints do not clearly demonstrate the inferior/distal aspect of the joints. What can the technologist do to better demonstrate this region?

a. Increase rotation of the pelvis.
b. Initiate exposure upon expiration.
c. Angle the CR 15- to 20-degree cephalad.
d. Perform positions erect.

Answer 19

c. Angle the CR 15- to 20-degree cephalad.

Question 20

58. Where is the CR centered for posterior oblique projections of the SI joints?

a. 1 inch (2.5 cm) medial to upside ASIS
b. 2 inches (5 cm) medial to upside ASIS
c. Centered at upside ASIS
d. 1 inch (2.5 cm) medial and inferior to upside ASIS

Answer 20

a. 1 inch (2.5 cm) medial to upside ASIS

Question 21

1 T/F The long axis of the sacrum is generally angled more posteriorly in males than females.

Answer 21

False

Question 22

2 T/F A female is more likely to suffer a fracture of the coccyx due to a backward, sitting type of fall than a male.

Answer 22

True

Question 23

3 T/F The Scottie dog sign is demonstrated with oblique projections of the thoracic and lumbar spine.

Answer 23

False

Question 24

4 T/F The anterior oblique (RAO and LAO) positions of the lumbar spine will demonstrate the zygapophyseal joints closest to the image receptor.

Answer 24

False

Question 25

5 T/F If the iliac crests are superimposed, the CR does not require any angulation for the recumbent lateral lumbar spine projection.

Answer 25

True

Question 26

6 T/F If the patient has scoliosis, the convexity of the spine should be down toward the image receptor for the lateral spine projection.

Answer 26

True

Question 27

7 T/F Gonadal shielding must always be used on adult female patients for the lumbar spine series.

Answer 27

False

Question 28

8 T/F Magnetic resonance imaging (MRI) is superior to computed tomography (CT) for evaluation of spinal cord and intervertebral disks.

Answer 28

True

Question 29

9 T/F Bone densitometry produces very little skin dose to the patient.

Answer 29

True

Question 30

10 T/F Conventional radiography does not detect bone loss from conditions such as osteoporosis until bone mass has been reduced at least 30%.

Answer 30

True

Question 31

11 T/F The AP and lateral projections for a pediatric scoliosis study should include the entire lumbar and thoracic spine.

Answer 31

True