P2 LAB

c

1. In a lateral lumbar spine projection, the central ray should be angled 5° caudad when:

A. The patient is extremely thin

B. The patient's lumbar spine is parallel to the table

C. The patient has a wide pelvis causing the lumbar spine to slope

D. The patient is positioned prone

c

2. For a left lateral lumbar spine with proper body alignment (spine parallel to IR), the central ray should be directed:

A. 15° cephalad

B. 5° caudad

C. Perpendicular to the IR

D. 30° caudad

c

3. The AP open-mouth projection is primarily performed to demonstrate the:

A. Intervertebral foramina of C3-C7

B. Spinous processes of C4-C6

C. Dens and lateral masses of C1

D. C7-T1 interspace

b

4. For proper AP open-mouth positioning, the line from the upper incisors to the mastoid tip should be:

A. Parallel to the IR

B. Perpendicular to the IR

C. Angled 15° cephalad

D. Angled 20° caudad

c

5. In an erect left lateral cervical spine projection, the central ray is directed:

A. 15°-20° cephalad to C4

B. 15°-20° caudad to C7

C. Perpendicular to C4

D. 5° caudad to C7-T1

Hangman’s fracture

6. Fracture through the pedicles and anterior arch of C2 with forward displacement on C3

Kyphosis

7. Abnormal or exaggerated convex curvature of the thoracic spine

Clay Shoveler’s Fracture

8. Avulsion fracture of the spinous process of C7

Scoliosis

9. Abnormal lateral curvature of the spine

Jefferson Fracture

10. Impact fracture from axial loading of the anterior and posterior arch of C1

c

11. Which of the following is found between the superior and inferior articular processes?

A. Intervertebral joints

B. Articular joints

C. Zygapophyseal joints

D. Intervertebral facets

d

12. Which of the following projections is considered a "functional study" of the cervical spine?

A. AP "wagging jaw" projection

B. AP "open mouth" position

C. Fuchs or Judd method

D. Hyperextension and hyperflexion lateral position

b

13. Which of the following structures is best demonstrated with an AP axial vertebral arch projection?

A. Spinous processes of the lumbar spine

B. Articular pillars (lateral masses) of the cervical spine

C. Zygapophyseal joints of the thoracic spine

D. Cervicothoracic spine region

c

14. What central-ray angle must be used with the AP axial-vertebral arch (Pillars) projection?

A. 15- to 20-degree cephalad

B. 5- to 10-degree cephalad

C. 20- to 30-degree caudad

D. None (central ray is perpendicular to IR

b

15. Which of the following projections of the cervical spine demonstrates the left intervertebral foramen?

A. Left posterior oblique (LPO)

B. Left anterior oblique (LAO)

C. Lateral projection

D. Right anterior oblique (RAO)

d

16. What type of CR angle is recommended for the AP axial projection of the SI joints on a female patient?

A. 20 degrees cephalad

B. 30 degrees cephalad

C. 30 degrees caudad

D. 35 degrees cephalad

d

17. For the lateral L5-S1 projection, the CR is parallel to the

A. Oblique

B. Midcoronal

C. Midsagittal

D. interiliac

b

18. AP axial oblique projections are used for the best demonstration of the pedicles and:

a. zygapophyseal joints.

b. intervertebral foramina.

c. superior articular facets.

d. spinous processes.

b

19. FIG 9.25: How many degrees and in what direction should the central ray be angled?

a. 15 to 20 degrees cephalic

b. 15 to 20 degrees caudal

c. 25 to 30 degrees cephalic

d. 25 to 30 degrees cauda

c

20. FIG 9.25: How many degrees should the entire body of the patient be rotated?

a. 25

b. 35

c. 45

b

21. FIG 9.25: Through which cervical vertebra should the central ray be directed?

a. C3

b. C4

c. C5

a

22. Which two ways can the central ray be directed for the swimmer's technique?

a. Perpendicular or 3 to 5 degrees caudad

b. Perpendicular or 3 to 5 degrees cephalad

c. 5 degrees caudad or 5 degrees cephalad.

d

23. According to Monda's recommendation, how many degrees and in which direction should the central ray be directed?

a. 3 to 5 degrees caudad

a. 3 to 5 degrees cephalad

c. 5 to 15 degrees caudad

D. 5 to 15 degrees cephalad

c

24. What specific location should the central ray be directed for the swimmer's technique?

a. Disk space of C1 and C2

b. Disk space of C4 and C5

C. Disk space of C7 and T1

d. Disk space of T1 and T2

c

25. FIG. 9.38: How should the central ray be directed when the long axis of the lumbar vertebral column is parallel with the table?

a. Caudad

b. Cephalad

c. Perpendicular

b

26. FIG. 9.38: What lumbar anatomy should be demonstrated with the lateral projection?

a. Lumbar zygapophyseal joints

b. Intervertebral foramina

c. Pars interarticularis

d. All of the above

c

27. For the lateral projection, which object should be placed behind the patient on the tabletop to improve image quality?

a. Foam cushion

b. Folded blanket

c. Sheet of leaded rubber

a

28. How many images are necessary to complete the Ferguson series?

a. 2

b. 3

c. 4

a

29. Which projection of the Ferguson method should be performed to evaluate scoliosis best?

a. Upright PA

b. Upright AP

c. Recumbent PA

d. Recumbent AP

a

30. How many degrees and in which direction should the central ray be directed for the lateral projection of the coccyx?

a. Perpendicular

b. 10 degrees caudad

c. 10 degrees cephalad

d. 15 degrees caudad

a

31. How many degrees and in which direction should the central ray be directed for the lateral projection of the sacrum?

a. Perpendicular

b. 10 degrees caudad

c. 15 degrees cephalad

d. 15 degrees caudad

b

32. How many degrees and in which direction should the central ray be directed if it is necessary to have the patient prone for a PA axial projection of the coccyx?

a. 10 degrees caudad

b. 10 degrees cephalad

c. 15 degrees caudad

d. 15 degrees cephalad

b

33. How many degrees and in which direction should the central ray be directed for an AP axial projection of the coccyx?

a. Perpendicular

b. 10 degrees caudad

c. 10 degrees cephalad

d. 15 degrees cephalad

c

34. How many degrees and in which direction should the central ray be directed if it is necessary to have the patient prone for a PA axial projection of the sacrum?

a. 10 degrees caudad

b. 10 degrees cephalad

c. 15 degrees caudad

d. 15 degrees cephalad

d

35. How many degrees and in which direction should the central ray be directed for AP axial projection of the sacrum?

a. 10 degrees caudad

b. 10 degrees cephalad

c. 15 degrees caudad

d. 15 degrees cephalad

b

36. How many degrees of body rotation from the supine position are required for an AP oblique projection of the SI joints?

a. 15 to 20 degrees

b. 25 to 30 degrees

c. 35 to 45 degrees

d. 45 to 55 degrees

d

37. Which projection best demonstrates the left SI joint?

a. Lateral projection with the patient in left lateral recumbent position

b. AP oblique projection with the patient in the LPO position

c. PA oblique projection with the patient in the RAO position

d. AP oblique projection with the patient in the RPO position

c

38. Which projection best demonstrates the right SI joint?

a. Lateral projection with the patient in right lateral recumbent position

b. PA oblique projection with the patient in the LAO position

c. AP oblique projection with the patient in the LPO position

d. AP oblique projection with the patient in the RPO position

d

39. How many degrees and in which direction should the central ray be directed for an AP axial projection of the lumbosacral junction and SI joints?

a. 5 to 8 degrees caudad

b. 5 to 8 degrees cephalad

c. 30 to 35 degrees caudad

d. 30 to 35 degrees cephalad

b

40. Which projection of the lumbar vertebrae requires MSP to be positioned parallel with the IR?

a. AP projection

b. Lateral projection

c. AP oblique projection

d. PA oblique projection

a

41. Which projection of the lumbar vertebrae requires MSP to be positioned perpendicular to the IR?

a. AP projection

b. Lateral projection

c. AP oblique projection

d. Lateral projection, L5-S1

c

42. How many degrees of body rotation are necessary for the AP oblique projection of the lumbar vertebrae?

a. 15 to 20 degrees

b. 25 to 30 degrees

c. 45 degrees

d. 70 degrees

a

43. What is demonstrated if the "Scottie dog" is well visualized?

a. Zygapophyseal joints of the lumbar vertebrae

b. Zygapophyseal joints of the thoracic vertebrae

c. Intervertebral foramina of the lumbar vertebrae

d. Intervertebral foramina of the thoracic vertebrae

c

44. Which projection of the vertebral column demonstrates the "Scottie dog"?

a. Lateral projection of the lumbar vertebral column

b. Lateral projection of the thoracic vertebral column

c. Oblique projection of the lumbar vertebral column

d.. Oblique projection of the cervical vertebral column

b

45. Which positioning error most likely occurred if the zygapophyseal joints were not well demonstrated and the pedicle was quite posterior on the vertebral body in an image of an AP oblique projection of the lumbar vertebrae?

a. The patient was rotated too much.

b. The patient was not rotated enough.

c. The spine was not parallel with the table.

d. The central ray was not perpendicular to the IR.

c

46. Which vertebral structures are best demonstrated with the AP oblique projection of the lumbar vertebral column with the patient positioned in a 45-degree LPO?

a. Intervertebral foramina

b. Lumbar vertebral bodies in profile

c. Zygapophyseal joints of the left side

d. Zygapophyseal joints of the right side

d

47. Which vertebral structures are best demonstrated with the AP oblique projection of the lumbar vertebral column with the patient positioned in a 45-degree RPO?

a. Intervertebral foramina of the right side

b. Intervertebral foramina of the left side

c. Zygapophyseal joints of the left side

d. Zygapophyseal joints of the right side

d

48. Which vertebral structures are best demonstrated if a supine patient is rotated 45 degrees with the right side elevated and a perpendicular central ray is directed at the third lumbar vertebra?

a. Intervertebral foramina on the left side

b. Intervertebral foramina on the right side

c. Zygapophyseal joints on the left side

d. Zygapophyseal joints on the right side

c

49. Which projection of the lumbar vertebrae best demonstrates the zygapophyseal joints?

a. AP projection

b. Lateral projection

c. AP oblique projection

d. AP axial oblique projection

b

50. How many degrees and in which direction should the central ray be directed for the lateral projection of L5-S1 when the vertebral column is positioned parallel with the table?

a. Perpendicular

b. 5 to 8 degrees caudad

c. 5 to 8 degrees cephalad

d. 10 to 15 degrees caudad

c

51. How many degrees and in which direction should the central ray be directed for the lateral projection of the lumbar vertebrae when the vertebral column is not parallel with the table?

a. Perpendicular for males, 8 degrees caudad for females

b. Perpendicular for females, 5 degrees caudad for males

C. 5 degrees caudad for males, 8 degrees caudad for females

d. 5 degrees caudad for females, 8 degrees caudad for males

a

52. How many degrees and in which direction should the central ray be directed for the lateral projection of the lumbar vertebrae when the vertebral column is positioned parallel with the table?

a. Perpendicular

c. 5 to 8 degrees cephalad

d. 15 to 20 degrees caudad

b

53. Which projection of the lumbar vertebrae best demonstrates intervertebral foramina?

a. AP projection

b. Lateral projection

c. PA oblique projection

d. AP oblique projection

d

54. Which plane or line of the patient should be centered on the midline of the table for the lateral projection of the lumbar vertebral column?

a. Oblique

b. Horizontal

C. Midsagittal

d. Midcoronal

a

55. Where should the central ray be directed for the AP projection of only the lumbar vertebrae?

a. L4

b. 1.5 inches (3.8 cm) above the iliac crests

c. 3 inches (7.6 cm) above the iliac crests

d. 2 inches (5 cm) above the symphysis pubis

b

56. Where should the central ray be centered on the patient for the AP projection of the lumbosacral vertebrae?

a. On the xiphoid process

b. On MSP at the level of the iliac crests

c. On MSP at the level of the greater trochanters

d. On MSP 1/2 inches (3.8 cm) above the iliac crests

a

57. Why should the patient flex the hips and knees for the AP projection of the lumbar vertebrae?

a. To reduce lumbar lordosis

b. To increase lumbar lordosis

c. To raise the diaphragm to its highest level

d. To depress the diaphragm to its lowest level

c

58. Which projection of the vertebral column best demonstrates lordosis?

a. AP projection of the lumbar vertebral column

b. AP projection of the thoracic vertebral columnande

c. Lateral projection of the lumbar vertebral column

d. Lateral projection of the thoracic vertebral column

a

59. Which projection of the vertebral column best demonstrates scoliosis?

a. PA projection of the thoracolumbar vertebral column

b. Lateral projection of the lumbosacral vertebral column

c. Lateral projection of the cervicothoracic vertebral column

d. AP projection of the cervicothoracic vertebral column

d

60. Which projection of the vertebral column best demonstrates kyphosis?

a. AP projection of the lumbar vertebral column

b. AP projection of the thoracic vertebral column

c. Lateral projection of the lumbar vertebral column

d. Lateral projection of the thoracic vertebral column

b

61. Which of the following would improve visualization of the spinous processes and overall image quality on the lateral projection of the thoracic vertebrae?

a. Activation of the center detector on the automatic exposure control

b. Placing lead rubber on the table behind the patient

c. Use of a breathing technique (low milliamperage with a long exposure time)

d. Use of a bow-tie-type compensating filter

d

62. What compensation should be made in the lateral projection of the thoracic vertebral column on a recumbent patient when the lower thoracic region is not parallel with the table?

a. Place cushions under the patient's head.

b. Direct the perpendicular central ray to T10.

c. Angle the central ray 10 to 15 degrees caudad.

d. Angle the central ray 10 to 15 degrees cephalad.

d

63. To what level of the body should the central ray be directed for the lateral projection of the thoracic vertebrae?

a. Sternal angle

b. Manubrial notch

c. Xiphoid process

d. T7

a

64. What structures are not well visualized on a lateral projection of the thoracic vertebrae?

a. T1 to T3

b. T1 to T5

c. Intervertebral disk spaces

d. Intervertebral foramen

b

65. Which projection best demonstrates the intervertebral foramina of the thoracic vertebral column?

a. AP projection

b. Lateral projection

c. From true lateral, patient rotated 20 degrees anteriorly

d. From true lateral, patient rotated 20 degrees posteriorly

b

66. Which projection most requires usage of the anode heel effect to improve its image quality?

a. AP projection of the lumbar vertebral column

b. AP projection of the thoracic vertebral column

c. AP axial projection of the cervical vertebral column

d. AP projection of the cervical vertebrae, open mouth technique

a

67. For the AP projection of the thoracic vertebral column with the patient in the supine position, why should the patient's hips and knees be flexed?

a. To reduce kyphosis

b. To decrease lordosis

c. To depress the diaphragm to its lowest level

d. To raise the diaphragm to its highest level

d

68. With reference to the patient, where should the top border of the IR or collimated field be positioned for the AP projection of the thoracic vertebrae?

a. To the level of T7

b. To the level of the jugular notch

c. 1½ to 2 inches (3.8 to 5 cm) above the sternal angle

d. 1% to 2 inches (3.8 to 5 cm) above the top of the shoulders

d

69. For the AP projection of the thoracic vertebral column, where should the central ray be centered on the anterior chest wall?

a. At the sternal angle

b. At the jugular notch

c. At the level of the inferior angles of the scapulae

d. At a point halfway between the jugular notch and the xiphoid process

a

70. Which of the following structures are best demonstrated with the lateral projection (swimmer's technique)?

a. Lower cervical and upper thoracic vertebrae

b. Lower thoracic and upper cervical vertebrae

c. Thoracic zygapophyseal joints

d. Cervical intervertebral foramina

b

71. For the lateral projection (swimmer's technique) of the cervical vertebrae, how and where should the central ray be directed?

a. Perpendicular to C4

b. Perpendicular to the intervertebral disk space of C7 and T1

c. Angled 15 degrees cephalad to C4

d. Angled 15 degrees cephalad to the intervertebral disk space of C7 and T1

b

72. Which projection should be included in a cervical series if the lateral projection does not demonstrate the C7 vertebra?

a. AP axial oblique projection

b. Lateral projection (swimmer's technique)

c. Lateral projection (dorsal decubitus position)

d. AP projection with a perpendicular central ray

c

73. Which evaluation criterion pertains to the PA axial oblique projection of the cervical vertebral column?

a. The rami of the mandible should be superimposed.

b. The spinous processes should be equidistant to the pedicles.

c. The intervertebral foramina should be open with foramina closest to the IR well demonstrated.

d. The intervertebral foramina should be open with foramina farthest from the IR well demonstrated

d

74. Which evaluation criterion pertains to the AP axial oblique projection of the cervical vertebral column?

a. The rami of the mandible should be superimposed.

b. The spinous processes should be equidistant to the pedicles.

c. The intervertebral foramina should be open with foramina closest to the IR well demonstrated.

d. The intervertebral foramina should be open with foramina farthest from the IR well demonstrated

a

75. Which evaluation criterion pertains to the lateral projection of the cervical vertebral column?

a. All seven cervical vertebrae should be demonstrated.

b. The spinous processes should be equidistant to the pedicles.

c. The intervertebral foramina should be open with foramina closest to the IR well demonstrated.

d. The intervertebral foramina should be open with foramina farthest from the IR well demonstrated

d

76. Which evaluation criterion pertains to the AP axial projection of the cervical vertebral column?

a. All seven cervical vertebrae should be demonstrated.

b. The spinous processes should be equidistant to the pedicles.

c. The intervertebral foramina should be open with foramina closest to the IR well demonstrated.

d. The intervertebral foramina should be open with foramina farthest from the IR well demonstrated.

d

77. What is the proper amount of head and body rotation for the PA axial oblique projection of the cervical vertebrae?

a. 15 degrees

b. 20 degrees

c. 35 degrees

d. 45 degrees

c

78. How many degrees from supine or the anatomic position should the entire body be rotated for the AP axial oblique projection of the cervical vertebrae?

a. 15 degrees

b. 20 degrees

c. 45 degrees

d. 90 degrees

c

79. Which position of the cervical vertebral column best demonstrates the right intervertebral foramina when the central ray is angled 15 to 20 degrees caudad?

a. LAO

b. LPO

c. RAO

d. RPO

d

80. Which position of the cervical vertebral column best demonstrates the left intervertebral foramina when the central ray is angled 15 to 20 degrees cephalad?

a. LAO

b. LPO

c. RAO

d. RPO

d

81. Which aspect of the Scottie dog is the inferior articular process?

a. A

b. B

c. C

d. D

a

82. Which aspect of the Scottie dog is the transverse process?

a. A

b. B

c. C

d. D

b

83. Which aspect of the Scottie dog is the pedicle?

a. A

b. B

c. C

d. D

c

84. The x-ray projection demonstrated in this figure is the:

a. AP cervical spine.

b. AP axial cervical spine.

c. AP, open mouth, atlas and axis.

d. AP, Fuchs method, atlas and axis.

a

85. What should be done to prevent mandibular rami from superimposing cervical vertebrae in the lateral projection of the cervical vertebral column?

a. Elevate the chin.

b. Direct a horizontal central ray to C4.

c. Angle the central ray 15 degrees cephalad.

d. Instruct the patient to hold weights in each hand.

a

86. For which projection of the cervical vertebrae should the central ray be angled 15 to 20 degrees cephalad?

a. AP axial projection

b. PA axial oblique projection

c. AP projection, open-mouth technique

d. AP projection (Fuchs method)

a

87. How should the IR be positioned for the AP axial projection of the cervical vertebral column?

a. Centered to C4

b. Centered to mastoid tips

c. With the top border at the level of C4

d. With the top border at the level of mastoid tips

a

88. Which cervical structures are best demonstrated with the AP projection, open-mouth technique?

a. C1 and C2

c. Intervertebral disks

b. Spinous processes

d. Intervertebral foramina

d

89. Which projection of the cervical vertebrae demonstrates the dens imaged within the foramen magnum

a. Lateral projection

b. AP axial oblique projection

c. AP projection, open-mouth technique

d. AP projection (Fuchs method)

c

90. With reference to the midsagittal plane, how do zygapophyseal joints open in thoracic vertebrae?

a. 15 to 20 degrees anteriorly

b. 30 to 45 degrees posteriorly

c. 70 to 75 degrees anteriorly

d. 90 degrees laterally

a

91. A key advantage of a posteroanterior (PA) projection taken during a pediatric scoliosis study as compared with the AP projection is that it reduces:

a. breast and thyroid dose by 90%.

b. female ovarian dose by 25% to 30%.

c. breast dose by 15% to 20%.

d. breast and thyroid dose by 150%.

d

92. The radiographic appearance on an oblique lumbar spine in which the neck of the Scottie dog appears broken suggests the presence of:

a. spondylolisthesis.

b. spina bifida.

c. compression fracture.

d. spondylolysis.

a

93. A patient comes to radiology for a follow-up study of the lumbar spine. The patient had a spinal fusion performed at the L3-4 level 4 months earlier. Which of the following would best demonstrate the degree of movement at the fusion site?

a. Lateral hyperextension and hyperflexion projections

b. Ferguson method

c. AP and lateral erect projections

d. Right and left 45° oblique projections

c

94. Which of the following fractures is due to a hyperflexion force injury?

a. Compression fx

b. Burst fx

c. Chance fx

d. Metastatic fx

d

95. A patient enters the ED due to an MVA. He is on a backboard and in a cervical collar. The initial lateral cervical spine projection demonstrates C1 to C6. The patient has broad and thick shoulders. Because the hospital is in a rural setting, no CT scanner is available. Which of the following modifications would best demonstrate the lower cervical spine?

a. Repeat the exposure and increase kV.

b. Repeat the exposure but ask the patient to stand up and do the lateral projection erect.

c. Repeat the exposure but have a student pull down on the arms during the exposure.

d. Perform the horizontal beam cervicothoracic (swimmer's) lateral position.

b

96. Which of the following projections will best demonstrate a compression fracture of the thoracic spine?

a. AP projection

b. Lateral projection

c. Posterior oblique positions

d. Anterior oblique positions

b

97. A radiograph of an AP open-mouth projection reveals that the base of the skull is superimposed over the dens. What positioning error led to this radiographic outcome?

a. Excessive flexion of the skull

b. Excessive extension of the skull

c. Excessive CR angulation

d. Rotation of the skull

b

98. Which of the following projections will project the dens within the shadow of the foramen magnum?

a. AP open mouth

b. AP projection (Fuchs method)

c. Twining method

d. None of the above

b

99. Which of the following positions will best demonstrate the left zygapophyseal joints of the thoracic spine?

a. LPO

b. RPO

C. RAO

d. Lateral

a

100. A patient comes to the radiology department for a cervical spine routine. The study is ordered for nontraumatic reasons. The AP open-mouth projection reveals that the base of the skull and upper incisors are superimposed, but they are obscuring the upper portion of the dens. On the repeat exposure, what should the technologist do to demonstrate the entire dens?

a. Increase the flexion of the skull.

b. Increase the extension of the skull.

c. Perform the Fuchs or Judd method.

d. Perform the AP chewing projection