Upper Extremity
When bilateral hands or wrists are requested, it is important to radiograph each side separately to prevent:
a. Excessive patient exposure
b. The distortion of the phalanges
c. The distortion of the joint spaces
d. The magnification of the wrist bones
What is C
Bilateral views of both hands on a single radiographic image are discouraged because the centered ray must be directed to the midpoint of the image receptor and not the anatomical structure. This causes the divergent rays to obscure the narrow joint spaces found between phalanges and the metacarpal bones.
A radiographic image of the foot is obtained in the AP oblique projection. The foot is medially rotated so the plantar surface forms a 30 degree angle with the plane of the image receptor. This will improve the visualization of which of the following structures?
1. First and second metatarsal bases
2. Fourth and fifth metatarsal bases
3. Cuboid bone
a. 1 & 2 only
b. 1 & 3 only
c. 2 & 3 only
d. 1, 2 & 3
What is C
A radiographic image of the foot is obtained in the AP oblique projection. The foot rotated medially until the plantar surface of the foot forms a 30 degree angle with the plane of the image receptor. The central ray should be directe perpendicular to the base of the third metatarsal. This projection is used to demonstrate the interspaces between the cuboid bone, calcaneus and fourth and fifth metatarsal bones and the lateral conforms as well as the articulations between the navicular and talus, navicular and cuneiform, and the sustentaculum tali and talus bone. This projection often provides an unobstructed view of the entire cuboid bone.
A radiographic image of the sternum is obtained in the right posteroanterior oblique (RAO) projection. This projection will project the image of the sternum.
a. Away from the shadow of the heart
b. Over the shadow of the heart
c. Over the shadow of the thoracic vertebrae
d. Away from the shadow of the posterior ribs
What is B
A radiographic image of the sternum is obtained in the right posteroanterior oblique (RAO) projection. The patient is placed in the RAO position with a 15-20 degree rotation. The central ray is directed perpendicular to enter the midsternum at the level of T7. Due to the low contrast between the sternum and overlaying shadows of the ribs, vertebra and lungs, the right PA 15-20 degree oblique RAO position will superimpose the heart and sternum, thus improving the visualization of the sternum. The use of a short source-toimage receptor distance of 15: (38cm) is also recommended to magnify and blur the posterior ribs. Breathing techniques which tend to blur the lung tissues are also recommended by some authors
The radiographic line that extends from the anterior nasal spine to the external auditory meatus (EAM) is known as:
a. Glabellomeatal line
b. Nasomeatal line
c. Acanthiomeatal line
d. infraorbitomeatal line
What is C
The acanthiomeatal line (ACML) extends from the point just below the nose (acanthion) to the external auditory meatus. This line is about 15 degrees below the infraorbitomeatal line.
In evaluating a radiographic image of the scapula in the true lateral projection, which of the following structures should be superimposed?
a. The vertebral and axillary borders
b. The acromion and coracoid process
c. The scapular body and axillary ribs
d. The humeral head and glenoid fossa
What is A
A radiographic image of the scapula, obtained in a lateral projection, demonstrates the vertebral and axillary borders superimposed on each other. This is best accomplished by placing the patient in the anterior oblique position with the coronal plane forming about a 60 degree angle with the plane of the image receptor. In the lateral projection, the affected scapula is placed closest to the image receptor. The dependent arm is placed at an angle of about 45 degrees to the body and the central ray is directed perpendicular to enter the mid-scapula. The position of the arm should be adjusted to avoid being imaged in the area of the primary injury.
A radiographic image of the knee is obtained in the lateral projection. Which of the following will prevent the medial femoral condyle from obscuring the joint space?
a. A 30-45 degree flexion of the knee joint
b. A 20-30 degree medial rotation of the leg
c. A 5-7 degree cephalic angulation of the central ray
d. A 10-15 degree lateral rotation of the leg
What is C
A radiographic image of the knee is obtained in the lateral projection. The patient is turned on to the affected side to place the knee in a lateral position. The knee should be flexed to 20-30 degrees to relax the muscles and to demonstrate the maximum volume of the joint space. The central ray is directed to the knee joint 2.5 centimeters distal to the medial epicondyle at an angle of 5-7 degrees cephalic to reduce the magnification of the more distal femoral condyle and improve the visualization of the joint space.
A radiographic image of the sternoclavicular joints is obtained in the PA oblique projection. The proper degree of obliquity to best evaluate an affected SC joint is a:
a. 10-15 degree rotation
b. 25-35 degree rotation
c. 45-55 degree rotation
d. 60-70 degree rotation
What is A
A radiographic image of the sternoclavicular joints is obtained in the PA oblique projection. The patient is placed prone with their head turned to the joint of interest. Because the AC joints are located near the midline of the body, their visualization will require that the central ray is directed 10-15 degrees medially toward the midsagittal plane to enter at the level of the T2-T3. Each AC joint should be examined separately.
A radiographic image obtained in submentovertical (Schuller)projection, is often imployed for the evaluation of:
1. Sphenoid sinuses
2. Zygomatic arches
3. Foramen magnum
a. 1 & 2 only
b. 1 & 3 only
c. 2 & 3 only
d. 1, 2 & 3
What is D
A radiographic image of the cranial base is obtained in the submentovertical (Schuller) projection. The patient is placed supine with the head resting on the vertex of the skull. This full basal projection is used to demonstrate the structures of the cranial base, the sphenoid sinuses and the mastoid processes. The inferosuperior path of the central ray in the full basal (SMV) projection is used to provide a tangential view of the zygomatic arches as well as visualization of the foramen magnum, internal auditory canals and mandibular condyles
A radiographic image of the elbow is obtained in the AP oblique projection for the demonstration of the radial head. This will require that the elbow be:
a. Medially rotated 15 degrees
b. Medially rotated 35 degrees
c. Laterally rotated 45 degrees
d. Laterally rotated 15 degrees
What is C
A radiographic image of the elbow is obtained in the AP oblique projection with the lateral (external) rotation. This projection is obtained with the arm rotated laterally about 45 degrees from the AP position with the hand supinated. The central ray is directed perpendicular to the elbow joint to provide an unobstructed image of the radial head without superimposition with the ulna.
A radiographic image of the calcaneus is obtained in the axial (plantodorsal) projection. In order to demonstrate the subtalar joint the central ray should be directed at an angle of:
a. 15 degrees to the long axis of the foot
b. 25 degrees to the long axis of the leg
c. 40 degrees to the long axis of the foot
d. 60 degrees to the long axis of the leg
What is C
A radiographic image of the calcaneus is obtained in the axial (plantodorsal) projection. The foot is placed vertically on the image receptor with toes in dorsiflexion. With the foot vertical, the central ray is directed to enter at the level of the base of the third metatarsal with a 40 degree angulation to the long axis, exiting proximal to the posterior ankle joijnt. This projection is used to obtain a frontal projection of the calcaneus and the subtalar joint.
In a radiographic image of the lumbar spine in the AP oblique projection, the “Scotty dogs: are seen when the patient is properly positioned. The front feet of the “dog” corresponds to the:
a. Lamina of the vertebra
b. Pedicle of the vertebra
c. Superior articular process of the vertebra
d. Inferior articular process of the vertebra
What is D
A radiographic image of the lumbar spine is obtained in the AP oblique projection with 45 degree rotation of the patient. With the patient in the RPO or LPO position, the central ray is directed perpendicular to enter 5 centimeters medial to the ASIS at a level of the iliac crest. This projection shows an oblique projection of the lumbar vertebra and zygapophyseal joints closest to the image receptor. These are the joints between the superior and inferior articulating processes of the vertebra. Radiographically, this image of the area should resemble an image of a “Scotty dog”. The nose is formed by the transverse process, the eye is from the pedicle and the body from the lamina of the vertebra. The superior and inferior articulating processes of the vertebra forms the ears and front foot of the “dog”.
When a radiographic image of the skull is obtained in the lateral projection which of the following is adjusted so that it is parallel to the plane of the image receptor?
a. The midsagittal plane
b. The interpupillary line
c. The coronal plane
d. The lambdoidal plane
What is A
A radiographic image of the cranium is obtained in the lateral projection. With the patient in the lateral position, the interpupillary line (IPL) which bisects the pupils of the eyes should be placed perpendicular to the image receptor and the midsagittal plane. In a true lateral projection of the skull, the midsagittal plane is parallel to the image receptor and coronal planes are perpendicular to the image receptor.
A radiographic image of the shoulder is obtained in the AP projection. If the patient’s arm is medially rotated this will provide a:
a. Profile view of the humeral epicondyles
b. Profile view of the greater tuberosity
c. Profile view of the glenoid fossa
d. Profile view of the lesser tuberosity
What is D
A radiographic image of the humerus obtained in the AP projection, will require an internal rotation in order to place the humerus in the lateral position. This is accomplished by rotating the humerus until a plane passing through the epicondyles is perpendicular to the plane of the image receptor. This projection will give a lateral image of the humerus which profiles the lesser tuberosity.
The dome of the acetabular cavity can be localized by finding the mid-point of the line drawn between the symphysis pubis and the :
a. Greater trochanter
b. Sacral promontory
c. Ischial tuberosity
d. Anterior superior iliac spine (ASIS)
What is D
The dome of the acetabulum is located at a point about 6 centimeters distal to a line drawn perpendicular to the midpoint between the symphysis pubis and the anterior superior iliac spine (ASIS)
A radiographic image of the cervical spine is obtained in the PA axial oblique projection. This projection is commonly employed to demonstrate the:
a. Vertebral foramina closest to the image receptor
b. Transverse foramina closest to the image receptor
c. Zygapophyseal articulations closest to the image receptor
d. Intervertebral foramina closest to the image receptor
What is D
A radiographic image of the cervical spine is obtained in the PA axial oblique projection to demonstrate the open intervertebral foamina. The patient is rotated obliquely to a 45 degree angle with the midsagittal plane. The central ray is directed to C4 at a caual angulatio of 15-20 degrees. The PA 45 degree axial oblique with the patient RAO and LAO demonstrates the foramina and pedicles closest to the image receptor and an open view of the intervertebral disk spaces.
Which of the following projections of the facial bones would be most helpful in diagnosing a “blowout” fracture of the floor of the orbit?
a. Parieto-orbital oblique projection
b. Orbitoparietal oblique projection
c. Parietoacanthial projection
d. Posteroanterior projection
What is C
A radiographic image of the maxillae is obtained in the parietoacanthial (Waters) projection. The patient is placed prone with the head resting on the chin, the neck is extended so that the orbitomeatal line forms an angle of 37 degrees with the plane of the image receptor. The floor of the orbit and roof of the maxillary sinus are formed by the maxillary bones. In cases of facial trauma, pressure on the orbit can fracture (blow out) this bony plate filling the maxillary sinus with fluid.
In order to visualize the glenoid fossa on a radiographic image of the humerus in the AP oblique (Grashey) projection, the patient is rotated:
a. 10-20 degrees
b. 20-30 degrees
c. 35-45 degrees
d. 60-70 degrees
What is C
A radiographic image of the glenohumeral joint space is obtained in the AP oblique (Grashey) projection. The image is obtained with the patient RPO or LPO with the affected joint closest to the image receptor. The patient is rotated 35-45 degrees and the central ray is directed perpendicular to a point 5 centimeters medial and 5 centimeters inferior to the superolateral border of the shoulder. This projection is used to open the joint space between the humeral head and the glenoid cavity.
A radiographic image of the ankle is obtained in the AP oblique projection. In order to maximize the opening of the mortise joint, the ankle and leg should be rotated:
a. 5-12 degrees laterally
b. 15-20 degrees medially
c. 35-45 degrees laterally
d. 45-55 degrees medially
What is B
Because of the relationship of the malleoli, a radiographic image of the ankle is obtained in the AP oblique projection with a medial rotation of the leg and foot together of about 15-20 degrees. This projection will place the two malleoli nearly parallel to the image receptor and improve the visualization of the ankle mortise.
A radiographic image of the right sacroiliac (SI) joint is to be obtained in the AP oblique projection. The joint space is best visualized when the patient is rotated:
a. 15 degrees to the plane of the image receptor
b. 25 degrees to the plane of the image receptor
c. 45 degrees to the plane of the image receptor
d. 70 degrees to the plane of the image receptor
What is B
A radiographic image of the right sacroiliac (SI) joint is to be obtained in the AP oblique projection The patient is placed in the LAO position with the affected joint farthest from the image receptor. The central ray is directed perpendicular to the joint entering 2.5 centimeters medial to the ASIS. The RPO position is used for the demonstration of the left SI joint. This joint is formed by the junction of the sacrum and the two innominate bones at their medial surface. Since the SI joint projects obliquely at an angle of 25-30 degrees from the midsagittal plane, this is the desired degree of obliquity to place the independent joint perpendicular to the image receptor
A radiographic image of the facial bones is obtained in the acanthioparietal (reverse Waters) projection. With the patient supine, the head is adjusted so the mentomeatal line is perpendicular to the image receptor. The central ray should be directed:
a. At a caudal angle of 30 degrees
b. At a cephalic angle of 30 degrees
c. At a medial angle of 15 degrees
d. Perpendicular to the image receptor
What is D
A radiographic image of the facial bones is obtained in the acanthioparietal (reverse Waters) projection. With the patient supine, the head is adjusted so the mentomeatal line is perpendicular to the image receptor. The central ray should be directed perpendicular to enter at the acanthion. This projection gives a similar image to the parietoacanthial projection of the facial bones. Another modification can be used for patient with facial trauma. This acanthioparietal projection requires that the patient be supine, with the infraorbitomeatal line perpendicular to the image receptor, the central ray is directed at a cephalic angulation of 30 degrees parallel to the mentomeatal line.