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MOCK 1 Flashcards

study the componenets of the x-ray tube, study the knee anatomy,

1
Q

what is KUB?

A

Kidneys
Ureter
Bladder

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2
Q

what are the radiography significant abdominal muscles?

A

Diaphragm (Umbrella-shaped
Separates thoracic & abdominal cavities)
Psoas (Lateral to vertebral column
Visible on abdominal radiograph)

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3
Q

what are the three accessory organs for digestion?

A

Liver
Gallbladder
Pancreas

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3
Q

what are the three segments of the small intestine?

A

Duodenum
Jejunum
Ileum

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4
Q

what is the duodenum?

A

1st segment of small intestine
Shortest & widest diameter
“C” loop appearance

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4
Q

what is the duodenal bulb or cap?

A

Proximal portion of duodenum

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5
Q

what makes up 2/5 of the small bowel?
3/5 of the small bowel?

A

Jejunum
Ileum

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5
Q

what is the ileocecal valve?

A

Connection between ileum and cecum

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6
Q

what consists in the urinary system?

A

2 kidneys
2 ureters
1 urethra
1 bladder
2 suprarenal adrenal glands

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7
Q

what is the peritoneum?
what is the visceral peritoneum? parietal?

A

double walled membrane enclosing the abdominal organs
inner layer
outer layer

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8
Q

what is the omentum?

A

Double fold peritoneum extending from stomach to another organ

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9
Q

what is the lesser Omentum?
Greater Omentum?

A

Extends superiorly from lesser curvature of stomach to portions of liver
Connects transverse colon to greater curvature of stomach inferiorly

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9
Q

where is the location for these:
Xiphoid process
Inferior costal margin
Iliac crest
Vertebra Prominens
Jugular notch
Mid-thorax
Larynx

A

T9 - T10
L2 - L3
L4 - L5
C7
T2/T3
T7
C3 to C6

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10
Q

what is the acute abdomen series?

A

AP supine abdomen
AP erect abdomen
PA erect chest

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11
Q

what is the kvp for AP erect abdomen?

A

70-80 kVp

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12
Q

what is the CR for erect AP abdomen?

A

2” superior to iliac crest

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12
Q

what is ileus?

A

Inability of intestine (bowel) to contract normally & move waste out
Paralysis of movement to the bowel

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13
Q

what is ascites?

A

accumulation of fluid in peritoneal

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14
Q

what is pneumoperitoneum?

A

free air or gas in peritoneal cavity

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15
Q

what is volvulus?

A

twisting of loop of intestine creating an obstruction

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16
Q

what is intussusception?

A

Telescoping of bowel onto itself
More common in children
Necrosis in 48 hrs

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17
Q

what is Crohn’s disease?

A

Chronic inflammation causing fistulas between loops of small bowl
affects young adults

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18
Q

what are the four divisions of the respiratory system?

A

pharynx, trachea, bronchi, & lungs

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19
Q

what is anterior trachea or esophagus?

A

trachea is anterior to the esophagus

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19
what device is used for pediatric imaging?
Pigg-O-Statt
20
What are these body types? Sthenic: hypersthenic: hyposthenic: asthenic:
average physique (50%) wide physique (5%) skinny (35%) sickly/ill (10%) *
21
why do we perform chest x-ray at 72"?
reduces distortion (magnification) and increases image resolution
22
what situs inversus?
heart is on the right side of the body
23
what is hemothorax?
blood accumulation in the plueral space
24
what is pnemothorax?
air accumulation in the pleura space
24
what is emphysema?
lungs lose elasticity and become long in dimension (become radiolucent, reduce technique)
25
what is kyphosis?
hump-back curvature
25
what pathologies can be seen on expiration chest x-ray?
pneumothorax & COPD
26
in a PA chest x-ray, the mid-sagittal plane is ___ to the x-ray and mid-coronal plane is ____
perpendicular parallel
27
where does the diaphragm move during expiration? Inspiration?
moves upward moves downward
28
what is the kVp range for a cxr?
110-125 kvp
29
how many ribs need to be present on a CXR to be diagnostic?
10 ribs
30
where is the base of the lung located? apex?
most inferior portion underneath the clavicles
30
what is the CR for a CXR?
T7 (mid-thorax) AP: 3-4 inches inferior to jugular notch PA: 7-8 inches inferior to C7
31
what happens to technique for suspected hemothorax? Pnemothorax?
increase decrease
32
what are the 3 parts of the sternum?
manubrium body xiphoid process
33
what is the outer layer of the pleural space called? inner?
parietal visceral
34
what is pleurisy?
inflammation of the pleura
35
why does the right hemi-diaphragm sit higher than the left?
presence of the liver
36
what is atlectasis?
collapse of a portion of the lung (pneumothorax or pleural effusion)
36
what is pleura effusion?
Accumulation of fluid in the pluera
37
how many phalanges are there?
14
37
what is the compression of the median nerve referred to as?
carpal tunnel syndrome
38
what are the four proximal carpals? four distal?
scaphoid, lunate, triquetrum, pisiform trapezium, trapezoid, capitate, hamate
39
what do these phalange articulate with proximally? first: second: third: fourth: fifth:
trapezium trapezoid capitate hamate
40
what articulates with the radius distally?
scaphoid & lunate
41
The capitulum is part of what bone?
distal humerus (Lateral side)
42
What elbow view causes ulna + radius cross over?
internal elbow (also PA forearm)
42
What kind of joint is radioulnar? elbow? humeroulnar? humeroradial?
pivot (trochoidal) joint hinge (ginglymus)
43
what kind of joints are the interphalangeal joints? What joint is Metacarpophalangeal? (MCP) What joint is Carpometacarpal (CMC)? 2-5 CMC?
hinge (ginglymus) Condyloid (ellipsoidal) 1st digit is Saddle (Sellar) joint 2-5 digits are plane (gliding) joints
44
what kind of joint is the radiocarpal joint?
ellipsoid (condyloid) joint
45
what position is the arm in a 90 degree flexion?
lateral
45
For a lateral view of the second digit what side do we place against the IR? why?
lateral side reduced OID
46
lateral fx is best displayed in what view? AP fx best displayed in?
AP Lateral
46
what view of the elbow shows the olecranon process free of superimposition? Coronoid process? radial head? how do we remeber this?
lateral (elbow) internal oblique external oblique ICER (internal=coronoid, external=radial head+capitulum)
47
what is the view that shows the scaphoid best?
ulnar deviation + 15 degree toward the wrist
48
what view best shows arthritis in the hand? carpal tunnel?
ball-catcher Gaynor-hart method
48
what view best shows the hook of the hamate (hamulus)? what is the CR?
Gaynor-hart method 25-30 degrees to the long axis of the hand + 1" distal to the third MCP
49
what is a colles fx? what is a smiths fx?
radius & ulna go anterior + distal radius go posterior radius & ulna go posterior + distal radius goes anterior
50
what is a Barton's fx? what is a Bennett's fx? Boxer's fx?
fx of posterior lip of distal radius (styloid process) fx at base of first metacarpal fx at fifth metacarpal (from fights)
50
what is osteoporosis? osteopetrosis?
decrease in bone density, decrease technique hereditary disease resulting in abnormal dense bone, increase technique
51
what is the CR for elbow views? forearm? hand views (PA, OBL, LAT)? digits? wrist views (PA, OBL, LAT)
mid-elbow mid-forearm 3rd MCP, 2nd MCP PIP joint mid carpals
51
what is the name of the process located on the posterior + superior ulna? when is it best seen?
olecranon process lateral
52
what is the name of the fossa located on the posterior distal humerus?
olecranon fossa
53
what is the name of the process located on the proximal anterior ulna?
coronoid process
53
how are the elbow epicondyles to the IR for these projections? AP: LAT: Internal/external:
parallel perpendicular to IR obliqued
54
in a trauma instance what view could replace an AP elbow?
2 projections forearm parallel + humerus parallel, CR mid elbow
54
what view do you see the fat pads on? what are the fat pads name?
lateral elbow anterior, posterior, & supinator fat pad
55
which Coyle view shows the radial head? coronoid process?
90 degree arm flexion + 45 degree toward shoulder CR mid-elbow 80 degree arm flexion + 45 degrees away from the head CR mid-elbow
55
what is the name of the view for the AP thumb projection? how is it positioned? what does this rule out?
roberts view hand supinated + 15 degrees toward the CMC joint bennets fx
56
The lateral elbow projection best demonstrates this anatomy free of superimposition?
Olecranon process
57
Located on distal, lateral end of the humerus?
Capitulum
57
Fracture of forearm causing posterior radial displacement is called this?
Colles fracture
58
Ulnar deviation best demonstrates this anatomy?
Scaphoid
58
Trochlear notch is on this anatomy?
Ulna
59
This joint is considered freely moveable? limited movement? immoveable?
Diarthrodial Amphiarthrodial Synarthrodial
59
For a lateral projection of the humerus how are the epicondyles to the IR? hand placement? for AP?
perpendicular + pronated parallel + supinated
60
What does the acromioclavicular joint articulate with? What does the sternoclavicular joint articulate with? What is the medial extremity? What is the lateral extremity?
Clavicle & acromion clavicle & sternum Sternal extremity Acromial extremity
61
Deep grove between the two tubercles?
Intertubercular groove (Bicipital groove)
61
What does the sternal extremity articulate with?
Manubrium
62
What are the 3 borders of the scapula?
Superior border, Axillary (lateral) border, & vertebral (medial) border
62
What are the angles of the scapula?
Superior angle & inferior angle
63
How many fossa’s on the scapula? What are the names?
4 Supraspinous fossa (superior, posterior) Infraspinous fossa (inferior, posterior) Subscapular fossa (ventral/anterior) Glenoid fossa (lateral, anterior)
63
On the Y view of the shoulder, what is shown on the scapula?
Coracoid process (right side) Acromion (left side) Inferior angle Spine of scapula Body of scapula
63
What kind of joint is the scapulohumeral (glenohumeral) joint? AC and SC joints are what type? what type of joint?
Ball or socket plane or gliding freely-moveable/ diarthrodial
64
What rotation best shows the greater tubercle? how is the hand rotation? how are the epicondyles? What rotation best shows the lesser tubercle? how is the hand rotation? how are the epicondyles?
External rotation + supination + parallel Internal rotation + pronation + perpendicular
64
What is the CR for AP humerus? What is the CR for Lateral humerus? What is the CR for Internal Shoulder? What is the CR for a transthoracic lateral?
mid-humerus 1 inch inferior to coracoid process surgical neck
65
What is the CR for Grashey?
35-45 degree LPO/RPO patient oblique 2 inches inferior 2 inches medially from supralateral border of shoulder
66
What is the CR for a Y shoulder view? Neer view?
patient rotated 45-60 degrees toward affected side (LAO/RAO) 48" SID 10 x 12 portrait CR is mid-scapula 10-15 degrees caudad
66
What is the CR for an Axillary shoulder? (Superiorinferior)
Scapulohumeral joint
67
CR for AP Clavicle: CR for AP axial clavicle:
AP: mid-clavicle AP-axial: 15-30 degrees cephalic (25-30 degrees asthenic) (15-20 for hypersthenic)
67
CR for AC joints:
1 inch above jugular notch, mid-point AC joints 72 Inch SID 2 views (one with weights, one without)
67
Why or when do we do the neutral rotation? What imaging is useful for shoulder joints and rotator cuff tears?
In trauma cases when the patient is unable to rotate Ultrasound
68
What is the Hill-Sachs defect?
A compression fx of the humeral head
69
What is idiopathic chronic adhesive capsulitis?
Frozen shoulder Caused by chronic inflammation around the shoulder joint Pain and limited movement
70
What is osteoarthritis?
Degenerative joint disease Non-inflammatory Gradual deterioration Most common arthritis and normal due to age
71
What a rotator cuff injury?
Acute or chronic trauma injury to the rotator cuff muscles: Tere’s minor Supraspinatus Infraspinatus Subcapularis
71
What is a shoulder dislocation?
Removal of humeral head from glenoid cavity 95% of dislocations are anterior
72
what is the kvp range for hand, elbow, & shoulder?
50, 60, 70 kVp
72
What is the CR for Internal Shoulder?
hand pronated CR 1 inch inferior to coracoid SID 48" 70 KVP shows lesser tubercle INT markers
73
What position is the greater tubercle superimposed over the humeral head?
Internal rotation
74
When performing the west point projection this is free of superimposition?
Coracoid process
74
the scapular notch is located on what part of the scapula?
Superior border
75
Why do we add weights to the AC joint projection?
to separate the joint spaces (weight add stress and allow the shoulders to "naturally" fall)
76
You would use this CR on a asthenic patient when performing an Axial Clavicle exam?
25-30 degrees (15-20 degrees for larger "hyperstenic" patients)
76
What is the CR for a transthoracic lateral projection?
surgical neck (on the humerus in profile)
77
Where do the medial and lateral borders of the scapula meet?
at the inferior angle
77
Medial aspect of the clavicle is called?
Sternal extremity (end)
78
What is the dislocation of the radial head called?
Nurse maid's jerked elbow/ Pulled elbow
78
The scapula is required to be in this position for the Neer method?
scapula needs to be lateral perpendicular to IR
78
What is the flattened triangular part on the scapula?
Acromion
79
What is the name of the larger depression on the anterior surface of the scapula?
subscapular fossa
80
What type of fractures force the splinted pieces through the skin?
Open or compound fx
81
This is the only bony articulation between the upper extremity and the torso:
Sternoclavicular joint (SC joint)
81
Another name for the lateral border of the scapula:
Axillary border
82
In an AP humerus, is the humerus flexed or extended? What is the rotation of the AP humerus?
extended external rotation
83
what consists in the shoulder girdle?
Clavicle Scapula NOT HUMERUS
83
your patient is in a 45-degree posterior oblique position with the affected side closest to the IR. The humeral epicondyles are parallel to the image receptor. CR is 2 inches inferior and 2 inches medial to the supralateral border of the shoulder. Which view would this be?
Grashey (hint is the CR and epicondyles)
84
(T/F) we use a breathing technique for transthoracic lateral projection
True (ALWAYS)
84
When were X-rays discovered? by who? Who discovered fluoroscopy?
November 8, 1895 Wilhelm Conrad Roentgen Thomas Edison
85
ALARA stands for? Largest source of radiation for average human?
As Low As Reasonably Achievable (Refers to occupational exposure) Radon gas
86
Scientific approach is _________
Self-correcting - it will always change
86
Unit prefix for hundredths: Unit prefix for millions: Unit prefix for thousandths: Unit prefix for millionths: Unit prefix for thousands:
centi = c mega = M milli = m micro = Mu kilo = k
87
2 types of Mechanical Energy? what is the law of conservation of energy?
Potential energy & Kinetic energy Energy can’t be created/destroyed Energy can only be transformed
88
what types of energy are these? Potential Energy: Conduction heat: Kinetic Energy: Convection heat: Radiation heat: 99% of X-ray tube interactions are ____ interactions
Energy of position Direct contact Energy of motion Mixing of hot & cold molecules Transfer Heat
88
what is the main reason for the use of technique charts? how do we determine technique?
Consistency Tissue density (Body part density muscle, air, fat) Tissue thickness (Measurement of body part thickness)
89
what are these and where are they located? proton: neutron: electron:
Positively charged particle located in nucleus No charge particle located in nucleus Negatively charged particle orbiting nucleus & creating orbital layers
90
what are atomic shells? what 2 rules are associated with shells?
Letters: K - Q Principle Quantum Numbers: 1 - 7 2n^2 rule & Octet rule
90
what is a nucleon? what is an Alpha particle? what is a beta particle?
Protons & neutrons 2 protons & 2 neutrons 20x more damaging than X-rays (Due to the size) Breakdown of neutron into positive neutron (now a proton) & high-speed negative electron
91
what is the z number? what is the 2n^2 rule? what is the octet rule?
Number of protons in (elements) nucleus maximum number of electrons allowed in a shell outermost shell can never hold more than 8 electrons
91
what is a mixture? aka? what is a molecule? what is an isotope?
2+ substances not chemically bonded aka Suspension 2+ atoms chemically bonded together atom w/ unusual number of neutrons (Not necessarily radioactive)
91
what is an ionic bond?
Positive & negative ions attracted to each other electrically Super strong bond
91
what is a covalent bond?
Bonding of 2 atoms w/odd number of electrons 2 atoms share “extra” electrons in figure 8 pattern Much weaker than ionic bond
91
what is the radioactive state? what is the ground state?
Nucleus is unstable & spends too much energy holding itself together most stable configuration of nucleons (correct number of neutrons to stabilize atom)
92
what are gamma rays? what is natural about these?
energy released from unstable nucleus w/o change to atomic structure naturally occurring X-rays
92
what are two ways an electron can be removed creating an ion?
Incident electron Incident x-ray
93
Outer shell electron gives off its energy in the form of _____
X-ray
94
what is wavelength? what is measured in?
distance between two like points on wave (measured in Angstroms) Angstrom = 10^ -10 m
94
what is velocity?
how fast energy of wave moves from one point to another
94
what is amplitude?
maximum displacement of media from its equilibrium (strength of the wave, not its energy)
95
what is tungsten's symbol? what is its z number? what is its K shell quantum number & binding energy? L shell? M shell?
W (wolfram) 74 #1 & binding energy of 69 kV #2 & binding energy of 12 kV #3 & binding energy of 3 kV
95
what is the electromagnetic formula?
c (speed of light)= frequency x wavelength
95
what is frequency? what is this measured in?
number of cycles passing through a fixed second hertz
96
Frequency & wavelength have ___ proportional relationship
inverse
97
what is velocity equaled too?
velocity= frequency x wavelength
97
Energy is directly proportional to ___ X-rays have ___ nature
frequency dual light photons and physical properties
98
High energies behave like ___
particles
99
Radiopaque Radiolucent
Very few X-rays pass thru X-rays can pass easily thru
99
Strength of attraction/repulsion of poles follows the ___ law Magnetic fields are strongest near the ___ Magnetic field - unit of measurement
Inverse square law poles Gauss (G) - roughly strength of earth’s magnetic field at the poles
99
Typical strength of MRI machine 1 Tesla (T) equals ___ gauss
2 Teslas (T) 10,000
100
Static electricity is generally caused by electrification by ___ To minimize static, humidity should be above ___
friction 40%
100
Electromotive Force (EMF)
Force created by any electric potential difference
100
Electrodynamics - Semiconductors
Electrical current flow in certain conditions
101
Electrodynamics - Conductors
Electrical current flow in most conditions
101
Current flow & electron flow are in ___ directions
opposite
102
Electrodynamics - Current
Flow of loosely-bound outer shell electrons
103
Electrodynamics - Insulators
No electrical current flow
104
Current - unit of measurement 1 Coulomb per second is equal to ___
Ampere / Amp 1 Coulomb per second 1 ampere
104
Ohm’s Law: Formula
V = I x R Voltage = Current x Resistance
105
Parallel circuit
Each component is connected to power source independently Failure of one component only breaks circuit to that component, not the others
106
Resistance affected by:
Length, Diameter, Material of conductor
107
Series circuit
Each component of circuit is connected to each other Failure of one component breaks the circuit
108
Electrical power
RATE at which electrical power is used
109
Resistance
Force preventing electrons from moving thru circuit
110
Electrical power - unit of measurement
Watt (W)
111
At frequency of 60 Hertz, each cycle lasts for ___
1/60th second
112
How many hertz in a second?
60
112
Alternating Current
Oscillation of current back & forth
113
How many pulses in a hertz?
2
113
3 ways to generate alternating current
1.Move conductor back & forth thru magnetic field - most common 2. Move magnetic field back & forth near conductor 3. Alternate the strength of magnetic field
113
Step-down transformer
Voltage goes down Amperage goes up
113
How many pulses in a second?
120
113
Step-up transformer voltage & amperage
Voltage goes up Amperage goes down
114
True/False Induction only works with Alternating Current
True
114
Autotransformer
Uses concept of self-induction to slightly change voltage in a circuit
114
What is the Typical incoming line voltage to the high voltage circuit?
220 volts
114
Autotransformer:
makes adjustments to voltage before it is stepped-up on low-voltage side of the high voltage circuit for safety
115
What is part B in the x-ray machine?
Autotransformer
115
What is part A in the X-ray machine?
Main power switch & circuit breaker Typical incoming line voltage is 220V
115
Autotransformer (step?):
B adjusts voltage before stepping up
115
What is part C in the x-ray machine?
Exposure switch & exposure timer initiates exposure and terminates 1 of 3 ways: Manual timer mAs Timer Automatic exposure control (AEC)
115
What is part D in the x-ray machine?
kVp Meter measures the Kvp (parallel circuit)
115
What is part E in the Xray machine?
Step-up transformer turn ratio 500:1 to 1000:1
116
What is part F in the x-ray machine?
mA meter Measures the amount of mA (series circuit)
116
What is part H in the x-ray machine?
x-ray tube thermionic emission- cathode (-) x-ray production- anode (+)
116
What is part G in the x-ray machine?
Rectification bridge (changes alternate to direct current)
117
What is part I in the x-ray machine?
Rotor switch anode spin at 3400 RPM heats up the filament boils off electrons from filament due to high amps and high resistance
118
What is part J in the Xray machine?
mA selection (resistors)
118
What is part K in the x-ray machine?
Step Down Transformer ratio 1:44 up to 5 amps
119
xray tube Cathode: Thermionic emission:
negative side of the x-ray tube Thermionic emission “BOILING OFF” electrons from filament due to high amperage and high resistance
119
Half wave/self-rectified circuits
60 pulses a second 100% voltage ripple 30% average Kvp
120
single-phase/ full wave rectified
120 pulses a second 100% voltage ripple 30% average Kvp
120
3 phase/ 6-pulse generators
360 pulses per second 14% voltage ripple 91% average Kvp
120
3-phase/ 12-pulse generators
720 pulses per second 4% voltage ripple 97% average Kvp
120
high frequency generators
greater than 500 pulses per second 500< 1% voltage ripple 100% average kvp hz is altered from 60 to 500-25,000 HZ
121
How many filaments in x-ray tube?
2 filaments small= 1 cm large: 1.5-2 cm
121
What does focal spot do? Small? Large?
smaller focal spot creates sharper images large focal spot better for high heat x-rays (L-spine)
121
what is heat units for?
to measure how much heat the anode can withstand (a unit of measurement for anode heat capacity)
121
Thermionic emission occurs in the: What is thermionic emission?
Cathode “boils off” electrons from the filament due to high current flow and high resistance
122
Focusing cup: What is its charge?
Negative charge prevents electrons from rushing away by surrounding the filament (negative focusing cup narrows the electrons due to the law of attraction)
122
focal spot (in anode) is _% of filament?
5% (0.5mm-1mm)
123
Focal spot for hands/feet x-rays:
Small focal spot 1cm
123
What is space charge?
electron cloud forms around the filament when the rotor button is pushed
124
mAs directly controls the number:
of x-rays that exit the tube
125
Doubling mAs will:
double the amount of x-rays created
126
Target: A part of what? Made of what?
area of the anode disk that is struck by the electrons made of tungsten and rhenium z=75
126
focal spot for lateral lumbar:
large focal spot 1.5cm to 2cm
127
Anode:
positive side of the x-rays tube Xray production
127
What is struck by electrons in the x-ray tube?
the target in the anode (anode disk) very durable to high amounts of heat
128
Rotor: A part of what?
Anode Connects the shaft and spins when influenced by the stator (induction)
128
What is arcing?
vaporized tungsten coats the inside of the tube type of short circuit: 1. cracks the glass 2. eliminates vacuum 3. burns out the filament
128
Main cause of x-ray tube failure?
arcing
129
What is a way we can protect the x-ray tube? (3)
1. warm up procedures to prevent thermal shock (hot water on cold glass=crack) 2. avoid excessive rotoring 3. calculate the heat units to prevent overheating of the anode
129
What is the anode cooling chart purpose?
how long will it take for the anode to cool before making another exposure
130
What is the purpose for a tube rating chart?
to ensure that a technique will not exceed the heat capacity of an x-ray tube
130
HU (heat units) formula:
1.4 (constant/ don’t forget) x kVp x mA x s (seconds)
130
heat interactions:
99.5% of interactions at 60 Kv 99% of interactions at 100 kv
131
bremsstrahlung is responsible for the:
vast majority of x-rays
131
stream of electrons: How fast?
using the voltages in x-ray electrons can accelerate at 1/2 the speed of light in just one inch
132
Bremsstrahlung:
“braking radiation” interactions with the nucleus
132
Characteristic:
projectile electron from CATHODE interacts with INNER shell electron it can be ejected
133
In Bremsstrahlung what is the average kv exiting?
(The avg kv after filtration is 1/3 of kvp setting) the average KV exiting the x-ray tube after filtration is about 1/3 of the kVp setting
133
Any _____ can fill the vacancy in an inner shell electron, including ____ _______ outside the atom in characteristic
Electrons Free electrons
134
Characteristic cascade:
Inner shell electrons are replaced in sequence (k by L,L by M, M by N,N by O). MULTIPLE x-rays are created
134
What are the steps of characteristic?
1. electron interacts with inner shell electron 2. outer shell electron will drop down to fill the vacancy (L to K) 3. The strength of the x-ray is equal to the difference between the two shell electrons
134
Filtration removes what kind of x-rays? adding more filtration will:
Filtration removes weak x-rays & adding more filtration will remove even more weak ones Increasing the average kvp
134
The result of characteristic cascade is x-rays at _____ _________
Specific energies K shell- 57, 66, 68, 69 KV L shell- 9,11,12 KV
135
(T/F) when the Bremsstrahlung spectrum and characteristic spectrum are combined we have a complete graph of all the x-rays leaving the x-ray tube
True
135
What are factors that affect the x-ray emission spectrum?
1. Target material (mammography) 2. Milliampere-seconds (mAs) 3. added filtration 4. Kilovoltage-peak (kVp) 5. generator type (3 are of these are most common/ I think 2,3,4)
135
Increasing the kVp will move:
the x-ray emission spectrum to the right due to the increase energy from x-rays
136
When we filtrate more x-rays what happens to the average KV? What is this known as?
the average KV will go up this is known as “hardening” the x-ray beam
136
How do generator type play a role in x-ray emission spectrum?
most importantly the average kvp Changes the pulses, voltage ripple, average kvp (high frequency, single phase, etc)
136
Average KV after exiting the x-ray tube after:
filtration is about 1/3 of the kVp setting
137
Hardening the x-ray beam:
adding more filtration for weak x-rays thus increasing the average kVp
137
At the bridge current:
can flow
137
(T/F) free electrons outside of the atom can fill the vacancy of the inner shell?
True ANY electron
138
what are these societies? JRCERT ARRT ISRRT ASRT AAPA ACR
Accreditation agency for radiography programs Certification body for radiography International Society Society for Radiologic Technologists Society for Medical Physicists
139
what are accreditation agencies? what is it for radiology?
ensure education programs meet standards JRCERT
139
Which modalities do NOT use ionizing radiation?
MRI Sonography
139
what are professional societies? what is this for radiology?
Voluntary organizations that inform, represent & lead members ASRT
139
what are certification bodies? what is this for radiology?
Accreditation agency for radiography programs ARRT
140
what are the six problem solving & critical thinking resources? (in order)
Institutional policies Federal laws State laws ARRT Standard of Ethics ARRT Code of Ethics ASRT Practice Standards
141
what are the steps for critical thinking & problem solving?
Identify the problem Investigate the problem, objectively Develop viable solutions Select the best solution, and Implement it
141
what is MQSA? What is OSHA?
Mammography Quality Standards Act - regulates mammography services on federal level Occupational Safety & Health Administration Regulates workplace federally
141
what is joint commission?
accreditation body for hospitals & clinics
141
Minimum of ___ views on all radiographs
2
142
what is the preferred imaging modality for pediatric patients?
sonography
143
patients that come to radiology are at low or high levels of the Maslow’s hierarchy?
low
143
what is the patient interaction for pediatrics?
what is the patient interaction for pediatrics?
143
what is the patient interaction for adolescents?
modesty (important) get them involved speak to them as an adult
144
For history taking, what are the two types of data? what are they?
subjective data (feelings/attitudes) objective data (measurable/physiologic)
144
wheel-chair transfers should occur with w/c at a ____ angle to the ____
45 degree table
145
where is the center gravity located?
at the level of the second sacral segment
145
what are the 4 principles of lifting?
communication patient does most work hold patient close watch for orthostatic hypotension (faint after standing to quickly)
145
what are the steps for a w/c transfer?
lock stretcher get patient involved use slider board three people needed for assisted transfer
145
what is the goal of immobilization techniques?
to reduce motion
145
what are the rules for trauma applications?
initial images should include the device device can only be removed after receiving permission
146
what is the main rule with restraints?
do not remove restraint without authorization do not restrain without permission
146
what is the average temperature for these? Oral: axillary (armpit): tympanic: temporal (head): rectal:
98.6 degrees 97.6 degrees 97.6 degrees 100 degrees 99.6 degrees
147
what is the range for hyperthermia? hypothermia?
Higher than 99.5 degrees Below 97.7 degrees
148
what is the average adult respiratory rate? child?
12 to 20 breaths per minute 20 to 30 breaths per minute
148
what are the pulse rates for adults? child?
60 to 100 bpm 70 to 120 bpm
149
what is tachypnea? bradypnea?
Fast breathing rate Slow breathing rate
149
what is tachycardia? what is bradycardia?
Fast pulse rate Slow pulse rate
149
what is the normal oxygen saturation for pulse oximeter?
95-100%
149
what is the normal range for blood pressure
120/80 systolic/diastolic
150
what is hypotension? hypertension?
Below normal blood pressure Above normal blood pressure
151
Oxygen is considered a ______ what is the color of the oxygen flowmeter?
drug Green
151
what is a central line? what are the most common insertion sites?
catheter inserted into large vein subclavian vein preferred also internal jugular & femoral vein
151
what is bacteria? classified: diseases associated with bacteria?
single celled organism reside in host as colony by shape strep throat & food poisoning
152
what is a virus? what are some common pathologies associated?
microscopic organism that infect animals/ people cant reproduce w/o host or live long outside a living cell flu, colds, COVID
153
what is fungi? common pathologies?
single celled or complex multicellular organism athletes foot, ringworm, thrush
153
what are nosocomial infections? what is the percentage that affects patients?
inpatient (hospital infections) 5% of all inpatient contract
153
what is the PPE (personal protection equipment) donning? removal?
gown, mask, goggles, then gloves gloves, goggles, gown, then mask
154
what is the recommended hand-washing time? hand rubbing?
154
what is surgical asepsis? medical asepsis?
elimination of all micro-organisms in an area reduce micro-organisms in area
154
what are the rules for a sterile field?
create field close to usage time below table is unsterile equipment must be covered with proper sterile covers
155
what are four common surgical procedures in radiology?
chest tube placement dressing changes tracheostomy urinary catheterization
156
what are five common non-aseptic activities done in radiology?
nasogastric tubes (NG) urinal use bedpan use enema barium enema
156
what are the responsibilities of the tech in emergencies?
recognize an emergency Preserve life Avoid further harm Get help
156
what are the three different types of shock?
hypovolemic (loss of blood or fluids) Cardiogenic (Cardiac disorders (MI) Neurogenic (spinal cord damage) Vasogenic (anaphylaxis)
156
what should a technologist be alert for changes in patients
level of consciousness Demeaner Pain level Respiration Speech patterns
156
what are the four signs of stroke?
slurred speech dizziness loss of vision one-side paralysis
157
what is the generic name for drugs?
name given to drug when commercially available
157
what is a drug’s chemical name?
identifies chemical structure of drug
157
what is a drugs trade name?
name given to drug by company (brand name)
157
what are the classifications of these drugs? antiarrhythmics: Antidiabetic drugs: Antihistamines: Antiplatelets: vasodilators:
adenosine Metformin (Glucophage) diphenhydramine (Benadryl) aspirin nitroglycerin
158
what is a mild drug reaction?
Anxiety lightheadedness nausea vomiting itching
159
what are the seven factors that influence drug action?
patient age health status time of day emotional status other drugs in the body genetics (genetic variations) disease state of the body (kidney/liver function)
159
what are severe drug reactions?
Bradycardia (<50 beats/min) cardiac arrythmias laryngeal swelling convulsions loss of consciousness cardiac arrest respiratory arrest no detectable pulse
159
what are moderate drug reactions?
urticaria bronchospasm angioedema hypotension Tachycardia (<100 beats/min)
160
what are the methods of administration? topical: enteral: parenteral:
application of drug directly on skin Drug administration through digestive system (oral, sublingual, buccal, rectal) administration usually from needles/syringes (Intradermal, intramuscular, intravenous, subcutaneous)
161
what are the five types of drug administration?
right drug right amount right patient right time right route
161
what are the needle diameter and length?
diameter expressed in gauges from 14-28 (smaller # is bigger diameter) Vary in length .25 inches to 5 inches most common is 1-1.5 inches
161
at what angle do we insert the needle for a venipuncture procedure?
insert needle next to vein at 15–30-degree angle
161
what is infiltration? what is extravasation?
medicine leaking into the soft tissue WITHOUT irritation medicine leaking into the tissue WITH irritation
161
what are these common medical abbreviations? C: IM: IV: PO:
with intramuscular intravenously by mouth
162
what are these common medical abbreviations? S: NPO: SC: Stat:
without nothing by mouth subcutaneously immediately
163
what are positive contrast media? how do they appear? what are some examples?
Composed of higher atomic number elements appears radiopaque on image barium sulfate water-soluble iodine contrast agents
164
what are negative contrast media? how do they appear? what are some examples?
composed of low atomic number elements appears radiolucent on image Examples: air/gas (CO2)
164
most adverse reactions to contrast result from the:
osmolality of the agent
164
what is a contraindication for barium sulfate? what should we do following a barium study? what does barium sulfate have a tendency to do?
suspected cases of Bowel Perforation push fluids flocculation
164
what are the contrast considerations?
renal function metformin (Glucophage) should be discontinued for 48 hrs before and after the use of iodine contrast
165
two types of radiopharmaceutical contamination:
external- spilled on Internal- ingested
166
ethical dilemmas occur when:
the correct choice is not clear and personal values may conflic
166
what are the six principle-based ethics?
beneficence (actions should always benefit the patient) nonmaleficence (actions should not harm the patient) autonomy (actions should respect patient independence) veracity (always be truthful) fidelity (actions should always meet promises) justice (actions should be fair)
167
In medical imaging and radiation therapy professional ethics are primarily maintained by the ______ in its _________ which contains __ main sections which are?
ARRT Standard of ethics 2 Code of ethics & Rules of ethics
168
what are the code of ethics? rule of ethics?
behaviors a professional should aspire to achieve mandatory rules that outline how a professional should behave
169
what is electronic medical record? (EMR)
medical records that are controlled by a single institution a patient can see their EMR apon request
169
what is the electronic health record? (HER)
medical records that are easily accessed by patient multiple medical institutions (patient portal)
169
what is the hospital information system? (HIS)
designed to share patient data: scheduling billing assigns patient number
169
what is the radiology information system? (RIS)
manages patient scheduling, billing, and orders in RAD department assigns accession number #
169
what is ICD-10-CM? CPT-4?
reason for the visit translated into a code codes used for specific diagnostic procedures and services
170
what patient information is protected? (9)
medical history current medical conditions prognosis current treatment financial information birth date social security number # address name
171
How is patient information protected?
administrative safeguards (security voliations) physical safeguards (doors) technical safeguards (passwords) organizational safeguards (training)
171
HIPPA is enforced by:
the US Department of Health and Human Services
171
Medical law What are the types of law? (4)
constitutional (supreme law of the land) legislative regulations that direct most of our days) case (judge/jury) contract (legal, ex: NDA)
171
10% of all medical negligence lawsuits originate from:
medical imaging (mis-diagnosis)
172
torts:
(patient believes they have been wronged or injured and can sue) patients can claim they have been wronged or sustained some injury (other than breach of contract) for which they can sue for damages
173
battery:
unlawful touching can occur w/o injury
173
false imprisonment:
a patient is restrained against there will
173
Defamation: two forms:
protected health information is released could cause: ridicule scorn contempt Written & Slander
173
libel: slander: fraud:
written spoken defamation intentional misrepresentation of facts that cause harm to individual
174
breach of privacy:
sharing protected health information without consent
175
negligence:
failure to use proper-care as reasonably prudent person would use under the same circumstance
175
standard of care:
RT's put themselves at legal risk if they perform an act outside the standard of care
175
Standard of care is defined by:
the ASRT practice standards for medical imaging and radiation therapy
176
informed consent:
requires written consent for an invasive procedure
177
consent:
patients have the right to make informed decisions about their care
177
Res ipsa loquitur (REGISTRY/EXAM QUESTION)
"the thing speaks for itself" the only explanation for the injury is the medical procedure and staff
177
(REGISTRY/EXAM QUESTION) Respondeat superior:
"the master speaks for the servant" physician or institution is responsible
177
Patient bill of rights:
a list of patient rights developed by the American Hospital Association
177
What are water-soluble iodine contrast agents?
Ionic contrast media non-ionic contrast media
178
What is the main difference between non-ionic and ionic contrast media?
Patient reactions osmolarity/viscosity Ions non-ionic: is better for patient reactions and ions don't disassociate & low osmolarity/viscosity
179
How many bones in the foot? What is the breakdown of these bones?
26 total 14 Phalanges 5 metatarsals 7 tarsals
180
TMT stands for? is what?
Tarsometatarsal joint joint located at in between the base of metatarsal and the tarsals
181
Sesamoid bones are?
small detached bones
181
The sesamoid bones in the foot location? 2 sesamoid bones name? Which is medial, which is lateral?
plantar surface first metatarsal (head) Tibial is medial sesamoid bone Fibular is lateral sesamoid bone
181
Mnemonic for Tarsals?
Come (calcaneus) To (talus) Colorado (cuboid) Next (Navicular) 3 Christmases (3 Cuneiforms)
181
What is the Sinus tarsi?
The space in between the calcaneus and talus articulation
181
Calcaneus articulates Distally with: Medially: What is the largest Tarsal bone?
Cuboid Talus Calcaneus
181
Deep depression between posterior and middle articular facets are:
Calcaneal sulcus
182
Plantar flexion: Dorsiflexion:
posterior side of the foot (plantar side) is flexed downwards (tippy toes) anterior side of the foot (dorsal side) is flexed upwards
182
What kind of joints are the Metatarsophalangeal joints?
ellipsoidal or condyloid (modified)
183
What kind of joints are the Tarsometatarsal joints: What kind of joints are the Intertarsal joint: (tarsals) What kind of joints are the ankle joint: What kind of joints are the knee joints: AKA Femorotibial
plane or gliding plane or gliding Saddle or sellar Bicondylar
183
What kind of joints are the proximal tibiofibular joint: Distal tibiofibular Classification: Mobility type:
plane or gliding Fibrous Amphiarthrodial (slightly moveable) syndesmosis Type
183
AP foot is what kind of projection?
Dorsoplantar (DP)
184
Gout
form of arthritis excessive blood in joints Starts in first MTP
185
Bone Cysts
bone lesions filled with clear fluid common in pediatric patients in the knee
185
Osgood-Schlatter disease
bone/cartilage inflammation of the anterior proximal tuberosity common among boys 10-15
185
Paget Disease
disrupts new bone growth very dense and soft bone
185
Don Juan
fx to the calcaneus resulting from blunt force trauma
186
Criteria for Oblique foot:
Patient supine Rotate foot medially 30-40 degrees (2 fingers underneath) CR base of 3rd metatarsal SID 40" 55 kVp 2-5 mAs
186
Criteria for lateral foot:
Patient Supine Mediolateral projection CR is at medial cuneiform (level of base of third metatarsal) SID 40" 55 kVp 2-5 mAs
186
Criteria for AP Toes:
Patient supine, knee flexed 10-15 degrees toward calcaneus/ (knee) CR at MTP joint 40 SID 55 kvp 2-5 mAs
187
Criteria for oblique Toes:
Patient supine, knee flexed 30-45 degrees rotation (medially or lateral) CR at the digits MTP SID 40" 55 kVp 2-5 mAs
188
Criteria for lateral Toes:
position towards side with least amount of OID (medial or lateral side) 40" SID CR at the IP joint for first digit CR at the PIP joint for digits 2-5
189
Criteria for AP foot: aka Dorsoplantar projection
Patient supine, knee flexed angle 10 degrees toward heel (posteriorly) (15 degrees for standing) CR at BASE of third metatarsal 40" SID 55 kVp 2-5 mAs
190
Criteria for lateral foot:
Patient Supine Mediolateral projection CR is at medial cuneiform (level of base of third metatarsal) SID 40" 55 kVp 2-5 mAs
190
Criteria for AP Mortise ankle:
patient supine internally rotate about 15-20 degrees until intermalleolar is parallel to IR (Malleoli are even) CR midway between malleoli SID 40" 55 kVp 2-5 mAs
190
Criteria for AP ankle:
Patient supine CR midpoint between malleoli SID 40" 55 kVp 2-5 mAs
190
Criteria for lateral ankle:
Patient supine Mediolateral projection CR pointed at medial malleolus SID 40" 55 kvp 2-5 mAs
191
How many degrees difference is there between the lateral and medial distal femur epicondyles?
5-7 degree difference (this is why we angle 5-7 degrees cephalic for superimposition for lateral knee)
192
The fibula is considered to be more _____
posterior
192
Sustentaculum tali means: Located?
support for the talus medial proximal aspect of the calcaneus
192
Which bone in the foot is most often fractured? what is the name of this fx?
base of fifth metatarsal jones fx
192
What is the strongest and largest tarsal bone?
calcaneus
193
What is the superior part of the patella called? The patella lies superior to the _____ ______
Base distal femur
193
Patella surface is also known as the:
intercondylar sulcus or trochlear groove
194
For an AP stress study for an ankle, what would we not do to the foot? Demonstrate a ligament tear Rupture ligament inversion/eversion demonstrate a fracture of the tib fib
Not move the foot around due to the fracture of the Tibia and fibula we would look at the ligaments
194
What is the difference between a mortise and an oblique ankle?
Mortise is rotated 15-20 degrees medially Oblique ankle is rotated 45 degrees
194
Which rotation has the intermalleolar line parallel to the IR?
AP Mortise ankle 15-20 degree internal/medial rotation
194
Which Malleoli is superior?
Medial Malleoli
194
Which tarsal bone makes up the mortise?
Talus + tibia
195
What is the CR for calcaneus? Is it Cephalic or Caudad?
40 degrees Cephalic to the long axis of the foot CR is at base of third metatarsal
195
When you are positioning for a trauma lateral ankle what is necessary? A. Ensure the plantar surface is in complete contact of the IR B. Rotate the leg laterally so the leg is against the table C. Ensure the plantar surface is perpendicular to the IR D. Plantarflex the foot
C. Ensure the plantar surface is perpendicular to the IR
195
When the patient is standing with the metatarsals of the foot in 90 degrees to the leg with a horizontal beam entering the lateral malleolus, which of the following of the weight-bearing projections?
Standing Lateromedial projection (key: CR is entering in the lateral malleolus)
196
In the axial calcaneus the plantar surface of the foot should be ____ to the image receptor?
Perpendicular
197
The most posterior part of the calcaneus would be? A. Sinus Tarsi B. Tuberosity C. Trochlear D. Peritoneal
B. Tuberosity
197
How many views for the calcaneus? What are the names?
2 views Plantodorsal Axial Calcaneus Lateral Calcaneus
197
When performing a lateral for the 2nd toe digit, what side should be closest to the Image receptor? Why?
Medial side To reduce OID
198
Where is the sustentaculum tali?
medial proximal calcaneus
198
What does the medial cuneiform articulate with distally?
First metatarsal
198
What does the metatarsal articulate with distally?
proximal phalanx
198
Medial oblique foot would show:
sinus tarsi free of superimposition (also cuboid)
199
What do the heads of the metatarsal articulate with distally?
proximal phalanx
199
Where are the sesamoid bones located?
plantar surface of the first metatarsal
200
What is Pes planus?
Flat foot
200
What does the base of the metatarsal articulate with?
Tarsals
200
If we are looking at a lateral foot, all of these are correct except for? A. We include at least one inch of the distal tibia fibula B. we want to visualize the foot from digit to calcaneus C. The cuboid is free of superimposition D. The heads of the metatarsals are superimposed
C. The cuboid is free of superimposition (we only see the cuboid slightly free of superimposition in mediolateral) Medial oblique shows the cuboid free of superimposition
201
If we are looking for a foreign body do we angle the central ray? Why?
No. An angle can distort the object and elongate it
201
T/F *The image critique for an oblique foot with lateral rotation we want to see the sinus tarsi free of superimposition.
False (medial oblique would show the sinus tarsi)
201
If the patients foot cannot be flat for an AP projection, what would we do? What is the angle?
We would use a wedge No angle for this
201
How many tarsal bones are in the foot?
7 tarsal bones
202
*The lateral oblique foot best shows?
The base of the first metatarsal
203
In the AP projection of the ankle the: 1. Plantar surface is perpendicular to the IR 2. The Fibula projects more distally than the tibia 3. The calcaneus is well-visualized
1 & 2
203
AP ankle the plantar surface is ____ to the IR?
Perpendicular
203
Lateral foot the plantar surface is ____ to the IR? How about standing?
Perpendicular supine Parallel for standing
203
The second metatarsophalangeal joint is what kind of joint?
ellipsoid or condyloid Synovial Diarthrodial (freely moveable)
204
Which of the following joints is a fibrous syndesmosis Amphiarthodial (slightly moveable) joint? A. Proximal interphalangeal B. Talonavicular C. Proximal tibiofibular D. Distal Tibiofibular
D. Distal Tibiofibular
205
When would you best see a medial displacement fracture? (bone protruding towards medial side)
AP view
205
If there's a posterior displacement, what view would best display that?
Lateral
205
What is the name of the fracture for the base of the fifth metatarsal?
Jones or nightstand fx
205
What joint is most affected by gout?
First MTP joint Form of arthritis (execessive blood in joint) that may be hereditary
205
What is the Don Juan fx?
fx in the calcaneus
206
Osgood Slatter is?
inflammation of bone/cartilage of anterior proximal tibia (tibial tuberosity) most common in boys 10-15
207
Inversion: AKA?
Inward turning/bending of the ankle aka Varus
207
Eversion: AKA?
outward turning/bending of ankle aka valgus
208
Dorsiflexion:
Dorsal/anterior surface of foot flexed upwards
208
Plantarflexion:
Posterior/Sole of foot is flexed downwards (tippy toes)
209
Posterior foot name:
Plantar surface Sole of foot
210
Anterior foot name:
Dorsum pedis
210
During most long bone exams, the part being radiographed should be _____ to the IR and ____ to the CR.
Parallel to IR Perpendicular to CR
210
What is the superior portion of the foot called?
Dorsum Pedis
210
Is the dorsum pedis considered anterior or posterior part of the foot?
Anterior
211
How many degrees for a lateral knee?
5-7 degrees cephalic
212
(T/F) The lateral projection of the Tibia and Fibula the image should demonstrate some space in-between the Tibia and fibula.
True (There should be some space in-between the tibia and fibula in lateral view)
212
The placement of the top border of the IR should extend at least ___ inches from the knee joint to avoid being projected off due to beam divergence: A. 4 - 4 1/2 inches B. 3 - 3 1/2 inches C. 2 - 2 1/2 inches D. 1 - 1 1/2 inches
D. 1 - 1 1/2 inches
212
What is the CR for AP foot? What is the angle?
base of 3rd metatarsal 10 degrees posteriorly
212
Which views do we use for patella?
Inferosuperior Hughston Settegast Merchant (Mayo uses Merchant)
212
What views do we use for intercondylar fossa?
Rosenburg (PA flexion- for tunnel view)
213
Which of the following tangential axial projections of the patella is the complete relaxation of the quadricep require for an accurate diagnosis? 1. Supine flexion 45 degrees (merchant) 2. Prone flexion 90 degrees (Settegast) 3. Prone flexion 55 degrees (hughston)
1. Supine flexion 45 degrees (supine keyword, relaxes the Quads)
214
What is considered a shock absorber between the femoral condyle and the tibial articular casset?
Meniscus
214
If we are looking to see arthritic changes (arthritis) in the knee we want to see it: 1. recumbent 2. Erect 3. Merchant
AP erect (we want weight bearing)
214
What knee oblique shows the proximal tibiofibular joint?
Internal/ medial oblique (shows the head/neck of fibula free of superimposition)
214
which projections are performed with the tube face is angled and parallel to the flexed tibia? A. Hughston B. Merchant C. Axial intercondylar fossa (BeClere) D. Settegast
C. BeClere
214
When we are doing a lateral knee, what needs to be seen so we know the lateral is positioned correctly? A. Patella is parallel to the IR B. Femoral condyles are superimposed C. Femoral condyles are perpendicular to the IR D. The proximal tibiofibular articulation is open
B. Femoral condyles are superimposed
215
What is proximal to the tibial plateau? A. The tibia condyles B. The tibial tuberosity C. intercondylar fossa
C. Intercondylar fossa
215
In a lateral projection of a normal knee: 1. The fibular head should be somewhat superimposed on the tibia 2. The patellofemoral joint should be visualized 3. The femoral condyles should be superimposed
1, 2 & 3
215
What is the CR for AP knees?
1/2" distal to the apex of the patella
215
These extra two bones underneath the first metatarsals?
Sesamoid bones
215
This is the name of the fossa on the distal posterior femur?
Intercondylar fossa
216
what is the saying for the sunrise view?
the merchant Houghton likes to watch the sunrise in Settegast
216
what is the saying for the intercondylar fossa? (PA flex)
To be Clere we have to go through the tunnel from camp Coventry to try some holmblad food
216
What kind of joints are the Tarsometatarsal joints:
plane or gliding
216
During a cervical myelogram what position do we placed the patient in for the best image?
Prone
217
What type of articulation is primarily used for arthrograms?
Synovial but more specifically diarthrodial
218
What are the most frequent joints for an arthrogram? What joints can't be examined during an arthrogram?
shoulder and knee (shoulder most likely) Pubis Symphysis
218
(t/f) Standard precautions must be followed for a T-Tube Cholangiogram placement
True (sterile)
218
What kind of joint is an amphiarthrodial?
distal tibiofibular joint (limited movement)
218
What is the insertion point for a myelogram LP?
L3-L4? subarachnoid space
218
What are the contraindications for an ERCP?
Mainly: pseudocyst of pancreas Also Can be: hypersensitivity to iodine contrast infection to biliary system elevated creatinine/BUN levels
219
What is the common reason for a myelogram?
to examine the spinal cord/nerve branch and find possible pathologies
220
What is the name of the scope for a ERCP?
duodenoscope
220
When it comes to slices what does more angle do? What does less angle do? What do small numbers mean? What do the large numbers mean?
Increasing the angle will make thinner slices less angle creates larger slices
220
How long does it take for contrast not to be radiographically detectable in a myelogram?
24 hours
220
Which of the following procedures may be performed during a post operative T tube cholangiogram? A. remove gallbladder B. remove a liver cyst C. remove a biliary stone D. remove the kidney
C. Biliary stone (Gall stone)
221
when it comes to humerus injections, how do we want the arm rotated? Why?
external rotation to see the joint space (glenoid cavity)
221
What is the name for the ruler?
Bell-Thompson
222
HSG contraindications:
pregnancy acute pelvic inflammatory disease active uterine bleeding
222
(T/F) bile is sterile.
False. Outside of the standard precautions, bile is not sterile.
222
_______ the slice, the ______ it is. Why? For examining the kidney, we want _____ slices. We want it to be ______. Why?
Thinner, Blurrier So we can see past the bone. Thinner slices Blurry (for the bones) We want to see the kidney and thin slices make the bones blurrier
222
Where are we imaging in a long bone study? Bell-Thompson ruler what joints are we looking at? For upper? For lower?
To examine the joint spaces Ruler is for synovial diarthrodial joints upper: shoulder, wrist, elbow Lower: Hips, Knee, ankle
223
(T/F) We can flex the knee when putting in contrast into the knee joint.
True. the doctor manipulates the knee to see how the fluid flows in the capsule
223
(T/F) Arthrogram should be a sterile procedure.
True We need to prep the skin for the needle
223
Myelogram is for?
abnormality in spinal cord spinal stenosis map out for spinal chemo
224
What is a necessity during a cervical myleogram?
patient either prone/fowler with chin hyperextended to prevent contrast going to the brain
224
What does ERCP stand for? What is it for?
endoscopic Retrograde Cholangiographic pancreatography examine the biliary and pancreatic ducts
224
What is a hysterosalpingogram?
demonstrates uterus/fallopian tubes
224
How much do you oblique for Judet views? What do you see on the upside of the Judet views? What do you see on the downside Judet view?
45 degrees LPO/ RPO posterior rim of the acetabulum & anterior iliopubic column anterior rim of the acetabulum & posterior ilioschial column
224
How do we position for an downside Judet view?
patient supine 45 degree oblique LPO/RPO 2 inches inferior + 2 inches medial to downside ASIS
225
How do we position for an upside Judet view?
patient supine 45 degree oblique LPO/RPO 2 inches inferior to ASIS
225
What is the posterior portion of the hip? What is the anterior portion of the hip? what is the superior portion of the hip?
Ischium (itchy bum) Pubis Ilium
226
What view/rotation best shows the lesser trochanters in profile? What view best shows the greater trochanter in profile?
external oblique/rotation internal oblique/rotation
226
What view best shows a lateral fracture?
an anterior/posterior (AP) projection
226
Axial lateral horizontal beam projection of the hips (cross table) requires the image receptor to be placed: 1. parallel to the central ray 2. parallel to the long axis of the femoral neck 3. in contact with the lateral surface of the body
2 bc internal rotation makes the femoral neck parallel 3 bc we have patients lateral side closer to IR to reduce OID cannot be no. 1 because the central ray is ALWAYS perpendicular to the image receptor
227
In a frog position the femoral neck is _____ to the image receptor
parallel
228
what part of the innominate bone makes up the obturator foramen?
Ischium Pubis (where the posterior and anterior meet to create the hole aka obturator foramen)
228
How much does the femur slant in?
5-15 degrees
228
What does the femur articulate with proximally?
acetabulum
228
When would we use the Nakayama method? What does it replace?
Trauma views it replaces our cross-table
228
What can we use for a cross table lateral projection to improve the quality of the image?
add filter & grid
229
What is the central ray for the AP pelvis?
2 inches inferior to ASIS midway point between ASIS and Pubis symphysis (15–20-degree internal rotation of affected leg)
229
What is the CR for inlet?
40 degrees caudad CR ASIS
229
What is the CR for outlet? (Taylor method)
20-35 degrees cephalic for men 30-45 degrees cephalic for women CR 1-2 inches inferior to pubis symphysis
229
where is the innominate bone located at? also known as?
at the hips (left or right there are two) ossa coxae
229
Where do you inject for a Myelogram (cervical)? What is this called?
C1-C2 Subarachnoid space Cisternal puncture
230
What is Lordosis?
increased concavity (lumbar) exaggerated lumbar curvature (swayback)
230
What is Scoliosis?
exaggerated lateral curvature of the spine
231
What is Kyphosis?
increased (exaggerated) convexity in the thoracic area (humpback)
231
what is concave? what is convex?
rounded inward or depressed surface like a cave rounded outward or elevated surface
231
Cervical is what type of curve? Thoracic is what type of curve? lumbar is what type of curve? sacrum (sacral) is what type of curve?
first compensatory curve (concave) first primary curve (convex) second compensatory curve (concave) second primary curve (convex)
231
What makes up the zygapophyseal joint?
superior and inferior articular processes
231
What are primary curves?
convex curves 1st primary curve: thoracic 2nd primary curve: sacral
232
What are compensatory curves?
Concave curves 1st compensatory curve: cervical 2nd compensatory curve: lumbar
232
Where is the pedicle located? What does it connect?
posterior to the body of the vertebrae attaches body to vertebral arch (terminate in the area of the transverse process)
232
Where are the laminae located? What does it connect?
connects the transverse process to the spinous process (posterior to transverse anterior to spinous)
233
In a cervical exam when would we see the zygapophyseal joints? (C2-C7)
true lateral 90 degrees to the midsagittal plane
233
When do we see the C1 & C2 Z joints?
In an AP open mouth
234
In a cervical exam when would we see the foramen?
45 degree oblique (15 cephalic AP)
235
How do we position for an open mouth?
upper incisors and base of skull lined up
235
When taking the Judd and Fuchs what are we looking for and what does it look like?
J: Dens sticking out in the hole of skull (foramen magna) Book: Den's and surrounding bony structures of the C1 ring
235
What is the name of the joint that articulates/connects the skull and the atlas?
Atlantooccipital joint
235
What is the purpose of the transverse foramen in the cervical spine?
For the nerve roots to connect to the brain
235
How many zygapophyseal joints do we see in a lateral (cervical)?
5 Z joints (C1 & C2 are seen in AP open mouth)
236
(t/f) During trauma we are doing a cross table lateral for a cervical spine we don't see the anatomy demonstrated we would use a sandbag.
false Sandbags would cause more harm then good
236
What skull line would we use to position for Judd and Fuchs?
MML (Mentomeatal line)
236
What is the space called that we inject myelograms? What level of the spine is this?
Subarachnoid space Cervical: C1-C2 Lumbar: L3-L4
236
Which foramen is seen in PA cervical oblique? (RAO/LAO)
downside (closest to IR) (marker is on side down)
236
Which foramen is seen in AP cervical oblique?
foramen farthest from IR (upside) (marker on side up) (RPO/LPO)
237
Which foramen is seen on LAO cervical oblique? how is the projection? how are the markers?
left foramen (downside) PA projection Mark side down, left side (cause that foramen is best demonstrated)
238
Which foramen is seen on RPO cervical oblique? how is the projection? how are the markers?
left foramen (upside so opposite) AP projection Marker on side up, left-side (bc that foramen is best shown)
238
Which foramen is seen on LPO cervical oblique? how is the projection? how are the markers?
Right foramen (upside) AP projection Marker on side up, right-side (bc that foramen is best shown)
238
Which foramen is seen on RAO cervical oblique? how is the projection? how are the markers?
right side (downside) PA projection Marker is side down, right-side (bc that foramen is best demonstrated)
238
What level is the vertebral prominens at? What level is the jugular notch located at? What level is the xiphoid tip located at? What level is the thyroid cartilage located at?What level is the sternal angle located at? What level is the EAM located at?
C7 T2-T3 T9-T10 C5 (varies between C4-C6) T4-T5 1 inch above C1 (mastoid tip)
239
At what level is the mastiod tip located?
C1 (one inch inferior to EAM)
239
What is the jeffersons fx?
fx of C1 Ant & Post arches from landing on feet/head abruptly (AP open mouth best demonstrates this)
240
What is the clay shoveler's fx?
avulsion fx of C6 to T1 from hyperextending neck (best demonstrated in a lateral C spine)
240
What is a compression wedge fx?
collapse of T/L vertebral bodies from flexion vertebral shapes like a wedge instead of a block
240
Scoliosis can be caused by:
Neuromuscular disorder congenital (happens from birth) idiopathic (just cause)
240
When do you see the zygapophyseal joints in a thoracic spine?
70-75 degree oblique from the midsagittal plane
240
When do you see the foramen in the thoracic spine?
90 degrees to the midsagittal plane (true lateral)
241
what helps form the intervertebral foramen?
inferior vertebral notch & superior vertebral notch
241
(t/f) If the patient has a traumatic injury to their spine, its best to manipulate the tube rather than move the patient
true Moving the patient in trauma situations can lead to more damage
241
What do you see in a PA cervical oblique? AO or PO? how is the positioning?
anterior oblique (AO) 15 degrees caudad pedicles and foramina closest to IR Mark side down
241
what do you see in an AP cervical oblique? AO or PO? how is the positioning?
posterior oblique (PO) 15 degrees cephalic pedicles and foramina farthest from IR Mark side up
241
What do you seen in the lateral cervical spine? What do you seen in a lateral thoracic spine? What do you see in a thoracic oblique spine? what do you see in a cervical oblique spine?
zygapophyseal joints intervertebral foramen zygapophyseal joints (70-75 degree oblique) intervertebral foramen (45 degree oblique)
241
What would we do for a functionality test of the spine? (stability)
flexion and extension
242
What is the nucleus pulposus? What is the annulus fibrosis?
inner layer of disk outer layer of disk
242
Where is the subarachnoid space?
L3-L4
242
LPO best demonstrates _____ lumbar Z joints. Upside or downside?
left zygapophyseal joints downside
243
RPO best demonstrates _____ lumbar Z joints. Upside or downside?
right zygapophyseal joints downside
243
The ear of the scotty dog is? The eye of the scotty dog is? The nose of the scotty dog is? The feet of the scotty dog is? The neck of the scotty dog is? The body of the scotty dog is? The tail of the scotty dog is the?
superior articular process Pedicle Transverse process inferior articular process Pars interarticularis Laminae Spinous process
243
What is an intrathecal procedure?
Administering drugs through the spinal canal (Ex: MP with chemo)
244
What is the CR for Sacrum and coccyx? What is the angle?
midway between pubis symphysis and ASIS or 2 inches inferior to ASIS or 2 inches superior to pubis symphysis (all mean the same thing) 15 cephalic for sacrum 10 caudad for coccyx
245
What do you see in a Myleogram? 1. posterior disk herniation 2. posttraumatic spinal cord swelling 3. internal disk legions
1 & 2 We can't see the internal disk legions because the contrast goes up and down the spinal cord. We can't see because the "gusher" in the disc space.
245
What is the angle for a AP sacrum and coccyx? PA?
15 cephalic for sacrum & 10 caudad for coccyx PA: 15 caudad for sacrum & 10 cephalic for coccyx
245
When are Zygapophyseal joints seen for cervical? When are the Zygapophyseal joints seen for thoracic? when are the zygapophyseal joints seen for lumbar?
True Lateral (90 degrees) 70–75-degree oblique 45 degree oblique
245
If we are doing a lateral lumbar spine, what plane is perpendicular to the IR?
mid-coronal plane
245
What connects the arch for the spinous process to the transverse process? What connects the vertebral body to the transverse process?
Laminae pedicle
245
What is the pathology that involves the PARS? What projection best shows this?
Spondylosis Oblique lumbar
246
You are performing a 5 view lumbar the patient is complaining of lower back pain from an old sports injury. After the AP projection you roll the patient into a RPO position and make an exposure. The right transverse process projects from the front of the vertebral body and the pedicle is near the anterior aspect of the body in the image. What correction could we do?
More oblique too AP (anterior) = under rotation too lateral (posterior)= over rotation
246
What is Spondylosis?
a fx (defect) to the PARS interarticularis ("Scottie dog wearing a collar") Most common at L4-L5
246
What is spondylolisthesis? Best shown in?
forward slipping of one vertebrae Originates from spondylosis Common in L5-S1 "Slipped disc" best shown in a lateral
247
When performing obliques if the pedicle appears to be too anterior what is the cause? How do we fix it?
under rotated (too AP/anterior) oblique the patient more
247
What is the angulation for AP Axial SI joints? What is the CR?
30 degrees cephalic for men 35 degrees cephalic for women midway between pubis symphysis and ASIS
248
What is the CR for lateral coccyx?
3-4 inches posterior to ASIS 2 Inches distal from ASIS (no more than 4!)
249
What is the CR for the spot (L5-S1 lateral)?
1.5 inches inferior to crest 2 inches posterior to ASIS 5-8 degrees caudad
249
What is the CR for AP lumbar? Lateral lumbar? obliques? flex Ext?
AP: Iliac crest (L4-L5) Lateral: iliac crest (L4-L5) Obliques: 2 inches medial and 1-2 inches superior to iliac crest + 45-degree PO rotations Flex/Ext: iliac crest (L4-L5) + extension and flexion
249
What does flex/ext show? what does side bending show?
posterior/anterior displacement lateral displacement
249
If we are shooting an AP projection of the coccyx and the distal tip is superimposed over the pubis symphysis, we could correct this by?
throw more of a caudad angle from 10 to 15 degrees
250
What is the CR for AP SI joints? What is the obliques?
AP: 30 cephalic for men 35 cephalic for women + 2 inches below ASIS or 2 inches superior to Pubis symphysis Obliques: 25–30-degree PO + 1 inch medial to UPSIDE ASIS
250
What is the CR for AP axial sacrum and coccyx?
Sacrum: 15 cephalic 2 inches superior to pubic symphysis Coccyx: 10 degrees caudad 2 inches superior to symphysis
251
At what angle (oblique) does the SI joints open up at?
25-30 degrees oblique
251
At what angles do the zygapophyseal joints open up at?
45 degree oblique
251
What kind of joints are the Zygapophyseal joints? What kind of joints are the intervertebral joints?
plane or gliding (synovial/diarthrodial) slightly movable (Amphiarthrodial) (cartilaginous/symphysis)
251
If we go from supine to prone what happens to the angle on spine?
changes from cephalic to caudad (Vice versa)
252
What is the posterior end of the rib called? What is the anterior end of the rib called?
vertebral end sternal end
252
The first _____ pair of ribs connect directly to the sternum The false ribs apply to ribs __ to ___ True ribs applies to the first ______ ribs The last pair of ribs is referred to as: Which ribs are these?
seven 8 through 12 seven floating ribs & 11-12
252
The vertebral end of the rib has four parts:
head neck tubercle angle
253
The head of the vertebral end of the rib connects to: The tubercle of the vertebral end of the rib connects to the: what is the name of this joint?
vertebral body transverse process of the thoracic spine costovertebral joint
253
Costotransverse ribs articulates between:
tubercle of the rib and the transverse process of the spine
253
Posterior pain is what rib projection? Anterior pain is what rib projection?
AP PA
253
Patient walks in the ER with anterior left upper pain what oblique would we use? What is the projection?
RAO PA projection
253
Patient walks in the ER with left lower posterior pain, what oblique best shows this? What is the projection?
LPO AP projection
253
Patient walks in the ER with right anterior pain what oblique would we use? What is the projection?
LAO PA
254
RAO best shows what axillary?
left axillary
254
LPO shows what axillary?
left axillary
254
RPO best shows what axillary?
right axillary
254
LAO best shows what axillary?
right axillary
254
If patient is in a RPO position, what pain are they experiencing? If patient is in a LPO position what pain are they experiencing? If patient is in a LAO position, what pain are they experiencing? If patient is in a RAO position, what pain are they experiencing?
right posterior pain (AP = side down) Left posterior pain (AP = side down) right anterior pain (PA = Away) left anterior pain (PA = Away)
254
What happens to the diaphragm on inspiration? What happens to the diaphragm on expiration?
diaphragm moves down diaphragm moves up
255
What pathologies can you see specifically from expiration x-rays?
pneumothorax hemothorax & Pulmonary contusions
255
which of the following positions will best demonstrate the ribs of the left thorax?
RAO & LPO
255
What kind of joint is the sternoclavicular joint? What kind of joint are the first to tenth costochondral joints? what kind of joint is the first sternocostal joint? what kind of joints are the second to seventh sternocostal joints? what kind of joints are the sixth to ninth interchondral joints? what kind of joints are the costotransverse joints? (1-10) What kind of joints are the costovertebral joints? (1-12)
plane or gliding (diarthrodial) synarthrodial (immoveable) cartilaginous (immoveable) plane or gliding (diarthrodial) plane or gliding (diarthrodial) plane or gliding (diarthrodial) plane or gliding (diarthrodial)
255
The ___________ _____ is the only articulation between the shoulder girdle (upper extremity) and the bony thorax
sternoclavicular joint
256
How much do we oblique for Sternum? What position do we oblique in? What is the CR? What is the SID? What is the breathing technique?
15-20 RAO oblique (LPO if not possible) CR mid sternum (1 inch from midline) SID 40-48 inches shallow breathing (expiration if not possible)
257
If a patient exhibits hemothorax on the right side and cannot stand what view could that best be shown in?
right lateral decubitus (on expiration)
257
If the patient is able to stand what view best shows hemothorax in the right lung?
PA chest on expiration
257
Why are upper ribs best taken erect?
allows gravity to lower the diaphragm even more
257
Photoelectric effect strikes: In photoelectric effect the x-ray photon ceases: In Photoelectric absorption the electron absorbs all: In photoelectric effect increased kVp leads to:
inner shell electron to exist the x-ray's photon's energy decreased photoelectric absorption (Beam is too fast/intense)
257
In Compton scatter the x-ray photon ceases:
to exist
257
photoelectric effect is _____ likely to occur when the _____ of the incident x-ray is slightly ______ than the binding energy of the orbital electron
more energy higher
257
In photoelectric effect the energy in excess of binding energy is given to:
the inner-shell electron
258
In photoelectric effect the inner shell electron ____ ups &: In photoelectric effect increased atomic number leads to increased
speeds (excites) leaves the atom photoelectric absorption (attentuation) (because more things to interact with)
258
In Compton scatter the electron absorbs:
all the incident x-rays energy
258
In Compton scatter _________ interacts (strikes) with an:
incident x-rays outer shell electron
258
In Coherent when an incident x-ray interacts with an orbital electron it is:
Thompson
258
In Compton scatter some of the energy excess of binding energy is given to an:
outer shell electron
258
In Compton scatter outer shell electron speeds up and leaves: what is this called?
the atom (recoil electron) (Excess energy leaves as a scatter photon)
259
Attenuation can be affected by?
-Tissues thickness (every 4 cm = 50% xray beam attenuation) -tissue atomic number (more z#= more attenuation) -tissue density (most important ex: air vs muscle vs fat) muscle most dense/ air least dense
259
In Compton scatter remaining energy is ______ as a new x-ray and leaves the _____ in a random direction
reemitted atom
259
Both the photoelectric effect and Compton scatter lead to
ionization (the removal of an electron from orbit and net positive charge to the atom)
259
In coherent scatter the orbital electron reaches a temporary:
state of excitation
259
Attenuation is? What different interactions result in attenuation?
Reduction in the number/intensity of x-rays reaching the IR (through scatter/absorption) Photoelectric (absorption) Coherent scatter (absorption) Compton (both scatter & absorption)
260
mA is limited by what?
Focal spot size
261
Compton scatter is proportionally more likely:
at high kVp levels (this is bc higher kVp levels have lower absorption rate but compton remains consistent at all levels)
261
In coherent scatter when an incident x-ray interacts with an entire atom is it called:
Rayleigh
261
In coherent scatter when the energy of the incident photon is ______ than the ________ no ________ occurs
less binding energy ionization
261
For each 4cm of tissue requires: For every 4 cm of tissue how much x-ray beam attenuation is occuring?
doubling of mAs & kVp by: 15% kVp 100% mAs - 50% x-ray beam attenuation
262
mAs is a measurement of what? it is considered: what is it not?
electron flow in a conductor an electrical term a unit of radiation output
263
mAs is the primary controller of:
intensity/quanity in the remnant beam
264
In coherent scatter the incident x-ray continues:
in a new direction
264
mAs math: 100 mA and .5 sec
50 mAs
264
In coherent scatter no _____ occurs
energy transfer
264
How do we reduce motion?
setting the shortest time while maintaining same mAs output (Shorter time requires more mA)
264
To calculate the mAs we:
multiply mA x Time
265
Attenuation is absorption & scattering as a result of:
photoelectric effect compton scatter coherent scatter
265
mAs math: 300 mA and .2 sec
60 mAs (300 x .2)
266
Radiologic time is measured in?
seconds .25 secs or 250 ms or 1/4 second (all the same)
267
mAs math: 200 mA and .2 sec
40 mAs
267
Maintaining density: 150 mAs to 300 mAs 72 kVp to ___ ?
61.2 (reduced 15%, cuts exposure in half)' mAs doubled kVp needs to come down 15% to maintain
267
the small increase of 15% kvp will?
double the exposure to the image receptor
267
What is penumbra? Is it good or bad?
blurry or unsharp edges of the shadow or image bad
268
Doubling in mAs leads to:
doubling of intensity or quantity
269
Kilovoltage is the measurement of
electrical force
269
What does kVp control?
the quality of the x-ray beam
269
when the kvp increases 15% patient exposure increases by:
1/3
269
kVp math: increase kVp 15% of 70 kvp: decrease kVp 15% of 100 kVp:
80.5 (70 x 1.15) 85 (100 x .85)
269
kVp means?
kilo voltage peak (the highest value in electrical generator)
269
What does a higher kVp do?
increase the x-ray's ability to penetrate through a particular tissue
270
OID stands for?
object image distance (patient distance from IR)
271
What is remnant radiation?
the part of the x-ray beam that has passed through the patient (Leftovers from the primary beam)
271
SID stands for?
source to image distance (x-ray tube to IR)
271
What is preferred, optimal kVp or minimal kvp? what is higher in kVp out of the 2?
optimal kVp
271
SOD stands for?
Source to object distance (x-ray tube to patient)
272
What is umbra?
is the ''pure" shadow or image of uniform darkness (crisp shadow line)
272
What is distortion?
misrepresentation of the size or shape of an object
273
As a radiographer do we want pneumbra?
no, we want to minimize this
273
What is elongation?
the object appears to be longer than its actual size
273
How much of the primary beam becomes remnant radiation?
less than 1%
273
What is shape distortion?
the difference between the actual shape of the object and the shape of its projected image (Difference between actual object shapes & the image shape)
273
What affects contrast?
kVp (low kvp = high contrast) image receptor (grids) computer algorithms (AEC) patient factors (tissue density)
273
What is the relationship with SID and pneumbra & spatial resolution?
the greater the SID the smaller the pneumbra & higher the spatial resolution
274
what is foreshortening?
the object appears to be shorter than its actual size
274
How do we calculate the mag factor?
dividing SID/SOD
274
An object that measures 6 cm is radiographed using SID of 48 and OID of 4. How many centimeters will the object measure on the completed radiograph?
6.54cm (48 (SID) - 4 (OID) = 44 SOD 48 (SID) / 44 (SOD)= 1.09 1.09 x 6 cm= 6.54cm
274
How can size distortion (magnification) be reduced?
decreasing OID or increasing SID
274
What can contrast be referred to as? which is?
gray scale the number of different brightness levels in a x-ray
274
What is size distortion? What is it also called?
misrepresentation of the size of the object aka magnification
275
How can we reduce shape distortion?
properly aligning the: tube (Object) part Image receptor
276
Mag Factor math: SID= 72 SOD=66
1.09 mag factor
276
What is spatial resolution? What is also referred to as?
the sharpness of the structural edges around the image AKA detail, sharpness, or decreased pneumbra (OR LOW BLUR)
276
what affects spatial resolution? (5)
motion focal spot size distance (SID, SOD, OID) patient factors (OID or motion) angulation (elongation/foreshortening)
276
What is postprocessing?
adjustment of the image by a rad tech or rad at a workstation
277
What is noise?
undesirable image input that interferes with ability to visualize the x-ray
277
How is resolution (spatial resolution) measured?
using a line-pair test tool (measured in line-pairs per millimeter or LP/mm)
278
What is contrast?
the difference between 2 adjacent brightness levels
278
What can be used to increase subject (patient) contrast?
barium & iodine
278
Low contrast = high contrast =
long scale = low kVp (many greys) short scale = high kVp(black & white)
279
What is SNR? What should it always be greater than?
Signal to noise ratio one
279
More kvp = ____ scatter more volume = _____ scatter more volume
more more (why collimation is key, and optimal kVp)
280
What is quantum mottle? What is the opposite?
insufficient number of x-rays reaching the image receptor scatter is too much x-rays reaching the image receptor
280
What causes quantum mottle? What is usually the cause?
low mAs low kVp or difficult anatomy to penetrate usually low technique, especially mAs
280
What is the rule regarding tissues thickness?
for every 4cm of tissue thickness 50% of x-ray beam is attenuated
280
Low contrast = High contrast=
Long scale & low kvp Short scale & high kVp
280
What is window level? What is window width?
post-processing of image brightness post-processing if image contrast
281
For digital systems, what is preferred quantum mottle or scatter?
Scatter (the digital systems are very good at filtering out too much information)
282
What does high tissue atomic number mean for attenuation?
means more attenuation due to more interactions (more electrons higher chance for photelectric absorption)
282
What does collimation do to radiologic contrast? How?
improves the radiologic contrast by limiting the volume of tissue that can create scatter
283
What does higher tissue density mean for attenuation?
more attenuation (implants most, then bone, then muscle, then fat, and least dense is air) more dense objects show up more dominantly on the x-ray
283
What is the collimator?
adjustable lead shutters
283
Who sets the standards for optimal contrast/brightness settings?
the radiologists
283
Collimation _____ patient dose by:
decreases limiting the volume of tissue exposed to radiation
283
What is the aperture diaphragm?
fixed opening between the x-ray tube & collimator box
284
Light/radiation field can be off by:
+/- 2% of the SID
284
What is PBL? What does it do? What can you do to manipulate this?
positive beam limitation automatic collimator (based on IR size) override if the desired field size is smaller than the IR
284
What are the other beam limitations? What are they?
aperture diaphragm: fixed opening between x-ray tube & collimator box) Mask: lead sheet with an opening used to image specific anatomy of interest (skull x-ray with a hole cut through)
284
Scatter occurs commonly with:
large field sizes increased tissue volume
284
What does scatter do to image recptor exposure?
scatter increases exposure to the IR (also decreases contrast & increase noise ALL BAD)
284
What happens to scatter at higher kVp levels? What happens to compton?
scatter is increased at higher kVp Compton interactions proportionally increase at higher kVp levels
285
What does scatter do to noise? how does scatter affect contrast? what does scatter do to detail, magnification, or distortion?
scatter increases noise scatter decreases contrast scatter does not affect detail, magnification, or distortion
286
What is scatter also known as?
Secondary radiation
286
What affects detail?
focal spot size penumbra
286
What do grids do?
affect scatter reaching the IR, not the PRODUCTION of scatter
286
What is the number one source for of occupational exposure?
scatter radiation
286
How do we calculate grid frequency?
number of lead strips per inch (100/inch)
287
How can we reduce scatter? what is the most effective way to reduce scatter? second most effective?
increase collimation (most effective way to control) decrease part volume (compression) (second most effective way) reduce kVp grids (affects scatter reaching the IR, not PRODUCTION) distance (SID < SOD< OID) (no effect on scatter production)
287
How are grids constructed?
alternating strips of lead & interspace material (AL most common but can also be plastic)
288
The effectiveness of the grids is measured by: also know as?
the ratio of the height of the lead strips to the width of the interspace material grid ratio
288
What is the purpose for grids? What does it not affect?
restore subject contrast in an image grids don't affect the production of scatter radiation
288
What are focused grids? Linear? crosshatched?
grids that follow the divergent beam run up and down (only can angle one way) run up/down & side to side
288
Focused gridlines are directed to:
a convergence point (generally the focal spot)
288
Grids can be _____ _____ or ______ (different types of grids)
linear crosshatched focused
288
Grids are designed to be used (need to be)
at a specific distance from the focal spot
288
What are the grid ratios? no grid: 5:1 6:1 8:1 10:1 12:1 16:1
1 2 3 4 5 5 6
289
modern grids attenuate:
70-80% of scattered photons
290
Grids allow the ______ ______ to pass through ______ _______ and absorb ____ ______
primary beam lead strips scattered x-rays
290
Motion will?
blur the gridlines
290
Grids should be used:
part thickness greater than 10cm kVp greater than 70 large field sizes
290
What type of grid errors are there? what is the worst case scenario?
off-center off-level off- focus upside down (worst outcome)
291
increasing kVp by 15% _____ image receptor exposure but only increases patient dose by _______
doubles 1/3 (kVp math will be on the test)
291
What does kVp affect?
the x-ray's beam's ability to penerate tissues
292
Grid math: Old 500 mA 1 sec 12:1 Grid New 50 mA ___ sec 6:1 grid math
Steps: 500 mA x.1= 50mA 12:1 grid (6) to 6:1 (3) (new/old) 3/5= .6 50 x .6= 30mA 30 mA/ 50 mA= .6
292
Exam: grid math Old 100 mA 5 secs 1no Grid New ____ mA .25 sec 6:1 Grid
Steps: 100 mA x .5= 50 mA no grid (1/old) to 6:1 (3/new)= 3/1 new/old 50 mA x 3= 150 mA 150 mA/.25 secs= 600 mA
292
How do generators affect penetration (x-ray technique)?
(generators affect technique by adjusting the kVp (penetration) of the created x-rays) generators affect penetration by altering the average energy of created x-rays
292
What is total filtration? what filtration is not apart of this?
added + inherent filtration compensating filtration
292
two types of filtration:
inherent (built-in (x-ray tube glass, cooling oil, beryllium window) added (usually aluminum but can be copper)
293
What exams are compensating filters used on?
x-table shoulder x-table hip swimmers c-spine
293
The primary purpose of beam filtration is? (filtration)
to reduce patient exposure
294
what is the required filtration? what kind of filtration is this?
2.5 mm Al/Eq (legally) total filtration
294
What generator have an effective kVp equal to the set kVP?
Portables are the only generators that have an effective kVp equal to the set kVp
294
Increasing the kVp by 15%: how much does patient dose increase?
doubles the number of x-ray photons that reach the image receptor 1/3
294
what does filtration do to the average kVp? why?
increases the average kVp bc of the removal of weak x-rays by filtration
294
What is compensating filtrations purpose?
to even out body parts that are inherently uneven
294
How is penetration measured?
half-value layers (HVL) (QC stuff)
295
For postmortem how should our technique be adjusted: in first 30 minutes after 30 minutes
increased technique 35% in the first 30 minutes increase technique 50% after the first 30 minutes increase technique
296
Compensating filtration is not considered to be apart of:
inherent or added filtration
296
what is hypersthenic? what do we do to technique?
large body type, increased fatty tissue increase kVp
296
What is sthenic?
a healthy average person
296
What is hyposthenic? what do we do to technique?
thin but healthy reduce mAs
296
The caliper should:
measure along the central ray
296
What is asthenic? What do we do to technique?
thin and ill/old reduce kVp
297
Technique for fiberglass casts:
no change to the technique
297
What is the technique for iodine studies? what about single contrast studies? what about double contrast studies?
80 kVp minimum for iodine studies (urinary systems) 120 kvp for single contrast GI studies using barium 90-100 kVp for double contrast studies with air and barium
297
How are contrast agents appearing on an x-ray? why?
contrast agents are easier to see on a radiograph due to their high atomic number (Z#)
297
What is the caliper?
device to measure a part thickness (accurately)
297
How much change in a technique is required to demonstrate a noticeable difference in an x-ray?
35% change in technique is required to demonstrate a change to a radiographic
298
What should we expect in postmortem patient in regards to technique & anatomy?
increase technique expect less air in the chest and increased fluids
299
Casts technique should:
be increased for plaster casts
299
what is the average abdomen thickness? AP: LAT:
AP: 22 cm Lat: 30 cm
299
Contrast agents only affect:
image contrast
299
What is needed for contrast agents regarding technique?
increase technique to partially penetrate the contrast agent (the introduction of contrast agent requires an increase in technique to partially penetrate the contrast agent)
300
Technique for dry casts:
double the kVp (+15%)
300
Technique for wet casts:
triple the kVp (+15% kvp then +15% again)
300
soft tissue Additive diseases: What do we increase?
Actinomycosis: 50% mAs Ascites: 50-75% mAs Carcinomas, fibrous: 50% mAs Cirrhosis: 50% mAs pulmonary edema: 50% mAs hydrocephalus: 50-75% mAs hydropneumothorax: 50% mAs pleural effusion: 35% mAs pneumonia: 50% mAs Syphilis: 50% mAs Tuberculosis, pulmonary: 50% mAs mAs
301
for additive disease that have bony growth we increase:
kVp for bony growth in order to penetrate additional bony tissue
301
Destructive disease pathologies: What is being done to technique?
aseptic necrosis: 8% kVp blastomycosis: 8% kVp bowel obstruction: 8% kVp cancers, osteolytic: 8% kVp emphysema: 8% kVp ewing's tumor: 8% kVp exostosis: 8% kVp Gout: 8% kVp hodgkin's disease: 8% kVp hyperparathyroidism: 8% kVp osteitis fibrosa cystica: 8% kVp osteomalacia: 8% kVp osteomyelitis: 8% kVp osteoporosis: 8% kVp pneumothorax: 8% kVp rheumatoid arthritis: 8% kVp Deceasing kVp
301
What is the typical anode angle?
15-17 degrees for diagnostic imaging (typical anode angles for diagnostic imaging range from 15-17 degrees)
301
Additive diseases require:
an increase in technique due to increase fluid, soft tissue, & bony growth
301
for additive diseases with soft tissue we need to increase:
mAs to maintain subject contrast for soft tissue disease
302
Destructive diseases require a decrease: what should be reduced? Why?
in technique due to increased air, fat, or bony destruction kVp should be reduced as penetration is easier
302
Which side of the x-ray beam is the weakest? why?
the intensity is weakest on the anode side of the x-ray beam due to the beam being attenuated bc of the material of the anode
303
additive disease, bony growth:
acromegaly: 8-10 kVp osteoarthritis (DJD) 8% kVp osteochrondroma: 8% kVp osteopetrosis: 8-12% kVp pagets disease: 8% kVp
303
What creates a small effective focal spot?
thin electron beam (cathode) + small anode bevel (angle, anode) (the combination of a thin electron beam (cathode) from the cathode and small anode bevel (angle) creates a small effective focal spot)
303
What and where is the effective focal spot? also can be referred to as?
below the actual focal spot projected focal spot (the effective focal spot is the projected focal spot located directly below the actual focal spot)
303
What are the typical focal spot sizes (cathode)?
small focal spot: 1 cm large focal spot: 1.5cm-2cm
303
What are the typical effective focal spot sizes?
small effective focal spot: 0.5-1mm large effective focal spot: 1-2mm
304
Focal spot affects: when would we use a large focal spot? when would we use a small focal spot?
spatial resolution & heat capacity the smaller the focal spot, the better the spatial resolution large focal spots can be used when detail is not critical to reduce heat in the tube (small+ better picture, large+ better for heat capacity)
304
What is the anode heel effect?
x-ray intensity from the long axis of anode to cathode side (the variation in x-ray intensity along the long axis of the x-ray beam from anode to cathode)
305
How would an increase in SID affect IR exposure?
Decrease IR exposure
305
The anode-heel effect is more significant when using:
larger field sizes shorter SID's
305
What does an increase in SID primarily affect?
Size distortion - decrease because of magnification
305
What factors does an increase in SID affect?
Size Distortion: Decrease (Primary controller) IR Exposure: Decrease Sharpness: Increase
306
How would an increase in OID affect IR exposure?
Decrease (Air Gap)
306
An increase in SID would do what to sharpness?
Increase
307
What does an increase in OID primarily affect?
Sharpness - decrease
307
Increased alignment does what to shape distortion?
Decrease
307
What affects shape distortion?
Alignment
307
What factors are affected by an increase in motion?
Subject contrast goes down Noise (blur) goes up Sharpness goes down
307
How would an increase in OID affect subject contrast?
Increase (Air Gap)
307
What primary factors are affected by an increase in SOD?
Sharpness increase Size Distortion decreases
307
How would an increase in OID without air gap technique affect noise?
No effect on noise or contrast
308
How would an increase in OID with air gap technique affect noise?
Decrease (Scatter)
308
Increased OID with air gap leads to ______ exposure to the IR
Decreased because there is less scatter hitting the IR
308
Increased OID leads to ______ penumbra and ______ spatial resolution
Increase penumbra Decreased spatial resolution (detail and sharpness)
308
What affects spatial resolution?
SID
308
Where is the SID measured from?
Focal Spot to image receptor
308
What is the inverse square law used for?
Used to determine intensity of new exposure (mGy or mSv)
309
Why is the measuring tape on the collimator cut?
Accounts for focal spot to collimator
309
What is the square law used for?
Used to maintain IR exposure (old/new)
309
What is the relationship of SID/SOD/OID?
SID = SOD + OID
309
What is a primary result of increased OID? (1) What else does it affect? (4)
Decreased sharpness Also: Decreased IR exposure (air gap) Increased subject contrast (air gap) Decreased noise (scatter) Increased size distortion (magnification)
309
What is a primary factor of increased SOD?(2)
Increased sharpness & decrease size distortion (lower penumbra)
309
What is a primary result for increased SID? (1) What is also affected? (2)
Decreased size distortion Also: decreased IR exposure (beam divergence) Increased sharpness (less penumbra)
310
What is the result of increased motion? (3)
Decreased subject contrast Increased noise (blur) Decreased sharpness
310
What is a primary result of increased alignment?
Decreased shape distortion
310
Increased SID without adjustment. How does it affect? IR exposure? Detail? Magnification?
IR exposure goes down (beam divergence) Detail increases (lower penumbra) Magnification decreases (increase SID decreases magnification)
311
Increased SID and adjusted technique to compensate. How does this affect: IR exposure? Detail? Magnification?
IR exposure stays the same (technique has been adjusted) Detail increases due to increase SID (technique plays no role in this) Magnification decreases due to increased SID (technique plays no role) (Only factor affected here is IR exposure & that has been compensated for)
311
Increased OID without any adjustments. How does this affect: Contrast? Noise? Shape distortion? What is the primary factor with increased OID?
Increased contrast (air gap technique) Noise decreased (less scatter) Shape distortion stays the same (shape distortion= elongation + foreshortening) Decreased sharpness
311
What affects spatial resolution?
SID affects (more SID less OID) Time not affected KVP not affected
311
Why is the measuring tape on the collimator cut?
To account for the distance within the x-ray tube (focal spot to the collimator)
311
What are the relationships between OID/SOD/SID?
OID + SOD = SID SID - OID = SOD SID- SOD =OID
311
In regards to formulas of the square & inverse square law what does these signs represent? E= D= n= O=
E= exposure (mGy or mSv) D = Distance (SID) N= new O= old
312
What is the SID measured from?
From the source (x-ray tube/anode focal spot) to the image receptor (distance)
312
What happens when AEC encounters metal?
Time motion patient exposure IR exposure all increase.
312
Density settings of ____ are needed to see a visible change.
+2 (1=25%)
312
Modulation Transfer Function: What is it? what can happen?
A way physicists measure contrast resolution When line pairs become too small their penumbrae merge and reduce contrast.
312
Backup time should be to ____% of anticipated time.
150% Ex: Anticipated: 0.4 sec; Backup Time: 0.6 sec.
313
Where is the AEC detector located?
Between the patient and the image receptor and use ionization.
313
How many lonization chambers do most AEC Systems consist of?
3 (the cells on the wall bucky)
314
The only thing AEC controls is:
time
314
What does the air-gap technique do?
increases size distortion (magnification) improves contrast (decreasing scatter) decreases detail (increased penumbra)
314
What's the primary reason for technique charts?
To maintain consistency
314
Air Gap Technique is based on creating a gap by increasing the ___
OID
315
What is magnification?
Size distortion
315
how do we calculate the magnification factor?
SID/SOD
316
How do you find the objects actual size?
divide projected size/magnification factor
317
How would you find the size of an anatomy on a projected image?
multiply actual size x mag factor
317
Elongation is:
anatomy appearing longer than normal (angle on tube or IR)
317
Foreshortening is:
part appears to be shorter than normal (part is angled)
317
What causes shape distortion?
Misalignment of tube, image receptor, or part
317
We should always have a minimum of ____ views
2
317
What is Cieszynski’s Law?
angle 1/2 of the part's angle to minimize distortion through elongation/foreshortening
318
Increase SID = ____ IR Exposure why?
decreased bc of beam divergence
319
Motion is generally caused by:
Patients
319
increased focal spot size will _____ sharpness
Decrease. (It is the one and only controller?)
319
Off-centering is the same as: why?
Angling bc of the beam divergence
319
Increasing the OID will decrease: A. Shape distortion. B. Subject contrast. C. Size distortion. D. Sharpness.
D. Sharpness.
319
Increasing collimation will result in increased: A. IR Exposure B. Subject contrast C. Noise D. Spatial Resolution
B. Subject Contrast
320
The smaller the focal spot size, the ______ spatial resolution
Higher
320
Decreasing the focal spot size will result in: A. Increase contrast. B. Decrease contrast. C. Increase sharpness. D. Decrease sharpness.
C. Increased sharpness
321
Which one of the following pathologist would be MOST LIKELY to result in increased shape distortion? A. Emphysema B. Large bowel obstruction C. Kyphosis D. Cirrhosis
C. Kyphosis.
321
Reducing SID but adjusting mAs to compensate will result in decreased: A. Subject contrast. B. Sharpness. C. Noise. D. Size distortion.
B. Sharpness.
321
Decreasing kVp will result in: A. Increased sharpness B. Decreased sharpness C. Increased IR Exposure D. Decreased IR Exposure
D. Decreased IR EXPOSURE
321
Reducing mAs but adjusting kVp to compensate will result in decreased: A. IR exposure B. Size distortion C. Subject contrast D. Sharpness
C. Subject contrast.
321
A transthoracic humorous exam results in a radiograph that displays decreased subject contrast. If the image was repeated, which change would be MOST EFFECTIVE in improving subject contrast? A. Increase mAs B. Increase collimation C. Decrease motion D. Reduce kVp
B. Increase collimation
321
Where is the outer canthus located? Where is the inner canthus located?
lateral junction of where the eyelids meet inner eyelids meet near the nose
322
Where is the Gabella located?
smooth, raised triangle process superior to eyebrows & bridge of nose
323
Where is the nasion located?
at the junction of the two nasal bones & the frontal bone
323
Where is the acanthion located?
midline junction where the upper lip and nasal septum meet
323
What is the thickest part of the cranium?
petrous portion of the temporal bone pyramid shaped
323
Where is the gonion located?
lower posterior "angle" of the mandible "jawline"
323
What is the pinna? What is it also referred to as?
large flap of ear made of cartilage aka auricle
323
What is the CR for Caldwell? What is the angle? What line is to the IR? What does this best show?
CR exits nasion Caudad 15 (30 exaggerated) OML perpendicular to IR Criteria: petrous pyramid located in lower 1/3 (15) petrous pyramid located IOM showing full orbit (30)
324
What is the difference between the lateral cranium and the lateral facial bones? What is different in the anatomy? What is the CR for both?
CR for Lat skull is 2 inches above EAM * CR for Lat Facial is between outer canthus & RAM Lat skull you can cut off the mandible * Lateral sinus can cut off the posterior skull (Positioning is RAO but cranium in lateral)
325
How do the Caldwell, exaggerated Caldwell, and PA skull look compared to each other?
15 degree caudad Caldwell puts petrious ridge in bottom 1/3 of orbit * exaggerated caldwell places petrious ridge completely out of the orbit * PA skill has the petrious ridge completely in the orbit *
325
What is mesocephalic?
average shaped head shaped at an angle of 47 degrees (75 to 80% of length) ''normal skull"
325
What is Brachycephalic?
wide skull, greater than 47 approximately 54 degrees (width is 80% or more of length) "fat head"
325
What is dolichocephalic?
skinny skull, less than 47 degrees from parietal tubercles width is less than 75% of length "skinny head"
325
What bone houses the hearing organs?
Temporal bone (Mastoid portion)
325
What does the occipital bone articulate with?
6 bones: 2 parietals 2 temporals 1 sphenoid 1 atlas (C1)
325
What does the parietal articulate with?
5 cranial bones: 1 frontal 1 occipital 1 temporal 1 sphenoid 1 (opposite parietal)
326
What does the temporal articulate with?
3 cranial bones: 1 parietal bone 1 occipital bone 1 sphenoid bone
326
What does the sphenoid articulate with?
all 7 of the cranial bones & 5 facial bones acts as the anchor for the cranium
326
What does the ethmoid articulate with?
2 cranial bones & 11 facial bones 1 frontal bone 1 sphenoid bone
326
What does the frontal bone articulate with?
4 cranial bones: 2 parietals (L & R) 1 sphenoid 1 ethmoid
326
What is GML? What is OML? What is IOML? What is AML? What is LML? What is MML? What's the degree difference between OML and IOML?
gabellomeatal line (GML) Orbitomeatal line (OML) infraorbitomeatal line (IOML) Acanthiomeatal line (AML) lips-meatal line (LML) mentomeatal line (MML) 7 degree difference
326
What is GAL? What is IPL?
Gabellaaveolar line Interpupilary line
327
What line is parallel or perpendicular in the SMV projection?
IOML is parallel to IR GAL is perpendicular
328
How is the image receptor for the skull projections?
All are portrait except for lateral cranium
328
How many cranial bones are there? What are the names?
8 1 frontal bone 2 parietal bones 2 temporal bones 1 ethmoid 1 sphenoid 1 occipital
328
How does Waters differ physically on an x-ray? What line is the IR? What is the CR? What is best shown? What is it also called?
Waters: MML perpendicular to IR CR exits acanthion best shows sinuses, nasal septum Parietoacanthial
328
How does Haas differ physically on an x-ray? What line is on the IR? What is the angle? What is the CR? What’s is best shown? What is magnified vs the Townes? Also called?
Haas: OML perpendicular to IR, CR exits 1 1/2 superior to nasion 25 cephalic best shows dorsum sellae in foramen magnum, Occipital bone is more magnified PA axial
328
What is another name for Waters? What is another name for Haas? What is another name for Townes?
parietoacanthial projection: Waters PA axial: Haas AP axial: Townes
328
What bones make up the orbit?
3 cranial bones & 4 facial bones C: frontal, sphenoid, & ethmoid F: Maxilla, zygoma, lacrimal, palatine
329
What is the widest portion of the skull?
parietal tubercles (eminences)
329
What bone contains the sellae turcica? What organ lies in the sellae turcica?
Sphenoid bone Pituitary gland
329
Your patient comes to radiology for a study of the cranium and is unable to flex his head and neck to place the OML perpendicular to the IR for an AP axial projection (Townes). What should the technologist do to compensate for this without causing distortion?
increase the angle by 7 degrees caudad to match the IOML (we don't switch to Haas because PA projection would enlarge the occipital bone)
329
Where is the pituitary gland?
in the sellae turcica of the sphenoid bone
329
Where is the supraorbital groove located? (SOG)
slight depression above eyebrow
329
What bone is the cribriform plate & Crista galli located on? * What lies anterior or posterior to each other?
ethmoid bone Crista galli located anterior to cribriform plate "Crista galli also known as rooster comb"
329
Where is the CR entering or exiting in the Caldwell projection?
CR is exiting the nasion (15 caudad/ 30 caudad exaggerated)
329
Where is the CR entering or exiting in the Townes projection?
CR enters 2 1/2 inches above the Gabella through the foramen magnum exiting at the base of the occipital bone
329
Where is the CR entering or exiting in the exaggerated Caldwell projection?
CR is exiting the nasion 30 caudad
330
Where is the CR entering or exiting in the Haas projection?
CR exits 1 1/2 inches superior to nasion Enters 1 1/2 below inion 25 degrees cephalic
330
Where is the Maxillary sinus located?
2 maxillary sinuses in both maxillae (only sinus that correlates to facial bones)
330
What views are for cranium?
PA skull Lateral skull Caldwell + exaggerated Caldwell Townes or Haas *
330
What views are for facial bones/sinuses?
Lateral facial bones Waters Caldwell
330
How do sinus and cranium views differ?
no angle for sinus views (we want to see air fluid levels) (sinus doesn't need full skull, cranium doesn't need mandible)
330
Where is the ethmoid sinus located?
lateral masses of the ethmoid bone (anterior, middle, and posterior portions)
330
Where is the sphenoid sinus located?
body of Sphenoid bone, inferior to sellae turcica
330
Where is the frontal sinus located?
Frontal bone (posterior to Gabella, rarely symmetric & mostly separated by a septum)
330
If we are shooting an AP axial (Townes) and in the picture the dorsum sellae is below the foramen magnum but the anterior arch of C1 is visible in the foramen. What error has taken place?
too much caudad angle (almost becoming a tangential) (dorsum sellae is supposed to be inside the foramen magnum, angling less will place it inside)
330
Should the orbital grooves be superimposed in the PA projection of the skull?
No Only superimposed in a right lateral cranium
330
How many junctions are there?
330
How many junctions are there? What is the name of the anterior junction? What is the name of the lateral junctions? What is the name of the lateral posterior junctions? What is the name of the posterior junctions?
6 junctions (1) bregma junction (2) Pterion junctions (L & R) (2) asterion junctions (L & R) (1) lambda junction
330
How many total sutures are there? What is the name of the lateral sutures? What is the name of the anterior suture? What is the name of the posterior suture? What is the name of the suture that goes down the midline of the cranium?
5 sutures (2) squamous suture coronal suture lambdoidal suture sagittal suture
330
What is best displayed in a Caldwell? What is the name & difference with the alternative view? Why would we want to shoot an alternative view?
petrous pyramids in lower 1/3 (15), or below the IOML in exaggerated (30) Exaggerated Caldwell (15 to 30 caudad) places petrous pyramids completely out of orbit to see the whole orbit
330
What is best show in a Water's projection? What is the alternative view and when do we use this?
Open mouth (transoral) Water's to show the sphenoid sinus (which shows the last and all 4 sinuses)
330
What is best shown in a Haas? What is best shown in a Townes?
Haas & Townes: best shows dorsum sellae in the shadow of the foramen magnum, & occipital bone, petrous pyramids (Haas enlarges the occipital bone, Townes enlarges the orbits)
330
What does the Haas do the x-ray? What does the Townes do to the x-ray?
enlarge the occipital bone enlarge the orbits
330
For the parietoacanthial projection, where does the CR exit?
Acanthion (hint the name parietoacanthion)
330
For a modified parietoacanthial projection how many degrees does it place the OML to the IR?
55 degrees (37 for regular waters)
330
What is the tragus?
external structure that acts as a shield to ear opening located anterior to EAM
330
What is the name of the two part articulation between the skull and the atlas?
atlanto-occipital joint
330
What are the two lateral oval convex processes located on each side of the ______?
Foramen magnum A: Occipital condyles
330
What is a tripod fracture?
a blow to the cheek resulting in a fx to the zygoma in 3 places
330
How does the stomach lie in a hypersthenic patient? What level is the stomach, pyloric portion, & duodenal bulb?
high & transverse Stomach: T9-T12 Pyloric portion: T11-T12 Duodenal bulb: T11-T12
330
How does the stomach lie in a hyposthenic/asthenic patient? What level is the stomach, pyloric portion, & duodenal bulb?
low & vertical (J shaped) Pyloric portion: L3-L4 Duodenal bulb: L3-L4
330
What is bile?
made by the liver breaks down fats
330
What is the CR for Upper GI RAO? For sthenic? Hyperstenic? Asthenic?
40-70 degree RAO prone rotation Sthenic: 45-55 oblique CR at L1 (duodenal bulb) Hypersthenic: 70 degree oblique (2 inches superior to L1) Asthenic: 40 degree oblique (2 inches inferior to L1) (suspend respiration, expose on expiration)
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What is the CR for Upper GI LPO? Sthenic: Hypersthenic: Asthenic: Expose on?
30-60 degree LPO supine rotation Sthenic: 45 degree oblique at L1 Hypersthenic: 60 degree oblique 2 inches superior to L1 Asthenic: 30 degree oblique 2 inches inferior to L1 (suspend respiration, expose on expiration)
331
What is the CR for upper GI AP? Sthenic: Hypersthenic: Asthenic:
Sthenic: at L1 45 LPO Hypersthenic: 2 inches superior to L1 60 LPO Asthenic: 2 inches inferior to L1 30 LPO (suspend respiration, expose on expiration)
331
What is the CR for an AP/PA esophagogram? expose on?
T5-T6 1 inches inferior to sternal angle or 3 inches inferior to jugular notch (suspend respiration, expose on expiration)
331
What is the CR for LAO/RAO esophagogram?
35-40 degree AO prone oblique CR: (LAO T5-T6) (RAO T6) (2-3 inches inferior to jugular notch)
331
What does LAO esophagogram show? What does RAO show?
LAO: esophagus is seen between hilar region & thoracic spine RAO: Esophagus is seen between thoracic spine & heart (entire esophagus is filled (or lined) with contrast)
331
What does angio mean? What does Choles mean? What does Cysto mean?
duct relationship with bile bag or sac
331
What is the stomach orientation?
Fundus (most posterior) Body (anterior/inferior to fundus) Pylorus (posterior/distal to body)
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What is the order for all the ducts? (know what it looks like on a picture)
Left & right hepatic (from liver) Common Hepatic duct cystic duct (duct into gallbladder) Common bile duct Pancreatic duct (duct of wirsung) Duodenum (sphincter of Oddi)
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What do you see in a lateral esophagogram? What is the CR?
esophagus is seen between the thoracic spine and heart T6 (2-3 inches inferior to jugular notch)
331
What do you see in LAO esophagogram? What is the CR?
Esophagus is seen between the hilar region & the thoracic region 35-40 degree anterior oblique + T5-T6 (2-3 inches inferior to jugular notch)
331
What do you see in a AP/PA esophagogram? What is the CR?
Esophagus superimposed over the spine T5-T6 (1 inch inferior to sternal angle)
331
What is the sphincter of Oddi? Also known as?
muscle fibers of the duct walls leading into the duodenum hepatopancreatic sphincter
331
How do you oblique for an Upper GI study?
40-70 degree anterior oblique for RAO 30-60 degree posterior oblique for LPO
331
What is the ligament of Treitz? Where is located? Why is this important?
fibrous muscular band superior to the duodenojejunal flexure suspensory muscle of the duodenum
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What is the kvp range for a double contrast exam?
90-100 kVp
332
What are the ionated contrasts? What else can you use this for? How does it taste & what is this an example of?
gastrogavin omnipaque visipeg pre-surgical exams bitter + water-soluble contrast
332
What is anterior & posterior when it comes to the trachea/esophagus?
trachea is anterior to the esophagus
332
Where is the gallbladder located? What is its main purpose? what are the 3 parts of the gallbladder? how much bile can it hold?
1. store bile, 2. concentrate bile (Hydrolysis: removal of water) (choleliths: gallstones), 3. contract 1. Fundus, Body, Neck 30-40 mL of bile
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What is the kvp range for a single contrast exam? What is the kVp range for water-soluble contrast studies?
110-125 kVp (to increase visibility of barium-filled structures) 80-90 kVp
332
What do these mean? Chole: Cysto: Angio: Choledocho: Cholangio: Cholecyst:
Relationship with bile Bag/sac duct Common bile duct bile ducts gallbladder
332
What do these terms mean? Cholecystography: Cholangiography: Cholecystangiography:
Radiography of gallbladder radiographic study of biliary ducts radiography of both gallbladder & biliary ducts
332
In LPO how is the barium in the stomach?
Barium in the fundus Air in the pylorus
332
In RAO how is the barium in the stomach?
Barium in the pylorus Air in the fundus
333
Which oblique places air in the fundus?
RAO
333
What oblique puts the esophagus between the heart & thoracic spine?
RAO
333
What oblique places barium in the pylorus of the stomach?
RAO (has to be prone)
333
What oblique places the esophagus in between the hilar region & thoracic spine?
LAO
333
What view superimposes the esophagus over the spine?
AP or (PA)
333
Which oblique places barium in the fundus of the stomach?
LPO (has to be supine)
333
Which oblique places air in the in the pylorus of the stomach?
LPO (has to be supine)
334
What is chymes?
semifluid mass as a result of mixing (churning) of stomach contents & stomach fluids
334
Where is the duct or wirsung? Also known as?
Duct leading into the pancreas Pancreatic duct
334
Which view of the stomach best displays the retrogastric space?
R lateral (upper GI) view (lateral)
334
What is swallowing called?
deglutition
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What is chewing called?
Mastication
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Where does barium go if the patient is lying prone? Where is the air?
barium in pylorus & air in the fundus
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What is peristalsis?
involuntary muscle contractions (wavelike movements that propel solid/semisolid structures)
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Where is the barium going if the patient is lying supine? Why?
Fundus
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What is the epiglottis? What does it do?
membrane-covered cartilage that moves down to cover the opening of the larynx during swallowing
335
How does the fundus lie in the stomach?
fundus is posterior
335
Barium is a:
colloidal suspension (not a solution)
335
What is rugae? where is the location?
internal lining of stomach thrown into numerus mucosal folds (when the stomach is empty) greater curvature
335
What helps food gets down the esophagus?
peristalsis (gravity + involuntary movement)
335
What is the gastric canal? Where is it located? What is its function?
canal formed by rugae along the lesser curvature funnels fluids directly from the stomach's body to the pylorus
335
Where is the cardiac antrum at?
distal portion of esophagus, that curves sharply into expanded portion of the esophagus (right before the esophagogastric junction)
336
Where is the angular notch? also known as:
ring like area that separate the body and pylorus region incisura angularis
336
What is GERD?
gastroesophageal reflux disease
336
What is an accessory organ? What is an example?
not a digestive organ but aids in digestion salivary glands, pancreas, liver, & gallbladder
336
What is used to prevent scatter radiation in fluro?
Bucky slot shield (lead drape shield, exposure patterns, lead aprons)
336
What is the 3 cardinal rules of radiation protection: (3)
Time Shielding Distance (most crucial)
336
What is the C loop of the duodenum? What is inside of this area? What is it referred to as?
The head of the pancreas Called the romance of the abdomen (stomach)
336
What is the special name for having gallstones?
choleliths (biliary calculi)
337
What is best shown in a RAO stomach?
barium in the pylorus air in the fundus
337
What is a trichobezoar? (cool/ scary thing)
Mass of ingested hair
338
What are the 3 parts of the pharynx?
Nasopharynx (nose area) Oropharynx (mouth) Laryngopharynx (throat area)
338
AP oblique that best demonstrates hepatic flexure + ascending colon? What is the PA oblique? What is the CR?
AP: LPO PA: RAO at crest
338
What is the AP oblique that best shows splenic flexure + descending colon? PA oblique?
AP: RPO PA: LAO
338
Which decubitus position best shows the air the splenic flexure + descending colon? Why?
Right lateral decub bc splenic flexure is on the left side of the body and to see air levels we need it to be side up
338
What decubitus position best shows the air in the posterior rectum? What decubitus position best shows the air in the anterior rectum? Why?
Ventral decubitus Dorsal decubitus bc air/fluid levels move depending on gravity. In prone position, air goes posterior and barium goes anterior
338
Where is the barium while the patient is PA? Where is the air? Why?
B: transverse & sigmoid colon A: ascending & descending colon
339
Which decubitus position best shows the air the hepatic flexure + ascending colon? Why?
left lateral decubitus bc we want to see the air levels on the hepatic (right side) so we must have right side of the body up
339
Where is the barium when the patient is AP? where is the air? Why?
B: ascending & descending colon A: transverse & sigmoid colon bc of gravity and the ascending & descending colon are retroperitoneal
340
Splenic flexure is located on ___ side Ascending colon is location on ___ side Hepatic flexure is located on ____ side descending colon is location on ____ side
left right right left
340
Which aspect of the large intestine is the highest?
left colic flexure
340
What part of the large intestine is the widest? What about the small intestine?
L: cecum S: duodenum
340
How long should the patient NPO for a barium enema?
8 hours
340
What are the contraindications for a barium enema?
perforated hollow viscus & large bowel obstruction
341
When inserting the tip for a barium enema it must be on: What position is best for a tipped insertion? Where should you aim for when doing a barium enema insertion?
expiration (relaxes the abdominal muscles) sims Step 5 aim tip toward umbilicus approximately 1-1/2 inches (3-4 cm)
341
where is the CR for an initial small bowel study? Where is the CR after 1-2 hours?
Initial: 2 inches above crest 1-2hr: at crest (bc barium has made its way from the stomach to bowel)
342
What does LPO best show?
Right hepatic flexure + ascending colon
342
Why do we prefer to take our images in PA vs AP during a small bowel study?
compresses the small bowel to best show the loops
342
What does ventral decubitus best display?
Air in the posterior portion of the rectum
342
What does LAO best show? What is the CR?
Splenic flexure + descending colon 2 inches superior to crest + 1 inch to the right of MSP
342
What does RPO best display?
Splenic flexure + descending colon
342
What does right lateral best display?
Air in the splenic flexure + descending colon (The side up)
343
What does left lateral decubitus best display?
air in the hepatic flexure + ascending colon + cecum (air in side up)
344
What does RAO best display? what is the CR? how much oblique?
Hepatic flexure + ascending colon CR at crest 35-45 oblique
344
What does lateral rectum best show? what positions achieve this? what the is the CR?
demonstrates polyps, strictures, & fistulas between rectum & bladder/uterus left lateral rectum or Ventral decubitus CR is at ASIS
344
What is the CR for AP axial & LPO oblique? (butterfly) What study is this for? Do you angle the patient or the tube?
AP: supine + 30-40 cephalic + CR 2 inches inferior to ASIS LPO: 30-40 LPO + 30-40 cephalic + 2 inches inferior & 2 inches medial to right ASIS Barium enema angle tube 30-40 cephalic
344
What is the difference between a PA and AP image? right/left lateral?
PA: Barium in the transverse & sigmoid with air in the A & D colon AP: Barium in the Ascending + descending with air in the Sigmoid + transverse R lateral: Air in the splenic + descending barium in hepatic + ascending L lateral: Air in the hepatic + ascending barium in the splenic + descending
344
which flexure is always higher?
splenic flexure
344
What is the CR for LPO/RAO ?
RAO: crest + 1 inch to the left of MSP LPO: crest + 1 inch to elevated side from MSP 35-45 AO/PO oblique
344
The enema bag should not be higher than _____
24 inches above table (2 feet)
345
During small bowel studies how often should images be taken?
every 20-30 minutes
346
Which part of the small intestine makes up the 3/5's? which part makes up the 2/5's?
ileum & jejunum
346
What is subluxation? what is an example of this?
a partial dislocation nursemaids jerked elbow
346
What is apposition? what are the types?
how fragmented ends of the bone make contact with each other anatomic apposition (normal, end-to-end contact) lack of apposition (distraction, end of fragments are alligned but don’t make contact with each other) bayonet apposition (fx fragments overlap and shafts make contact but not the fx ends)
346
What is a contusion?
bruise injury (possible avulsion fx)
346
What is a fracture?
a break or altering of the bone
346
What is a sprain?
forced wrenching/twisting of a joint (damages ligament without dislocation)
346
What is varus? What is valgus? What are the deformities?
valgus is away from the mid-line (medial) Varus is toward from mid-line (lateral) distal fragments are angled in these directions *
347
What is a greenstick fracture? What is a closed fx? also known as?
fx is on one side only fx with bone not though the skin (simple fx)
347
What is a complete fx? what are the 3 types of fx?
fx is complete, broken into two pieces transverse fx (transverse fx near the right angle to long axis) oblique fx (fx passes through bone at oblique angle) spiral fx (bone is twisted, fx spirals around long axis)
347
what is a smiths fx?
fx of the wrist with distal radius displaced anteriorly, with radius & ulna posteriorly
347
What is a comminuted fracture? what are the types?
bone is splintered/crushed causing it to be in two or more fragments segmental fx: (bone broken into 3 pieces, middle fragment fx at both ends) butterfly fx: two fragments on each side of the main, wedged shape resemblance to butterfly) splintered fx: splintered into thin sharp fragments
347
what is a colles fx?
distal radius is displaced posteriorly, with radius & ulna anteriorly
347
What is compound fracture? also known as?
portion of bone (fx) is piercing through the skin open fx
348
What is a stellate fx? most commonly seen?
fx lines radiate from central point of injury that resembles a star-like pattern (ex: most commonly seen in the patella, after knees hitting the dashboard in an accident)
349
What is a pott's fx?
complete fx of distal tib/fib (major injury to ankle + ligament damage) (commonly seen in medial malleolus/distal tibia)
350
what is a boxer's fx?
fx of distal 5th metacarpal (fx comes from punching)
350
What is an impacted fx? most common in?
one fragment is firmly driven into the other (most common in femurs, humerus, & radius)
350
What is a jefferson fx? aka? how does this happen?
comminuted fx of anterior/posterior arches of C1 seen from landing on the head (skull slams into the ring)
350
what is the minimum distance you should be away from exposing on portable x-ray?
6 feet
350
what is a hangman's fx?
fx occurs in pedicles of C2 or with/without displacement of C2/C3
350
what is a compression fx?
vertebral fx from compression injury (vertebral body collapses or compresses)
350
why do we prefer AP over PA view of the thumb?
for OID
351
What are the roles for the radiologic technologist?
radiation safety expert (check for overuse of c-arm, failure to wear aprons, placement of hands in field)
351
if you are doing a horizontal beam in the OR, where should the surgeon stand?
near the image intensifier (not near the x-ray tube for sterilization)
351
what is the CR for a portable chest?
AP: 3-4 inches inferior to jugular notch (T7) 3-5 caudad CR perpendicular to the long axis of the sternu
351
If a patient has a dislocated shoulder, unable to sit erect or stand what view should we do to replace a lateral?
supine, transthoracic (usually will have to break it up into a distal and proximal because of tissue)
351
What are the roles of the CST? What does it stand for?
prepares with OR + supplying appropriate supplies and instruments (prepping patient for surgery, connect surgical equipment, maintain a sterile field)
351
(t/f) When working in surgery we need to be confident about how to manipulate the factors & anatomy to make a "textbook" image
true
351
what is spiral fracture?
bone is twisted apart & fx spirals around the long axis
352
What are the roles for the scrub (scrub tech)?
prepares sterile field scrubs gowns surgical team, prepares/sterilizes instruments before procedure CST or RN
353
when using fluro & boost fluro it is important to use: Why? How does image look?
intermittent fluro (pulse fluro) bc less patient dose less crisp
353
What does ORIF stand for? What is it?
open reduction with internal fixation fx site is exposed to a variety of screws, plates, & rods inserted to maintain alignment
353
What is the normal range for creatinine levels?
0.6 to 1.5 mg/dL
354
What is the average levels for BUN?
8-25mg per 100 ml
354
What medication do you hold for procedures?
Metformin 48 hours before or after administration of iodinated contrast
354
What is micturition?
the act of voiding or urination
354
What is incontinence?
involuntary passage (leakage) of urine through the urethra (failure to control vesical and urethral sphincters)
354
What is retention?
inability to void: bladder unable to empty (obstruction in the urethra or lack of sensation to urinate)
355
What exams/studies would you need to premedicate for? What medications? What are examples of procedures?
patients with history of hay fever, asthma, or food allergies antihistamines (benadryl) + prednisone 12 or more hours prior to procedure IVU
355
What position would you use for voiding cystograms? What are the procedure steps? What supplies do you need?
supine or erect (makes voiding easier) (women) 30 degree RPO (male, best shown)
355
What drugs would you use to reduce a reaction?
prednisone & Benadryl
355
What are mild reaction symptoms?
non allergic reactions: anxiety lightheadedness nausea vomiting metallic taste (common side effect) mild erythema warm flush (common side effect) itching mid scattered hives
355
what is an IVU?
excretory urography IV injection with contrast through superficial vein in arm
355
What is a retrograde urography study?
injection through ureteral catheter by urologist as a surgical procedure
356
What is a retrograde cystography?
contrast flowing to bladder through urethral catheter pushed by gravity
357
what is a voiding cystourethrography? what is the positioning?
contrast flowing to from urethral catheter to bladder & withdrawal of catheter for voiding imaging women: supine (lithotomy) or erect AP men: 30 degree RPO
357
what is a retrograde urethrography study? (RUG)
for males retrograde injection through Brodney clamp or special catheter
357
What are moderate reaction symptoms?
true allergic reactions (anaphylactic): urticaria possible laryngeal swelling bronchospasm angioedema hypotension tachycardia >100 beats/min bradycardia >60 beats/min
357
what are severe reaction symptoms?
vasovagal (life-threatening reaction): hypotension (systolic <80) bradycardia (<50 beats/min) cardiac arrhythmias laryngeal swelling possible convulsions cardiac arrest respiratory arrest no detectable pulse
357
What is an HSG? What is it looking for?
contrast study of the uterus to assess the function
357
Which kidney sits lower than the other? Why?
right sits more inferior to the left kidney bc of the presence of the liver
357
What are the functions of the kidneys?
filter blood & remove waste through urine*
358
What are the reasons for using a uterus compression study? Where do you place the compression device? (what level)
enhance filling of pelvicalyceal system/proximal ureters & allows renal collecting system to retain the contrast medium longer (at ASIS) inflated paddles over outer pelvic brim
358
How do you position for an IVU? What is the prep?
Scout: supine (AP) CR is iliac crest 5 min: Supine (AP) (KUB) CR is iliac crest 10-15 min: supine (AP +KUB) CR is iliac crest 20 min: 30 degree LPO/RPO (ureters away from spine) CR is iliac crest postvoid: prone or erect AP (include bladder) Prep: light evening meal before procedure bowel-cleansing laxative NPO after midnight enema on morning of exam
359
What is an essential component of the kidney?
nephrons
359
What is the positioning for the retrograde urography? What is the prep?
30 degree RPO special catheter inserted to distal urethra (contrast medium inserted by injection)
359
What is a retrograde study? What is an excretory study?
contrast through catheter (retro=backwards) contrast through the vein (intravenous) (forward)
359
What organs make up the urinary system?
two kidneys two ureters one urinary bladder one urethra
359
Where do the suprarenal glands lie in relation to the urinary system?
superior and medial to each kidney (important glands of the endocrine system located in fatty capsule that surrounds each kidney)
360
What position do we need to place the patient in to get the kidneys parallel to the IR?
30 degree LPO/RPO (30 LPO places right kidney parallel) (30 RPO places left kidney parallel)
360
What is the name of the functional study of the bladder and urethra?
voiding cystourethrography (VCU)
361
When would we not use the uterus compression?
ureteric stones abdominal mass abdominal aortic aneurysm recent abdominal surgery severe abdominal pain acute abdominal trauma (pregnancy)?
361
what angle does the kidney sit to the midsagittal plane?
20 degrees from the midsagittal plane due to the psoas major muscles (vertical angle)
361
where should the tourniquet be placed in relation to the injection site?
3-4 inches above injection site
361
What is acute renal failure?
(Can’t filter waste from the blood) inability of a kidney to excrete metabolites & inability to retain electrolytes (at normal plasma levels & under normal conditions)
361
Three purposes for an IVU?
visualize portion of urinary system assess function of kidneys evaluate urinary system pathology
361
What is oliguria?
diminished amount of urine in relation to fluid intake low urine output (less than 400mL in 24 hr)
361
What is retention?
inability to void: bladder unable to empty (due to obstruction in urethra or lack of sensation to urinate)
362
What is anuria?
complete cessation of urinary secretion by the kidneys (kidneys producing none-little urine due to a blockage)
362
At what level does the kidney lie in an adult body?? Where in relation to the abdomen?
T11-T12 (between xiphoid process (T10) and iliac crest (L3-L4) (Left kidney T11-T12) (Bottom right is at L3) retroperitoneal
363
What is the bladder capactity?
350ml-500ml
363
To prevent contrast reaction
To prevent contrast reactions
363
Where are the kidneys located?
Midway between the xiphoid process and the iliac crest
363
What is the name of the leakage of contrast outside of the vessel and into surrounding tissue?
extravasation
363
This exam may be performed to demonstrate uterine position, uterine lesions, and uterine tubal obstruction?
HSG study (hysterosalpinography)
363
What calyx's form the renal pelvis?
major & minor
364
What drug combination is given to patients before an IVU to reduce the risk of a reaction?
prednisone + Benadryl
364
What type of contrast reaction affects the entire body or a specific organ system?
systemic reaction
365
What is the device used and positioned at the level of ASIS?
ureteral compression device
365
what type of contrast media dissociates into separate ions when injected?
ionic contrast media
365
What blood chemistry level should read 8-25 mg/100mL if in normal range?
BUN
365
Which of the following is not a reason to be pretreated before a contrast enema?
itching
365
We must verify ____ ____ for patients with _____ before resuming metformin?
kidney function diabetes
366
The right kidney sits ____ to the left kidney due to the liver
inferior
366
for a male retrograde urethrogram the patient position should be?
30 degree RPO
367
Which study injects contrast through a catheter into the renal pelvis?
retrograde urethrogram (RUG)
367
What is the purpose for voiding a cystourethrogram?
to evaluate the patient's ability to urinate
367
What position is best to see the ureters without obstruction?
RPO/ LPO
367
What is the name of the action urination?
micturition
367
Which two types of fractures are most commonly seen in victims of child abuse?
Bucket & Corner fx
367
What is necrotizing enterocolitis (NEC)?
condition causes the intestinal tissue to die
368
What is the life-threatening condition that occurs when the intestines fold into itself?
intussusception
368
What position of the abdomen is recommended for demonstrating the prevertebral region of the abdomen?
Dorsal Decubitus
369
what is atresia?
a medical condition where a body part that tubular in shape and either closed or doesn't have a normal opening
369
What must you never do when using tape on a pediatric patient?
stick the adhesive side to the patient (could have an undiagnosed allergy to ashesives)
369
what set of images would best demonstrate Croup?
AP + Lateral soft tissue neck
369
what is a weighted device used to assist in positioning?
sandbag
370
What is the primary technical factor to eliminate motion for pediatric patients?
shorten exposure time
370
What is pyloric stenosis?
rare condition affects the pylorus and muscular opening between the stomach and the small intestine in babies
370
For a patient with osteogenesis imperfecta how would you properly adjust your technique? What is this?
decrease technique a condition where bones easily break
371
What genetic disorder that causes bones to break easily?
osteogenesis imperfecta
372
What is the name of the flat radiolucent device with straps that assists with supine imaging?
Tam-em board
372
what is a common birth defect that causes one or both feet to turn inward and downward?
talipes equinovarus
372
What is the CR for a ped abdomen?
1" superior to umbilicus
372
What is the mummifying technique?
technique that helps to immobilize the child's arms (by wrapping patient up in a towel)
372
what is the rare birth defect that occurs when the nerves in the lower part of the intestine don't develop properly?
Hirschsprung's disease
372
which modality would help to diagnose congenital hip dislocations in newborns?
sonography (US)
373
what is the technical term for newborn?
neonate
373
what is the device used to image a child in upright/erect position? What exams are these for?
pigg-o-stat erect abdomen + chest
374
By the age of ______ a child can be spoken to and they can follow instructions
2-3 years old
374
what position is performed to look at both hip joints in a lateral perspective?
bilateral frogs (included as much as possible in one image
374
what exam or position is performed to determine if a child has stopped growing?
bone age survey (one x-ray of the left hand)
374
what is a disorder of abnormal development resulting in dysplasia, subluxation, and possible subluxation of hip secondary to capsular laxity and mechanical instability?
DDH (developmental dysplasia of the hip)
375
what is croup? How is it diagnosed?
infection in the upper airway which becomes more narrow and making it hard to breathe AP + Lat soft neck tissue
376
What is intussusception?
telescoping of the bowel causing life threatening folds in the stomach
377
What is RDS? what exam would we perform for this?
respiratory distress syndrome chest
377
What is the older term for child abuse? What is the new & more acceptable term?
Battered child syndrome suspected non- accidental trauma (SNAT)
377
What is osteogenesis imperfecta? what happens to technique?
bones that easily break decreases
377
What is RSV?
Respiratory syncytial virus Common virus that affects most infants by age 2 & mimics symptoms of a cold (Cough + running nose)
377
What is cystic fibrosis?
inherited disease which causes heavy mucus or clogging in the bronchi hyperinflation of lungs from blocked airways (shows up on x-rays as radiopaque & not obvious at birth but are more obvious later on)
377
What is the space between the primary and secondary growth center is called?
epiphyseal plate
377
what are the different abdomen positions? why are these used?
Lat Decub + erect abdomen (to evaluate air-fluid levels) Dorsal decub (to see pre-vertebral region of the abdomen) Supine abdomen (regular KUB)
378
what demonstrates the pre-vertebral region of the abdomen?
dorsal decubitus
378
What are these? SCA: SNAT: PIT: BCS:
suspected child abuse suspected non-accidental trauma pediatric intentional trauma battered child syndrome (old name)
378
what is the kVp range for PA + lateral chest x-rays?
70-80 kVp or 75 to 85 (D) 75-80 or 80-85 kVp (D)
379
what are the restraining devices used?
sandbag pigg-o-stat
379
What aids motion in pediatric exams?
short exposure time
379
how are hip dislocations identified in newborns?
ultrasound (sonography)
380
What modality would we use to diagnose for ADHD & evaluate for suspected tumors?
MRI
381
what is the CR for KUB? Chest?
1" above umbilicus Mammillary line
381
What is the hip protocol for pediatric patients?
if it is paired with other imaging complete in one exposure to reduce radiation exposure (ALARA)
381
what is a neonate?
technical term for newborns
381
how should tape be applied to pediatric patients?
adhesive side not touching patient (could have an undiagnosed allergy)
381
What are Pigg-O-stats?
immobilization technique for erect abdomen & chest for infant up to age 5
381
What are the six categories of child abuse?
neglect physical abuse sexual abuse psychological maltreatment medical neglect other
382
What is radiation protection for child? what is optimal regarding exposures and imaging?
Gonadal shielding if there are exams including wrist and forearm complete in one exam (hip to ankle)
382
what is the CML fx? what is another name for this?
classic metaphyseal lesion fx along the metaphysis that results in tearing or avulsion fx can be also called corner fracture
382
What positioning aid can we use for erect abdomens?
pigg-o-stat
382
Quality control is part of what kind of program?
Quality assurance
382
What is the purpose of the QC program?
To achieve the best image quality
382
What does the SMPTE pattern test for? What does SMPTE stand for? what does JND stand for?
the luminance response Society of motion production and television engineers Just-noticeable-difference
382
How do we calculate the repeat/reject rate? What is the optimal number we like to stay within? What is the primary cause of repeats on DR systems?
Divide total X-rays/ repeat 3-5% patient positioning
382
What is a way to test the collimator alignment? what is the tolerance?
A-penny test 2%
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If we are testing the “hardness” of the x-ray beam what are we primarily looking at?
half-value layers
382
what is the tolerance for SID accuracy?
+/- 2% variance
382
what is the acceptable range of accuracy for collimator alignment test is? we find this by using the:
+/- 2% variance A-penny test
382
what is the tolerance range for Kvp variations?
5% variance
382
In Fluro units, what is the tolerance in one direction? (for collimation) In total?
3% variance 4% variance total
382
what are the main components in quality control program?
Acceptance test (baseline for new machines) Annual testing Diagnose & documenting deviations
382
Which of the following tests of QC imaging can be performed visually by the radiographer? what kind?
Uniformity issues Artifacts (Also can be uneven spatial resolution or dark noise)
382
If we are doing a repeat/reject analysis what is a good percent range to stay within?
3-5%
382
what is a primary reason we see repeats on digital exams?
patient positioning (motion will be on there, nit the primary)
382
what is the tolerance for timer accuracy?
5% variance
382
what kind of monitors do we mainly use? what is the disadvantage? what is the official name of this disadvantage?
LCD monitors Limited viewing angle VAD (viewing angle dependence)
382
what type of monitor or workstation is critical that the illuminance & contrast is set to a precise setting? also known as?
Class 1 monitor Diagnostic work station
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What is illuminance? What tool measures this?
the light that strikes the surface of an object photometer
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what is an example of a class 2 monitor? what do we use these for?
technologist work station Post processing & window leveling
383
What measures illuminance?
photometer
383
what is the least reliable exposure factor? What is the tolerance?
MA-linearity 10% (from tube fatigue)
383
If we are using SMPTE test pattern and use the photometer and place it on the squares to measure the JND, what test are we performing?
luminance response test
383
if we are measuring resolution within an image what tool do we use?
Lines-pairs tool
383
What is the spatial resolution we should see on a monitor? what about on the detector?
2.5 LP/mm 2.5 LP/mm
383
how often do we test aprons?
annually
383
What is the tolerance of these: kVp accuracy: Exposure reproducibility: automatic exposure control: collimator accuracy: central ray accuracy: SID accuracy: Fluro collimation: what is the Fluro exposure rate? Boost? Exposure reproducibility?
5% 5% 10% 2% 1% 2% 3% one direction 4% total 10R 20R 5% of the average
383
What type are the radiation measurement units for radiation biology? What are these units?
Systeme international SI Grays, sieverts, and coulombs
383
What is exposure? What units do we use to measure this?
Amount of radiation in the primary beam (x-ray tube output/air) (what’s in the air?) Coulombs per kilogram (C/kg)
383
What is absorbed dose? What is the unit of measurement for this? Which also equals?
Energy per unit mass absorbed by an irradiated object (What’s the radiation striking patient/healthcare worker) Gray (Gy) 1 J/kg = 1 Gray
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What is dose equivalent? What is the unit we use for measurement?
Absorbed dose x radiation weighting factor (What type of radiation is hitting us) Sievert (SV)
383
What are the radiation weighting factors? What are there values?
Gamma ray = 1 x-ray= 1 positron= 1 proton= 2 alpha particles= 20
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What is effective dose? What is the main thing that it accounts for? what is the formula for this? What is the unit for measuring this?
The sum of the equivalent doses for all irradiated tissues Considers the type of radiation and the sensitivity of the tissues Absorbed dose x radiation weighting factor x tissue weighting factor Sieverts
384
What are these tissue weighting factor for these? Gonads: Red bone marrow: Colon: Liver (organs): Skin:
0.20 0.12 0.12 0.05 0.01
384
What is Air KERMA? What does this stand for? What is the unit of measurement for this?
Kinetic energy of the air in the primary beam Kinetic energy released in matter Gray (Gy)
384
What is the dose area product? How can this be measured?
Takes into account the area being irradiated DAP meter (More area radiated, more radiation) (Increased collimation= less DAP) (Decreased collimation = more DAP)
384
What is half-life? Specific to:
Time required for radioactivity to reduce to half its original measurement Isotope and constant
384
If we have 12 mGy with a 6 hour half life, how much time will it take for the radiation to get to 6 mGy? For 3 mGy?
6 hours 12 hours
384
For radiation with 24 mGy how much time will need to pass for us to reach 3 mGy with a 6 hour half life?
18 hours
384
What is the integral dose? What is an example of this?
sum of a all absorbed doses in an exam L-spine (AP + LAT + OBL)
384
What is the annual limit for natural radiation? Where does this radiation originate from? What is the limit for manmade?
3 mSv & radon gas which is highest in tightly sealed structures such as granite/marble 3 mSv
384
What is an OSL or OSLD? How is it released?
Optically stimulated luminescent dose (dosimeter) released by light
384
What is a TLD? How is it released?
Thermoluminescent dose (dosimeter) By heat
384
What is a film badge? What is the purpose of this?
A dosimeter with a small piece of film/ foil filter For determining the type of radiation (Ex: alpha particles)
384
What is a pocket or ion chamber? What is an example of this?
Real-time dose readings using anode pin or plate Pen or Geiger counters/ AEC (not for general use)
384
What is the occupational dose limit? Where do we see most of this at?
50 mSv Fluoroscopy
384
What is the radiation limit for the public?
1 mSv
385
What is the limit for the fetus?
0.5 mSv/month
385
what is the dose limit for the lens of the eye?
150 mSv
385
what is the radiation dose limit for everything else?
500 mSv
385
what does LET stand for? what is it?
linear energy transfers Amount of energy deposited in tissue per radiations travel (How much energy is given off into the tissue)
386
What does high LET mean? What is an example of this?
More concentrated which means more harmful to tissue (like alpha particles)
386
What is an example of low LET? What is an example of high LET?
Gamma ray (lowest) & x-ray (2nd lowest) Alpha particles
386
Gamma ray
Gamma ray
386
What does RBE stand for? What does it do?
Relative biological effectiveness Compares different types of radiation
386
If one type of radiation can cause the same effect as the other with a lower amount (quantity) this type has?
A higher relative biological effectiveness (RBE)
386
what is radiation response curves? What are the types of these?
Graph (ic) representation of the biological response to increasing doses of ionizing radiation Linear or non-linear/ threshold or non threshold-hold
386
What is the most common CT scan done at a stoke center?
head CT (CT Brain Attack)
386
What are the abdominal quadrants?
RUQ LUQ LLQ RLQ
386
what is in the RUQ?
right lobe of liver gallbladder right kidney head of the pancreas portions of stomach + large intestine
386
what is in the LUQ?
left lobe of the liver tail of the pancreas left kidney spleen portions of stomach + large intestine
386
what is the RLQ?
cecum appendix right ureter right ovary right spermatic cord (2/3 of ileum + ileocecal valve
386
what is the in the LLQ?
left ureter left ovary left spermatic cord most of small intestine + portions of large intestine
386
What kind of joint is the TMJ?
modified hinge (necessary for mastication)
386
where is the CSF housed? located? what provides a pathway for this?
mid-brain & superior to the pons between middle and posterior cranial fossae (smallest portion of the brainstem) ventricles
386
how many cranial bones enclose the brain?
8 1 frontal 1 occipital 1 ethmoid (smallest) 1 sphenoid 2 parietals 2 temporal
386
where is the pituitary gland located? what is another name for this? function?
Sella turcica master gland & regulates many hormones within the body
386
what is the cerebrum? what is the function?
largest portion of the brain divided into left and right ventricles responsible for thought, judgement, memory, and discrimination
386
what is the largest facial bone?
mandible
386
how many cranial nerves originate from the brainstem?
10 (10/12 of the cranial nerves originate from the brainstem) First two originate from the cerebrum
386
how many lobes make up the cerebral cortex?
frontal lobe parietal lobe occipital lobe temporal lobes
386
how many facial bones are there?
14 facial bones 2 maxillae 2 zygomatic 2 lacrimal 2 nasal 2 nasal conchae 2 palatine 1 vomer 1 mandible (largest)
387
which cranial bone articulates with all the other cranial bones?
sphenoid
387
what is osmolality?
the number of particles in a solution per unit liquid compared to blood
387
what are high osmolality agents? (HOCM) low osmolality agents? (LOCM)
agents that may have as much as seven times the osmolality of blood have roughly twice the osmolality of blood
388
what are Isosmolar agents? (IOCM)
agents that have the osmolality as blood
388
what is viscosity? what affects viscosity?
thickness or friction of a fluid as it flows brand, temperature, and concentration affect the contrast media/viscosity (could affect how CM is injected intravascularly)
388
what is a mild reaction to contrast? consists of?
short duration and self limiting difficulty breathing light headache pain at the injection site
388
what is a moderate reaction to contrast? consists of?
not immediately life threating, but could potentially be if untreated feeling of warmth hypertension bradycardia
388
what is a severe reaction to contrast? consists of?
potentially or immediately life threatening cardiac or respiratory arrest
388
what are the positive agents? examples?
possess a higher density than the surrounding structures (anatomy) barium, iodine
388
what are the negative agents? examples?
possess a lower density than the surrounding structures (anatomy) air, cO2

Registry Prep (12 decks)

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