Ch9 combined

Gonadal shielding must always be used on adult female patients for the lumbar spine series.

False

A patient comes to radiology for a study of the lumbar spine. He has a clinical history of spondylolisthesis of L5. Which of the following projections will best demonstrate the severity of this condition?

Lateral L5-S1 projection

The small section of bone found between the superior and inferior articular processes of the lumbar spine is termed:

pars interarticularis.

A female is more likely to suffer a fracture of the coccyx due to a backward, sitting type of fall than a male.

True

Which labeled structure is the inferior articular process?

B

Radiographs of oblique projections of the SI joints do not clearly demonstrate the inferior/distal aspect of the joints. What can the technologist do to better demonstrate this region?

Angle the CR 15 to 20 degrees cephalad.

The intervertebral foramina of the lumbar spine are located at an angle of _____ in relation to the midsagittal plane.

90 degrees

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

Chance

The AP and lateral projections for a pediatric scoliosis study should include the entire lumbar and thoracic spine.

True

The anterior oblique (RAO and LAO) positions of the lumbar spine will demonstrate the zygapophyseal joints closest to the image receptor.

False

Another term for the sacral horns is the:

cornu of the sacrum.

A patient comes to radiology for a study of the lumbar spine. The initial radiographs demonstrate potential pathology involving the L5-S1 zygapophyseal joint. Which of the following positions and/or projections would best demonstrate this joint space?

Right and left 30 degree oblique projections

The anterior projecting bony process of the sacrum that forms part of the inlet of the true pelvis is the:

promontory of the sacrum.

The LPO position for sacroiliac joints will best demonstrate the right joint.

True

A radiograph of the left sacroiliac joint demonstrates it open and clearly seen. Which of the following positions was performed?

RPO

A fracture through the vertebral body and posterior elements caused by lap seat belts during an auto accident involving sudden deceleration is a ____ fracture.

Chance

The Scottie dog sign is demonstrated with oblique projections of the thoracic and lumbar spine.

False

The average degree of rotation required to demonstrate the L3-4 zygapophyseal joints is:

45 degree

What is the term for the superior aspect of the coccyx?

Base

Collimated PA and lateral projections

An abnormal lateral curvature of the spine is a congenital condition termed:

scoliosis.

The long axis of the sacrum is generally angled more posteriorly in males than females.

False

If the waist is supported properly, an average-size patient does not require any CR angulation for the lateral lumbar spine projection.

True

What CR angle should be used for a lateral sacrum/coccyx projection?

None. CR is perpendicular to the image receptor.

How much obliquity of the body is required for posterior oblique (LPO/RPO) positions for the sacroiliac joints?

20-30 degrees

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

breast dose by 90%.

Which labeled structure in the figure is the superior articular process?

E

Which specific aspect of the sacrum articulates with the ilium to form the sacroiliac joint?

Auricular surface

Magnetic resonance imaging (MRI) is superior to computed tomography (CT) for evaluation of spinal cord and intervertebral disks.

True

Lateral projections of the sacrum and coccyx must be performed as two separate exposures.

False

Which of the following statements is NOT true about the lateral L5-S1 projection?

A 14- × 17-inch (35- × 43-cm) IR is required.

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?

Lateral hyperextension and hyperflexion projections

Where is the CR centered for an AP axial projection of the sacrum?

2 inches (5 cm) above the symphysis pubis

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

C

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

spondylolysis.

Which of the following is a condition of unknown cause in which calcification of bony ridges between vertebrae occurs, creating a lack of mobility with a "bamboo" appearance?

kylosing spondylitis

A radiograph of an AP axial sacrum reveals that it is foreshortened and the sacral foramina are not clearly seen. The patient was in an AP supine position, and the technologist angled the CR 5° to 7° cephalad. What specific positioning error is present on this radiograph?

Insufficient CR angulation

Which aspect of the Scottie dog is the superior articular process?

E

An anterior wedging of vertebrae with a loss of body height but rarely causing neurologic symptoms is called:

a compression fracture.

A radiograph of an AP axial coccyx reveals that the symphysis pubis is superimposed over the distal end of the coccyx. Which of the following modifications will correct this problem during the repeat exposure?

Increase the CR angulation.

Where is the CR centered for posterior oblique projections of the SI joints?

1 inch (2.5 cm) medial to upside ASIS

Where is the central ray (CR) centered for an AP projection of the lumbar spine with a 14- × 17-inch (35- × 43-cm) IR?

At the iliac crest

Conventional radiography does not detect bone loss from conditions such as osteoporosis until bone mass has been reduced at least 30%.

True

Which of the following structures is located at the level of the ASIS?

S1-2 (sacral segments)

Which aspect of the Scottie dog is the transverse process?

A

A female patient is brought to the emergency department (ED) because of a motor vehicle accident (MVA). Her chief complaint is pain in the lower lumbar region. The ED physician orders a lumbar series. Upon questioning, the technologist learns that the patient is pregnant. The ED physician is made aware of the pregnancy but still wants the lumbar spine series performed. What can the technologist do to minimize dose to the fetus and mother?

All of the above should be done.

An average of ____ segment(s) make up the adult coccyx.

four

Which one of the following structures of the sacrum is considered to be the most posterior?

Median sacral crest

Why should the hips and knees be flexed for an anteroposterior (AP) projection of the lumbar spine?

Both A and B

For a lateral L5-S1 projection, the CR must be parallel to the:

interiliac line.

Which aspect of the Scottie dog is the pedicle?

B

Which labeled structure is the spinous process?

A

A radiograph of a lateral projection of the lumbar spine reveals that the mid- to lower-intervertebral joint spaces are not open. The patient's waist was supported and the CR was perpendicular to the IR. Which of the following modifications will help open these joint spaces during the repeat exposure?

Increase waist support and/or angle the CR 5 to 8 degrees caudad.

A radiograph of a left posterior oblique (LPO) projection of the lumbar spine reveals that the downside pedicle is projected too far posterior on the vertebral body. What specific positioning error is present on this radiograph?

Excessive rotation of the spine

The "nose" of the Scottie dog represents the spinous process of a lumbar vertebra.

False

Which labeled structure is the pars interarticularis?

C

If the patient has scoliosis, the convexity of the spine should be down toward the image receptor for the lateral spine projection.

True

Which of the following should be done to reduce scatter radiation from reaching the image receptor for the lateral lumbar, sacrum, and coccyx projections?

Place a lead mat on the tabletop behind the patient's lower back and pelvis.

Sciatic type of pain resulting from a "slipped disk" indicates:

herniated nucleus pulposus.

What type of CR angulation is required for an AP axial projection of the coccyx?

10 degrees caudad

1. The intervertebral formaina of the Lumbar spine are located at an angle of ___ in relation to the midsagittal plane.

a. 45 degrees

b. 30-35 degrees

c. 70-75 degrees

d. 90 degrees

d. 90

2. The small section of the bone found between the superior and inferior articular processes of the lumbar spine is termed:

a. pillar

b. transverse processes

c. articular facets

d. par interarticularis

d. pars interarticularis

3. The zygapophyseal joints of the upper lumbar vertebrae are ___ in relationship to the midsagittal plane.

a. 30 degrees

b. 50 degrees

c. 45 degrees

d. 90 degrees

b. 50 degrees

4. The anterior projecting bony process of the sacrum that forms part of the inlet of the true pelvis is the:

a. Promontory of the sacrum

b. body of the S1

c. apex of coccyx

d. sacral foramina

a. Promontory of the sacrum

5. Another term for the sacral horns is the:

a. base of the sacrum

b. promontory of the sacrum

c. cornu of the sacrum

d. median sacral crest

c. cornu of the sacrum

6. Which aspect of the sacrum articulates with the ilium to form the sacroiliac joint?

a. Promontory

b. cornu

c. Auricular surface

d. Inferior articular processes

c. Auricular surface

7. Which one of the following structures of the sacrum is considered to be the most posterior?

a. median sacral crest

b. promontory

c. Superior articular processes

d. spinous processes

a. Median Sacral Crest

8. What is the best term for the superior aspect of the coccyx?

a. Base

b. Apex

c. superior margin

d. sacrococcygeal junction

a. Base

9. Which one of the following topographical landmarks corresponds with the L4-5 vertebral level?

a. Xiphoid process

b. Lower costal margin

c. ASIS

d. Iliac crest

d. iliac crest

10. Which one of the following structures is located at the level of the ASIS?

a. S1-2

b. Tip of coccyx

c. Promontory of sacrum

d. L4-5

a. S1-2

15. The Scottie dog sign is demonstrated with oblique projections of the thoracic and lumbar spine.

a. true

b. false

b. false

16. The anterior oblique (RAO/LAO) positions of the lumbar spine will demonstrate the zygapophyseal joints closest to the image receptor.

a. true

b. false

b. false

17. The average degree of rotation required to demonstrate the L3-4 zygapophyseal joints is:

a. 50 degrees

b. 30 degrees

c. 20-25 degrees

d. 45 degrees

b. 30 degrees

18. Why should the hips and knees be flexed for an AP projection of the lumbar spine?

a. for patient comfort

b. to reduce the lumbar curvature

c. to demonstrate and possible spondylolisthesis

d. both answers A and B

d. both answers A and B

19. Which of the following should be done to reduce scatter radiation from reaching the image receptor for the lateral lumbar, sacrum, and coccyx projections?

a. use a lower kV

b. Place a lead mat on the tabletop behind the patient

c. Increase the SID to 44 inches (110 cm)

d. use a smaller image receptor

b. Place a lead mat on the tabletop behind the patient

20. Where is the CR centered for an AP projection of the lumbar spine with a 14 x 17-inch (35-x43-cm) IR?

a. At the iliac crest

b. At the ASIS

c. 1 to 1.5 inches (2.5 to 3 cm) above the iliac crest

d. At the lower costal margin

a. At the iliac crest

21. An average of ___segment(s) make up the adult coccyx.

a. 1

b. 4

c. 5

d. 3

d. 3

22. If the waist is supported properly, and average-size patient does not require any CR angulation for the lateral lumbar spine projection.

a. true

b. false

a. true

23. Which of the following statements is not true about the lateral L5-S1 projection?

a. If the waist is not supported, the CR must be angled 5-8 degrees caudad.

b. A lead mat should be placed on the tabletop behind the patient, and there should be close collimation to improve image quality.

c. A 14 x 17-inch (35- x 43-cm) IR should be used.

d. The CR is centered 1.5 inches (3-4 cm) inferior to the iliac crest and 2 inches (5 cm) posterior to the ASIS.

a. If the waist is not supported, the CR must be angled 5-8 degrees caudad.

28. What CR angulation should be used for an AP axial projection of the L5-S1 joint space on a male patient?

a. 20 degree cephalad

b. 30 degree cephalad

c. 35 degree caudad

d. 40-45 degree cephalad

b. 30 degree cephalad

29. Carefully placed gonadal shielding must always be used on female patients for the AP lumbar spine projection.

a. true

b. false

b. false

30. The AP and lateral projections for a pediatric scoliosis study should include the entire lumbar and thoracic spine.

a. true

b. false

a. true

31. The second projection for the Ferguson methos of the scoliosis series requires that the concave side of the curve be built up 3 to 4 inches (8 to 10 cm) by placing blocks beneath the patient's foot.

a. true

b. false

a. true

32. A key advantage of a PA projection taken suring a pediatric scoliosis study as compared with the AP projection is:

a. it reduces breast and thyroid dose by 90%

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

c. it reduces breast dose by 15% to 30%

d. it reduces breast and thyroid dose by 150%

a. it reduces breast and thyroid dose by 90%

33. Where is the CR centered for an AP axial projection of the sacrum?

a. At the level of the ASIS

b. At the level of the symphysis pubis

c. 1 to 1 1/2 inches (3-4 cm) below the iliac crest

d. 2 inches (5 cm) above symphysis pubis

d. 2 inches (5 cm) above symphysis pubis

34. What type of CR angulation is required for an AP axial projection of the coccyx?

a. 10 degrees caudad

b. 15 degrees cephalad

c. 10 degrees cephalad

d. perpendicular to the cassette

a. 10 degrees caudad

35. The radiographic appreance on an oblique lumbar spine in which the neck of the Scottie dog appears broken suggest the presence of ___.

a. spondylolisthesis

b. spina bifida

c. compression fracture

d. spondyloysis

d. Spondylolysis

36. Which of the following is a condition of unknown cause in which calcification of bony ridges between vertebrae occurs, creating a lack of mobility with a "bamboo" appearance?

a. Scheuermann disease

b. Ankylosing spondylitis

c. Spondylolisthesis

d. Osteoblastic type of metastases

b. Ankylosing spondylitis

37. The anterior wedging of vertebrae with a loss of body height but rarely causing neurologic symptoms is called:

a. a teardrop burst fracture

b. a chance fracture

c. a compression fracture

d. spondylolysis

c. a compression fracture

38. Sciatic type of pain resulting from a "slipped disk" indicates:

a. Spondylolisthesis

b. herniated nucleus pulposus

c. Ankylosing spondylitis

d. spina bifida

b. herniated nucleus pulposus

39. An abnormal lateral curvature of the spine is a congenital condition termed:

a. spina bifida

b. Spondylolisthesis

c. lordorsis

d. scoliosis

d. scoliosis

40. What CR angle should be used for a lateral sacrum/coccyx projection?

a. 15 degree cephalad

b. 30 degree cephalad

c. None. CR is perpendicular to the image receptor.

d. 10 degrees cephalad

c. None. CR is perpendicular to the image receptor.

41. A radiograph of an AP axial sacrum reveals that it is foreshortened and hte sacral foramina are not clearly seen. The patient was in an AP supine position and the technologist angled the CR 10 cephalad. What specific positioning error is present on this radiograph?

a. excessive CR angle

b. Rotation of the sacrum

c. Insufficient CR angle

d. Wrong direction of the CR angle

C

42. A radiograph of an AP axial L5/S1 projection reveals that the jt space is not open. The following factors were used on this female patient: 80 kV, 40 SID, grid, 35 caudal, and CR centered to ASIS. Which of the following factor needs to be mod to produce a more diagnostic image?

a. Increase the CR angle

b. Decrease the CR angle

c. Change the direction of the CR angle

d. Center the CR higher to place it parallel to the jt space

C

43. A patient comes to radiology for a study of the lumbar spine. He has a clinical history of spondylolisthesis of L5. Which of hte following proj will best demonstrate severity of this condition?

a. 30 oblique

b. 50 oblique

c. Lateral L5/S1

d. AP axial L5/S1

c

44. 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 thet following would best demonstrate the degree of movement at the fusion site?

a. Lateral flex/exten

b. ferguson

c. AP and lateral erect

d. Rt and Lf 45 oblique

A

45. Young female patient comes to radiology for a scoliosis study. The patient has had this series performed frequently. How much will the breast dose be decreased if a PA rather than a AP proj taken?

a. 15%

b. 90%

c. 35%

d. No difference

b

46. Patient comes in with a possible compression fracture of L3. Which one of the following positioning routines would best demonstrate the body of L3 and the intervertebral jt space above and below it?

a. collimate R and L P.O and AP proj

b. Collimate Pa and Lateral proj

c. Erect AP and lateral

d. Collimated LPO and RPO

b

47. Geriatric patient comes to radiology for a lumbar spine series. She has severe kyphosis of the thoracolumbar spine. Which one of the following mod should be applied to this patient?

A. perform all positions erect

b. perform all positions recumbent, include flex and ext

c. include entire spine regardless whats ordered

d. Use high 90 kV for all proj

a

48. Female patient is brought to Er bc of a MVA. Her chief complaint is pain in the lower lumbar region. The er dr. orders a lumbar series. Upon questioning the tech learns that the patient is pregnant. ER dr knows of pregnancy but still wants the lumbar spine series performed. What can the tech do to minimize dose to the fetus and mother?

a. Use high kV reduce mAs

b. Increase the SID

c. Collimate as much as feasible

d. All above

d