Bontrager Chapter 15 Workbook/Self Test

List the 2 primary types of mobile x-ray units

1. Battery-powered, Battery-driven type

2. Standard AC power source, non-motor drive

True/False: A fully charged battery-powered mobile unit has driving range of up to 10 miles on level ground

True

With battery-powered types, how long does recharging take if the batteries are fully discharged?

8 hours

Which type of mobile unit is lighter in weight?

Standard power source, non-motor drive

What is the common term for a mobile fluoroscopy unit?

C-arm

What are the two primary components of a mobile fluoroscopy unit (located on each end of the structure from which it derives its name)?

A. X-ray tube

B. Image Intensifier

Why should the mobile fluoroscopy unit not be placed in the AP projection ("tube on top" position)?

It results in a significant increase in exposure to the head, eyes, & neck region of the operator

With the tube & intensifier in a horizontal position, at which side of the patient should the surgeon stand if he or she must remain near the patient - the x-ray tube side or the intensifier side?

Why?

Intensifier side; the radiation field pattern extends out farther on the x-ray tube side

Of the two monitors found on most mobile fluoroscopy units, which is generally considered the "active" monitor - the right or the left?

Left monitor

True/False: The operator must determine image orientation on the mobile fluoroscopy monitors before the patient is brought into the room

True

True/False: All mobile digital fluoroscopy units include the ability to magnify the image on the monitor during fluoroscopy

True

A 30-degree C-arm tilt from the vertical perspective increases exposure to the head & neck regions of the operator by a factor of_______

4

True/False: AEC exposure systems are not feasible with mobile fluoroscopy

False (can be used)

Name the feature that allows an image to be held on the monitor while also providing continuous fluoroscopy imaging

Roadmapping

Situation: The C-arm is in position for a PA projection. What exposure field range would the operator receive at waist level standing 3 feet from the patient?

50 to 100 mR/hour

Approximately how much exposure at waist level would the operator receive with 5 minutes of fluoroscopy exposure standing 3 feet from the patient? (Hint: First convert mR/hour to mR/minute by dividing by 60; then multiply by minutes of fluoroscopy time.)

5 mR (60 mR/60 min = 1 mR x 5 min = 5)

If a technologist receives 50 mR/hour standing 3 feet from the mobile fluoroscopy unit, what would be the exposure rate be if he or she moved back to a distance of 4 feet?

25 mR/hour

A technologist standing 1 foot from a mobile fluoroscopy unit is receiving approximately 400 mR/hour. What is the total exposure to the technologist if the procedure takes 10 minutes of fluoroscopy time to complete?

67 mR (400/60 x 10=67)

Situation: An operator receives 25 mR/hour to the facial & neck region with the C-arm in position for a PA projection (intensifier on top). Approximately how much would the operator receive at the same distance if the C-arm were reversed to an AP projection position (tube on top)?

100 to 300 mR/hour

True/False: The intermittent mode used during mobile fluoroscopy procedures is helpful during procedures to produce brighter images, but it results in significantly increased patient exposure.

False (reduces exposure to patient

Which single term best describes the primary difference between trauma positions & standard positioning?

Adaptation

What should be done to achieve specific projections if the patient cannot move because of trauma?

Move the CR & IR around the patient to produce similar projections rather than moving the patient.

What is the minimum number of projections generally required for any trauma study?

2 projections taken 90-degrees to each other

How many joints must be included for an initial study of a long bone?

2; both joints must be included on the initial study

True/False: A follow-up postreduction radiograph of the middle portion of long bones should be collimated closely to the fracture region.

False (must include at least one joint nearest injury)

True/False: Digital radiography is well suited for ED & mobile procedures.

True

True/False: Nuclear medicine is effective in diagnosing certain emergency conditions such as pulmonary emboli.

True

True/False: For trauma patients who cannot be moved for conventional diagnostic imaging, other modalities, such as ultrasound or nuclear medicine, may be used rather than trying to move the patient into specific positions.

False (it is important to rotate the x-ray tube & IR around patients if they are unable to move.)

List the 2 terms for describing displacement of a bone from a joint

A. Dislocation

B. Luxation

List the 4 regions of the body most commonly dislocated during trauma.

A. Shoulder

B. Fingers or thumb

C. Patella

D. Hip

What is the correct term for a partial dislocation?

Subluxation

A forced wrenching or twisting of a joint that results in a tearing of supporting ligaments is a __________

Sprain

An injury in which there is no fracture or breaking of the skin is called a ____________

Contusion

What is the term that describes the associative relationship between the long axes of fracture fragments?

Alignment

Which term describes a type of fracture in which the fracture fragment ends are overlapped & not in contact?

Bayonet apposition

A. Which term describes the angulation of a distal fracture fragment toward the midline?

B. Would this fracture angulation be described as a medial or a lateral apex?

A. Varus (deformity) angulation

B. A lateral apex

What is the primary difference between simple & a compound fracture?

A simple fracture does not break through the skin, but a compound fracture does

List 2 types of incomplete fractures

A. Torus

B. Greenstick

Which type of comminuted fracture produces several separate wedge-shaped fragments?

Butterfly

What is the name of the fracture in which one fragment is driven into the other?

Impacted

List the secondary name for:

Hutchinson's fracture

Chauffeur's

List the secondary name for:

Baseball fracture

Mallet

List the secondary name for:

Compound fracture

Open

List the secondary name for:

Depressed fracture

Ping-pong

List the secondary name for:

Simple fracture

Closed

True/False: An avulsion fracture is the same as a chip fracture

False (A chip fracture involves an isolated fracture not associated with a tendon or ligament.)

What type of reduction fracture does not require surgery?

Closed reduction

Define the fracture:

Greenstick

Incomplete fracture with broken cortex on one side of bone only

Define the fracture:

Comminuted

Fracture resulting in multiple (2 or more) fragments

Define the fracture:

Monteggia

Fracture of proximal half of ulna with dislocation of radial head

Define the fracture:

Boxer's

Fracture of distal fifth metacarpal

Define the fracture:

Smith's

Fracture of distal radius with anterior displacement

Define the fracture:

Hutchinson's

Intra-articular fracture of radial styloid process

Define the fracture:

Bennett's

Fracture of the base of the first metacarpal

Define the fracture:

Avulsion

Fracture resulting from a severe stress to a tendon

Define the fracture:

Depressed

Indented fracture of the skull

Define the fracture:

Stellate

Fracture with fracture lines radiating from a center point

Define the fracture:

Trimalleolar

Fracture of lateral malleolus, medial malleolus, & distal posterior tip of tibia

Define the fracture:

Compression

Fracture producing a reduced height of the anterior vertebral body

Define the fracture:

Pott's

Complete fracture of distal fibula, frequently with fracture of medial malleolus

Define the fracture:

Colles'

Fracture of distal radius with posterior displacement

Define the fracture:

Hangman's

Fracture of the pedicles of C2

Which bone is most commonly fractured in a Colles' fracture, & which displacement commonly occurs? Describe the type of injury or fall commonly results in this type of fracture?

Distal radius, posterior displacement of distal fragment; fall on outstretched arm

Which bones are commonly fractured with the Pott's fracture?

Distal fibula & occasionally the distal tibia or medial malleolus

How is the CR centered and aligned in relationship to the sternum for an AP portable projection of the chest?

3-4" below jugular notch, angled caudad so as to be perpendicular to sternum

A 14- x 17-inch IR should be placed _________ (landscape or portrait) for an AP portable chest on an average or large patient, and why?

Landscape; to prevent side cutoff of the right or left lateral margins of the chest

True/False: Focused grids are recommended for mobile chest projections

False

Which position can be used to replace the RAO of the sternum for the patient who cannot lie prone on the table but can be rotated into a semisupine position?

15-20 degrees LPO

How must the grid be aligned to prevent grid cutoff when angling the CR mediolaterally for an oblique projection of the sternum when the patient cannot be rotated or moved at all from the supine position?

Landscape

Other than the straight AP, what other projection of the ribs can be taken for the supine immobile patient who cannot be rotated into an oblique position?

30- 40-degree cross-angled mediolateral projection

Which of the following positions or projections best demonstrates free intra-abdominal air for the patient who cannot stand or sit erect?

Left lateral decubitus

Which of the following projections of the abdomen most effectively demonstrates a possible abdominal aortic aneurysm?

Dorsal decubitus

What is the disadvantage of performing a PA rather than an AP projection of the thumb?

Increase OID of the thumb

Which projections are taken for a postreduction study (casted) of the wrist?

PA & Lateral

True/False: A PA horizontal beam projection of the elbow can be taken for a patient with multiple injuries.

True

True/False: For a trauma lateral projection of the elbow, the CR must be kept parallel to the interepicondylar plane.

True

Situation: A patient with a possible fracture of the proximal humerus enters the ER. Because of multiple injuries, the patient is unable to stand or sit erect. What positioning routine should be performed to diagnose the extend of the injury?

AP & transthoracic lateral or scapular Y projection

Situation: A patient with a possible dislocation of the proximal humerus enters the ER. Because of multiple injuries, the patient is unable to stand or sit erect. In addition to a routine AP projection, what second projection demonstrates whether the condition is an anterior or posterior dislocation?

A horizontal beam transthoracic lateral

A scapular Y projection taken AP supine for a trauma patient usually requires a ________-degree rotation of the body away from the IR.

25 to 30

How much CR angulation should be used for an AP axial projection of the clavicle on a hypersthenic patient?

15 degrees

To ensure that the joints are opened up for an AP projection of the foot, how is the CR aligned?

10 degrees posteriorly from perpendicular to the plantar surface

Situation: An orthopedic surgeon orders a mortise projection of the ankle, but the patient has a severely fractured ankle & cannot rotate the ankle medially for the mortise projection. What can the technologist do to provide this projection without rotating the ankle?

Angle the CR 15 to 20 degrees lateromedially to the long axis of the foot

Situation: A patient with a possible dislocation of the patella enters the emergency room. What type of positioning routine should be performed on this patient that would safely demonstrate the patella?

AP & horizontal beam lateral with no flexion of the knee

Situation: A patient with a possible fracture of the proximal tibia & fibula enters the ER. The routine AP & lateral projections are inconclusive. Because of severe pain, the patient is unable to rotate the leg from the AP position. What position or projection could be performed that would provide an unobstructed view of the fibular head & neck?

45-degree lateromedial cross-angle AP projection of the knee & proximal tibia/fibula

To provide a lateral view of the proximal femur, which of the following projections would be performed on a trauma patient?

Danelius-Miller method

How must the IR & grid be positioned for the inferosuperior (axiolateral) projection of the hip?

Direct horizontal CR perpendicular to the femoral neck & to the plane of the IR

Which of the following projections demonstrates the odontoid process for the trauma patient who is unable to open the mouth yet can extend the skull & neck? (Subluxation & fracture have been ruled out.)

Fuchs method

Situation: A patient with injuries suffered in a motor vehicle accident enters the ER. The ER physician orders a lateral C-spine projection to rule out a fracture or dislocation. Because of the thickness of the shoulders, C6-C7 is not visualized. What additional projection can be taken safely to demonstrate this region of the spine?

Cervicothoracic projection (Swimmer's lateral) using a horizontal beam CR

Situation: A patient with a possible C2 fracture enters the ER on a backboard. The AP projection does not demonstrate C2. In addition, the patient cannot open his mouth because of a mandible fracture. Which projection can be performed safely to demonstrate this region of the spine?

35- to 40-degree cephalad axial projection CR parallel to MML)

Which projection will best demonstrate (with only minimal distortion) the pedicles of the cervical spine on a severely injured patient?

AP axial trauma oblique projections

Identify the 2 CR angles for the AP axial trauma oblique projections of the cervical spine:

A. _________ lateromedial

B. _________ cephalad

A. 45-degrees lateromedial

B. 15-degrees cephalad

True/False: A grid must be used with the AP axial trauma oblique projection for the cervical spine to reduce scatter radiation reaching the IR.

False

Situation: A patient with a possible basilar skull fracture enters the ER. The ER physician wants a projection that best demonstrates a sphenoid effusion. The patient cannot stand or sit erect. Which of the following projections would achieve this goal?

Horizontal beam lateral skull

Which of the following projections of the skull would project the petrous ridges in the lower one-third of the orbits on a supine trauma patient?

AP skull, CR 15 degrees cephalad to OML

True/False: The CR should not exceed a 30-degree caudad angle for the AP axial projection of the cranium to avoid excessive distortion of the cranial bones

False; should not exceed 45-degrees

True/False: AP projections of the skull & facial bones will increase exposure to the thyroid gland as compared with PA projections.

True

How is the CR angled and where is it centered for the AP acanthioparietal (reverse Waters) projection of the facial bones?

Parallel to the MML, centered to acanthion

What type of CR angulation is required for the trauma version of an axiolateral projection of the mandible?

25 to 30-degrees cephalad & possibly 5 to 10-degrees posterior to clear the shoulder

Situation: A patient with a Monteggia fracture enters the ER. Which of the following positioning routines should be performed on this patient?

PA or AP & horizontal beam lateral forearm

Situation: A patient with a possible greenstick fracture enters the ER. What age group does this type of fracture usually affect?

Pediatric