Radiographic Procedures formed by the talus and the os calcis (calcaneus).
The plantodorsal and dorsoplantar projections of the os calcis
1. Which of the following projections or positions will best demonstrate should exhibit sufficient density to visualize the talocalcaneal joint
subacromial or subcoracoid dislocation? (Fig. 2-36).
(A) Tangential o This is the only "routine" projection that will
(B) AP axial demonstrate the talocalcaneal joint.
(C) Transthoracic lateral If evaluation of the talocalcaneal joint is desired, special views ( h
(D) PA oblique scapular Y as the Broden and Isherwood methods) are required.
(Ballinger & Frank, vol 1, p 215)
The "scapular Y" refers to the characteristic Y formed by the Ans. B
humerus, acromion, and coracoid processes.
o The patient is positioned in a PA oblique position an 5. Which of the following projections is most likely to demonstrate the
RAO or LAO, depending on which is the affected side. carpal pisiform free of superimposition?
o The midcoronal plane is adjusted approximately 60º to (A) Radial flexion
the film, and the affected arm is left relaxed at the (B) Ulnar flexion
patient's side. (C) AP oblique
The scapular Y position is employed to demonstrate anterior (D) AP
(subcoracoid) or posterior (subacromial) humeral dislocation.
The humerus is normally superimposed on the scapula in this In the direct PA projection of the wrist, the carpal pisiform is
position; any deviation from this may indicate dislocation. superimposed on the carpal triquetrum.
(Ballinger & Frank, vol 1, pp 179-181) The AP oblique projection (medial surface adjacent to the film)
Ans. D separates the pisiform and triangular and projects the pisiform as a
separate structure.
2. The sternoclavicular joints are best demonstrated with the patient PA o The pisiform is the smallest and most palpable carpal.
and (Ballinger & Frank, p 117)
(A) in a slight oblique position, affected side adjacent to the image Ans. C
recorder.
(B) in a slight oblique position, affected side away from the image 6. Angulation of the central ray may be required.
recorder. 1. to avoid superimposition of overlying structures.
(C) erect and weight-bearing. 2. to avoid foreshortening or self-superimposition.
(D) erect, with and without weights. 3. in order to project through certain articulations.
(A) 1 only
Sternoclavicular joints should be performed PA whenever possible (B) 2 only
to keep the object-to-image distance (OID) to a minimum. (C) 1 and 3 only
The Oblique position (about 15º) opens the joint closest to the (D) 1, 2, and 3
image recorder. —————————————————
The erect position may be used, but is not required. If structures are overlying or underlying the area to be
Weight-bearing images are not recommended. demonstrated (as with structures overlying the occipital bone in
(Ballinger & Frank, vol 1, p 485) the AP skull), central ray angulation is employed (as in AP axial skull
Ans. A to visualize occipital bone).
o If structures would be foreshortened or self-superimposed, as in
3. Which of the positions should be used to demonstrate the cervical the scaphoid, central ray angulation may be employed to place the
apophyseal articulations? structure more closely parallel with the film.
1. RAO o Some articulations, such as the knee, require angulation to better
2. Lateral visualize the joint space.
3. LPO (Ballinger & Frank, vol 1, p 17)
(A) 1 only Ans. D
(B) 2 only
(C) 1 and 3 only 7. With the patient and the x-ray tube positioned as illustrated in Figure 2-
(D) 2 and 3 only 2, which of the following will be obtained?
1. Intercondyloid fossa
Lateral projections of the cervical spine are done to demonstrate 2. Patellofemoral articulation
the 3. Tangential patella
o intervertebral disk spaces, (A) 1 only
o apophyseal joints, (B) 1 and 2 only
o spinous processes. (C) 2 and 3 only
Anterior oblique positions (LAO, RAO) of the cervical spine (D) 1, 2, and 3
demonstrate the intervertebral foramina closer to the film, —————————————————
while Posterior oblique positions (LPO, RPO) demonstrate the The relationship between the thigh, lower leg, patella, and central ray should
intervertebral foramina farther from the film. be noted.
(Ballinger & Frank, pp 400-403) The central ray is directed parallel to the plane of the patella, thereby
Ans. B providing a tangential projection of the patella (patella in profile) and an
unobstructed view of the patellofemoral articulation (Fig. 2-37).
4. In which of the following positions / projections will the talocalcaneal A "tunnel view" is required in order to demonstrate the intercondyloid fossa
joint be visualized? and the articulating surfaces of the tibia and femur.
(A) Dorsoplantar projection of the foot (Ballinger & Frank, vol 1, p 311)
(B) Plantodorsal projection of the os calcis Ans. C
(C) Medial oblique position of the foot
(D) Lateral foot 8. Which of the following are part of the bony thorax?
1. 12 thoracic vertebrae
The talocalcaneal, or subtalar, joint is a three-faceted articulation 2. Scapulae
, 3. 24 ribs surfaces are connected by cartilage, such as intervertebral joints.
(A) 1 only Synarthroticjoints, such as the cranial sutures, are immovable.
(B) 1 and 2 only (Bontrager, pp 10-13)
(C) 1 and 3 only Ans. C
(D) 1, 2, and 3
————————————————— 12. "Flattening" of the hemidiaphragms is characteristic of which of the
The bony thorax consists of 12 pairs of ribs and the structures to following conditions?
which they are attached anteriorly and posteriorly: the sternum (A) Pneumothorax
and the 12 thoracic vertebrae (Fig. 2-38). (B) Emphysema
o These structures form a bony cage that surrounds and (C) Pleural effusion
protects the vital organs within (the heart, lungs, and great (D) Pneumonia
vessels). —————————————————
The scapulae, together with the clavicles, form the shoulder Chest radiographs demonstrating emphysema will show the characteristic
(1pectoral) girdle. irreversible trapping of air that gradually increases and overexpands the lungs.
(Bontrager, p 336) This produces the characteristic flattening of the diaphragm and widening of
Ans. C the intercostal spaces.
The increased air content of the lungs requires a
9. All of the following statements regarding an exact PA projection of the compensating decrease in technical factors.
skull, with the central ray perpendicular to the film, are true except Pneumonia is inflammation of the lungs, usually caused by
(A) The orbitomeatal line is perpendicular to the film. bacteria, virus, or chemical irritant.
(B) The petrous pyramids fill the orbits. Pneumothorax is a collection of air or gas in the pleural cavity
(C) The midsagittal plane (MSP) is parallel to the film. (outside the lungs), with an accompanying collapse of the
(D) The central ray exits at the nasion. lung.
————————————————— Pleural effusion is excessive fluid between the parietal and
In the exact PA projection of the skull with the perpendicular central ray visceral layers of pleura.
exiting the nasion, the petrous pyramids should fill the orbits (Fig. 2-39). (Bontrager, p 80)
As the central ray is angled caudally, the petrous pyramids are projected Ans. B
lower in the orbits, and at about 25 to 30º, they are below the orbits.
The orbitomeatal line must be perpendicular to the film or the petrous 13. Which of the following structures is (are) located in the right lower
pyramids will not be projected into the expected location. quadrant (RLQ)?
The MSP must be perpendicular to the film or the skull will be rotated. 1. Gallbladder
With the MSP parallel to the film, a lateral skull projection is obtained. 2. Hepatic flexure
(Ballinger & Frank, vol 2, p 242) 3. Cecum
Ans. C (A) 1 only
(B) 1 and 2 only
10. Which of the following statements regarding the radiograph in Figure 2- (C) 3 only
3 is (are) true? (D) 1, 2, and 3
1. The tibial eminences are well visualized. —————————————————
2. The intercondyloid fossa is demonstrated between the 1. The gallbladder is located on the posterior surface of the liver
femoral condyles. in the right upper quadrant (RUQ).
3. The femorotibial articulation is well demonstrated. 2. The hepatic flexure, so named because of its close proximity
(A) 1 only to the liver, is also in the (RUQ)
(B) 1 and 2 only 1. The vermiform appendix projects from the first portion of the
(C) 1 and 3 only large bowel, the cecum, located in the right lower quadrant
(D) 2 and 3 only (RLQ).
————————————————— (Bontrager, p 104)
The pictured radiograph is an AP projection of the knee with the knee Ans. C
extended.
The tibial intercondylar eminences are well demonstrated on the 14. The number 4 in the radiograph in Figure 2-4 represents which of the
tibial plateau, and the femorotibial joint is well visualized. following renal structures?
o The intercondyloid fossa is not demonstrated here. (A) Vesicoureteral junction
A "tunnel" view of the knee is required to demonstrate the (B) Renal pelvis
intercondyloid fossa. (C) Minor calyx
(Ballinger & Frank, vol 1, p 290) (D) Major calyx
Ans. C —————————————————
The pictured radiograph is one of a series of intravenous pyelogram
11. Which of the following articulations may be described as Diarthrotic? (intravenous urography) films. It was done prone at 20 min after injection of
1. Knee the contrast medium. The urinary collecting system is well demonstrated. The
2. Intervertebral joints renal pelvis (number 1) is the proximal expanded end of the ureter lying
3. Temporomandibular joint (TMJ) within the renal sinus. The minor calyces (number 3) receive urine from the
(A) 1 only collecting tubules of the renal pyramids and convey it to the major calyces
(B) 2 only (number 2), which empty into the renal pelvis. Urine is carried down the
(C) 1 and 3 only ureters by peristaltic waves. The vesicoureteral junction (number 4) is located
(D) 1, 2, and 3 at the distal end of the ureter, where it unites with the urinary bladder.
————————————————————————— (Bontrager, pp 543-544)
Diarthrotic, or (synovial joints) such as the knee and the TMJ, are Ans. A
freely movable.
o Most diarthrotic joints are associated with a joint capsule 15. During a gastrointestinal examination, the AP recumbent projection of a
containing synovial fluid. stomach of average shape will usually demonstrate
o Diarthrotic joints are the most numerous in the body and are 1. anterior and posterior aspects of the stomach.
subdivided according to type of movement. 2. barium-filled fundus.
Amphiarthrotic joints are partially movable joints whose articular 3. double-contrast body and antral portions.
, (A) 1 only (Cornuelle & Gronefeld, p 174)
(B) 1 and 2 only Ans. C
(C) 2 and 3 only
(D) 1, 2, and 3 19. The cross-table or axiolateral projection of the hip requires the cassette
————————————————— to be placed
With the body in the AP recumbent position, barium flows easily into the 1. in contact with the lateral surface of the body, with the top
fundus of the stomach, displacing the stomach somewhat superiorly. edge slightly above the iliac crest.
The fundus, then, is filled with barium, while the air that had been in the 2. in a vertical position and exactly perpendicular to the long axis
fundus is displaced into the gastric body, pylorus, and duodenum, illustrating of the femoral neck.
them in double-contrast fashion. 3. just above the iliac crest and adjacent to the lateral surface of
Air-contrast delineation of these structures allows us to see through the the affected hip.
stomach to the retrogastric areas and structures.
Anterior and posterior aspects of the stomach are visualized (A) 1 only
in the Lateral position; (B) 1 and 2 only
medial and lateral aspects of the stomach are visualized in (C) 1 and 3 only
the AP projection. (D) 1, 2, and 3
(Ballinger & Frank, vol 2, p 110) —————————————————
Ans. C The cassette for a cross-table lateral projection of the hip is placed in a
vertical position. The top edge of the cassette should be placed directly above
16. The ridge that marks the bifurcation of the trachea into the right and left the iliac crest and adjacent to the lateral surface of the affected hip. The
primary bronchi is the. cassette is positioned parallel to the femoral neck; the central ray is
(A) root. perpendicular to the femoral neck and cassette. (Ballinger, vol 2, p 290)
(B) hilus. Ans. C
(C) carina.
(D) epiglottis. 20. In the AP axial projection (Towne method) of the skull, with the central
————————————————— ray directed 30º caudad to the orbitomeatal line (OML) and passing
a) The carina is an internal ridge located at the bifurcation of the midway between the external auditory meatus, which of the following is
trachea into right and left primary, or mainstem, bronchi. best demonstrated?
b) The epiglottis is a flap of elastic cartilage that functions to prevent (A) Occipital bone
fluids and solids from entering the respiratory tract during (B) Frontal bone
swallowing. (C) Facial bones
c) The root of the lung attaches the lung, via dense connectivetissue, (D) Basal foramina
to the mediastinum. The root of the left lung is at the level of T6, —————————————————
and the root of the right is at T5. The AP axial position projects the anterior structures (frontal and facial bones)
d) The hilus (hilum) is the slitlike opening on the medial aspect of the downward, thus permitting visualization of the occipital bone without
lung through which arteries, veins, lymphatics, and so forth, enter superimposition (Grashey / Towne method). The dorsum sella and posterior
and exit. clinoid processes of the sphenoid bone should be visualized within the
(Bontrager, p 68) foramen magnum. This projection may also be obtained by angling the central
Ans. C ray 30º caudad to the OML (Fig. 2-40). The frontal bone is best shown with
the patient PA and a perpendicular central ray. The parietoacanthial
17. Which projection of the foot will best demonstrate the longitudinal projection is the single best position for facial bones. Basal foramina are well
arch? demonstrated in the submentovertical projection. (Ballinger & Frank, vol 2, p
(A) Mediolateral 270)
(B) Lateromedial Ans. A
(C) Lateral weight-bearing
(D) 30º medial oblique 21. The best way to control voluntary motion is
————————————————— (A) immobilization of the part.
The bones of the foot are arranged to form a number of longitudinal and (B) careful explanation of the procedure.
transverse arches. The longitudinal arch facilitates walking and is evaluated (C) short exposure time.
radiographically in Lateral weight-bearing (erect) projections. (D) physical restraint.
Recumbent laterals would not demonstrate any structural change that occurs —————————————————
when the individual is erect. Patients who are able to cooperate are usually able to control voluntary
(Ballinger, vol 1, p 256) motion if they are provided with an adequate explanation of the procedure.
0Ans. C Once patients understand what is needed, most will cooperate to the best of
their ability (by suspending respiration and holding still for the exposure).
18. Which of the following articulate(s) with the bases of the metatarsals? Certain body functions and responses, such as heart action, peristalsis, pain,
1. The heads of the first row of phalanges and muscle spasm, cause involuntary motion that is uncontrollable by the
2. The cuboid patient. The best and only way to control involuntary motion is by always
3. The cuneiforms selecting the shortest possible exposure time. Involuntary motion may also be
(A) 1 only minimized by careful explanation, immobilization, and (as a last resort and
(B) 1 and 2 only only in certain cases) restraint. (Ballinger & Frank, vol 1, pp 12-13)
(C) 2 and 3 only Ans. B
(D) 1, 2, and 3
————————————————— 22. Figure 2-5 illustrates which of the following positions?
The foot is composed of the 7 tarsal bones, 5 metatarsals, and 14 phalanges. (A) AP
The metatarsals and phalanges are miniature long bones; each has a shaft, (B) Medial oblique
base (proximal), and head (distal). (C) Lateral oblique
The bases of the first to third metatarsals articulate with the three (D) Partial flexion
cuneiforms. —————————————————
The bases of the fourth and fifth metatarsals articulate with the cuboid. The radiograph is a lateral oblique (external rotation) projection of the elbow,
The heads of the metatarsals articulate with the bases of the first row of removing the proximal radius from superimposition with the ulna and
phalanges. demonstrating its articulation with the ulna at the radial notch, that is, the
, proximal radioulnar articulation. An AP projection of the elbow would Ans. A.
demonstrate partial overlap of the proximal radius and ulna. A medial oblique
would demonstrate complete overlap of the proximal radius and ulna; this 26. Which of the following projections of the abdomen may be used to
position is used to demonstrate the coronoid process in profile and the demonstrate air or fluid levels?
olecranon process within the olecranon fossa. (Ballinger & Frank, vol 1, p 135) 1. Dorsal decubitus
Ans. C 2. Lateral decubitus
3. AP Trendelenburg
23. What are the positions most commonly employed for a radiographic (A) 1 only
examination of the sternum? (B) 1 and 2 only
1. Lateral (C) 1 and 3 only
2. RAO (D) 1, 2, and 3
3. LAO —————————————————
(A) 1 and 2 only Air or fluid levels will be clearly demonstrated only if the central
(B) 1 and 3 only ray is directed parallel to them.
(C) 2 and 3 only o Therefore, to demonstrate air or fluid levels, the erect or
(D) 1, 2, and 3 decubitus position should be used.
————————————————— Dorsal and ventral decubitus positions made with a horizontal x-ray
Because the sternum and vertebrae would be superimposed in a direct PA or beam can also be used to demonstrate air or fluid levels.
AP projection, a slight oblique (just enough to separate the sternum from o Small amounts of air are best demonstrated in the Lateral
superimposition on the vertebrae) is used instead of a direct frontal decubitus position, affected side up.
projection. o Small amounts of fluid are best demonstrated in the lateral
a) In the RAO position, the heart superimposes a homogeneous decubitus position, affected side down.
density over the sternum, there by providing clearer radiographic (Cornuelle & Gronefeld, pp 76-77)
visualization of its bony structure. Ans. B
b) If the LAO position were used to project the sternum to the right of
the thoracic vertebrae, the posterior ribs and pulmonary markings 27. What should you do if you discover while taking the patient history that
would cast confusing shadows over the sternum becauseof their a patient scheduled for an intravenous pyelogram (IVP) takes
differing densities. Glucophage (metformin hydrochloride) daily?
c) The Lateral projection requires that the shoulders be rolled back 1. Proceed with the exam.
sufficiently to project the sternum completely anterior to the ribs. 2. Reschedule the exam until the patient has been off
Prominent pulmonary vascular markings can be obliterated using a Glucophage for 48 h.
"breathing technique," that is, using an exposure time long enough 3. Instruct the patient to withhold the Glucophage for 48 h
(with appropriately low milliamperage) to equal at least a few after the exam.
respirations. (Ballinger & Frank, vol 1, pp 476-477) (A) 1 only
Ans. A (B) 1 and 2 only
(C) 1 and 3 only
24. Which of the following are demonstrated in the oblique position of the (D) 1, 2, and 3
cervical spine? —————————————————
1. Intervertebral foramina Glucophage (metformin hydrochloride) is used as an adjunct to appropriate
2. Apophyseal joints diet to lower blood glucose in patients who have type 2 diabetes and whose
3. Intervertebral joints hyperglycemia is not being managed satisfactorily with diet alone.
(A) 1 only Patients on Glucophage who are having intravascular iodinated contrast
(B) 1 and 2 only studies can develop an acute alteration of renal function or acute acidosis.
(C) 2 and 3 only If you discover while taking patient history that your IVP patient takes
(D) 1, 2, and 3 Glucophage daily, you should still continue with the exam.
————————————————— In these patients, however, Glucophage should be discontinued for 48 h
a) Intervertebral joints are well visualized in the lateral projection of subsequent to the procedure and continued again only after renal function
all the vertebral groups. has been re-evaluated and found to be normal.
b) Cervical articular facets (forming apophyseal joints) are 90º to the (PDR, 55 ed, 2001)
midsagittal plane and are therefore well demonstrated in the Ans. C
lateral projection.
a) The cervical intervertebral foramina lie 45º to the midsagittal plane 28. In which of the following ways was the image seen in Figure 2-6
(and 15 to 20º to a transverse plane) and are therefore obtained?
demonstrated in the oblique position. (A) PA, chin extended, OML forming 37º to table
(Bontrager, p 294) (B) PA, OML and central ray (CR) perpendicular to table
Ans. A (C) PA, OML perpendicular to table, CR 25º caudad
(D) PA, OML perpendicular to table, CR 25º cephalad
25. Aspirated foreign bodies in older children and adults are most likely to —————————————————The illustrated radiograph is a PA axial projection
lodge in the (Caldwell Method) of the frontal and anterior ethmoidal sinuses. The frontal
(A) right main bronchus. sinuses are seen centrally in the vertical plate of the frontal bone behind the
(B) left main bronchus. glabella and extending laterally over the superciliary arches. The ethmoidal
(C) esophagus. sinuses are seen adjacent and inferior to the medial aspect of the orbits. The
(D) proximal stomach. patient is positioned with the OML perpendicular to the film and the CR
————————————————— angled about 25º caudally. This angle projects the petrous pyramids at the
Because the right main bronchus is wider and more vertical, lower rim of the orbits; superior orbital fissures are well demonstrated in this
aspirated foreign bodies are more likely to enter it than the left position. A caudal angle of 15 to 20º would project the petrous pyramids in
main bronchus, which is narrower and angles more sharply from the lower third of the orbits. In the PA position with chin extended (choice A)
the trachea. and OML 37º to the table (parietoacanthial projection, Waters' method), the
o An aspirated foreign body does not enter the esophagus or petrous pyramids are projected below the maxillary sinuses. With the patient
the stomach,as they are not respiratory structures, but PA and the CR angled 25º cephalad (Haas method), the occipital bone and
rather digestive structures. sella turcica are demonstrated.
(Tortora & Grabowski, p 814) (Ballinger & Frank, vol 2, pp 366-367)
The plantodorsal and dorsoplantar projections of the os calcis
1. Which of the following projections or positions will best demonstrate should exhibit sufficient density to visualize the talocalcaneal joint
subacromial or subcoracoid dislocation? (Fig. 2-36).
(A) Tangential o This is the only "routine" projection that will
(B) AP axial demonstrate the talocalcaneal joint.
(C) Transthoracic lateral If evaluation of the talocalcaneal joint is desired, special views ( h
(D) PA oblique scapular Y as the Broden and Isherwood methods) are required.
(Ballinger & Frank, vol 1, p 215)
The "scapular Y" refers to the characteristic Y formed by the Ans. B
humerus, acromion, and coracoid processes.
o The patient is positioned in a PA oblique position an 5. Which of the following projections is most likely to demonstrate the
RAO or LAO, depending on which is the affected side. carpal pisiform free of superimposition?
o The midcoronal plane is adjusted approximately 60º to (A) Radial flexion
the film, and the affected arm is left relaxed at the (B) Ulnar flexion
patient's side. (C) AP oblique
The scapular Y position is employed to demonstrate anterior (D) AP
(subcoracoid) or posterior (subacromial) humeral dislocation.
The humerus is normally superimposed on the scapula in this In the direct PA projection of the wrist, the carpal pisiform is
position; any deviation from this may indicate dislocation. superimposed on the carpal triquetrum.
(Ballinger & Frank, vol 1, pp 179-181) The AP oblique projection (medial surface adjacent to the film)
Ans. D separates the pisiform and triangular and projects the pisiform as a
separate structure.
2. The sternoclavicular joints are best demonstrated with the patient PA o The pisiform is the smallest and most palpable carpal.
and (Ballinger & Frank, p 117)
(A) in a slight oblique position, affected side adjacent to the image Ans. C
recorder.
(B) in a slight oblique position, affected side away from the image 6. Angulation of the central ray may be required.
recorder. 1. to avoid superimposition of overlying structures.
(C) erect and weight-bearing. 2. to avoid foreshortening or self-superimposition.
(D) erect, with and without weights. 3. in order to project through certain articulations.
(A) 1 only
Sternoclavicular joints should be performed PA whenever possible (B) 2 only
to keep the object-to-image distance (OID) to a minimum. (C) 1 and 3 only
The Oblique position (about 15º) opens the joint closest to the (D) 1, 2, and 3
image recorder. —————————————————
The erect position may be used, but is not required. If structures are overlying or underlying the area to be
Weight-bearing images are not recommended. demonstrated (as with structures overlying the occipital bone in
(Ballinger & Frank, vol 1, p 485) the AP skull), central ray angulation is employed (as in AP axial skull
Ans. A to visualize occipital bone).
o If structures would be foreshortened or self-superimposed, as in
3. Which of the positions should be used to demonstrate the cervical the scaphoid, central ray angulation may be employed to place the
apophyseal articulations? structure more closely parallel with the film.
1. RAO o Some articulations, such as the knee, require angulation to better
2. Lateral visualize the joint space.
3. LPO (Ballinger & Frank, vol 1, p 17)
(A) 1 only Ans. D
(B) 2 only
(C) 1 and 3 only 7. With the patient and the x-ray tube positioned as illustrated in Figure 2-
(D) 2 and 3 only 2, which of the following will be obtained?
1. Intercondyloid fossa
Lateral projections of the cervical spine are done to demonstrate 2. Patellofemoral articulation
the 3. Tangential patella
o intervertebral disk spaces, (A) 1 only
o apophyseal joints, (B) 1 and 2 only
o spinous processes. (C) 2 and 3 only
Anterior oblique positions (LAO, RAO) of the cervical spine (D) 1, 2, and 3
demonstrate the intervertebral foramina closer to the film, —————————————————
while Posterior oblique positions (LPO, RPO) demonstrate the The relationship between the thigh, lower leg, patella, and central ray should
intervertebral foramina farther from the film. be noted.
(Ballinger & Frank, pp 400-403) The central ray is directed parallel to the plane of the patella, thereby
Ans. B providing a tangential projection of the patella (patella in profile) and an
unobstructed view of the patellofemoral articulation (Fig. 2-37).
4. In which of the following positions / projections will the talocalcaneal A "tunnel view" is required in order to demonstrate the intercondyloid fossa
joint be visualized? and the articulating surfaces of the tibia and femur.
(A) Dorsoplantar projection of the foot (Ballinger & Frank, vol 1, p 311)
(B) Plantodorsal projection of the os calcis Ans. C
(C) Medial oblique position of the foot
(D) Lateral foot 8. Which of the following are part of the bony thorax?
1. 12 thoracic vertebrae
The talocalcaneal, or subtalar, joint is a three-faceted articulation 2. Scapulae
, 3. 24 ribs surfaces are connected by cartilage, such as intervertebral joints.
(A) 1 only Synarthroticjoints, such as the cranial sutures, are immovable.
(B) 1 and 2 only (Bontrager, pp 10-13)
(C) 1 and 3 only Ans. C
(D) 1, 2, and 3
————————————————— 12. "Flattening" of the hemidiaphragms is characteristic of which of the
The bony thorax consists of 12 pairs of ribs and the structures to following conditions?
which they are attached anteriorly and posteriorly: the sternum (A) Pneumothorax
and the 12 thoracic vertebrae (Fig. 2-38). (B) Emphysema
o These structures form a bony cage that surrounds and (C) Pleural effusion
protects the vital organs within (the heart, lungs, and great (D) Pneumonia
vessels). —————————————————
The scapulae, together with the clavicles, form the shoulder Chest radiographs demonstrating emphysema will show the characteristic
(1pectoral) girdle. irreversible trapping of air that gradually increases and overexpands the lungs.
(Bontrager, p 336) This produces the characteristic flattening of the diaphragm and widening of
Ans. C the intercostal spaces.
The increased air content of the lungs requires a
9. All of the following statements regarding an exact PA projection of the compensating decrease in technical factors.
skull, with the central ray perpendicular to the film, are true except Pneumonia is inflammation of the lungs, usually caused by
(A) The orbitomeatal line is perpendicular to the film. bacteria, virus, or chemical irritant.
(B) The petrous pyramids fill the orbits. Pneumothorax is a collection of air or gas in the pleural cavity
(C) The midsagittal plane (MSP) is parallel to the film. (outside the lungs), with an accompanying collapse of the
(D) The central ray exits at the nasion. lung.
————————————————— Pleural effusion is excessive fluid between the parietal and
In the exact PA projection of the skull with the perpendicular central ray visceral layers of pleura.
exiting the nasion, the petrous pyramids should fill the orbits (Fig. 2-39). (Bontrager, p 80)
As the central ray is angled caudally, the petrous pyramids are projected Ans. B
lower in the orbits, and at about 25 to 30º, they are below the orbits.
The orbitomeatal line must be perpendicular to the film or the petrous 13. Which of the following structures is (are) located in the right lower
pyramids will not be projected into the expected location. quadrant (RLQ)?
The MSP must be perpendicular to the film or the skull will be rotated. 1. Gallbladder
With the MSP parallel to the film, a lateral skull projection is obtained. 2. Hepatic flexure
(Ballinger & Frank, vol 2, p 242) 3. Cecum
Ans. C (A) 1 only
(B) 1 and 2 only
10. Which of the following statements regarding the radiograph in Figure 2- (C) 3 only
3 is (are) true? (D) 1, 2, and 3
1. The tibial eminences are well visualized. —————————————————
2. The intercondyloid fossa is demonstrated between the 1. The gallbladder is located on the posterior surface of the liver
femoral condyles. in the right upper quadrant (RUQ).
3. The femorotibial articulation is well demonstrated. 2. The hepatic flexure, so named because of its close proximity
(A) 1 only to the liver, is also in the (RUQ)
(B) 1 and 2 only 1. The vermiform appendix projects from the first portion of the
(C) 1 and 3 only large bowel, the cecum, located in the right lower quadrant
(D) 2 and 3 only (RLQ).
————————————————— (Bontrager, p 104)
The pictured radiograph is an AP projection of the knee with the knee Ans. C
extended.
The tibial intercondylar eminences are well demonstrated on the 14. The number 4 in the radiograph in Figure 2-4 represents which of the
tibial plateau, and the femorotibial joint is well visualized. following renal structures?
o The intercondyloid fossa is not demonstrated here. (A) Vesicoureteral junction
A "tunnel" view of the knee is required to demonstrate the (B) Renal pelvis
intercondyloid fossa. (C) Minor calyx
(Ballinger & Frank, vol 1, p 290) (D) Major calyx
Ans. C —————————————————
The pictured radiograph is one of a series of intravenous pyelogram
11. Which of the following articulations may be described as Diarthrotic? (intravenous urography) films. It was done prone at 20 min after injection of
1. Knee the contrast medium. The urinary collecting system is well demonstrated. The
2. Intervertebral joints renal pelvis (number 1) is the proximal expanded end of the ureter lying
3. Temporomandibular joint (TMJ) within the renal sinus. The minor calyces (number 3) receive urine from the
(A) 1 only collecting tubules of the renal pyramids and convey it to the major calyces
(B) 2 only (number 2), which empty into the renal pelvis. Urine is carried down the
(C) 1 and 3 only ureters by peristaltic waves. The vesicoureteral junction (number 4) is located
(D) 1, 2, and 3 at the distal end of the ureter, where it unites with the urinary bladder.
————————————————————————— (Bontrager, pp 543-544)
Diarthrotic, or (synovial joints) such as the knee and the TMJ, are Ans. A
freely movable.
o Most diarthrotic joints are associated with a joint capsule 15. During a gastrointestinal examination, the AP recumbent projection of a
containing synovial fluid. stomach of average shape will usually demonstrate
o Diarthrotic joints are the most numerous in the body and are 1. anterior and posterior aspects of the stomach.
subdivided according to type of movement. 2. barium-filled fundus.
Amphiarthrotic joints are partially movable joints whose articular 3. double-contrast body and antral portions.
, (A) 1 only (Cornuelle & Gronefeld, p 174)
(B) 1 and 2 only Ans. C
(C) 2 and 3 only
(D) 1, 2, and 3 19. The cross-table or axiolateral projection of the hip requires the cassette
————————————————— to be placed
With the body in the AP recumbent position, barium flows easily into the 1. in contact with the lateral surface of the body, with the top
fundus of the stomach, displacing the stomach somewhat superiorly. edge slightly above the iliac crest.
The fundus, then, is filled with barium, while the air that had been in the 2. in a vertical position and exactly perpendicular to the long axis
fundus is displaced into the gastric body, pylorus, and duodenum, illustrating of the femoral neck.
them in double-contrast fashion. 3. just above the iliac crest and adjacent to the lateral surface of
Air-contrast delineation of these structures allows us to see through the the affected hip.
stomach to the retrogastric areas and structures.
Anterior and posterior aspects of the stomach are visualized (A) 1 only
in the Lateral position; (B) 1 and 2 only
medial and lateral aspects of the stomach are visualized in (C) 1 and 3 only
the AP projection. (D) 1, 2, and 3
(Ballinger & Frank, vol 2, p 110) —————————————————
Ans. C The cassette for a cross-table lateral projection of the hip is placed in a
vertical position. The top edge of the cassette should be placed directly above
16. The ridge that marks the bifurcation of the trachea into the right and left the iliac crest and adjacent to the lateral surface of the affected hip. The
primary bronchi is the. cassette is positioned parallel to the femoral neck; the central ray is
(A) root. perpendicular to the femoral neck and cassette. (Ballinger, vol 2, p 290)
(B) hilus. Ans. C
(C) carina.
(D) epiglottis. 20. In the AP axial projection (Towne method) of the skull, with the central
————————————————— ray directed 30º caudad to the orbitomeatal line (OML) and passing
a) The carina is an internal ridge located at the bifurcation of the midway between the external auditory meatus, which of the following is
trachea into right and left primary, or mainstem, bronchi. best demonstrated?
b) The epiglottis is a flap of elastic cartilage that functions to prevent (A) Occipital bone
fluids and solids from entering the respiratory tract during (B) Frontal bone
swallowing. (C) Facial bones
c) The root of the lung attaches the lung, via dense connectivetissue, (D) Basal foramina
to the mediastinum. The root of the left lung is at the level of T6, —————————————————
and the root of the right is at T5. The AP axial position projects the anterior structures (frontal and facial bones)
d) The hilus (hilum) is the slitlike opening on the medial aspect of the downward, thus permitting visualization of the occipital bone without
lung through which arteries, veins, lymphatics, and so forth, enter superimposition (Grashey / Towne method). The dorsum sella and posterior
and exit. clinoid processes of the sphenoid bone should be visualized within the
(Bontrager, p 68) foramen magnum. This projection may also be obtained by angling the central
Ans. C ray 30º caudad to the OML (Fig. 2-40). The frontal bone is best shown with
the patient PA and a perpendicular central ray. The parietoacanthial
17. Which projection of the foot will best demonstrate the longitudinal projection is the single best position for facial bones. Basal foramina are well
arch? demonstrated in the submentovertical projection. (Ballinger & Frank, vol 2, p
(A) Mediolateral 270)
(B) Lateromedial Ans. A
(C) Lateral weight-bearing
(D) 30º medial oblique 21. The best way to control voluntary motion is
————————————————— (A) immobilization of the part.
The bones of the foot are arranged to form a number of longitudinal and (B) careful explanation of the procedure.
transverse arches. The longitudinal arch facilitates walking and is evaluated (C) short exposure time.
radiographically in Lateral weight-bearing (erect) projections. (D) physical restraint.
Recumbent laterals would not demonstrate any structural change that occurs —————————————————
when the individual is erect. Patients who are able to cooperate are usually able to control voluntary
(Ballinger, vol 1, p 256) motion if they are provided with an adequate explanation of the procedure.
0Ans. C Once patients understand what is needed, most will cooperate to the best of
their ability (by suspending respiration and holding still for the exposure).
18. Which of the following articulate(s) with the bases of the metatarsals? Certain body functions and responses, such as heart action, peristalsis, pain,
1. The heads of the first row of phalanges and muscle spasm, cause involuntary motion that is uncontrollable by the
2. The cuboid patient. The best and only way to control involuntary motion is by always
3. The cuneiforms selecting the shortest possible exposure time. Involuntary motion may also be
(A) 1 only minimized by careful explanation, immobilization, and (as a last resort and
(B) 1 and 2 only only in certain cases) restraint. (Ballinger & Frank, vol 1, pp 12-13)
(C) 2 and 3 only Ans. B
(D) 1, 2, and 3
————————————————— 22. Figure 2-5 illustrates which of the following positions?
The foot is composed of the 7 tarsal bones, 5 metatarsals, and 14 phalanges. (A) AP
The metatarsals and phalanges are miniature long bones; each has a shaft, (B) Medial oblique
base (proximal), and head (distal). (C) Lateral oblique
The bases of the first to third metatarsals articulate with the three (D) Partial flexion
cuneiforms. —————————————————
The bases of the fourth and fifth metatarsals articulate with the cuboid. The radiograph is a lateral oblique (external rotation) projection of the elbow,
The heads of the metatarsals articulate with the bases of the first row of removing the proximal radius from superimposition with the ulna and
phalanges. demonstrating its articulation with the ulna at the radial notch, that is, the
, proximal radioulnar articulation. An AP projection of the elbow would Ans. A.
demonstrate partial overlap of the proximal radius and ulna. A medial oblique
would demonstrate complete overlap of the proximal radius and ulna; this 26. Which of the following projections of the abdomen may be used to
position is used to demonstrate the coronoid process in profile and the demonstrate air or fluid levels?
olecranon process within the olecranon fossa. (Ballinger & Frank, vol 1, p 135) 1. Dorsal decubitus
Ans. C 2. Lateral decubitus
3. AP Trendelenburg
23. What are the positions most commonly employed for a radiographic (A) 1 only
examination of the sternum? (B) 1 and 2 only
1. Lateral (C) 1 and 3 only
2. RAO (D) 1, 2, and 3
3. LAO —————————————————
(A) 1 and 2 only Air or fluid levels will be clearly demonstrated only if the central
(B) 1 and 3 only ray is directed parallel to them.
(C) 2 and 3 only o Therefore, to demonstrate air or fluid levels, the erect or
(D) 1, 2, and 3 decubitus position should be used.
————————————————— Dorsal and ventral decubitus positions made with a horizontal x-ray
Because the sternum and vertebrae would be superimposed in a direct PA or beam can also be used to demonstrate air or fluid levels.
AP projection, a slight oblique (just enough to separate the sternum from o Small amounts of air are best demonstrated in the Lateral
superimposition on the vertebrae) is used instead of a direct frontal decubitus position, affected side up.
projection. o Small amounts of fluid are best demonstrated in the lateral
a) In the RAO position, the heart superimposes a homogeneous decubitus position, affected side down.
density over the sternum, there by providing clearer radiographic (Cornuelle & Gronefeld, pp 76-77)
visualization of its bony structure. Ans. B
b) If the LAO position were used to project the sternum to the right of
the thoracic vertebrae, the posterior ribs and pulmonary markings 27. What should you do if you discover while taking the patient history that
would cast confusing shadows over the sternum becauseof their a patient scheduled for an intravenous pyelogram (IVP) takes
differing densities. Glucophage (metformin hydrochloride) daily?
c) The Lateral projection requires that the shoulders be rolled back 1. Proceed with the exam.
sufficiently to project the sternum completely anterior to the ribs. 2. Reschedule the exam until the patient has been off
Prominent pulmonary vascular markings can be obliterated using a Glucophage for 48 h.
"breathing technique," that is, using an exposure time long enough 3. Instruct the patient to withhold the Glucophage for 48 h
(with appropriately low milliamperage) to equal at least a few after the exam.
respirations. (Ballinger & Frank, vol 1, pp 476-477) (A) 1 only
Ans. A (B) 1 and 2 only
(C) 1 and 3 only
24. Which of the following are demonstrated in the oblique position of the (D) 1, 2, and 3
cervical spine? —————————————————
1. Intervertebral foramina Glucophage (metformin hydrochloride) is used as an adjunct to appropriate
2. Apophyseal joints diet to lower blood glucose in patients who have type 2 diabetes and whose
3. Intervertebral joints hyperglycemia is not being managed satisfactorily with diet alone.
(A) 1 only Patients on Glucophage who are having intravascular iodinated contrast
(B) 1 and 2 only studies can develop an acute alteration of renal function or acute acidosis.
(C) 2 and 3 only If you discover while taking patient history that your IVP patient takes
(D) 1, 2, and 3 Glucophage daily, you should still continue with the exam.
————————————————— In these patients, however, Glucophage should be discontinued for 48 h
a) Intervertebral joints are well visualized in the lateral projection of subsequent to the procedure and continued again only after renal function
all the vertebral groups. has been re-evaluated and found to be normal.
b) Cervical articular facets (forming apophyseal joints) are 90º to the (PDR, 55 ed, 2001)
midsagittal plane and are therefore well demonstrated in the Ans. C
lateral projection.
a) The cervical intervertebral foramina lie 45º to the midsagittal plane 28. In which of the following ways was the image seen in Figure 2-6
(and 15 to 20º to a transverse plane) and are therefore obtained?
demonstrated in the oblique position. (A) PA, chin extended, OML forming 37º to table
(Bontrager, p 294) (B) PA, OML and central ray (CR) perpendicular to table
Ans. A (C) PA, OML perpendicular to table, CR 25º caudad
(D) PA, OML perpendicular to table, CR 25º cephalad
25. Aspirated foreign bodies in older children and adults are most likely to —————————————————The illustrated radiograph is a PA axial projection
lodge in the (Caldwell Method) of the frontal and anterior ethmoidal sinuses. The frontal
(A) right main bronchus. sinuses are seen centrally in the vertical plate of the frontal bone behind the
(B) left main bronchus. glabella and extending laterally over the superciliary arches. The ethmoidal
(C) esophagus. sinuses are seen adjacent and inferior to the medial aspect of the orbits. The
(D) proximal stomach. patient is positioned with the OML perpendicular to the film and the CR
————————————————— angled about 25º caudally. This angle projects the petrous pyramids at the
Because the right main bronchus is wider and more vertical, lower rim of the orbits; superior orbital fissures are well demonstrated in this
aspirated foreign bodies are more likely to enter it than the left position. A caudal angle of 15 to 20º would project the petrous pyramids in
main bronchus, which is narrower and angles more sharply from the lower third of the orbits. In the PA position with chin extended (choice A)
the trachea. and OML 37º to the table (parietoacanthial projection, Waters' method), the
o An aspirated foreign body does not enter the esophagus or petrous pyramids are projected below the maxillary sinuses. With the patient
the stomach,as they are not respiratory structures, but PA and the CR angled 25º cephalad (Haas method), the occipital bone and
rather digestive structures. sella turcica are demonstrated.
(Tortora & Grabowski, p 814) (Ballinger & Frank, vol 2, pp 366-367)
