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Mock 2 Flashcards

1
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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2
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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3
Q

what is the duodenum?

A

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

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3
Q

what is the duodenal bulb or cap?

A

Proximal portion of duodenum

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3
Q

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

A

Jejunum
Ileum

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3
Q

what is the ileocecal valve?

A

Connection between ileum and cecum

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4
Q

what consists in the urinary system?

A

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

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4
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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5
Q

what is the omentum?

A

Double fold peritoneum extending from stomach to another organ

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6
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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6
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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6
Q

what is the acute abdomen series?

A

AP supine abdomen
AP erect abdomen
PA erect chest

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7
Q

what is the kvp for AP erect abdomen?

A

70-80 kVp

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7
Q

what is the CR for erect AP abdomen?

A

2” superior to iliac crest

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8
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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8
Q

what is ascites?

A

accumulation of fluid in peritoneal

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9
Q

what is pneumoperitoneum?

A

free air or gas in peritoneal cavity

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9
Q

what is volvulus?

A

twisting of loop of intestine creating an obstruction

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10
Q

what is intussusception?
Most common with?
Can cause?

A

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

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10
Q

what is Crohn’s disease?
What does it cause?
Who does it affect mostly?

A

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

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11
Q

what are the four divisions of the respiratory system?

A

pharynx, trachea, bronchi, & lungs

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11
Q

what is anterior trachea or esophagus?

A

trachea is anterior to the esophagus

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11
Q

what device is used for pediatric imaging

A

Pigg-O-Statt

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12
What are these body types? Sthenic: hypersthenic: hyposthenic: asthenic:
average physique (50%) wide physique (5%) skinny (35%) sickly/ill (10%)
13
why do we perform chest x-ray at 72”?
reduces distortion (magnification) and increases image resolution
14
what situs inversus?
heart is on the right side of the body
15
what is hemothorax?
blood accumulation in the pleural space
16
what is pneumothorax?
air accumulation in the pleura space
17
what is emphysema?
lungs lose elasticity and become long in dimension (become radiolucent, reduce technique)
17
what is kyphosis?
hump-back curvature
18
what pathologies can be seen on expiration chest x-ray?
pneumothorax & COPD
18
in a PA chest x-ray, the mid-sagittal plane is ___ to the x-ray and mid-coronal plane is ____
perpendicular parallel
19
where does the diaphragm move during expiration? Inspiration?
moves upward moves downward
19
what is the kVp range for a cxr?
110-125 kvp
20
how many ribs need to be present on a CXR to be diagnostic?
10 ribs
21
where is the base of the lung located? apex?
most inferior portion underneath the clavicles
21
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
22
what happens to technique for suspected hemothorax? Pnemothorax?
increase decrease
22
what are the 3 parts of the sternum?
manubrium body xiphoid process
23
what is the outer layer of the pleural space called? inner?
parietal visceral
24
what is pleurisy?
inflammation of the pleura
25
why does the right hemi-diaphragm sit higher than the left?
presence of the liver
25
what is atelectasis?
collapse of a portion of the lung (pneumothorax or pleural effusion)
26
what is pleura effusion?
accumulation of fluid in the pleural cavity
26
how many phalanges are there?
14
27
what is the compression of the median nerve referred to as?
carpal tunnel syndrome
28
what are the four proximal carpals? four distal?
scaphoid, lunate, triquetrum, pisiform trapezium, trapezoid, capitate, hamate
29
what do this phalange articulate with proximally? first: second: third: fourth: fifth:
trapezium trapezoid capitate hamate
30
what articulates with the radius distally?
scaphoid & lunate
30
The capitulum is part of what bone?
distal humerus (Lateral side)
31
What elbow view causes ulna + radius cross over?
internal elbow (also PA forearm)
32
What kind of joint is proximal/distal radioulnar? elbow? humeroulnar? humeroradial?
pivot (trochoidal) joint hinge (ginglymus)
33
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
34
what kind of joint is the radiocarpal joint?
ellipsoid (condyloid) joint
34
what position is the arm in a 90-degree flexion?
lateral
35
For a lateral view of the second digit what side do we place against the IR? why?
lateral side reduced OID
35
lateral fx is best displayed in what view? AP fx best displayed in?
AP Lateral
36
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)
37
what is the view that shows the scaphoid best?
ulnar deviation + 15 degree toward the wrist
38
what view best shows arthritis in the hand? carpal tunnel?
ball-catcher Gaynor-hart method
38
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
39
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
39
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)
40
what is osteoporosis? osteopetrosis?
decrease in bone density, decrease technique hereditary disease resulting in abnormal dense bone, increase technique
40
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
41
what is the name of the process located on the posterior + superior ulna? when is it best seen?
olecranon process lateral
41
what is the name of the fossa located on the posterior distal humerus?
olecranon fossa
42
what is the name of the process located on the proximal anterior ulna?
coronoid process
42
how are the elbow epicondyles to the IR for these projections? AP: LAT: Internal/external:
parallel perpendicular to IR obliqued
43
in a trauma instance what view could replace an AP elbow?
2 projections forearm parallel + humerus parallel, CR mid elbow
44
what view do you see the fat pads on? what are the fat pads name?
lateral elbow anterior, posterior, & supinator fat pad
44
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
45
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 Bennetts fx
45
The lateral elbow projection best demonstrates this anatomy free of superimposition?
Olecranon process
46
Located on distal, lateral end of the humerus?
Capitulum
47
Fracture of wrist causing posterior radial displacement is called this?
Colles fracture
47
Ulnar deviation best demonstrates this anatomy?
Scaphoid
48
Trochlear notch is on this anatomy?
Ulna
49
This joint is considered freely moveable? limited movement? immoveable?
Diarthrodial Amphiarthrodial Synarthrodial
50
For a lateral projection of the humerus how are the epicondyles to the IR? hand placement? for AP?
perpendicular + pronated parallel + supinated
50
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
50
Deep grove between the two tubercles?
Intertubercular groove (Bicipital groove)
51
What does the sternal extremity articulate with?
Manubrium
51
What are the 3 borders of the scapula?
Superior border, Axillary (lateral) border, & vertebral (medial) border
52
What are the angles of the scapula?
Superior angle & inferior angle
53
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)
54
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
54
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
55
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
56
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
57
What is the CR for Grashey?
35-45 degree LPO/RPO patient oblique 2 inches inferior 2 inches medially from supralateral border of shoulder
57
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
58
What is the CR for an Axillary shoulder? (Superiorinferior)
Scapulohumeral joint
59
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)
59
CR for AC joints:
1 inch above jugular notch, mid-point AC joints 72 Inch SID 2 views (one with weights, one without)
60
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
61
What is the Hill-Sachs defect?
A compression fx of the humeral head
61
What is idiopathic chronic adhesive capsulitis?
Frozen shoulder Caused by chronic inflammation around the shoulder joint Pain and limited movement
61
What is osteoarthritis?
Degenerative joint disease Non-inflammatory Gradual deterioration Most common arthritis and normal due to age
61
What a rotator cuff injury?
Acute or chronic trauma injury to the rotator cuff muscles: Tere’s minor Supraspinatus Infraspinatus Subcapularis
62
What is a shoulder dislocation?
Removal of humeral head from glenoid cavity 95% of dislocations are anterior
62
what is the kvp range for hand, elbow, & shoulder?
50, 60, 70 kVp
63
What is the CR for Internal Shoulder?
hand pronated CR 1 inch inferior to coracoid SID 48” 70 KVP shows lesser tubercle INT markers
64
What position is the greater tubercle superimposed over the humeral head?
Internal rotation
64
When performing the west point projection this is free of superimposition?
Coracoid process
65
the scapular notch is located on what part of the scapula?
Superior border
65
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)
66
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)
66
What is the CR for a transthoracic lateral projection?
surgical neck (on the humerus in profile)
66
Where do the medial and lateral borders of the scapula meet?
at the inferior angle
67
Medial aspect of the clavicle is called?
Sternal extremity (end)
67
What is the dislocation of the radial head called?
Nurse maid’s jerked elbow/ Pulled elbow
67
The scapula is required to be in this position for the Neer method?
scapula needs to be lateral perpendicular to IR
68
What is the flattened triangular part on the scapula?
Acromion
69
What is the name of the larger depression on the anterior surface of the scapula?
subscapular fossa
69
What type of fractures force the splinted pieces through the skin?
Open or compound fx
69
This is the only bony articulation between the upper extremity and the torso:
Sternoclavicular joint (SC joint)
70
Another name for the lateral border of the scapula:
Axillary border
70
In an AP humerus, is the humerus flexed or extended? What is the rotation of the AP humerus?
extended external rotation
71
what consists in the shoulder girdle?
Clavicle Scapula NOT HUMERUS
71
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)
72
(T/F) we use a breathing technique for transthoracic lateral projection
True (ALWAYS)
72
When were X-rays discovered? by who? Who discovered fluoroscopy?
November 8, 1895 Wilhelm Conrad Roentgen Thomas Edison
73
ALARA stands for? Largest source of radiation for average human?
As Low As Reasonably Achievable (Refers to occupational exposure) Radon gas
73
Scientific approach is _________
Self-correcting - it will always change
73
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
73
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
74
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
74
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)
74
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
74
what are atomic shells? what 2 rules are associated with shells?
Letters: K - Q Principle Quantum Numbers: 1 - 7 2n^2 rule & Octet rule
75
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
75
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
75
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)
75
what is an ionic bond?
Positive & negative ions attracted to each other electrically Super strong bond
76
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
76
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)
77
what are gamma rays? what is natural about these?
energy released from unstable nucleus w/o change to atomic structure naturally occurring X-rays
77
what are two ways an electron can be removed creating an ion?
Incident electron Incident x-ray
78
Outer shell electron gives off its energy in the form of _____
X-ray
78
what is wavelength? what is measured in?
distance between two like points on wave (measured in Angstroms) Angstrom = 10^ -10 m
79
what is velocity?
how fast energy of wave moves from one point to another
80
what is amplitude?
maximum displacement of media from its equilibrium (strength of the wave, not its energy)
81
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
82
what is the electromagnetic formula?
c (speed of light) = frequency x wavelength
83
what is frequency? what is this measured in?
number of cycles passing through a fixed second hertz
84
Frequency & wavelength have ___ proportional relationship
inverse
85
what is velocity equaled too?
velocity= frequency x wavelength
86
Energy is directly proportional to ___ X-rays have ___ nature
frequency dual light photons and physical properties
87
Radiopaque: Radiolucent:
Very few X-rays pass thru X-rays can pass easily thru
88
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
89
Typical strength of MRI machine 1 Tesla (T) equals ___ gauss
2 Teslas (T) 10,000
89
Static electricity is generally caused by electrification by ___ To minimize static, humidity should be above ___
friction 40%
90
Electromotive Force (EMF)
Force created by any electric potential difference
90
Electrodynamics - Semiconductors
Electrical current flow in certain conditions
90
Electrodynamics - Conductors
Electrical current flow in most conditions
90
Current flow & electron flow are in ___ directions
opposite
91
Electrodynamics - Current
Flow of loosely-bound outer shell electrons
91
Electrodynamics - Insulators
No electrical current flow
92
Current - unit of measurement 1 Coulomb per second is equal to ___
Ampere / Amp 1 Coulomb per second 1 ampere
93
Ohm’s Law: Formula
V = I x R Voltage = Current x Resistance
93
Parallel circuit
Each component is connected to power source independently Failure of one component only breaks circuit to that component, not the others
94
Resistance affected by:
Length, Diameter, Material of conductor
94
Series circuit:
Each component of circuit is connected to each other Failure of one component breaks the circuit
94
Electrical power is the rate
RATE at which electrical power is used
95
what is resistance?
Force preventing electrons from moving thru circuit
95
what is the unit of measurement for electrical power?
Watt (W)
96
At frequency of 60 Hertz, each cycle lasts for ___ How many hertz in a second?
1/60th second 60
96
what is alternating current?
Oscillation of current back & forth
97
How many pulses in a hertz?
2
98
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
98
Step-down transformer, volt & amp goes:
Voltage goes down Amperage goes up
99
How many pulses in a second?
120
99
Step-up transformer voltage & amperage
Voltage goes up Amperage goes down
100
True/False Induction only works with Alternating Current
True
100
Autotransformer
Uses concept of self-induction to slightly change voltage in a circuit
101
What is the Typical incoming line voltage to the high voltage circuit?
220 volts
102
Autotransformer:
makes adjustments to voltage before it is stepped-up on low-voltage side of the high voltage circuit for safety
102
What is part B in the x-ray machine?
Autotransformer
102
What is part A in the X-ray machine?
Main power switch & circuit breaker Typical incoming line voltage is 220V
103
Autotransformer (step?):
B adjusts voltage before stepping up
103
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)
103
What is part D in the x-ray machine?
kVp Meter measures the Kvp (parallel circuit)
104
What is part E in the Xray machine?
Step-up transformer turn ratio 500:1 to 1000:1
105
What is part F in the x-ray machine?
mA meter Measures the amount of mA (series circuit)
105
What is part H in the x-ray machine?
x-ray tube thermionic emission- cathode (-) x-ray production- anode (+)
106
What is part G in the x-ray machine?
Rectification bridge (changes alternate to direct current)
106
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
107
What is part J in the Xray machine?
mA selection (resistors)
107
What is part K in the x-ray machine?
Step Down Transformer ratio 1:44 up to 5 amps
108
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
108
Half wave/self-rectified circuits
60 pulses a second 100% voltage ripple 30% average Kvp
108
single-phase/ full wave rectified
120 pulses a second 100% voltage ripple 30% average Kvp
109
3 phase/ 6-pulse generators
360 pulses per second 14% voltage ripple 91% average Kvp
110
3-phase/ 12-pulse generators
720 pulses per second 4% voltage ripple 97% average Kvp
110
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
111
How many filaments in x-ray tube?
2 filaments small= 1 cm large: 1.5-2 cm
111
What does focal spot do? Small? Large?
smaller focal spot creates sharper images large focal spot better for high heat x-rays (L-spine)
111
what is heat units for?
to measure how much heat the anode can withstand (a unit of measurement for anode heat capacity)
112
Thermionic emission occurs in the: What is thermionic emission?
Cathode “boils off” electrons from the filament due to high current flow and high resistance
112
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)
112
focal spot (in anode) is _% of filament?
5% (0.5mm-1mm)
113
Focal spot for hands/feet x-rays:
Small focal spot 1cm
113
What is space charge?
electron cloud forms around the filament when the rotor button is pushed
113
mAs directly controls the number:
of x-rays that exit the tube
114
Doubling mAs will:
double the amount of x-rays created
114
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
114
focal spot for lateral lumbar:
large focal spot 1.5cm to 2cm
114
Anode is what kind of charge:
positive side of the x-rays tube Xray production
115
What is struck by electrons in the x-ray tube?
the target in the anode (anode disk) very durable to high amounts of heat
115
Rotor: A part of what?
Anode Connects the shaft and spins when influenced by the stator (induction)
115
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
115
Main cause of x-ray tube failure?
arcing
115
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
116
What is the anode cooling chart purpose?
how long will it take for the anode to cool before making another exposure
116
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
117
HU (heat units) formula:
1.4 (constant/ don’t forget) x kVp x mA x s (seconds)
117
heat interactions:
99.5% of interactions at 60 Kv 99% of interactions at 100 kv
117
bremsstrahlung is responsible for the:
vast majority of x-rays
117
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
117
Bremsstrahlung:
“braking radiation” interactions with the nucleus
118
Characteristic:
projectile electron from CATHODE interacts with INNER shell electron it can be ejected
119
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
119
Any _____ can fill the vacancy in an inner shell electron, including ____ _______ outside the atom in characteristic
Electrons Free electrons
119
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
120
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
121
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
121
The result of characteristic cascade is x-rays at _____ _________
Specific energies K shell- 57, 66, 68, 69 KV L shell- 9,11,12 KV
121
(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
121
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)
122
Increasing the kVp will move:
the x-ray emission spectrum to the right due to the increase energy from x-rays
122
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
122
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)
123
Average KV after exiting the x-ray tube after:
filtration is about 1/3 of the kVp setting
124
Hardening the x-ray beam:
adding more filtration for weak x-rays thus increasing the average kVp
124
At the bridge current:
can flow
124
(T/F) free electrons outside of the atom can fill the vacancy of the inner shell?
True ANY electron
125
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 American college of radiography
126
what are accreditation agencies? what is it for radiology?
ensure education programs meet standards JRCERT
126
Which modalities do NOT use ionizing radiation?
MRI Sonography
126
what are professional societies? what is this for radiology?
Voluntary organizations that inform, represent & lead members ASRT
126
what are certification bodies? what is this for radiology?
Accreditation agency for radiography programs ARRT
127
what is MQSA? What is OSHA?
Mammography Quality Standards Act - regulates mammography services on federal level Occupational Safety & Health Administration Regulates workplace federally
127
Minimum of ___ views on all radiographs
2
127
what is the preferred imaging modality for pediatric patients?
sonography
127
patients that come to radiology are at low or high levels of the Maslow’s hierarchy?
low
128
what is the patient interaction for pediatrics?
129
what is the patient interaction for adolescents?
modesty (important) get them involved speak to them as an adult
129
For history taking, what are the two types of data? what are they?
subjective data (feelings/attitudes) objective data (measurable/physiologic)
130
wheel-chair transfers should occur with w/c at a ____ angle to the ____
45 degree table
130
where is the center gravity located?
at the level of the second sacral segment
130
what are the 4 principles of lifting?
communication patient does most work hold patient close watch for orthostatic hypotension (faint after standing to quickly)
131
what are the steps for a w/c transfer?
lock stretcher get patient involved use slider board three people needed for assisted transfer
131
what is the goal of immobilization techniques?
to reduce motion
132
what are the rules for trauma applications?
initial images should include the device device can only be removed after receiving permission
132
what is the main rule with restraints?
do not remove restraint without authorization do not restrain without permission
132
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
132
what is the range for hyperthermia? hypothermia?
Higher than 99.5 degrees Below 97.7 degrees
132
what is the average adult respiratory rate? child?
12 to 20 breaths per minute 20 to 30 breaths per minute
132
what are the pulse rates for adults? child?
60 to 100 bpm 70 to 120 bpm
132
what is tachypnea? bradypnea?
Fast breathing rate Slow breathing rate
133
what is tachycardia? what is bradycardia?
Fast pulse rate Slow pulse rate
133
what is the normal oxygen saturation for pulse oximeter?
95-100%
133
what is the normal range for blood pressure
120/80 systolic/diastolic
133
what is hypotension? hypertension?
Below normal blood pressure Above normal blood pressure
133
Oxygen is considered a ______ what is the color of the oxygen flowmeter?
drug Green
133
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
134
what is bacteria? classified: diseases associated with bacteria?
single celled organism reside in host as colony by shape strep throat & food poisoning
134
Infection Control - chain of infection
Pathogen Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host
134
what is a pathogen?
Bacteria Virus Fungi Parasite
134
Reservoir - 5 examples
People Animals Soil Food Water
135
Portal of Exit - 3 examples
Coughing/sneezing Bodily secretions Feces
135
Mode of Transmission - 3 examples
Direct contact Indirect contact Vectors
135
Portal of Entry - 4 places
Mouth Nose Eyes Cuts in skin
136
what is a susceptible host?
Elderly Infants Immunocompromised ANYONE!
136
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
136
what is fungi? common pathologies?
single celled or complex multicellular organism (small number of fungi cause disease in animals) athletes foot, ringworm, thrush
136
what are nosocomial infections? what is the percentage that affects patients?
inpatient (hospital infections) 5% of all inpatient contract
136
what is a parasitic protozoa? Classified by? where do they live?
Neither plant nor animal but larger than bacteria Classified by their movement Live on or in other organisms at expense of host
136
what parasitic disease that causes most deaths globally?
Malaria
136
what types are these? reservoir: Portal of exit: Direct Contact transmission: Droplet transmission: Blood-borne transmission: Airborne transmission: Vector transmission: Fomite transmission:
Place for pathogen to thrive Any route for pathogen to LEAVE reservoir Person-to-person contact Pathogen transferred thru air via droplet of body secretion (3-6 feet) Pathogen transmitted directly thru blood Pathogens smaller than 5 microns remain suspended in air long after person left area Insects transport pathogen Inanimate objects carry & spread disease
136
what are these? Portal of entry: Susceptible host - factors:
Any route that pathogen uses to enter host age, health, medication usage
136
what is the PPE (personal protection equipment) donning? removal?
gown, mask, goggles, then gloves gloves, goggles, gown, then mask
137
what is the recommended hand-washing time? hand rubbing?
40-60 seconds 20-30 seconds
137
what is surgical asepsis? medical asepsis?
elimination of all micro-organisms in an area reduce micro-organisms in area
137
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
137
what are four common surgical procedures in radiology?
chest tube placement dressing changes tracheostomy urinary catheterization
137
what are five common non-aseptic activities done in radiology?
nasogastric tubes (NG) urinal use bedpan use enema barium enema
137
what are the responsibilities of the tech in emergencies?
recognize an emergency Preserve life Avoid further harm Get help
137
what are the four different types of shock?
hypovolemic (loss of blood or fluids) Cardiogenic (Cardiac disorders (MI) Neurogenic (spinal cord damage) Vasogenic (anaphylaxis)
137
what should a technologist be alert for changes in patients
level of consciousness Demeaner Pain level Respiration Speech patterns
137
what are the four signs of stroke?
slurred speech dizziness loss of vision one-side paralysis
137
what is the generic name for drugs?
name given to drug when commercially available
137
what is a drug’s chemical name?
identifies chemical structure of drug
137
what is a drugs trade name?
name given to drug by company (brand name)
137
what are the classifications of these drugs? antiarrhythmics: Antidiabetic drugs: Antihistamines: Antiplatelets: vasodilators:
adenosine Metformin (Glucophage) diphenhydramine (Benadryl) aspirin nitroglycerin
138
what is a mild drug reaction?
Anxiety lightheadedness nausea vomiting itching
138
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)
138
what are severe drug reactions?
Bradycardia (<50 beats/min) cardiac arrythmias laryngeal swelling convulsions loss of consciousness cardiac arrest respiratory arrest no detectable pulse
138
what are moderate drug reactions?
urticaria bronchospasm angioedema hypotension Tachycardia (<100 beats/min)
138
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)
138
what are the five types of drug administration?
right drug right amount right patient right time right route
138
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
138
at what angle do we insert the needle for a venipuncture procedure?
insert needle next to vein at 15–30-degree angle
138
what is infiltration? what is extravasation?
medicine leaking into the soft tissue WITHOUT irritation medicine leaking into the tissue WITH irritation
138
what are these common medical abbreviations? C: IM: IV: PO:
with intramuscular intravenously by mouth
138
what are these common medical abbreviations? S: NPO: SC: Stat:
without nothing by mouth subcutaneously immediately
138
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
138
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)
138
most adverse reactions to contrast result from the:
osmolality of the agent
138
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
138
what are the contrast considerations?
renal function metformin (Glucophage) should be discontinued for 48 hrs before and after the use of iodine contrast
138
two types of radiopharmaceutical contamination:
external- spilled on Internal- ingested
138
ethical dilemmas occur when:
the correct choice is not clear and personal values may conflic
138
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
138
what is electronic medical record? (EMR)
medical records that are controlled by a single institution a patient can see their EMR apon request
138
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
138
what is the electronic health record? (HER)
medical records that are easily accessed by patient multiple medical institutions (patient portal)
139
what is the hospital information system? (HIS)
designed to share patient data: scheduling billing assigns patient number
139
what is the radiology information system? (RIS)
manages patient scheduling, billing, and orders in RAD department assigns accession number #
139
what is ICD-10-CM? CPT-4?
reason for the visit translated into a code codes used for specific diagnostic procedures and services
139
what patient information is protected? (9)
medical history current medical conditions prognosis current treatment financial information birth date social security number # address name
139
How is patient information protected?
administrative safeguards (security violations) physical safeguards (doors) technical safeguards (passwords) organizational safeguards (training)
139
HIPPA is enforced by:
the US Department of Health and Human Services
139
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)
139
10% of all medical negligence lawsuits originate from:
medical imaging (mis-diagnosis)
139
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
139
battery:
unlawful touching can occur w/o injury
139
false imprisonment:
a patient is restrained against there will
139
Defamation: two forms:
protected health information is released could cause: ridicule scorn contempt Written & Slander
139
libel: slander: fraud:
written spoken defamation intentional misrepresentation of facts that cause harm to individual
139
breach of privacy:
sharing protected health information without consent
139
negligence:
failure to use proper-care as reasonably prudent person would use under the same circumstance
139
standard of care:
RT’s put themselves at legal risk if they perform an act outside the standard of care
139
Standard of care is defined by:
the ASRT practice standards for medical imaging and radiation therapy
139
informed consent:
requires written consent for an invasive procedure
139
consent:
patients have the right to make informed decisions about their care
139
Res ipsa loquitur (REGISTRY/EXAM QUESTION)
“the thing speaks for itself” the only explanation for the injury is the medical procedure and staff
139
(REGISTRY/EXAM QUESTION) Respondeat superior:
“the master speaks for the servant” physician or institution is responsible
139
Patient bill of rights:
a list of patient rights developed by the American Hospital Association
139
What are water-soluble iodine contrast agents?
Ionic & non-ionic contrast media
139
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
139
How many bones in the foot? What is the breakdown of these bones?
26 total 14 Phalanges 5 metatarsals 7 tarsals
139
TMT stands for? is what?
Tarsometatarsal joint joint located at in between the base of metatarsal and the tarsals
139
Sesamoid bones are?
small detached bones
139
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
139
Mnemonic for Tarsals?
Come (calcaneus) To (talus) Colorado (cuboid) Next (Navicular) 3 Christmases (3 Cuneiforms)
139
What is the Sinus tarsi?
The space in between the calcaneus and talus articulation
139
Calcaneus articulates Distally with: Medially: What is the largest Tarsal bone?
Cuboid Talus Calcaneus
139
Deep depression between posterior and middle articular facets are:
Calcaneal sulcus
139
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
139
What kind of joints are the Metatarsophalangeal joints?
ellipsoidal or condyloid (modified)
139
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
139
What kind of joints are the proximal tibiofibular joint: Distal tibiofibular Classification: Mobility type:
plane or gliding Fibrous Amphiarthrodial (slightly moveable) syndesmosis Type
139
AP foot is what kind of projection?
Dorsoplantar (DP)
139
what is Gout?
form of arthritis excessive blood in joints Starts in first MTP
139
what are bone cysts?
bone lesions filled with clear fluid common in pediatric patients in the knee
139
what is Osgood-Schlatter disease?
bone/cartilage inflammation of the anterior proximal tuberosity common among boys 10-15
139
what is Paget disease?
disrupts new bone growth very dense and soft bone
139
what is the Don Juan fx?
fx to the calcaneus resulting from blunt force trauma
139
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
139
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
139
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
139
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
139
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
139
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
139
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
139
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
139
Criteria for AP ankle:
Patient supine CR midpoint between malleoli SID 40” 55 kVp 2-5 mAs
139
Criteria for lateral ankle:
Patient supine Mediolateral projection CR pointed at medial malleolus SID 40” 55 kvp 2-5 mAs
139
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)
139
The fibula is considered to be more _____
posterior
139
Sustentaculum tali means: Located?
support for the talus medial proximal aspect of the calcaneus
139
Which bone in the foot is most often fractured? what is the name of this fx?
base of fifth metatarsal jones fx
139
What is the strongest and largest tarsal bone?
calcaneus
139
What is the superior part of the patella called? The patella lies superior to the _____ ______
Base distal femur
139
Patella surface is also known as the:
intercondylar sulcus or trochlear groove
139
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
139
What is the difference between a mortise and an oblique ankle?
Mortise is rotated 15-20 degrees medially Oblique ankle is rotated 45 degrees
139
Which rotation has the intermalleolar line parallel to the IR?
AP Mortise ankle 15-20 degree internal/medial rotation
139
Which Malleoli is superior?
Medial Malleoli
139
Which tarsal bone makes up the mortise?
Talus + tibia
139
What is the CR for axial calcaneus? Is it Cephalic or Caudad?
40 degrees Cephalic to the long axis of the foot CR is at base of third metatarsal
139
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
139
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)
139
In the axial calcaneus the plantar surface of the foot should be ____ to the image receptor?
Perpendicular
139
The most posterior part of the calcaneus would be? A. Sinus Tarsi B. Tuberosity C. Trochlear D. Peritoneal
B. Tuberosity
139
How many views for the calcaneus? What are the names?
2 views Plantodorsal Axial Calcaneus Lateral Calcaneus
139
When performing a lateral for the 2nd toe digit, what side should be closest to the Image receptor? Why?
Medial side To reduce OID
139
Where is the sustentaculum tali?
medial proximal calcaneus
139
What does the medial cuneiform articulate with distally?
First metatarsal
139
What does the metatarsal articulate with distally?
proximal phalanx
139
Medial oblique foot would show:
sinus tarsi free of superimposition (also cuboid)
139
What do the heads of the metatarsal articulate with distally?
proximal phalanx
139
Where are the sesamoid bones located?
plantar surface of the first metatarsal
139
What is Pes planus?
Flat foot
139
What does the base of the metatarsal articulate with?
Tarsals
139
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
139
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
139
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)
139
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
139
How many tarsal bones are in the foot?
7 tarsal bones
139
The lateral oblique foot best shows?
The base of the first metatarsal
139
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
139
AP ankle the plantar surface is ____ to the IR?
Perpendicular
139
Lateral foot the plantar surface is ____ to the IR? How about standing?
Perpendicular supine Parallel for standing
140
The second metatarsophalangeal joint is what kind of joint?
ellipsoid or condyloid Synovial Diarthrodial (freely moveable)
140
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
140
When would you best see a medial displacement fracture? (bone protruding towards medial side)
AP view
140
If there’s a posterior displacement, what view would best display that?
Lateral
140
What is the name of the fracture for the base of the fifth metatarsal?
Jones or nightstand fx
140
What joint is most affected by gout?
First MTP joint Form of arthritis (execessive blood in joint) that may be hereditary
140
What is the Don Juan fx?
fx in the calcaneus
140
Osgood Slatter is?
inflammation of bone/cartilage of anterior proximal tibia (tibial tuberosity) most common in boys 10-15
140
Inversion: AKA?
Inward turning/bending of the ankle aka Varus
140
Eversion: AKA?
outward turning/bending of ankle aka valgus
140
Dorsiflexion:
Dorsal/anterior surface of foot flexed upwards
140
Plantarflexion:
Posterior/Sole of foot is flexed downwards (tippy toes)
140
Posterior foot name:
Plantar surface Sole of foot
140
Anterior foot name:
Dorsum pedis (top of foot)
140
During most long bone exams, the part being radiographed should be _____ to the IR and ____ to the CR.
Parallel to IR Perpendicular to CR
140
What is the superior portion of the foot called?
Dorsum Pedis
140
Is the dorsum pedis considered anterior or posterior part of the foot?
Anterior
140
How many degrees for a lateral knee?
5-7 degrees cephalic (mediolateral)
140
(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)
140
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
140
What is the CR for AP foot? What is the angle?
base of 3rd metatarsal 10 degrees posteriorly
140
Which views do we use for patella?
Inferosuperior Hughston Settegast Merchant (Mayo uses Merchant)
140
What views do we use for intercondylar fossa?
Rosenburg (PA flexion- for tunnel view)
140
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)
Supine flexion 45 degrees (supine keyword, relaxes the Quads)
140
What is considered a shock absorber between the femoral condyle and the tibial articular casset?
Meniscus
140
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)
140
What knee oblique shows the proximal tibiofibular joint?
Internal/ medial oblique (shows the head/neck of fibula free of superimposition)
140
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
140
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
140
What is proximal to the tibial plateau? A. The tibia condyles B. The tibial tuberosity C. intercondylar fossa
C. Intercondylar fossa
140
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
140
What is the CR for AP knees?
1/2” distal to the apex of the patella
140
These extra two bones underneath the first metatarsals?
Sesamoid bones
140
This is the name of the fossa on the distal posterior femur?
Intercondylar fossa
140
what is the saying for the sunrise view?
the merchant Houghton likes to watch the sunrise in Settegast
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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
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What kind of joints are the Tarsometatarsal joints:
plane or gliding
140
During a cervical myelogram what position do we placed the patient in for the best image
Prone
140
What type of articulation is primarily used for arthrograms?
Synovial but more specifically diarthrodial
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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
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(t/f) Standard precautions must be followed for a T-Tube Cholangiogram placement
True (sterile)
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What kind of joint is an amphiarthrodial?
distal tibiofibular joint (limited movement)
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What is the insertion point for a myelogram LP?
L3-L4 subarachnoid space
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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
140
What is the common reason for a myelogram?
to examine the spinal cord/nerve branch and find possible pathologies
140
What is the name of the scope for a ERCP?
duodenoscope
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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
140
How long does it take for contrast not to be radiographically detectable in a myelogram?
24 hours
140
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)
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when it comes to humerus injections, how do we want the arm rotated? Why?
external rotation to see the joint space (glenoid cavity)
140
What is the name for the ruler?
Bell-Thompson
140
HSG contraindications:
pregnancy acute pelvic inflammatory disease active uterine bleeding
140
(T/F) bile is sterile.
False. Outside of the standard precautions, bile is not sterile.
140
_______ 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
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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
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(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
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(T/F) Arthrogram should be a sterile procedure.
True We need to prep the skin for the needle
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Myelogram is for?
abnormality in spinal cord spinal stenosis map out for spinal chemo
140
What is a necessity during a cervical myelogram?
patient either prone/fowler with chin hyperextended to prevent contrast going to the brain
140
What does ERCP stand for? What is it for?
endoscopic Retrograde Cholangiographic pancreatography examine the biliary and pancreatic ducts
140
What is a hysterosalpingogram?
demonstrates uterus/fallopian tubes
140
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
140
How do we position for a downside Judet view?
patient supine 45 degree oblique LPO/RPO 2 inches inferior + 2 inches medial to downside ASIS
140
How do we position for an upside Judet view?
patient supine 45 degree oblique LPO/RPO 2 inches inferior to ASIS
140
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
140
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
140
What view best shows a lateral fracture?
an anterior/posterior (AP) projection
140
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
140
In a frog position the femoral neck is _____ to the image receptor
parallel
140
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)
140
How much does the femur slant in?
5-15 degrees
140
What does the femur articulate with proximally?
acetabulum
140
When would we use the Nakayama method? What does it replace?
Trauma views it replaces our cross-table
140
What can we use for a cross table lateral projection to improve the quality of the image?
add filter & grid
140
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)
140
What is the CR for inlet?
40 degrees caudad CR ASIS
140
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
140
where is the innominate bone located at? also known as?
at the hips (left or right there are two) ossa coxae
140
Where do you inject for a Myelogram (cervical)? What is this called?
C1-C2 Subarachnoid space Cisternal puncture
140
What is Lordosis?
increased concavity (lumbar) exaggerated lumbar curvature (swayback)
140
What is Scoliosis?
exaggerated lateral curvature of the spine
140
What is Kyphosis?
increased (exaggerated) convexity in the thoracic area (humpback)
140
what is concave? what is convex?
rounded inward or depressed surface like a cave rounded outward or elevated surface
140
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)
140
What makes up the zygapophyseal joint?
superior and inferior articular processes
140
What are primary curves?
convex curves 1st primary curve: thoracic 2nd primary curve: sacral
140
What are compensatory curves?
Concave curves 1st compensatory curve: cervical 2nd compensatory curve: lumbar
140
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)
140
Where are the laminae located? What does it connect?
connects the transverse process to the spinous process (posterior to transverse anterior to spinous)
140
In a cervical exam when would we see the zygapophyseal joints? (C2-C7)
true lateral 90 degrees to the midsagittal plane
140
When do we see the C1 & C2 Z joints?
In an AP open mouth
140
In a cervical exam when would we see the foramen?
45 degree oblique (15 cephalic AP)
140
How do we position for an open mouth?
upper incisors and base of skull lined up
140
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
140
What is the name of the joint that articulates/connects the skull and the atlas?
Atlantooccipital joint
140
What is the purpose of the transverse foramen in the cervical spine?
For the nerve roots to connect to the brain
140
How many zygapophyseal joints do we see in a lateral (cervical)?
5 Z joints (C1 & C2 are seen in AP open mouth)
140
(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
140
What skull line would we use to position for Judd and Fuchs?
MML (Mentomeatal line)
140
What is the space called that we inject myelograms? What level of the spine is this?
Subarachnoid space Cervical: C1-C2 Lumbar: L3-L4
141
Which foramen is seen in PA cervical oblique? (RAO/LAO)
downside (closest to IR) (marker is on side down)
141
Which foramen is seen in AP cervical oblique?
foramen farthest from IR (upside) (marker on side up) (RPO/LPO)
141
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)
141
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)
141
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)
141
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)
141
What level is the vertebral prominence 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)
141
At what level is the mastoid tip located?
C1 (one inch inferior to EAM)
141
What is the Jefferson's fx?
fx of C1 Ant & Post arches from landing on feet/head abruptly (AP open mouth best demonstrates this)
141
What is the clay shoveler’s fx?
avulsion fx of C6 to T1 from hyperextending neck (best demonstrated in a lateral C spine)
141
What is a compression wedge fx?
collapse of T/L vertebral bodies from flexion vertebral shapes like a wedge instead of a block
141
Scoliosis can be caused by:
Neuromuscular disorder congenital (happens from birth) idiopathic (just cause)
141
When do you see the zygapophyseal joints in a thoracic spine?
70-75 degree oblique from the midsagittal plane
141
When do you see the foramen in the thoracic spine
90 degrees to the midsagittal plane (true lateral)
141
what helps form the intervertebral foramen?
inferior vertebral notch & superior vertebral notch
141
(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
141
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
141
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
141
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)
141
What would we do for a functionality test of the spine? (stability)
flexion and extension
141
What is the nucleus pulposus? What is the annulus fibrosis?
inner layer of disk outer layer of disk
141
Where is the subarachnoid space?
L3-L4
141
LPO best demonstrates _____ lumbar Z joints. Upside or downside?
left zygapophyseal joints downside
141
RPO best demonstrates _____ lumbar Z joints. Upside or downside?
right zygapophyseal joints downside
141
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
141
What is an intrathecal procedure?
Administering drugs through the spinal canal (Ex: MP with chemo)
141
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
141
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.
141
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
141
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
141
If we are doing a lateral lumbar spine, what plane is perpendicular to the IR?
mid-coronal plane
141
What connects the arch for the spinous process to the transverse process? What connects the vertebral body to the transverse process?
Laminae pedicle
141
What is the pathology that involves the PARS? What projection best shows this?
Spondylosis Oblique lumbar
141
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
141
What is Spondylosis?
a fx (defect) to the PARS interarticularis (“Scottie dog wearing a collar”) Most common at L4-L5
141
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
141
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
141
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
141
What is the CR for lateral coccyx?
3-4 inches posterior to ASIS 2 Inches distal from ASIS (no more than 4!)
141
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
141
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
141
What does flex/ext show? what does side bending show?
posterior/anterior displacement lateral displacement
141
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
141
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
141
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
141
At what angle (oblique) does the SI joints open up at?
25-30 degrees oblique
141
At what angles do the zygapophyseal joints open up at?
45 degree oblique
141
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)
141
If we go from supine to prone what happens to the angle on spine?
changes from cephalic to caudad (Vice versa)
141
What is the posterior end of the rib called? What is the anterior end of the rib called?
vertebral end sternal end
141
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
141
The vertebral end of the rib has four parts:
head neck tubercle angle
141
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
141
Costotransverse ribs articulates between:
tubercle of the rib and the transverse process of the spine
141
Posterior pain is what rib projection? Anterior pain is what rib projection?
AP PA
141
Patient walks in the ER with anterior left upper pain what oblique would we use? What is the projection?
RAO PA projection
141
Patient walks in the ER with left lower posterior pain, what oblique best shows this? What is the projection?
LPO AP projection
141
Patient walks in the ER with right anterior pain what oblique would we use? What is the projection?
LAO PA
141
RAO best shows what axillary?
left axillary
141
LPO shows what axillary?
left axillary
141
RPO best shows what axillary?
right axillary
141
LAO best shows what axillary?
right axillary
141
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)
141
What happens to the diaphragm on inspiration? What happens to the diaphragm on expiration?
diaphragm moves down diaphragm moves up
141
What pathologies can you see specifically from expiration x-rays?
pneumothorax hemothorax & Pulmonary contusions
141
which of the following positions will best demonstrate the ribs of the left thorax?
RAO & LPO
141
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)
141
The ___________ _____ is the only articulation between the shoulder girdle (upper extremity) and the bony thorax
sternoclavicular joint
141
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)
141
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)
141
If the patient is able to stand what view best shows hemothorax in the right lung?
PA chest on expiration
141
Why are upper ribs best taken erect?
allows gravity to lower the diaphragm even more
141
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)
141
In Compton scatter the x-ray photon ceases:
to exist
141
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
141
In photoelectric effect the energy in excess of binding energy is given to:
the inner-shell electron
141
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)
141
In Compton scatter the electron absorbs:
all the incident x-rays energy
141
In Compton scatter _________ interacts (strikes) with an:
incident x-rays outer shell electron
141
In Coherent when an incident x-ray interacts with an orbital electron it is:
Thompson
141
In Compton scatter some of the energy excess of binding energy is given to an:
outer shell electron
141
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)
141
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
141
In Compton scatter remaining energy is ______ as a new x-ray and leaves the _____ in a random direction
reemitted atom
141
Both the photoelectric effect and Compton scatter lead to
ionization (the removal of an electron from orbit and net positive charge to the atom)
141
In coherent scatter the orbital electron reaches a temporary:
state of excitation
141
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)
141
mA is limited by what?
Focal spot size
141
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)
141
In coherent scatter when an incident x-ray interacts with an entire atom is it called:
Rayleigh
141
In coherent scatter when the energy of the incident photon is ______ than the ________ no ________ occurs
less binding energy ionization
141
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
141
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
141
mAs is the primary controller of:
intensity/quantity in the remnant beam
141
In coherent scatter the incident x-ray continues:
in a new direction
141
mAs math: 100 mA and .5 sec
50 mAs
141
In coherent scatter no _____ occurs
energy transfer
141
How do we reduce motion?
setting the shortest time while maintaining same mAs output (Shorter time requires more mA)
141
To calculate the mAs we:
multiply mA x Time
141
Attenuation is absorption & scattering as a result of:
photoelectric effect compton scatter coherent scatter
141
mAs math: 300 mA and .2 sec
60 mAs (300 x .2)
141
Radiologic time is measured in?
seconds .25 secs or 250 ms or 1/4 second (all the same)
141
mAs math: 200 mA and .2 sec
40 mAs
141
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
141
the small increase of 15% kvp will?
double the exposure to the image receptor
141
What is penumbra? Is it good or bad?
blurry or unsharp edges of the shadow or image bad
141
Doubling in mAs leads to:
doubling of intensity or quantity
141
Kilovoltage is the measurement of
electrical force
141
What does kVp control?
the quality of the x-ray beam
141
when the kvp increases 15% patient exposure increases by:
1/3
141
kVp math: increase kVp 15% of 70 kvp: decrease kVp 15% of 100 kVp:
80.5 (70 x 1.15) 85 (100 x .85)
141
kVp means?
kilo voltage peak (the highest value in electrical generator)
141
What does a higher kVp do?
increase the x-ray’s ability to penetrate through a particular tissue
141
OID stands for?
object image distance (patient distance from IR)
141
What is remnant radiation?
the part of the x-ray beam that has passed through the patient (Leftovers from the primary beam)
141
SID stands for?
source to image distance (x-ray tube to IR)
141
What is preferred, optimal kVp or minimal kvp? what is higher in kVp out of the 2?
optimal kVp
142
SOD stands for?
Source to object distance (x-ray tube to patient)
142
What is umbra?
is the ‘‘pure” shadow or image of uniform darkness (crisp shadow line)
142
What is distortion?
misrepresentation of the size or shape of an object
142
As a radiographer do we want penumbra?
no, we want to minimize this
142
What is elongation?
the object appears to be longer than its actual size
142
How much of the primary beam becomes remnant radiation?
less than 1%
142
What is shape distortion? What are the types?
the difference between the actual shape of the object and the shape of its projected image (Difference between actual object shapes & the image shape) Elongation & foreshortening
142
What affects contrast?
kVp (low kvp = high contrast) image receptor (grids) computer algorithms (AEC) patient factors (tissue density)
142
What is the relationship with SID and pneumbra & spatial resolution?
the greater the SID the smaller the pneumbra & higher the spatial resolution
142
what is foreshortening?
the object appears to be shorter than its actual size
142
How do we calculate the mag factor?
dividing SID/SOD
142
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
142
How can size distortion (magnification) be reduced?
decreasing OID or increasing SID
142
What can contrast be referred to as? which is?
gray scale the number of different brightness levels in a x-ray
142
What is size distortion? What is it also called?
misrepresentation of the size of the object aka magnification
142
How can we reduce shape distortion?
properly aligning the: tube (Object) part Image receptor
142
Mag Factor math: SID= 72 SOD=66
1.09 mag factor
142
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)
142
what affects spatial resolution? (5)
motion focal spot size distance (SID, SOD, OID) patient factors (OID or motion) angulation (elongation/foreshortening)
142
What is postprocessing?
adjustment of the image by a rad tech or rad at a workstation
142
What is noise?
undesirable image input that interferes with ability to visualize the x-ray
142
How is resolution (spatial resolution) measured?
using a line-pair test tool (measured in line-pairs per millimeter or LP/mm)
142
What is contrast?
the difference between 2 adjacent brightness levels
142
What can be used to increase subject (patient) contrast?
barium & iodine
142
Low contrast = high contrast =
long scale = low kVp (many greys) short scale = high kVp(black & white)
142
What is SNR? What should it always be greater than?
Signal to noise ratio one
142
More kvp = ____ scatter more volume = _____ scatter
more more (why collimation is key, and optimal kVp)
142
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
142
What causes quantum mottle? What is usually the cause?
low mAs low kVp or difficult anatomy to penetrate usually low technique, especially mAs
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What is the rule regarding tissues thickness?
for every 4cm of tissue thickness 50% of x-ray beam is attenuated
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Low contrast = High contrast=
Long scale & low kvp Short scale & high kVp
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What is window level? What is window width?
post-processing of image brightness post-processing if image contrast
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For digital systems, what is preferred quantum mottle or scatter?
Scatter (the digital systems are very good at filtering out too much information)
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What does high tissue atomic number mean for attenuation?
means more attenuation due to more interactions (more electrons higher chance for photelectric absorption)
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What does collimation do to radiologic contrast? How?
Increases contrast Decreases amount of area irradiated which thus reduces scatter
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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
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What is the collimator?
adjustable lead shutters
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Who sets the standards for optimal contrast/brightness settings?
the radiologists
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Collimation _____ patient dose by:
decreases limiting the volume of tissue exposed to radiation
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What is the aperture diaphragm?
fixed opening between the x-ray tube & collimator box
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Light/radiation field can be off by:
+/- 2% of the SID
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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
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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)
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Scatter occurs commonly with:
large field sizes increased tissue volume
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What does scatter do to image receptor exposure?
scatter increases exposure to the IR (also decreases contrast & increase noise ALL BAD)
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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
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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
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What is scatter also known as?
Secondary radiation
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What affects detail?
focal spot size penumbra
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What do grids do?
affect scatter reaching the IR, not the PRODUCTION of scatter
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What is the number one source for of occupational exposure?
scatter radiation
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How do we calculate grid frequency?
number of lead strips per inch (100/inch)
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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)
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How are grids constructed?
alternating strips of lead & interspace material (AL most common but can also be plastic)
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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
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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
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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
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Focused gridlines are directed to:
a convergence point (generally the focal spot)
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Grids can be _____ _____ or ______ (different types of grids)
linear crosshatched focused
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Grids are designed to be used (need to be)
at a specific distance from the focal spot
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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
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modern grids attenuate:
70-80% of scattered photons
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Grids allow the ______ ______ to pass through ______ _______ and absorb ____ ______
primary beam lead strips scattered x-rays
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Motion will?
blur the gridlines
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Grids should be used:
part thickness greater than 10cm kVp greater than 70 large field sizes
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What type of grid errors are there? what is the worst case scenario?
off-center off-level off- focus upside down (worst outcome)
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increasing kVp by 15% _____ image receptor exposure but only increases patient dose by _______
doubles 1/3 (kVp math will be on the test)
142
What does kVp affect?
the x-ray’s beam’s ability to penerate tissues
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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
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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
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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
142
What is total filtration? what filtration is not apart of this?
added + inherent filtration compensating filtration
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two types of filtration:
inherent (built-in (x-ray tube glass, cooling oil, beryllium window) added (usually aluminum but can be copper)
142
What exams are compensating filters used on?
x-table shoulder x-table hip swimmers c-spine
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The primary purpose of beam filtration is? (filtration)
to reduce patient exposure
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what is the required filtration? what kind of filtration is this?
2.5 mm Al/Eq (legally) total filtration
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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
142
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
142
what does filtration do to the average kVp? why?
increases the average kVp bc of the removal of weak x-rays by filtration
142
What is compensating filtrations purpose?
to even out body parts that are inherently uneven
142
How is penetration measured?
half-value layers (HVL) (QC stuff)
142
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
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Compensating filtration is not considered to be apart of:
inherent or added filtration
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what is hypersthenic? what do we do to technique?
large body type, increased fatty tissue increase kVp
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What is sthenic?
a healthy average person
142
The caliper should:
measure along the central ray
142
What is hyposthenic? what do we do to technique?
thin but healthy reduce mAs
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What is asthenic? What do we do to technique?
thin and ill/old reduce kVp
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Technique for fiberglass casts: Casts technique should: Technique for dry casts: Technique for wet casts:
no change to the technique be increased for plaster casts double the kVp (+15%) triple the kVp (+15% kvp then +15% again)
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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
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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#)
142
What is the caliper?
device to measure a part thickness (accurately)
142
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
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What should we expect in postmortem patient in regards to technique & anatomy?
increase technique expect less air in the chest and increased fluids
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what is the average abdomen thickness? AP: LAT:
AP: 22 cm Lat: 30 cm
142
Contrast agents only affect:
image contrast
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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)
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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
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for additive disease that have bony growth we increase:
kVp for bony growth in order to penetrate additional bony tissue
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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
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What is the typical anode angle?
15-17 degrees for diagnostic imaging (typical anode angles for diagnostic imaging range from 15-17 degrees)
142
Additive diseases require:
an increase in technique due to increase fluid, soft tissue, & bony growth
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for additive diseases with soft tissue, we need to increase:
mAs to maintain subject contrast for soft tissue disease
142
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
142
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
142
additive disease, bony growth:
acromegaly: 8-10 kVp osteoarthritis (DJD) 8% kVp osteochrondroma: 8% kVp osteopetrosis: 8-12% kVp pagets disease: 8% kVp
142
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)
142
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)
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What are the typical focal spot sizes (cathode)? What are the typical effective focal spot sizes?
small focal spot: 1 cm large focal spot: 1.5cm-2cm small effective focal spot: 0.5-1mm large effective focal spot: 1-2mm
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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)
142
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)
142
How would an increase in SID affect IR exposure?
Decrease IR exposure
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The anode-heel effect is more significant when using:
larger field sizes shorter SID’s
142
What does an increase in SID primarily affect?
Size distortion - decrease because of magnification
142
What factors does an increase in SID affect?
Size Distortion: Decrease (Primary controller) IR Exposure: Decrease Sharpness: Increase
142
How would an increase in OID affect IR exposure?
Decrease (Air Gap)
142
An increase in SID would do what to sharpness?
Increase
142
What does an increase in OID primarily affect?
Sharpness - decrease
143
Increased alignment does what to shape distortion?
Decrease
143
What affects shape distortion?
Alignment
143
What factors are affected by an increase in motion?
Subject contrast goes down Noise (blur) goes up Sharpness goes down
143
How would an increase in OID affect subject contrast?
Increase (Air Gap)
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What primary factors are affected by an increase in SOD?
Sharpness increase Size Distortion decreases
143
How would an increase in OID without air gap technique affect noise?
No effect on noise or contrast
143
How would an increase in OID with air gap technique affect noise?
Decrease (Scatter)
143
Increased OID with air gap leads to ______ exposure to the IR
Decreased because there is less scatter hitting the IR
143
Increased OID leads to ______ penumbra and ______ spatial resolution
Increase penumbra Decreased spatial resolution (detail and sharpness)
143
What affects spatial resolution?
SID
143
Where is the SID measured from?
Focal Spot to image receptor
143
What is the inverse square law used for?
Used to determine intensity of new exposure (mGy or mSv)
143
Why is the measuring tape on the collimator cut?
Accounts for focal spot to collimator
143
What is the square law used for?
Used to maintain IR exposure (old/new)
143
What is the relationship of SID/SOD/OID?
SID = SOD + OID
143
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)
143
What is a primary factor of increased SOD? (2)
Increased sharpness & decrease size distortion (lower penumbra)
143
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)
143
What is the result of increased motion? (3)
Decreased subject contrast Increased noise (blur) Decreased sharpness
143
What is a primary result of increased alignment?
Decreased shape distortion
143
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)
143
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)
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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
143
What affects spatial resolution?
SID affects (more SID less OID) Time not affected KVP not affected
143
Why is the measuring tape on the collimator cut?
To account for the distance within the x-ray tube (focal spot to the collimator)
143
What are the relationships between OID/SOD/SID?
OID + SOD = SID SID - OID = SOD SID- SOD =OID
143
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
143
What is the SID measured from?
From the source (x-ray tube/anode focal spot) to the image receptor (distance)
143
What happens when AEC encounters metal?
Time motion patient exposure IR exposure all increase.
143
Density settings of ____ are needed to see a visible change.
+2 (1=25%)
143
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.
143
Backup time should be to ____% of anticipated time.
150% Ex: Anticipated: 0.4 sec; Backup Time: 0.6 sec.
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Where is the AEC detector located?
Between the patient and the image receptor and use ionization.
143
How many ionization chambers do most AEC Systems consist of
3 (the cells on the wall bucky)
143
The only thing AEC controls is:
time
143
What does the air-gap technique do?
increases size distortion (magnification) improves contrast (decreasing scatter) decreases detail (increased penumbra)
143
What’s the primary reason for technique charts?
To maintain consistency
143
Air Gap Technique is based on creating a gap by increasing the ___
OID
143
What is magnification?
Size distortion
143
how do we calculate the magnification factor?
SID/SOD
143
How do you find the objects actual size?
divide projected size/magnification factor
143
How would you find the size of an anatomy on a projected image?
multiply actual size x mag factor
143
Elongation is:
anatomy appearing longer than normal (angle on tube or IR)
143
Foreshortening is:
part appears to be shorter than normal (part is angled)
143
What causes shape distortion?
Misalignment of tube, image receptor, or part
143
We should always have a minimum of ____ views
2
143
What is Cieszynski’s Law?
angle 1/2 of the part’s angle to minimize distortion through elongation/foreshortening
143
Increase SID = ____ IR Exposure why?
decreased bc of beam divergence
143
Motion is generally caused by:
Patients
143
increased focal spot size will _____ sharpness
Decrease. (It is the one and only controller?)
143
Off-centering is the same as: why?
Angling bc of the beam divergence
143
Increasing the OID will decrease: A. Shape distortion. B. Subject contrast. C. Size distortion. D. Sharpness.
D. Sharpness.
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Increasing collimation will result in increased: A. IR Exposure B. Subject contrast C. Noise D. Spatial Resolution
B. Subject Contrast
143
The smaller the focal spot size, the ______ spatial resolution
Higher
143
Decreasing the focal spot size will result in: A. Increase contrast. B. Decrease contrast. C. Increase sharpness. D. Decrease sharpness.
C. Increased sharpness
143
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.
143
Reducing SID but adjusting mAs to compensate will result in decreased: A. Subject contrast. B. Sharpness. C. Noise. D. Size distortion.
B. Sharpness.
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Decreasing kVp will result in: A. Increased sharpness B. Decreased sharpness C. Increased IR Exposure D. Decreased IR Exposure
D. Decreased IR EXPOSURE
143
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.
143
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
143
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
143
Where is the Gabella located?
smooth, raised triangle process superior to eyebrows & bridge of nose
143
Where is the nasion located?
at the junction of the two nasal bones & the frontal bone
143
Where is the acanthion located?
midline junction where the upper lip and nasal septum meet
143
What is the thickest/densest part of the cranium?
petrous portion of the temporal bone pyramid shaped
143
Where is the gonion located?
lower posterior “angle” of the mandible “jawline”
143
What is the pinna? What is it also referred to as?
large flap of ear made of cartilage aka auricle
143
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)
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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 & EAM Lat skull you can cut off the mandible * Lateral sinus can cut off the posterior skull (Positioning is RAO but cranium in lateral)
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How do the Caldwell, exaggerated Caldwell, and PA skull look compared to each other?
15 degree caudad Caldwell puts petrous ridge in bottom 1/3 of orbit * exaggerated Caldwell places petrous ridge completely out of the orbit * PA skill has the petrous ridge completely in the orbit *
143
What is mesocephalic? What is Brachycephalic? What is dolichocephalic?
average shaped head shaped at an angle of 47 degrees wide skull, greater than 47 (54) skinny skull, less than 47 degrees from parietal tubercles
143
What bone houses the hearing organs?
Temporal bone (Mastoid portion)
143
What does the occipital bone articulate with?
6 bones: 2 parietals 2 temporals 1 sphenoid 1 atlas (C1)
143
What does the parietal articulate with?
5 cranial bones: 1 frontal 1 occipital 1 temporal 1 sphenoid 1 (opposite parietal)
143
What does the temporal articulate with?
3 cranial bones: 1 parietal bone 1 occipital bone 1 sphenoid bone
143
What does the sphenoid articulate with?
all 7 of the cranial bones & 5 facial bones acts as the anchor for the cranium
143
What does the ethmoid articulate with?
2 cranial bones & 11 facial bones 1 frontal bone 1 sphenoid bone
143
What does the frontal bone articulate with?
4 cranial bones: 2 parietals (L & R) 1 sphenoid 1 ethmoid
143
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
143
What is GAL? What is IPL?
Gabellaveolar line Interpupillary line
143
What line is parallel or perpendicular in the SMV projection?
IOML is parallel to IR GAL is perpendicular
143
How is the image receptor for the skull projections?
All are portrait except for lateral cranium
143
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
143
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
143
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
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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
143
What bones make up the orbit?
3 cranial bones & 4 facial bones C: frontal, sphenoid, & ethmoid F: Maxilla, zygoma, lacrimal, palatine
144
What is the widest portion of the skull?
parietal tubercles (eminences)
144
What bone contains the sellae turcica? What organ lies in the sellae turcica?
Sphenoid bone Pituitary gland
145
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)
146
Where is the pituitary gland?
in the sellae turcica of the sphenoid bone
146
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”
147
Where is the CR entering or exiting in the Caldwell projection?
CR is exiting the nasion (15 caudad/ 30 caudad exaggerated)
147
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
148
Where is the CR entering or exiting in the exaggerated Caldwell projection?
CR is exiting the nasion 30 caudad
148
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
148
Where is the Maxillary sinus located?
2 maxillary sinuses in both maxillae (only sinus that correlates to facial bones)
149
What views are for cranium?
PA skull Lateral skull Caldwell + exaggerated Caldwell Townes or Haas
149
What views are for facial bones/sinuses?
Lateral facial bones Waters Caldwell
150
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)
150
Where is the ethmoid sinus located?
lateral masses of the ethmoid bone (anterior, middle, and posterior portions)
150
Where is the sphenoid sinus located?
body of Sphenoid bone, inferior to sellae turcica
150
Where is the frontal sinus located?
Frontal bone (posterior to Gabella, rarely symmetric & mostly separated by a septum)
151
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)
151
Should the orbital grooves be superimposed in the PA projection of the skull?
No Only superimposed in a right lateral cranium
151
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
151
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
151
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
151
What is best shown 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)
151
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)
151
What does the Haas do the x-ray? What does the Townes do to the x-ray?
enlarge the occipital bone enlarge the orbits
151
For the parietoacanthial projection, where does the CR exit?
Acanthion (hint the name parietoacanthion)
151
For a modified parietoacanthial projection how many degrees does it place the OML to the IR?
55 degrees (37 for regular waters)
151
What is the tragus?
external structure that acts as a shield to ear opening located anterior to EAM
151
What is the name of the two part articulation between the skull and the atlas?
atlanto-occipital joint
152
What are the two lateral oval convex processes located on each side of the ______?
Foramen magnum A: Occipital condyles
152
What is a tripod fracture?
a blow to the cheek resulting in a fx to the zygoma in 3 places
152
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
152
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
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What is bile?
made by the liver breaks down fats
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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)
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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)
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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)
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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)
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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)
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What does angio mean? What does Choles mean? What does Cysto mean?
duct relationship with bile bag or sac
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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)
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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)
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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)
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What is the sphincter of Oddi? Also known as?
muscle fibers of the duct walls leading into the duodenum hepatopancreatic sphincter
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How do you oblique for an Upper GI study?
40-70 degree anterior oblique for RAO 30-60 degree posterior oblique for LPO
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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
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What are the ionized 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
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What is anterior & posterior when it comes to the trachea/esophagus?
trachea is anterior to the esophagus
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Where is the gallbladder located? What is its main purpose? what are the 3 parts of the gallbladder? how much bile can it hold?
inferior to liver store bile, 2. concentrate bile (Hydrolysis: removal of water) (choleliths: gallstones), 3. contract 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
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What do these mean? Chole: Cysto: Angio: Choledocho: Cholangio: Cholecyst:
Relationship with bile Bag/sac duct Common bile duct bile ducts gallbladder
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What do these terms mean? Cholecystography: Cholangiography: Cholecystangiography:
Radiography of gallbladder radiographic study of biliary ducts radiography of both gallbladder & biliary ducts
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In LPO how is the barium in the stomach?
Barium in the fundus Air in the pylorus
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In RAO how is the barium in the stomach?
Barium in the pylorus Air in the fundus
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Which oblique places air in the fundus?
RAO
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What oblique puts the esophagus between the heart & thoracic spine?
RAO
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What oblique places barium in the pylorus of the stomach?
RAO (has to be prone)
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What oblique places the esophagus in between the hilar region & thoracic spine?
LAO
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What view superimposes the esophagus over the spine?
AP or (PA)
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Which oblique places barium in the fundus of the stomach?
LPO (has to be supine)
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Which oblique places air in the in the pylorus of the stomach?
LPO (has to be supine)
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What is chymes?
semifluid mass as a result of mixing (churning) of stomach contents & stomach fluids
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Where is the duct or Wirsung? Also known as?
Duct leading into the pancreas Pancreatic duct
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Which view of the stomach best displays the retrogastric space?
R lateral (upper GI) view (lateral)
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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
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How does the fundus lie in the stomach?
fundus is posterior
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Barium is a:
colloidal suspension (not a solution)
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What is rugae? where is the location?
internal lining of stomach thrown into numerus mucosal folds (when the stomach is empty) greater curvature
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What helps food gets down the esophagus?
peristalsis (gravity + involuntary movement)
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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
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Where is the cardiac antrum at?
distal portion of esophagus, that curves sharply into expanded portion of the esophagus (right before the esophagogastric junction)
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Where is the angular notch? also known as:
ring like area that separate the body and pylorus region incisura angularis
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What is GERD?
gastroesophageal reflux disease
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What is an accessory organ? What is an example?
not a digestive organ but aids in digestion salivary glands, pancreas, liver, & gallbladder
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What is used to prevent scatter radiation in fluro?
Bucky slot shield (lead drape shield, exposure patterns, lead aprons)
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What is the 3 cardinal rules of radiation protection: (3)
Time Shielding Distance (most crucial)
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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)
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What is the special name for having gallstones?
choleliths (biliary calculi)
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What is best shown in a RAO stomach?
barium in the pylorus air in the fundus
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What is a trichobezoar? (cool/ scary thing)
Mass of ingested hair
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What are the 3 parts of the pharynx?
Nasopharynx (nose area) Oropharynx (mouth) Laryngopharynx (throat area)
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AP oblique that best demonstrates hepatic flexure + ascending colon? What is the PA oblique? What is the CR?
AP: LPO PA: RAO at crest
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What is the AP oblique that best shows splenic flexure + descending colon? PA oblique?
AP: RPO PA: LAO
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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
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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
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Where is the barium while the patient is PA? Where is the air? Why?
B: transverse & sigmoid colon A: ascending & descending colon
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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
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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
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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
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Which aspect of the large intestine is the highest?
left colic flexure
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What part of the large intestine is the widest? What about the small intestine?
L: cecum S: duodenum
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How long should the patient NPO for a barium enema?
8 hours
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What are the contraindications for a barium enema?
perforated hollow viscus & large bowel obstruction
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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)
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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)
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What does LPO best show?
Right hepatic flexure + ascending colon
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compresses the small bowel to best show the loops
compresses the small bowel to best show the loops
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What does ventral decubitus best display?
Air in the posterior portion of the rectum
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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
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What does RPO best display?
Splenic flexure + descending colon
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What does right lateral best display?
Air in the splenic flexure + descending colon (The side up)
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What does left lateral decubitus best display?
air in the hepatic flexure + ascending colon + cecum (air in side up)
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What does RAO best display? what is the CR? how much oblique?
Hepatic flexure + ascending colon CR at crest 35-45 oblique
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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
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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
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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
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which flexure is always higher?
splenic flexure
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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
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The enema bag should not be higher than _____
24 inches above table (2 feet)
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During small bowel studies how often should images be taken?
every 20-30 minutes
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Which part of the small intestine makes up the 3/5’s? which part makes up the 2/5’s?
ileum & jejunum
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What is subluxation? what is an example of this?
a partial dislocation nursemaids jerked elbow
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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)
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What is a contusion?
bruise injury (possible avulsion fx)
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What is a fracture?
a break or altering of the bone
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What is a sprain?
forced wrenching/twisting of a joint (damages ligament without dislocation)
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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
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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)
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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)
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what is a smiths fx?
fx of the wrist with distal radius displaced anteriorly, with radius & ulna posteriorly
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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
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what is a colles fx?
distal radius is displaced posteriorly, with radius & ulna anteriorly
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What is compound fracture? also known as?
portion of bone (fx) is piercing through the skin open fx
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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)
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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)
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what is a boxer’s fx?
fx of distal 5th metacarpal (fx comes from punching)
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What is an impacted fx? most common in?
one fragment is firmly driven into the other (most common in femurs, humerus, & radius)
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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)
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what is the minimum distance you should be away from exposing on portable x-ray?
6 feet
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what is a hangman’s fx?
fx occurs in pedicles of C2 or with/without displacement of C2/C3
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what is a compression fx?
vertebral fx from compression injury (vertebral body collapses or compresses)
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why do we prefer AP over PA view of the thumb?
for OID
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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)
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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)
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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 sternum
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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)
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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)
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(t/f) When working in surgery we need to be confident about how to manipulate the factors & anatomy to make a “textbook” image
true
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what is spiral fracture?
bone is twisted apart & fx spirals around the long axis
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What are the roles for the scrub (scrub tech)?
prepares sterile field scrubs gowns surgical team, prepares/sterilizes instruments before procedure CST or RN
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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
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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
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What is the normal range for creatinine levels?
0.6 to 1.5 mg/dL
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What is the average levels for BUN?
8-25mg per 100 ml
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Metformin 48 hours before or after administration of iodinated contrast
Metformin 48 hours before or after administration of iodinated contrast
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What is micturition?
the act of voiding or urination
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What is incontinence?
involuntary passage (leakage) of urine through the urethra (failure to control vesical and urethral sphincters)
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What is retention?
inability to void: bladder unable to empty (obstruction in the urethra or lack of sensation to urinate)
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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
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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)
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What drugs would you use to reduce a reaction?
prednisone & Benadryl
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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
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what is an IVU?
excretory urography IV injection with contrast through superficial vein in arm
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What is a retrograde urography study?
injection through ureteral catheter by urologist as a surgical procedure
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What is a retrograde cystography?
contrast flowing to bladder through urethral catheter pushed by gravity
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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
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what is a retrograde urethrography study? (RUG)
for males retrograde injection through Brodney clamp or special catheter
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What are moderate reaction symptoms?
true allergic reactions (anaphylactic): urticaria possible laryngeal swelling bronchospasm angioedema hypotension tachycardia >100 beats/min bradycardia >60 beats/min
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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
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What is an HSG? What is it looking for?
contrast study of the uterus to assess the function
163
Which kidney sits lower than the other? Why?
right sits more inferior to the left kidney bc of the presence of the liver
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What are the functions of the kidneys?
filter blood & remove waste through urine*
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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
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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
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What is an essential component of the kidney?
nephrons
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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
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What is a retrograde study? What is an excretory study?
contrast through catheter (retro=backwards) contrast through the vein (intravenous) (forward)
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What organs make up the urinary system?
two kidneys two ureters one urinary bladder one urethra
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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)
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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)
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What is the name of the functional study of the bladder and urethra?
voiding cystourethrography (VCU)
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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)?
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what angle does the kidney sit to the midsagittal plane?
20 degrees from the midsagittal plane due to the psoas major muscles (vertical angle)
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where should the tourniquet be placed in relation to the injection site?
3-4 inches above injection site
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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)
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Three purposes for an IVU?
visualize portion of urinary system assess function of kidneys evaluate urinary system pathology
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What is oliguria?
diminished amount of urine in relation to fluid intake low urine output (less than 400mL in 24 hr)
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What is retention?
inability to void: bladder unable to empty (due to obstruction in urethra or lack of sensation to urinate)
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What is anuria?
complete cessation of urinary secretion by the kidneys (kidneys producing none-little urine due to a blockage)
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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
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What is the bladder capacity?
350ml-500ml
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why do we premedicate for patients with allergies?
To prevent contrast reactions
164
Where are the kidneys located?
Midway between the xiphoid process and the iliac crest
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What is the name of the leakage of contrast outside of the vessel and into surrounding tissue?
extravasation
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This exam may be performed to demonstrate uterine position, uterine lesions, and uterine tubal obstruction?
HSG study (hysterosalpinography)
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What calyx’s form the renal pelvis?
major & minor
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What drug combination is given to patients before an IVU to reduce the risk of a reaction?
prednisone + Benadryl
164
What type of contrast reaction affects the entire body or a specific organ system?
systemic reaction
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What is the device used and positioned at the level of ASIS?
Uterine compression device
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what type of contrast media dissociates into separate ions when injected?
ionic contrast media
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What blood chemistry level should read 8-25 mg/100mL if in normal range?
BUN
164
Which of the following is not a reason to be pretreated before a contrast enema?
itching
164
We must verify ____ ____ for patients with _____ before resuming metformin?
kidney function diabetes
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The right kidney sits ____ to the left kidney due to the liver
inferior
164
for a male retrograde urethrogram the patient position should be?
30 degree RPO
164
Which study injects contrast through a catheter into the renal pelvis?
retrograde urethrogram (RUG)
164
What is the purpose for voiding a cystourethrogram?
to evaluate the patient’s ability to urinate
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What position is best to see the ureters without obstruction?
RPO/ LPO
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What is the name of the action urination?
micturition
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Which two types of fractures are most commonly seen in victims of child abuse?
Bucket & Corner fx
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What is necrotizing enterocolitis (NEC)?
condition causes the intestinal tissue to die
164
What is the life-threatening condition that occurs when the intestines fold into itself?
intussusception
164
What position of the abdomen is recommended for demonstrating the prevertebral region of the abdomen?
Dorsal Decubitus
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what is atresia?
a medical condition where a body part that tubular in shape and either closed or doesn’t have a normal opening
164
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 adhesives)
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what set of images would best demonstrate Croup?
AP + Lateral soft tissue neck
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what is a weighted device used to assist in positioning?
sandbag
164
What is the primary technical factor to eliminate motion for pediatric patients?
shorten exposure time
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What is pyloric stenosis?
rare condition affects the pylorus and muscular opening between the stomach and the small intestine in babies
164
For a patient with osteogenesis imperfecta how would you properly adjust your technique? What is this?
decrease technique a condition where bones easily break
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What genetic disorder that causes bones to break easily?
osteogenesis imperfecta
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What is the name of the flat radiolucent device with straps that assists with supine imaging?
Tam-em board
164
what is a common birth defect that causes one or both feet to turn inward and downward?
talipes equinovarus
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What is the CR for a ped abdomen?
1” superior to umbilicus
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What is the mummifying technique?
technique that helps to immobilize the child’s arms (by wrapping patient up in a towel)
164
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
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which modality would help to diagnose congenital hip dislocations in newborns?
sonography (US)
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what is the technical term for newborn?
neonate
164
what is the device used to image a child in upright/erect position? What exams are these for?
pigg-o-stat erect abdomen + chest
164
At what age can pediatrics understand simple commands?
2-3 years old
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what position is performed to look at both hip joints in a lateral perspective?
bilateral frogs (included as much as possible in one image
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what exam or position is performed to determine if a child has stopped growing?
bone age survey (one x-ray of the left hand)
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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)
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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
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What is intussusception?
telescoping of the bowel causing life threatening folds in the stomach
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What is RDS? what exam would we perform for this?
respiratory distress syndrome chest
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What is the older term for child abuse? What is the new & more acceptable term?
Battered child syndrome suspected non- accidental trauma (SNAT)
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What is osteogenesis imperfecta? what happens to technique?
bones that easily break decreases
165
What is RSV?
Respiratory syncytial virus Common virus that affects most infants by age 2 & mimics symptoms of a cold (Cough + running nose)
165
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)
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What is the space between the primary and secondary growth center is called?
epiphyseal plate
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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)
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what demonstrates the pre-vertebral region of the abdomen?
dorsal decubitus
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What are these? SCA: SNAT: PIT: BCS:
suspected child abuse suspected non-accidental trauma pediatric intentional trauma battered child syndrome (old name)
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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)
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what are the restraining devices used?
sandbag pigg-o-stat
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What aids motion in pediatric exams?
short exposure time
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how are hip dislocations identified in newborns?
ultrasound (sonography)
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What modality would we use to diagnose for ADHD & evaluate for suspected tumors?
MRI
165
what is the CR for KUB? Chest?
1” above umbilicus Mammillary line
165
if it is paired with other imaging complete in one exposure to reduce radiation exposure (ALARA)
if it is paired with other imaging complete in one exposure to reduce radiation exposure (ALARA)
165
what is a neonate?
technical term for newborns
165
What are Pigg-O-stats?
immobilization technique for erect abdomen & chest for infant up to age 5
165
What are the six categories of child abuse?
neglect physical abuse sexual abuse psychological maltreatment medical neglect other
165
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)
165
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
165
What positioning aid can we use for erect abdomens?
pigg-o-stat
165
Quality control is part of what kind of program?
Quality assurance
165
What is the purpose of the QC program?
To achieve the best image quality
165
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
165
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
165
What is a way to test the collimator alignment? what is the tolerance?
A-penny test 2%
165
If we are testing the “hardness” of the x-ray beam what are we primarily looking at?
half-value layers
165
what is the tolerance for SID accuracy?
+/- 2% variance
165
what is the acceptable range of accuracy for collimator alignment test is? we find this by using the:
+/- 2% variance A-penny test
165
what is the tolerance range for Kvp variations?
5% variance
165
In Fluro units, what is the tolerance in one direction? (for collimation) In total?
3% variance 4% variance total
165
what are the main components in quality control program?
Acceptance test (baseline for new machines) Annual testing Diagnose & documenting deviations
165
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)
165
If we are doing a repeat/reject analysis what is a good percent range to stay within?
3-5%
165
what is a primary reason we see repeats on digital exams?
patient positioning (motion will be on there, nit the primary)
165
what is the tolerance for timer accuracy?
5% variance
165
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)
165
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
165
What is illuminance? What tool measures this?
the light that strikes the surface of an object photometer
165
what is an example of a class 2 monitor? what do we use these for?
technologist work station Post processing & window leveling
165
What measures illuminance?
photometer
166
what is the least reliable exposure factor? What is the tolerance?
MA-linearity 10% (from tube fatigue)
166
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
166
if we are measuring resolution within an image what tool do we use?
Lines-pairs tool
166
What is the spatial resolution we should see on a monitor? what about on the detector?
2.5 LP/mm 2.5 LP/mm
166
how often do we test aprons?
annually
166
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
166
What type are the radiation measurement units for radiation biology? What are these units?
Systeme international SI Grays, sieverts, and coulombs
166
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)
166
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
166
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)
166
what are the radiation weighting factors? What are their values?
Gamma ray = 1 x-ray= 1 positron= 1 proton= 2 alpha particles= 20
166
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
166
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
166
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)
166
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)
166
What is half-life? Specific to:
Time required for radioactivity to reduce to half its original measurement Isotope and constant
166
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
166
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
166
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)
166
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
166
What is an OSL or OSLD? How is it released?
Optically stimulated luminescent dose (dosimeter) released by light
166
What is a TLD? How is it released?
Thermoluminescent dose (dosimeter) By heat
166
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)
166
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)
166
What is the occupational dose limit? Where do we see most of this at?
50 mSv Fluoroscopy
166
What is the radiation limit for the public?
1 mSv
166
What is the limit for the fetus?
0.5 mSv/month
166
what is the dose limit for the lens of the eye?
150 mSv
166
what is the radiation dose limit for everything else?
500 mSv
166
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)
166
What does high LET mean? What is an example of this?
More concentrated which means more harmful to tissue (like alpha particles)
166
What is an example of low LET? What is an example of high LET?
Gamma ray (lowest) & x-ray (2nd lowest) Alpha particles
166
What does RBE stand for? What does it do?
Relative biological effectiveness Compares different types of radiation
166
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)
166
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
166
What is the most common CT scan done at a stoke center?
head CT (CT Brain Attack)
166
what does LD x/y stand for?
LD= lethal dose x= percentage of population y== number of days it is measured (how much lethal dose and how many days it will take to kill the population, LD 50/30)
166
what are the orders for cell phases?
prophase metaphase anaphase telophase
166
what is dose response?
linear non-threshold assumes that any dose of radiation can cause damage most late effects follow this dose response
166
what is Dose rate? what happens to effect if dose rate goes up?
how quickly a dose is delivered dose rate goes up, effect increases
166
what is protraction? if protraction goes up, what happens to effect?
how slowly a dose is delivered protraction increases, effect decreases
166
what is the most radiosensitive phase of a cell? what is the most radioresistant cell phase?
mitosis (division) mid to late S phase (DNA replication)
166
what is the law of Bergonie & Tribondeau? Like?
cells are more sensitive if they are more primitive & prolific (lymphocytes)
166
what is interphase cell death?
several hundred Gray can kill a cell before it can divide
166
what are somatic effects? what two ways can this be measured in?
systemic effects of radiation to an individual deterministic & stochastic
166
what is deterministic?
biological effects that can be directly related to the dose received threshold dose occurs after a large dose of radiation can occur in fluroscopy
166
what is fractionation? what happens to effect if fractionation increases?
delivering dose in discrete portions with a recovery period in between fractionation increases effect deceases (90% repairable)
166
what are deterministic early effects? later effects?
Erythema (2Gy), epilation, infertility (hours/days/weeks 90% repairable) cataracts, temporary sterility (100 mSv)
166
what are stochastic effects? what type of effects?
randomly occurring biological effects of radiation non-threshold can happen in radiology (unlikely) probability increases with dose late effect (cancer/ genetic abnormalities)
166
what are teratogenic effects? What are the by products of this?
occurs en-utero to a developing embryo or fetus Congenital abnormalities, skeletal defects, & leukemia
166
skeletal defects result during exposure at:
3rd week of gestation
166
A ___ ____ embryo is ____ ____more sensitive to radiation than an adult
10-day 10 times
166
how much of the skin exposure of the mother does the fetus receive?
1/3 (for abdomen)
166
Leukemia results from exposure during:
mid-to late fetal growth
166
Congenital abnormalities are likely caused by:
radiation (exposure) at 2-8 weeks
166
Genetic code consists of what?
a sequence of nitrogenous bases found in the DNA
166
how many pairs of chromosomes are there?
23 pairs
166
Transfer RNA (tRNA) is attached to a specific ___
amino acid
166
what is target theory?
certain molecules are critical to the survival of a cell
166
what is direct effects? Example?
x-ray photon deactivates a target molecule (x-ray photon directly damages a key gene of a chromosome) (deactivation of a target molecule from an x-ray photon)
166
what is indirect effect? What is most affected?
radiation ionizes water which in turn deactivates a target molecule most damage caused by this effect (cytoplasm of the cell)
166
what is a free radical?
any uncharged atom with a single unpaired electron in its outermost shell
166
what can be the end result of hydrolysis (radiation) of water?
hydrogen peroxide
166
what is the oxygen effect? What kind of hits?
tissue is more sensitive to radiation when irradiated in an oxygen rich environment (indirect hits)
166
what is acute radiation syndrome?
"radiation sickness" occurs after large doses of radiation over a short period of time
166
What are the 4 stages of acute radiation syndrome?
prodromal latent manifest illness death
166
Prodromal: side effects?
ARS within hours nausea, vomiting, diarrhea, & fatigue
166
Latent: symptoms?
1 week no symptoms, false sense of recovery
166
manifest illness:
less than 1 week syndrome effects
166
death:
instant or in some cases recovery with long-term effects/damage
166
what are the 3 main symptoms/syndromes?
hematopoietic gastrointestinal cerebrovascular
166
Hematopoietic syndrome: range? death? effects? who suffered early on?
1-10Gy death in 6-8 weeks decreased blood cells in bone marrow & body is susceptible to organ failure/infection early radiologists suffered from leukemia
166
what are the gastrointestinal syndromes:
6-10 Gy death in 4-10 days damage to epithelial cells that line the GI tract (inability to absorb nutrients) dehydration & severe diarrhea
166
what is the cerebrovascular syndrome? range? death? effects?
50Gy+ death in hours to 3 days fluid leaks into brain and intracranial pressure + central nervous system failure
166
what does LET stand for? what is it?
linear energy transfer the amount of energy deposited by radiation into a material per unit path or length
166
what is high LET? high LET= Example?
is low penetration (alpha particles) & high RBE Alpha particles
166
what kind of LET has high penetration?
low LET (Gamma & x-ray's)
166
linear energy transfer of x-ray is low due to ___ ____
high penetration
166
low LET is associated with:
single strand DNA breaks
166
High LET= Low LET=
Low penetration High penetration
166
what is CPU?
central processing unit coordinates all computer operations
166
what is the RAM?
random access memory can be overwritten by the user and accessed very quickly memory stored on a chip or disc
166
what is ROM?
read-only memory memory that can't be changed by user (foundational programs)
166
what is BIOS?
basic input/output system internal/primary ROM that directs the flow of information between CPU & peripherals
166
what is the motherboard?
houses CPU, RAM, ROM chips and connections for USB/audio
166
what is LAN?
Local area network a network contained within a single building or business
167
what is WAN?
wide area network extends to multiple businesses or geographical areas
167
what is teleradiology?
remote transmission of medical images via telephone wire or fiber cable outside a facility to a radiologists home or remote radiologist on the other side of the world
167
what is a bit? how many bits become a byte?
small unit for binary numbers 8 bits
167
Bit units are used for:
binary numbers
167
convert this binary code: 110011
51
167
what is the smallest unit of a digital image?
pixel
167
the smaller the pixel:
the better the spatial resolution
167
in diagnostic imaging pixel size is limited by:
detector element size (DEL)
167
what is the field of view? (FOV)
the physical area of an image
167
what is the matrix? 15 x 15?
a pattern of pixels laid out in rows and columns 225
167
what is scanning? what is sampling? what is quantization?
creating a matrix measuring the intensity assigning a value
167
what is bit depth?
maximum range of pixel values that a computer can measure or store
167
what is a bit depth of 5?
32 shades of gray (human eye can distinguish between 32 shades)
167
what is a bit depth of 8?
256 shades of gray common for non-medical imaging
167
what is the bit depth 10?
1024 shades of gray number of shade of gray in the remnant beam
167
what is dynamic range?
the range of shades of gray that a system can generate (diagnostic is large)
167
what is window leveling?
adjusting the image brightness increasing the window level decreases the brightness decreasing the window level increases the brightness
167
what is window width?
adjusting the images contrast increasing the width increases the shade of grey in the image (low contrast) decreasing the width decreases the shade of greys in the image (high contrast)
167
what is the greatest benefit of digital imaging?
the ability to control contrast resolutions
167
what is the image matrix of these modalities? Nuc med: US: MR: CT: x-ray: Mammo:
64 x 64 128 x 128 512 x 512 512 x 512 1024 x 1024 3328 x 3328 (bit depth 14 & 27 MB file size)
167
what is preprocessing?
automatic cleaning up of the raw image before the initial image is visible to us (cleaned up by computer)
167
pre-processing makes ____ post-processing makes ____
corrections refinements
167
what is flat field uniformity?
type of preprocessing that corrects for flaws in the electronics/optics of the image receptor system
167
what is the noise reduction for del drop-outs?
compensating for malfunctioning DEL's by taking the surrounding 8 DELs and assigning a value to the malfunctioning one
167
what can happen to individual detector elements? (DELs)
can malfunctions and return no data
167
what is segmentation? this occurs to what only?
error that occurs when the computer sees multiple images as a single image CR (computed radiography) only
167
what is exposure field recognition?
error that occurs when the computer analyzes raw radiation outside the anatomy of interest
167
what is the histogram?
a bar graph created by counting the number of pixels (DELs) at each brightness level
167
how does a histogram visually appeal?
dark pixels to the right white pixels to the left
167
what are the Smax & Smin?
Smax are the maximum pixel values that are used for analysis Smin are the minium pixel values that are used for analysis
167
what are the different type of histogram analysis? Type 1: Type 2: Type 3:
detects smax and removes the values to the right (that represent raw radiation) (gets rid of ultra black feeback) assumes no raw radiation to the right of smax and identifies highest value as smax (abdomen) (assigns a smax) detects Smin and removes values to the left that represent metal or prothesis (gets rid of ultra white)
167
what are the VOI?
value of interest different value ranges within the histogram selected to highlight specific anatomy such as bone or soft tissue
167
what are the histogram process errors?
segmentation error exposure field recognition error unexpected objects in the data set (led apron, large prothesis, lead gloves, etc) too little/ too much radiation mispositioning
167
what is the primary thing that rescaling does?
affects brightness
167
what is rescaling?
the initial processing to make images appear "normal"
167
what is the goal of a lookup tables?
adjust input so that the image appears "normal"
167
what is spatial domain?
processing based on the location of a pixel in the overall matrix
167
what is intensity domain?
processing based on the greyscale value of an individual pixel
167
what is the frequency domain?
processing based on the size of an object
167
what does gradation processing primarily control?
contrast
167
what is data clipping?
a limited bit depth that can limit our ability to adjust the brightness or contrast as it will "clip" the ends of the processing curve (we don't want to data clip for our radiologist)
167
what is detail processing?
breaks down an image into a larger & smaller object based on how many pixels are used to create it
167
large objects have ____ ____ & ______ ______ small objects have _____ _____ & ____ _____
large waves & low frequency (large objects are not muted) short waves & high frequency (small objects are not muted)
167
high pass filtering mutes: low pass filtering mutes:
large objects small objects
167
what is the rule? low pass = high pass=
low pass= low frequency= large objects high pass= high frequency= small objects
167
what is edge enhancement?
mutes large objects and enhances smaller objects (including artifacts)
167
what is a kernel?
small matrix used to apply effects to a small section of an image or overall image
167
what is speed class?
how sensitive an imaging system is to radiation
167
increasing the speed (class) reduces: increasing the speed (class) can increase:
patient dose quantum mottle
167
what speed can modern CR & DR systems operate at? without?
speed class of 400 the appearance of substantial quantum mottle
167
what do digital images lack? why is this bad?
visual cues that can indicate correct technical factors
167
the exposure indicator is not ___
an actual exposure reading taken at the image receptor (median point between Smin and Smax on the image histogram)
167
the standardized EI is based on _____ ______ to the image receptor and is measured in?
actual exposure Micro-gray (siemens only)
167
what is the target EI? (EIT)
the ideal exposure to the image receptor for a particular projection
167
what is signal-to-noise- ratio? (SNR) always greater than?
to produce the highest quality image, the signal should be as high as possible, and noise should be as low as possible 1
167
what is the deviation index?
indicator of how far away a technique was from ideal
167
If the index for deviation index were to change by +1 how much increased exposure is that? and for -1?
25% increase in exposure for +1 20% decrease in exposure for -1
167
what happens if an x-ray results in -3.0?
automatic repeat as quantum mottle is likely
167
what is saturation? what can be a result of this?
extreme overexposure (10x) can overwhelm the digital detection system, causing a loss of data
167
what is alternative processing? how can this affect a radiologist?
processing under incorrect anatomy (processing a knee as a hand) affect there ability to window or adjust the image data
168
what is dark masking?
darkens the collimated areas
169
what is the minimal spatial resolution when reviewing an image on a workstation?
6 LP/mm
170
what is the only controlling factor common to film and digital imaging?
distortion (garbage in, garbage out)

Registry Prep (12 decks)

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