HESI RADIOGRAPHY EXAM NEWEST 2026 ACTUAL EXAM COMPLETE 400+
QUESTIONS AND CORRECT DETAILED ANSWERS/NEWEST UPDATE!!
Question 1
To best visualize the tarsal sinus (sinus tarsi) in the foot, which of the following radiographic
projections is required?
A) Anteroposterior (AP) Projection
B) Lateral Projection
C) 30-degree Medial Oblique Projection
D) 30-degree Lateral Oblique Projection
E) Tangential Projection
Correct Answer: C) 30-degree Medial Oblique Projection
Rationale: The sinus tarsi is an anatomical space located between the talus and the
calcaneus on the lateral aspect of the foot. A 30-degree medial oblique projection opens this
space, whereas a standard lateral view would result in superimposition and an AP view
would not demonstrate the cavity clearly.
Question 2
Which of the following radiographic examinations is classified as a nonfunctional study of the
urinary system?
A) Intravenous Urogram (IVU)
B) Voiding Cystourethrogram (VCUG)
C) Retrograde Urogram
D) Hypertensive IVP
E) 15-minute Nephrogram
Correct Answer: C) Retrograde Urogram
Rationale: A nonfunctional examination is one where the physiological function of the organ
is not being measured. In a retrograde urogram, contrast is injected against the normal
flow of urine directly into the ureters by a urologist. This demonstrates anatomy only,
unlike an IVU, which relies on the kidneys to filter and excrete contrast.
Question 3
A radiograph of an AP Oblique Mortise Joint projection reveals the distal fibula without talar
overlap. What is the clinical significance of this finding?
A) The ankle was over-rotated.
B) The ankle was under-rotated.
C) This is a normal, properly positioned mortise view.
D) The central ray was angled cephalic.
E) The foot was in plantar flexion.
Correct Answer: C) This is a normal, properly positioned mortise view.
Rationale: The goal of the mortise joint projection (usually a 15–20 degree medial rotation)
is to demonstrate the entire joint space. In a properly positioned mortise view, the lateral
malleolus (distal fibula) is shown in profile and is free of superimposition by the talus.
, 2
Question 4
Which of the following parts of the "Scotty Dog" seen on an oblique lumbar spine radiograph
represents the pars interarticularis?
A) The eye
B) The nose
C) The neck
D) The ear
E) The front leg
Correct Answer: C) The neck
Rationale: In the radiographic "Scotty Dog" appearance of the lumbar vertebrae, the neck
of the dog corresponds to the pars interarticularis. Defects in this area (spondylolysis)
appear as a "collar" on the dog’s neck.
Question 5
The only true saddle joint in the human body is found between which of the following
structures?
A) C1 and C2 (Atlas and Axis)
B) Trapezium and First Metacarpal
C) Scapula and Humerus
D) Talus and Calcaneous
E) Femur and Tibia
Correct Answer: B) Trapezium and First Metacarpal
Rationale: A saddle (sellar) joint allows for movement in two planes (circumduction and
opposition). The articulation between the trapezium of the wrist and the first metacarpal of
the thumb is the primary example of this joint type in the body.
Question 6
A patient with a sthenic body habitus requires a lateral lumbar spine radiograph. If the spine is
not horizontal to the IR, how should the central ray (CR) be adjusted for a female patient?
A) Perpendicular to the IR
B) 5 degrees caudad
C) 8 degrees caudad
D) 5 degrees cephalic
E) 12 degrees cephalic
Correct Answer: C) 8 degrees caudad
Rationale: Female patients typically have wider hips, causing the lumbar spine to sag
toward the table in a lateral position. To open the intervertebral joints when the spine isn't
horizontal, an 8-degree caudal angle is recommended for women, while a 5-degree caudal
angle is used for men.
, 3
Question 7
The Holmblad Method is used to visualize which of the following anatomical structures?
A) The patella in profile
B) The intercondylar fossa of the knee
C) The bicipital groove of the humerus
D) The zygomatic arches
E) The odontoid process
Correct Answer: B) The intercondylar fossa of the knee
Rationale: The Holmblad Method requires the patient to be in a kneeling position (or
partially kneeling) to demonstrate the intercondylar fossa (tunnel view). This method is
preferred by some because it minimizes distortion compared to the Camp Coventry
method.
Question 8
When performing an AP projection of the lower leg (Tibia/Fibula), where should the central ray
be directed?
A) At the level of the tibial tuberosity
B) At the medial malleolus
C) At the mid-shaft of the lower leg
D) 2 inches superior to the patellar apex
E) At the level of the knee joint
Correct Answer: C) At the mid-shaft of the lower leg
Rationale: To demonstrate both the knee and ankle joints on a single IR for a lower leg
projection, the CR must be directed to the midpoint of the lower leg. If the limb is too long,
separate images of the joints must be taken.
Question 9
To demonstrate the ramus of the mandible using an axiolateral oblique projection, how should
the patient's head be positioned?
A) True lateral
B) Rotated 30 degrees toward the IR
C) Rotated 45 degrees toward the IR
D) Kept in a true PA position
E) Rotated 15 degrees toward the IR
Correct Answer: A) True lateral
Rationale: In the axiolateral oblique mandible projection, different parts of the mandible
are visualized based on head rotation: True lateral demonstrates the ramus; 30-degree
rotation demonstrates the body; and 45-degree rotation demonstrates the
symphysis/mentum.
, 4
Question 10
A radiologist suspects esophageal varices and requests an esophagram. Which of the following
breathing instructions will best demonstrate this condition?
A) Shallow breathing during exposure
B) Suspended inspiration
C) Full expiration
D) Valsalva maneuver
E) Rapid panting
Correct Answer: D) Valsalva maneuver
Rationale: Esophageal varices (dilated veins) are best demonstrated when intra-abdominal
and intrathoracic pressure is increased. The Valsalva maneuver involves forced expiration
against a closed glottis, which increases venous pressure and makes the varices more
visible.
Question 11
Which of the following positions is most effective for demonstrating free air under the right
hemidiaphragm when a patient cannot stand?
A) Right lateral decubitus
B) Left lateral decubitus
C) Ventral decubitus
D) Dorsal decubitus
E) Supine AP
Correct Answer: B) Left lateral decubitus
Rationale: To visualize free intraperitoneal air, the air must be able to rise against a solid
organ. In a left lateral decubitus position, free air will rise and be visible between the liver
(on the right) and the abdominal wall. This prevents the air from being confused with the
gastric bubble in the stomach.
Question 12
In a PA chest radiograph, why are the shoulders rotated anteriorly/posteriorly?
A) To elevate the clavicles
B) To expand the lungs
C) To move the scapulae out of the lung fields
D) To depress the diaphragm
E) To minimize magnification of the heart
Correct Answer: C) To move the scapulae out of the lung fields
Rationale: During a PA chest radiograph, the patient is instructed to roll their shoulders
forward (anteriorly) against the IR. This action rotates the scapulae laterally, moving them
out of the bony superimposition of the lung fields so that the lung tissue can be assessed
clearly.
QUESTIONS AND CORRECT DETAILED ANSWERS/NEWEST UPDATE!!
Question 1
To best visualize the tarsal sinus (sinus tarsi) in the foot, which of the following radiographic
projections is required?
A) Anteroposterior (AP) Projection
B) Lateral Projection
C) 30-degree Medial Oblique Projection
D) 30-degree Lateral Oblique Projection
E) Tangential Projection
Correct Answer: C) 30-degree Medial Oblique Projection
Rationale: The sinus tarsi is an anatomical space located between the talus and the
calcaneus on the lateral aspect of the foot. A 30-degree medial oblique projection opens this
space, whereas a standard lateral view would result in superimposition and an AP view
would not demonstrate the cavity clearly.
Question 2
Which of the following radiographic examinations is classified as a nonfunctional study of the
urinary system?
A) Intravenous Urogram (IVU)
B) Voiding Cystourethrogram (VCUG)
C) Retrograde Urogram
D) Hypertensive IVP
E) 15-minute Nephrogram
Correct Answer: C) Retrograde Urogram
Rationale: A nonfunctional examination is one where the physiological function of the organ
is not being measured. In a retrograde urogram, contrast is injected against the normal
flow of urine directly into the ureters by a urologist. This demonstrates anatomy only,
unlike an IVU, which relies on the kidneys to filter and excrete contrast.
Question 3
A radiograph of an AP Oblique Mortise Joint projection reveals the distal fibula without talar
overlap. What is the clinical significance of this finding?
A) The ankle was over-rotated.
B) The ankle was under-rotated.
C) This is a normal, properly positioned mortise view.
D) The central ray was angled cephalic.
E) The foot was in plantar flexion.
Correct Answer: C) This is a normal, properly positioned mortise view.
Rationale: The goal of the mortise joint projection (usually a 15–20 degree medial rotation)
is to demonstrate the entire joint space. In a properly positioned mortise view, the lateral
malleolus (distal fibula) is shown in profile and is free of superimposition by the talus.
, 2
Question 4
Which of the following parts of the "Scotty Dog" seen on an oblique lumbar spine radiograph
represents the pars interarticularis?
A) The eye
B) The nose
C) The neck
D) The ear
E) The front leg
Correct Answer: C) The neck
Rationale: In the radiographic "Scotty Dog" appearance of the lumbar vertebrae, the neck
of the dog corresponds to the pars interarticularis. Defects in this area (spondylolysis)
appear as a "collar" on the dog’s neck.
Question 5
The only true saddle joint in the human body is found between which of the following
structures?
A) C1 and C2 (Atlas and Axis)
B) Trapezium and First Metacarpal
C) Scapula and Humerus
D) Talus and Calcaneous
E) Femur and Tibia
Correct Answer: B) Trapezium and First Metacarpal
Rationale: A saddle (sellar) joint allows for movement in two planes (circumduction and
opposition). The articulation between the trapezium of the wrist and the first metacarpal of
the thumb is the primary example of this joint type in the body.
Question 6
A patient with a sthenic body habitus requires a lateral lumbar spine radiograph. If the spine is
not horizontal to the IR, how should the central ray (CR) be adjusted for a female patient?
A) Perpendicular to the IR
B) 5 degrees caudad
C) 8 degrees caudad
D) 5 degrees cephalic
E) 12 degrees cephalic
Correct Answer: C) 8 degrees caudad
Rationale: Female patients typically have wider hips, causing the lumbar spine to sag
toward the table in a lateral position. To open the intervertebral joints when the spine isn't
horizontal, an 8-degree caudal angle is recommended for women, while a 5-degree caudal
angle is used for men.
, 3
Question 7
The Holmblad Method is used to visualize which of the following anatomical structures?
A) The patella in profile
B) The intercondylar fossa of the knee
C) The bicipital groove of the humerus
D) The zygomatic arches
E) The odontoid process
Correct Answer: B) The intercondylar fossa of the knee
Rationale: The Holmblad Method requires the patient to be in a kneeling position (or
partially kneeling) to demonstrate the intercondylar fossa (tunnel view). This method is
preferred by some because it minimizes distortion compared to the Camp Coventry
method.
Question 8
When performing an AP projection of the lower leg (Tibia/Fibula), where should the central ray
be directed?
A) At the level of the tibial tuberosity
B) At the medial malleolus
C) At the mid-shaft of the lower leg
D) 2 inches superior to the patellar apex
E) At the level of the knee joint
Correct Answer: C) At the mid-shaft of the lower leg
Rationale: To demonstrate both the knee and ankle joints on a single IR for a lower leg
projection, the CR must be directed to the midpoint of the lower leg. If the limb is too long,
separate images of the joints must be taken.
Question 9
To demonstrate the ramus of the mandible using an axiolateral oblique projection, how should
the patient's head be positioned?
A) True lateral
B) Rotated 30 degrees toward the IR
C) Rotated 45 degrees toward the IR
D) Kept in a true PA position
E) Rotated 15 degrees toward the IR
Correct Answer: A) True lateral
Rationale: In the axiolateral oblique mandible projection, different parts of the mandible
are visualized based on head rotation: True lateral demonstrates the ramus; 30-degree
rotation demonstrates the body; and 45-degree rotation demonstrates the
symphysis/mentum.
, 4
Question 10
A radiologist suspects esophageal varices and requests an esophagram. Which of the following
breathing instructions will best demonstrate this condition?
A) Shallow breathing during exposure
B) Suspended inspiration
C) Full expiration
D) Valsalva maneuver
E) Rapid panting
Correct Answer: D) Valsalva maneuver
Rationale: Esophageal varices (dilated veins) are best demonstrated when intra-abdominal
and intrathoracic pressure is increased. The Valsalva maneuver involves forced expiration
against a closed glottis, which increases venous pressure and makes the varices more
visible.
Question 11
Which of the following positions is most effective for demonstrating free air under the right
hemidiaphragm when a patient cannot stand?
A) Right lateral decubitus
B) Left lateral decubitus
C) Ventral decubitus
D) Dorsal decubitus
E) Supine AP
Correct Answer: B) Left lateral decubitus
Rationale: To visualize free intraperitoneal air, the air must be able to rise against a solid
organ. In a left lateral decubitus position, free air will rise and be visible between the liver
(on the right) and the abdominal wall. This prevents the air from being confused with the
gastric bubble in the stomach.
Question 12
In a PA chest radiograph, why are the shoulders rotated anteriorly/posteriorly?
A) To elevate the clavicles
B) To expand the lungs
C) To move the scapulae out of the lung fields
D) To depress the diaphragm
E) To minimize magnification of the heart
Correct Answer: C) To move the scapulae out of the lung fields
Rationale: During a PA chest radiograph, the patient is instructed to roll their shoulders
forward (anteriorly) against the IR. This action rotates the scapulae laterally, moving them
out of the bony superimposition of the lung fields so that the lung tissue can be assessed
clearly.
