Rad Qual II - Exam 1 (X-ray changes + Review Q)

How do you fix an UNDEREXPOSED xray (too light)

double mAs

increase kVp 10%

How do you fix an OVEREXPOSED xray (too dark)

½ mAs

decrease kVp 10%

Is this film of diagnostic quality (Lateral Cervical)

NO

• take off jewelry

• move pt backwards in light field

• move tube back to 72”

• overexposed - decrease mAs by ½

Is this film of diagnostic quality (AP Lower Cervical)

NO

• mitchell marker over anatomy

• overexposed - decrease mAs by ½

• make sure pt back is touching bucky

Is this film of diagnostic quality (Lateral Cervical)

NO

• collimation should be 8 x 10

• CR is at C1, should be at C4 (move bucky and tube)

• overexposed - decrease mAs by ½

Is this film of diagnostic quality (AP Thoracic)

NO

• no mitchell marker

• too much grey - increase kVp by 10%

• overexposed - increase mAs by 2 (double)

• IR is too low, should be 1 ½ inch above VP

Is this film of diagnostic quality (Lateral Thoracic)

NO

• underexposed - increase kVp by 10% until see osseous structures

Is this film of diagnostic quality (Lateral Cervical)

YES doesn’t require a retake

Is this film of diagnostic quality (APOM Cervical)

NO

• collimation is too big

• CR is not focused on pertinent anatomy, should be corner of mouth

• underexposed - could double mAs if needed

Is this film of diagnostic quality (AP Thoracic)

YES doesn’t require a retake

• pt not centered to CR

• collimation is too big

Is this film of diagnostic quality (Lateral Cervical)

NO

• mitchell marker over anatomy

• underexposed - double mAs

• CR is too low (can’t see sella turcica)

• pt is rotated

Is this film of diagnostic quality (Lateral Thoracic)

NO

• CR is too fare forward and too low

• no mitchell marker

• overexposed - ½ mAs

• pt is rotated

• wrong breathing instructions should be inhale and hold

Is this film of diagnostic quality (APOM Cervical)

NO

• no mitchell marker

• CR is too low

• collimation is too big

• pt mouth is not open or head tilted backwards

• pt not gowned

Is this film of diagnostic quality (Lateral Cervical)

NO

• no mitchell marker

• CR is to low (change to C4)

• collimation is too big (change to 8 × 10)

• overexposed - decrease mAs by ½

Is this film of diagnostic quality (AP Thoracic)

NO

• no mitchell marker

• CR is too high (change to 1 ½ inch above VP)

• collimation is too big (change to 7 × 17)

• pt is not gowned

• overexposed - decrease mAs by ½ and decrease kVp by 10%

Is this film of diagnostic quality (Lateral Cervical)

YES doesn’t require a retake

• collimation is too big possibly

Is this film of diagnostic quality (Lateral Thoracic)

NO

• pt is not gowned, rotated, humerus is in way

• CR is too high (change to IR ½ inch above VP)

• collimation is too big (change to 10 × 17)

Is this film of diagnostic quality (Lateral Cervical)

NO

• overexposed - decrease mAs by ½

Is this film of diagnostic quality (AP Lower Cervical)

YES doesn’t require a retake

• pt is laterally bent

• collimation should be 8 × 10

• CR is too low

Is this film of diagnostic quality (Lateral Cervical)

NO

• CR is too low (can’t see sella turcica)

• pt is laterally bent

• collimation should be 8 x 10

Is this film of diagnostic quality (AP Thoracic)

NO

• mitchell marker over anatomy

• CR is too low (clipping T1 and first rib)

Is this film of diagnostic quality (Lateral Thoracic)

YES doesn’t require a retake

Fix this image (Lateral Cervical)

NO

• underexposed - double mAs

• add mitchell marker

• could do swimmer’s view instead

Fix this image (AP Cervical)

NO

• add cephalic tube tilt

• CR should be at C4

• collimation should be 8 x 10

Is this film of diagnostic quality (AP Thoracic)

NO

• add mitchell marker

• change CR to 1 ½ inch above VP

• collimation should be 7 x 17

Fix this image (Lateral Thoracic)

NO

• pt not gowned

• add mitchell marker

Fix this image (APLP)

NO

• lower CR to 1-2 inch below crest

Fix this image (Lateral Lumbar)

NO

• move mitchell marker off anatomy

Is this film of diagnostic quality (Lateral Lumbar)

NO

• underexposed - double mAs

What is the correct collimation for a lateral Lspine

10 × 17

Which of the following view would NOT be included in the series on a pt who has suspected atlantoaxial instability

articular pillar

When performing a RAO Lspine, what would the correct tube tilt be

there is NO tube tilt for RAO/LAO Lspine xrays

If you wanted to specifically look at the left L5 pars in a 15 yo female w/suspected spondylolysis, which projection would allow me to visualize it the best

LPO Lspine

You notice on the AP Tspine that your pt had a 15 deg right thoracic scoliosis/convexity. When setting up the lateral Tspine, which projection should you perform?

Right lateral Tspine

Which of these projections would have the lowest radiation dose to the pt

500 mA x 0.6 sec

What is the significance of the inverse square law

helps determine that adjustments to technique we need to make when going from 72” to 40” FFD/SID and vice versa

What is the correct PP and FFD/SID for a Lateral Swimmer’s

seated 40”

You perform a lateral cervical using 90 kVp and 40 mAs. The image itself is very dark to the point you cannot see any osseous or soft tissue anatomy (overexposed). What is the best way to fix it

Decrease kVp to 75

You suspect you 58 yo female pt has L5 radiculopathy w/potential lumbar IVF stenosis as a result of facet OA. Which view would be the best to evaluate for lumbar IVF osseous stenosis

Lateral Lspine