Rad Qual II - Final Exam

3v Cspine views (MC)

APOM, AP (APLC), Lateral

5v Cspine views

3v plus obliques OR flexion/extension

7v Cspine views (Davis Series)

3v plus obliques plus flexion/extension

**trauma cases

Which elbow projection is best for determining an intra-articular effusion as evidenced by anterior/posterior displacement of the distal humeral fat pad (Sail sign)

lateral

What projection of teh knee is this

intercondylar (holmblad)

What is the correct tube direction and angulation for a Scapular Y view projection

15 caudal

Which elbow view would be the best to assess for a potential avulsion fracture of the coronoid process

internal oblique

When performing a long bone study of the femur or humerus, if the entire bone does not fit on the image receptor, what modification should you make

include the joint closest to the pain

Which views are taken with a routine Knee series in the palmer clinics to perform a complete series

frontal and lateral

Name the projection demonstrated in this image

medial oblique ankle

What are within each circle

green = left L4 pedicle

orange = anterior superior iliac spine

pink = inferior pubic ramus

What projection is shown in the image

AP apical lordotic (Look for lung tumors)

Identify the projection and what would be the correct tube angulation and direction

AP shoulder

No tube angulation

What are in each of the circles in this PA wrist image

orange = trapezium

blue = hamate

pink = ulnar styloid

What are the only views that are taken at 72” (everything else 40”)

Lateral cervical (Neutral, Flexion, Extension)

Cervical obliques (Anterior and Posterior)

Chest (PA and Lateral)

Standard projections of Chest

PA + Left Lateral

PA Chest

PP - standing w/chest touching bucky, shoulders rolled forward

Collimation - 14 × 17

CR - top of IR 1” above VP

SID - 72”

Breathing - Inhale and Hold

PA Chest demonstrates

lung fields, heart, greater vessels, ribs, shoulders, thoracic spine, upper abdomen

Supplementary Chest view = AP Lordotic view

evaluates suspicious areas within the lung apices that appeared obscured by overlying soft tissue

can tell it is this view b/c heart is too large (magnified) and clavicles are above apices

The __ hilum of the lung is normally 1-2cm higher

left

How many posterior/anterior ribs should be noted with a PA chest image

10 posterior

7 anterior

Lateral Chest

PP - standing w/left side touching bucky + arms above head

Collimation - 14 × 17

CR - top of IR 1” above VP

SID - 72”

Breathing - Inhale and Hold

Lateral chest view demonstrates

lung fields, heart, great vessels, ribs, sternum, thoracic spine

Standard projections of Ribs

AP, Oblique, PA Chest (included if complications)

AP Ribs (AD)

PP - standing w/back touching bucky

Collimation - 14 × 17

CR - top of IR 1 1/2” above VP

SID - 40”

Breathing - Inhale and Hold

AP Ribs view demonstrates

ribs 1-12 on affected side and some lung tissue

Posterior Oblique Ribs (AD)

PP - standing facing away from bucky

Collimation - 14 × 17

CR - top of IR 1 1/2” above VP

SID - 40”

Breathing - Inhale and Hold

Posterior Oblique Ribs view demonstrates

ribs 1-12 on affected side of pt w/increased clarity of costal angles

Supplementary projections - AP Ribs BD (lower ribs)

PP - standing w/back touching bucky

Collimation - 14 × 17

CR - bottom of IR at iliac crest

SID - 40”

Breathing - Exhale and Hold

Supplementary projections - Posterior Oblique Ribs BD (lower ribs)

PP - standing facing away from bucky

Collimation - 14 × 17

CR - bottom of IR at iliac crest

SID - 40”

Breathing - Exhale and Hold

Posterior Oblique Rib (BD) views demonstrate

inferior aspect of ribs and isolates curvature of the axillary rib aspect

Standard projections of Abdomen

AP supine

Acute Abdomen series = AP supine abdomen + PA Erect

Abdomen KUB

AP Abdomen

PP - lying supine or standing w/arms at side

Collimation - 14 × 17

CR - iliac crests

SID - 40” Table top or Bucky

Breathing - Exhale and Hold

AP Abdomen views demonstrate

spleen, liver, kidneys, psoas shadow, bowel, bladder

**ureters are not visible unless intravenous contrast has been administered

Bowel gas

Small bowel = up to 3cm

Large bowel = up to 5cm

Cecum = up to 9cm

Standard Projections of Shoulder

AP Internal Rotation

AP External Rotation (Grashey view)

Scapular Y

AP Internal Rotation

PP - back touching bucky w/dorsum of hand touching thigh

Collimation - 12 × 10

CR - 1” inferior to coracoid process

SID - 40”

Breathing - DBDM

AP Internal Rotation views demonstrate

lesser tuberosity, greater tuberosity, bicipital groove, distal clavicle, AC joint, scapula

AP External Rotation (Grashey view)

PP - scapula flat on bucky w/arm ext. rotated and extended

Collimation - 12 × 10

CR - 1” inferior to coracoid process

SID - 40”

Breathing - DBDM

AP External Rotation views demonstrate

greater tuberosity, lesser tuberosity, bicipital groove, distal clavicle, AC joint, scapula

What is BEST viewed with a AP External rotation shoulder image

GH joint space

Scapular Y Shoulder (PA)

PP - standing facing bucky obliquely, scapula perpendicular to film

Collimation - 10 × 12

CR - medial border of scapula + scapular spine intersection

Tube Tilt - 15 Caudal

SID - 40”

Breathing - DBDM

Scapular Y Shoulder (PA) views demonstrates

subacromial outlet and acromion process

shoulder dislocations and direction

What structures makes up the “Y” in the Scapular Y view

coracoid, acromion, humeral head

Standard Projections of Acromioclavicular joint

Bilateral without weights

Bilateral with weights (stress view)

**Unilateral views are supplementary

AP Acromioclavicular

PP - standing back touching bucky w/arms at side (w/weight hold in both hands)

Collimation - part size

CR - AC joint

Tube Tilt - 5 Cephalic

SID - 40”

Breathing - DBDM

**Use additional marker to indicate it is weighted

AP acromioclavicular views demonstrate

AC joint space and alignment

**used for AC separations

Standard projections of Clavicle

PA and Axial

PA Clavicle

PP - standing facing bucky w/head turned away from clavicle

Collimation - 12 × 10

CR - mid-clavicle

SID - 40”

Breathing - DBDM

PA Clavicle views demonstrate

medial to lateral dimension of clavicle

both AC and sternoclavicular joints

AP Axial Clavicle

PP - standing w/back touching bucky

Collimation - 12 × 10

CR - mid-clavicle

Tube Tilt - 15 Cephalic

SID - 40”

Breathing - DBDM

Standard projections of Humerus

AP and Lateral

AP Humerus

PP - standing w/back touching bucky leaning towards arm

Collimation - 7 × 17

CR - centered so jt closest to injury is in view

SID - 40”

Breathing - DBDM

Lateral Humerus

PP - standing w/back touching bucky arm supinated, elbow flexed in front

Collimation - 7 × 17

CR - centered so jt closest to injury is in view

SID - 40”

Breathing - DBDM

Standard projections of Elbow

AP, Lateral, Internal Oblique, External Oblique

AP Elbow

PP - hand supinated, elbow and shoulder in same plane

Collimation - part size

CR - center of cubital fossa

SID - 40” Table Top

Breathing - DBDM

AP Elbow views demonstrate

distal humeral diaphysis → bicipital/radial tuberosity of diaphysis

Internal Oblique Elbow

PP - arm and shoulder on same plane, hand pronated

Collimation - part size

CR - lateral to center of cubital fossa

SID - 40” Table top

Breathing - DBDM

External Oblique Elbow

PP - arm and shoulder in same plane, epicondyles 45 deg

Collimation - part size

CR - medial to center of cubital fossa

SID - 40” Table top

Breathing - DBDM

External oblique elbow is great to view

radial head and neck

Lateral Elbow

PP - elbow flexed 90, thumb up (karate chop)

Collimation - part size

CR - radial head

SID - 40” Table top

Breathing - DBDM

Supplementary projections for Elbow

Coyle (Radial head)

Jones (Olecranon)

What is the most important of the elbow views

lateral → identify fx (sail sign)

Elbow ossification centers appear (CRITOE) **NO Odd #**

Capitellum - 1

Radial head - 3

Internal/medial epicondyle - 5

Trochlea - 7

Olecranon process - 9

External/lateral epicondyle - 11

Knowing the age of the pt is important to determine fx/avulsion vs normal anatomy - if you see 5 ossification centers in a 5yo, think

avulsion fracture

If you see 5 ossification centers in a 10yo, think

most likely normal

Standard projections of the Forearm

AP and Lateral

AP Forearm

PP - arm and shoulder on same plane, hand supinated

Collimation - part size

CR - middle of anatomy

SID - 40” Table top

Breathing - DBDM

AP Forearm views demonstrate

above epicondyles → metacarpal bases of wrist

Lateral Forearm

PP - elbow flexed 90deg, thumb up (karate chop)

Collimation - part size

CR - middle of anatomy

SID - 40” table top

Breathing - DBDM