Based on Workbook Objectives + Added Powerpoint Notes

Chapter Objectives:

General, Systemic, and Skeletal anatomy and Arthrology

• What are the 4 basic types of tissues?

  1. Epithelial – tissues that cover internal and external surfaces of body, lining of vessels and organs (like stomach and intestines)

  2. Connective – supportive tissues that bind together and support various structures

  3. Muscular – tissues that make up muscle

  4. Nervous – tissues that make up nerves and nerve centers

  • What are the 10 systems of the body?

  • Match the specific bodily functions to their correct anatomic systems.

    1. Nervous

       1. Composed of brain, spinal cord, nerves, ganglia, special sense organs (eyes, ears)

       2. 2 function:

          1. coordinate voluntary + involuntary body activities

          2. Transmit electrical impulses to body and brain

          3. Regulates body activities

    2. Muscular

       1. 3 types: skeletal, smooth, cardiac

          1. Skeletal – most muscle mass is this; involuntary + voluntary

          2. Smooth – involuntary; in internal hollow organ walls (blood vessels, stomach, intestines)

          3. Cardiac – only in walls of heart; involuntary

       2. 3 functions:

          1. Allow movement; locomotion or movement through alimentary canal

          2. Keep posture

          3. Make body heat

    3. Skeletal

       1. 206 separate bones

          1. Axial skeleton – 80 bones

Central axis of body

Skull, vertebral column, ribs, sternum

• Appendicular skeleton – 126 bones

Limbs

Shoulder + pelvic girdles

• Osteology – study of bones

  • Arthrology – study of joints

  • 4 functions:

    1. Support and protect soft tissues of body

    2. Allow movement through interaction with muscles to form system of levers

    3. Produce blood cells

    4. Store calcium

  1. Endocrine

     1. Made of all ductless glands (testes, ovaries, pancreas, adrenals, thymus, thyroid, parathyroid, pineal, pituitary, placenta) of body

     2. Hormones– secretions of glands– are released into bloodstream

     3. 1 function:

        1. Regulate body activities through hormones by cardiovascular system

  2. Urinary

     1. Includes organs (kidneys, ureters, bladder, urethra) that produce, collect, eliminate urine

     2. 4 functions:

        1. Regulate chemical composition of blood

        2. Eliminate waste products

        3. Regulate fluid and electrolyte balance and volume

        4. Maintain acid-base balance of body

  3. Reproductive

     1. Composed of organs (testes, ovaries, vas deferens, prostate gland, penis, uterine (fallopian tubes, uterus, vagina) that produce, transport and store germ cells

     2. 1 function: reproduce organism

  4. Respiratory

     1. Composed of 2 lungs + series of passages that connect lungs to outside atmosphere

     2. Includes nose, mouth, pharynx, larynx, trachea, bronchial tree

     3. 3 functions:

        1. Supply oxygen to blood + cells

        2. Eliminate carbon dioxide from blood

        3. Help regulate acid-base balance of blood

  5. Circulatory

     1. Composed of cardiovascular organs (heart, blood, blood vessels) + lymphatic system (lymph nodes, lymph vessels, glands, spleen)

     2. 6 functions:

        1. Distribute oxygen + nutrients to body cells

        2. Transport cell waste and carbon dioxide from cells

        3. Transport water, electrolytes, hormones, enzymes

        4. Protect against disease

        5. Prevent hemorrhage by forming blood clots

        6. Assist in regulating body temp.

  6. Integumentary

     1. Made of skin and structures from skin (hair, nails, sweat, oil glands)

     2. 5 functions:

        1. Regulate body temp

        2. Protect body from microbial invasion + mechanical, chemical, UV radiation

        3. Eliminate waste through perspiration

        4. Receive stimuli like temp, pressure, pain

        5. Synthesize vitamins + biochemicals (vit D)

  7. Digestive

     1. Composed of alimentary canal (mouth, pharynx, esophagus, stomach, small + large intestine, anus) + accessory organs of digestion (salivary glands, liver, gallbladder, pancreas)

     2. 2 functions:

        1. Prepare food for absorption by cells through numerous physical and chemical breakdown processes

        2. Eliminate solid wastes from body

  1. What are the 4 general classifications of bone?

     1. Long bone

        1. Limbs

        2. Compact bone

        3. Spongy bone

        4. Periosteum

        5. Ex. humerus

     2. Short bone

        1. Carpal + tarsal bones

     3. Flat bone

        1. Calvarium, sternum, rubs, scapulae

     4. Irregular bone

        1. Limbs

        2. Peculiar shapes (vertebrae, facial bones, pelvic bones)

  2. What are the specific characteristics and aspects of bone?

  3. Classify specific joints by their structure and function.

     1. 3 function: (S.A.D)

        1. Synarthrosis – NOT movable

        2. Amphiarthrosis – LIMITED movement

        3. Diarthrosis – freely MOVABLE

     2. 3 structural by tissue type: check this

        1. Fibrous joints – held by fibrous tissue

           1. Syndesmosis

Ex. skull suture

• Suture joints

Ex. teeth roots check this

• Gomphosis joints

Ex.

• Cartilaginous – held by cartilage

  1. Symphyses – amphiarthrodial

Ex. intervertebral joint, symphysis pubis

• Synchondroses – synarthrodial

Ex. epiphyseal plates

• Synovial – held by synovial fluid in joint capsule

  1. Generally diarthrodial

  1. Classify specific synovial joints by their movement types.

     1. Trochoid joint – pivot; rotate

        1. Ex. Proximal + distal radioulnar joints, C1-2 joint

     2. Ginglymus joint – hinge

        1. Ex. Interphalangeal joints (fingers), elbow joint

     3. Spheroidal joint – ball and socket

        1. Ex. hip joint, shoulder joint

     4. Sellar joint – saddle

        1. Ex. 1st carpometacarpal joint (thumb)

     5. Plane joint – gliding

        1. Ex. intercarpal, intermetacarpal, carpometacarpal

     6. Ellipsoid joint – condyloid

        1. Ex. metacarpophalangeal joints, wrist joint

     7. Bicondylar joint

• Healthy Skeletons Protect Cartilage Bones Perfectly

  • (hinge, saddle, pivot, condyloid, ball + socket, plane)

Positioning Terminology

• What is general radiographic and anatomic relational terminology?

  1. Anatomical Position: The standard reference position for the body in the study of anatomy. The body is standing erect, facing forward, with arms at the sides and palms facing forward.

  2. Medial vs. Lateral: Medial refers to being closer to the midline of the body, while lateral refers to being farther from the midline.

  3. Superior vs. Inferior: Superior means toward the head, and inferior means toward the feet.

  4. Anterior (Ventral) vs. Posterior (Dorsal): Anterior refers to the front of the body, while posterior refers to the back.

     1. Dorsum manus – posterior of hand; dorsal

     2. Palmar – anterior of hand

     3. Plantar – sole/posterior of foot

     4. Dorsal – top/anterior of foot

  5. Proximal vs. Distal: Proximal indicates closer to the point of attachment or the trunk of the body, while distal refers to being farther away.

  6. Cephalad vs. Caudad: Cephalad (cranial) means toward the head, and caudad means toward the feet or tail.

• What are the imaginary planes, sections, and surfaces of the body used to describe central ray (CR) angles or relationships among body parts?

  1. Sagittal (longitudinal) Plane: Divides the body into left and right sections.

     1. The midsagittal plane (median plane) divides the body into equal left and right halves. The CR may be aligned parallel or perpendicular to this plane.

  2. Coronal (longitudinal) Plane: Divides the body into anterior (front) and posterior (back) sections.

     1. The midcoronal plane divides the body into equal anterior and posterior halves. CR angles may relate to this plane when positioning for lateral radiographs.

  3. Transverse (Axial or Horizontal) Plane: Divides the body into superior (upper) and inferior (lower) parts.

     1. This plane is essential for determining the CR angle for axial views.

  4. Oblique (longitudinal) Plane: A diagonal plane that divides the body at an angle. Often used for imaging specific structures at oblique angles.

  • Distinguish among a radiographic projection, position, and view.

    1. Radiographic Projection: Refers to the path of the x-ray beam as it travels through the patient. Common projections include:

       1. Anteroposterior (AP) Projection: The CR enters the anterior surface and exits the posterior surface.

       2. Posteroanterior (PA) Projection: The CR enters the posterior surface and exits the anterior surface.

       3. Lateromedial Projection: CR enters lateral surface and exits medial surface

       4. Mediolateral Projection: CR enters medial surface and exits lateral surface

       5. Lateral Projection: The CR enters from the side of the body, either left or right.

       6. Oblique Projection: The CR enters the body at an angle, neither AP nor PA nor lateral.

    2. Radiographic Position: Refers to the position of the patient’s body during the imaging procedure. Common positions include:

       1. Supine: Lying on the back.

       2. Prone: Lying on the stomach.

       3. Trendelenburg: lying down with feet elevated

       4. Fowler: lying down with head elevated

       5. Recumbent: patient is lying face up, down, or any position

          1. Dorsal

          2. Ventral

          3. Lateral

       6. Erect: sitting or standing; body vertical, upright

          1. Erect right lateral

          2. Recumbent left lateral

       7. Lateral: Lying on either side, left or right lateral depending on the side closer to the image receptor (IR).

       8. Oblique Position: The body is rotated at an angle; based on side towards IR

          1. LPO – left posterior oblique

          2. RAO – right anterior oblique

          3. LPO – left posterior oblique

          4. RAO – right anterior oblique

       9. Lithotomy Position: laying on back (supine) with legs flexed at hips and knees; legs elevated + separated with stirrups for support

       10. Modified Sims’ Position: used for insertion of a rectal enema tip; laying down laterally with one leg over the other in right angle

       11. Decubitis Position: lying down on flat surface + x-ray beam is always horizontal

           1. AP left lateral decub

           2. PA right lateral decub

           3. Left lateral dorsal decub

           4. Right lateral ventral decub

       12. Special Projection Terms:

           1. AP axial (semiaxial) Projection: x-ray beam enters anterior side and exits through posterior at an angle

           2. Axial (superoinferior) Projection: x-ray beam enters superior and exits inferiour

    3. Radiographic View: Describes what is visualized on the radiograph. The view correlates to the body part that is closest to the IR and is typically the opposite of the projection (e.g., an AP projection provides a PA view).

       1. IR position

          1. Landscape-crosswise

          2. Portrait-lengthwise

       2. Placing Radiographs for Viewing

          1. Patient facing the viewer

          2. Patient’s right to the viewer’s left

       3. Viewing Radiographs

          1. Limbs; in anatomic position

Patient’s left will be viewer’s right

• Hands and feet; get your digits up!

  1. Given various hypothetical situations, identify the correct radiographic projection.

     1. Example: If the patient is positioned with their back against the image receptor and the CR is directed toward the front of their body, the projection is an AP (Anteroposterior) Projection.

     2. Example: If the CR is directed from the side of the body (e.g., through the shoulder), the projection is a Lateral Projection.

  2. Given various hypothetical situations, identify the correct radiographic position.

     1. Example: If the patient is lying face-up on the imaging table, this is the Supine Position.

     2. Example: If the patient is lying on their right side with their left side elevated and rotated forward, this is the Right Anterior Oblique (RAO) Position.

  3. What are the antonyms (opposites) of specific terms relate to movement?

     1. Flexion vs. Extension: Flexion is the bending movement that decreases the angle between two parts, while extension is the straightening movement that increases the angle.

     2. Abduction vs. Adduction: Abduction is moving a body part away from the midline, while adduction is moving it toward the midline.

     3. Internal (Medial) Rotation vs. External (Lateral) Rotation: Internal rotation involves turning a limb toward the body's midline, while external rotation involves turning it away from the midline.

     4. Supination vs. Pronation: Supination is rotating the forearm so the palm faces up (or anteriorly in the anatomical position), while pronation rotates the forearm so the palm faces down (or posteriorly).

     5. Inversion vs. Eversion: Inversion is turning the sole of the foot inward, while eversion is turning it outward.

     6. Protraction vs. Retraction: Protraction is moving a body part forward (e.g., the jaw), while retraction is moving it backward.

     7. Hyperextension vs. Dorsiflexion: Hyperextension is when arm is extended backwards past straight line, when knee is pushed backward, when back is bending backward; dorsiflexion is when feet is bending upward, decreasing angle

     8. Radial vs. Ulnar Deviation: radial deviation – bending of hand towards radial side; ulnar deviation – bending hand towards ulnar side

     9. Eversion vs. Inversion: eversion – outward movement of food; inversion – inward stress movement of foot

     10. Medial rotation vs Lateral Rotation: medial – rotating anterior body part (hand) towards inside; lateral – rotating body part towards outside or away from median

     11. Elevation vs Depression: upward motion of body part (shoulders); downward motion of body part

     12. Circumduction – move around in a circle

Positioning Principles

• Given a hypothetic clinical situation, what is the response as required in the professional code of ethics?

  1. In any clinical situation, radiologic technologists must adhere to the American Registry of Radiologic Technologists (ARRT) Code of Ethics. Here's a typical response:

     1. Example Situation: A patient refuses to undergo a necessary radiographic procedure due to fear of radiation exposure.

     2. Ethical Response: According to the Code of Ethics, the radiologic technologist must respect the patient's autonomy while ensuring the patient is fully informed about the procedure. The technologist would explain the procedure, its benefits, the risks of not performing it, and how radiation protection measures are in place to minimize exposure. If the patient still refuses, the technologist must honor the patient's decision, documenting it and informing the referring physician or supervisor.

  • What is the correct sequence of steps taken to perform a routine radiographic procedure?

    1. Verify Patient Identity: Confirm the patient’s identity using two identifiers (e.g., name and date of birth).

    2. Confirm doctor orders and reason of visit.

    3. Obtain Clinical History: Review the clinical indication for the radiograph and check for any contraindications (e.g., pregnancy).

    4. Explain the Procedure: Provide a clear explanation of the exam, addressing any questions or concerns from the patient.

    5. Position the Patient: Correctly position the patient according to the required projection, ensuring comfort while achieving diagnostic accuracy.

    6. Align the Equipment: Align the x-ray tube, image receptor (IR), and the body part being imaged. Ensure proper CR angle and alignment with the anatomical region of interest.

    7. Apply Radiation Protection: Use lead shielding to protect non-imaged parts of the body from unnecessary radiation.

    8. Set Technical Factors: Select the appropriate exposure factors (kVp, mA, and time) based on the body part being imaged and patient characteristics.

    9. Take the Exposure: Ensure the patient is still and give exposure commands before taking the radiograph.

    10. Check the Image: Evaluate the resulting image for proper exposure, positioning, and clarity. If necessary, repeat the exposure with adjustments.

    11. Document the Procedure: Record relevant information such as the exam performed, number of exposures, and any deviations from routine.

  • Given a set of circumstances, apply the 3 general rules of radiography concerning the minimal number of projections required for specific regions the body.

    1. Two Projections at 90 Degrees to Each Other:

       1. General Rule: For most body parts, at least two projections (e.g., AP and lateral) are taken to provide different perspectives of the structure.

          1. Anatomic structure superimposed

          2. Localisation of lesions or foreign bodies

          3. Determination of alignment of fractures

       2. Example: For imaging the forearm, you would perform an AP projection and a lateral projection to assess the bone from different angles.

    2. Three Projections for Joints:

       1. General Rule: Joints often require three projections (e.g., AP, lateral, and oblique) to fully visualize the joint space, surrounding structures, and any potential injury.

          1. AP or PA

          2. Lateral

          3. Oblique

       2. Example: For a knee injury, the standard projections might be AP, lateral, and a medial oblique projection to evaluate the joint from multiple angles.

    3. One Projection for Special Cases:

       1. General Rule: Sometimes, only one projection is required in follow-up situations or for special cases where additional projections are not necessary.

       2. Example: A follow-up chest x-ray for checking line placement or monitoring a known condition may only require a single AP or PA view.

       3. Long bones require 2 projections

  • What is the correct way to view a conventional radiograph, computed tomography image, and magnetic resonance image?

    1. Conventional Radiograph: View as if you are looking directly at the patient in the anatomical position (facing you). For lateral images, position them as if the patient’s right side is to your left (right lateral), and vice versa.

    2. Computed Tomography (CT) Image: Typically, axial slices are viewed from the feet upwards, as if you are looking from the patient's feet toward the head. The patient's right side will appear on your left, as if they are lying on their back.

       1. One of the first applications of computers in radiography

    3. Magnetic Resonance Imaging (MRI) Image: Similar to CT images, axial MRI images are viewed from the feet upwards, with the patient's right side on your left. Coronal and sagittal images follow a similar convention to radiographs (facing the viewer).

  • What are the 3 key elements of the American Society of Radiologic Technologists ACE campaign?

    1. Announce your name

    2. Communicate your credentials

    3. Explain the procedure

    4. Conventional Radiograph: View as if you are looking directly at the patient in the anatomical position (facing you). For lateral images, position them as if the patient’s right side is to your left (right lateral), and vice versa.

    5. Computed Tomography (CT) Image: Typically, axial slices are viewed from the feet upwards, as if you are looking from the patient's feet toward the head. The patient's right side will appear on your left, as if they are lying on their back.

    6. Magnetic Resonance Imaging (MRI) Image: Similar to CT images, axial MRI images are viewed from the feet upwards, with the patient's right side on your left. Coronal and sagittal images follow a similar convention to radiographs (facing the viewer).

Imaging Principles

• Describe the major exposure factors that influence the diagnostic quality of the radiograph.

  1. kVp (Kilovoltage Peak): Controls the energy and penetrability of the x-ray beam. Higher kVp increases the ability of x-rays to penetrate tissues, which can enhance image contrast and reduce patient dose (due to reduced mAs requirement).

  2. mAs (Milliampere-Seconds): The product of tube current (mA) and exposure time (seconds). It controls the quantity of x-rays produced and directly influences the receptor exposure (density of the image). Higher mAs increases image brightness but also increases patient dose.

  3. Exposure Time: Part of the mAs equation, it determines the length of time that the x-rays are emitted. Shorter exposure times reduce the chances of motion blur.

  4. SID (Source-to-Image Distance): The distance between the x-ray tube and the image receptor. An increase in SID reduces beam intensity (inverse square law), affecting receptor exposure and sharpness.

• Brightness – intensity of light representing individual pixels in image- controlled by processing software through predetermined algorithms

  • Contrast resolution – differences in brightness between light and dark areas of image- helps to distinguish between similar tissues

  1. What are the 4 image quality factors and their impact on a radiograph?

     1. The four image quality factors are:

     2. Density/Receptor Exposure:

        1. Definition: The amount of blackening on the radiograph, or how much exposure the image receptor received.

        2. Impact: Inadequate exposure results in a light (underexposed) image, while excessive exposure produces a dark (overexposed) image. Proper exposure ensures enough detail without image noise.

     3. Contrast:

        1. Definition: The difference in optical density between adjacent structures or areas on the radiograph.

        2. Impact: High contrast (few shades of gray) is useful for bone imaging, while low contrast (many shades of gray) is better for soft tissue imaging. kVp is the primary controller of contrast.

     4. Spatial Resolution:

        1. Definition: The sharpness of the structures on the image or the ability to distinguish small details.

        2. Impact: High spatial resolution provides better detail and clearer borders. It is affected by factors such as focal spot size, motion, and the distance between the object and image receptor (OID).

     5. Distortion:

        1. Definition: Misrepresentation of the size or shape of the anatomical structure.

        2. Impact: Size distortion (magnification) occurs when the SID or OID is not optimal. Shape distortion happens due to improper alignment of the x-ray tube, body part, or image receptor.

  2. What are the exposure factors controlling receptor exposure and penetrability?

     1. Receptor Exposure (Density): Controlled primarily by mAs (directly proportional) and kVp (indirectly). Increasing mAs or kVp increases receptor exposure, while reducing them decreases it.

     2. Penetrability: Controlled by kVp. Higher kVp increases the energy of the x-ray beam, allowing it to penetrate denser tissues more effectively. Lower kVp reduces penetrability and increases contrast.

  3. Explain SID (source to image distance) and its impact on x-ray beam intensity.

     1. SID refers to the distance between the x-ray tube and the image receptor. It directly affects beam intensity and image quality:

        1. Impact on Beam Intensity: As SID increases, beam intensity decreases according to the inverse square law. Doubling the SID results in one-fourth of the beam intensity, which can reduce the exposure on the image receptor.

        2. Impact on Image Quality: Increasing SID reduces magnification and improves spatial resolution. However, to maintain receptor exposure with a greater SID, mAs must be increased to compensate for the reduced beam intensity.

  4. What is the 15% rule?

     1. The 15% rule is a technique used to maintain or adjust exposure while controlling image contrast:

        1. Definition: Increasing the kVp by 15% will approximately double the exposure to the image receptor (similar to doubling mAs), while decreasing kVp by 15% will halve the exposure.

        2. Application: This rule is used to adjust kVp for different clinical needs. If an increase in penetrability is needed without increasing patient dose, the kVp can be increased by 15% and the mAs can be halved.

  5. What are grids and the factors for when they are used?

     1. Grids: Grids are devices placed between the patient and the image receptor to reduce the amount of scatter radiation that reaches the image receptor. They consist of alternating strips of radiopaque material (like lead) and radiolucent material.

     2. When Used: Grids are primarily used when imaging body parts that are more than 10 cm thick or when using higher kVp settings. These situations result in more scatter radiation, which can degrade image quality by reducing contrast.

     3. Grid Ratio: The ratio of the height of the lead strips to the distance between them. Higher grid ratios are more effective at reducing scatter but also require increased exposure (mAs) to compensate for the loss of primary radiation.

• Best way to control scatter is using grids and close collimation

  1. What are the benefits of collimation?

     1. Collimation refers to the restriction of the x-ray beam to the area of interest, which reduces the field size and minimizes exposure to surrounding tissues.

     2. Benefits:

        1. Reduces Patient Dose: Limiting the field size reduces the amount of radiation the patient receives.

        2. Improves Image Quality: By reducing scatter radiation, collimation increases image contrast and clarity.

        3. Limits Unnecessary Radiation: Helps in protecting surrounding tissues and sensitive organs not involved in the imaging study.

  2. What is Exposure Index (EI)?

     1. The Exposure Index (EI) is a numerical value provided by digital imaging systems that reflects the amount of radiation received by the image receptor during an exposure. It is not a direct measurement of patient dose but indicates whether the image was overexposed, underexposed, or within the appropriate exposure range for diagnostic quality.

  3. What are the 3 critical concepts related to EI and radiation exposure to the UR?

     1. Accuracy of Exposure: EI helps assess whether the correct amount of radiation was used. Underexposure can result in image noise (graininess), while overexposure may result in loss of contrast and unnecessary radiation dose.

     2. Calibration and Consistency: The EI value depends on the calibration of the imaging system. Consistent monitoring and maintenance of the system are required to ensure accurate EI readings, correlating exposure to image quality.

     3. Patient Radiation Safety: By monitoring EI, radiographers can adjust future exposures to avoid overexposure and reduce the patient's radiation dose while ensuring diagnostic image quality.

  4. What is spatial resolution and its controlling factors?

     1. Spatial Resolution refers to the ability of an imaging system to distinguish small structures and detail. It affects the sharpness of the image and is controlled by:

        1. Pixel Size: Smaller pixels allow for better spatial resolution as more detail can be captured within the image.

        2. Matrix Size: Larger matrix sizes (number of pixels) improve spatial resolution by capturing more detail.

        3. Focal Spot Size: Smaller focal spots produce sharper images with higher spatial resolution. Larger focal spots result in less sharpness.

        4. Object-to-Image Distance (OID): Decreasing the distance between the object and the image receptor improves spatial resolution.

        5. Source-to-Image Distance (SID): Increasing SID improves spatial resolution by reducing magnification and distortion.

  5. What is blur and its controlling factors?

     1. Blur in radiography refers to the loss of image sharpness due to movement, improper focus, or geometric issues. It is controlled by:

        1. Motion: Patient movement or tube movement can cause motion blur. Controlling voluntary and involuntary motion is crucial to reducing blur.

        2. Focal Spot Size: A smaller focal spot minimizes geometric blur, improving image sharpness.

        3. OID: Reducing the distance between the object and image receptor minimizes geometric blur and improves sharpness.

        4. Exposure Time: Shorter exposure times reduce motion blur by limiting the time during which the patient or the tube can move.

  6. What are the 3 geometric factors that influence image sharpness?

     1. Focal Spot Size: A smaller focal spot size improves image sharpness by reducing the penumbra effect (blurring at the edges of the image).

     2. OID (Object-to-Image Distance): A shorter OID reduces magnification and geometric blur, resulting in better sharpness.

     3. SID (Source-to-Image Distance): A longer SID reduces magnification and improves sharpness by minimizing geometric distortion.

        1. Increased SID reduces/decreases magnification

        2. Distortion – the closer an object is to IR, less magnification and shape distortion there is

           1. Object (anatomy) must parallel to IR

           2. Digitals parallel → joints are open

           3. CR alignment – must be aligned to anatomy for joint space opening

At the center of CR there is no divergence because it projects that part of the object at 90 degrees, or perpendicular to the plane of the IR

Distortion increases at the angle of the divergence It slowly increases from the center of the x-ray beam to the outer edges of the light field.

• What are the best ways of controlling voluntary and involuntary motion?

  1. Voluntary Motion: This type of motion is caused by the patient’s movement. It can be controlled by:

     1. Clear Instructions: Providing the patient with clear instructions on how to remain still during the exposure.

     2. Positioning Aids: Using immobilization devices (sponges, straps) to help the patient maintain the correct position.

     3. Short Exposure Times: Reducing the exposure time minimizes the chance of voluntary motion affecting the image.

     4. Can be minimized with support blocks/sponges, sandbags, tape

  2. Involuntary Motion: This includes motion from physiological processes like heartbeat or breathing. It can be controlled by:

     1. Short Exposure Times: Using fast exposure times to freeze motion.

     2. Patient Breathing Instructions: Instructing the patient to hold their breath during the exposure, particularly in chest and abdominal imaging.

  • Given a hypothetical situation, select the correct factor to improve radiographic detail.

    1. Situation: A radiograph of the wrist shows slightly blurred bones due to minor patient movement.

       1. Correct Factor: To improve radiographic detail in this case, you would reduce the exposure time while increasing mA to maintain the correct overall exposure. This decreases the likelihood of motion blur while preserving image quality.

  • What is radiographic distortion and its controlling factors?

    1. Radiographic Distortion refers to the misrepresentation of the size or shape of an anatomical structure in an image. The two types of distortion are:

       1. Size Distortion (Magnification): Occurs when the image appears larger than the actual object. This is influenced by the OID and SID:

          1. Controlling Factors: To reduce size distortion, decrease OID and increase SID.

    2. Shape Distortion: Occurs when the shape of the structure is altered due to improper alignment of the x-ray tube, image receptor, or body part. It includes foreshortening (object appears shorter) and elongation (object appears longer):

       1. Controlling Factors: Properly aligning the x-ray tube, image receptor, and body part reduces shape distortion.

  • Given a hypothetical situation, select the correct factor to minimize radiographic distortion.

    1. Situation: You are imaging a foot, and the radiograph shows elongation of the bones.

    2. Correct Factor: To minimize shape distortion (elongation), you would need to correct the alignment of the x-ray tube with the anatomical part and image receptor. Ensuring that all three elements are properly aligned will reduce shape distortion and provide a more accurate representation of the anatomy.

Digital Imaging Characteristics

• Radiography – processes and procedures of producing a radiograph

• Radiograph – recording medium and the image of the anatomy

• X-ray film – physical material; tangible item with latent unprocessed radiographic image

• IR – image receptor; captures radiographic image that exits patient

• CR – central ray; centermost portion of x-ray beam from x-ray tube

• Projection – refers to path or direction of CR projecting an image onto an image receptor (IR)

• Position – restricted to discussion of patient's physical

  • Specific position – describes specific body positions by body part closest to IR

  • Positioning factors must be accurate and meet standards of projection

  • Centering must be accurate

  • Colimate!!

• Radiograph Critique

  • Anatomy demonstrated – needed anatomy must be visualized on the radiograph

  • Exposure

    • Kilovoltage (kV) – energy power controlling quality

    • Milliamperage (mA) – controls quantity (number) of x-rays produced

    • Exposure Time – controls duration (seconds)

    • mAs (milliampere-seconds) = mA x kVP

  • Position

  • Image marker

    • Right or left; required on all images

    • Placed inside collimated field but not in pertinent anatomy

• Patient ID on Digital Radiograph

  • Name

  • DOB

  • Date of exam

  • Case number (facility-bassed)

  • Institution name

  1. What is digital medical imaging?

     1. Digital medical imaging refers to the use of electronic sensors and computer systems to capture, store, and display medical images. Instead of using film, digital systems use detectors that convert x-ray energy into digital signals, which are then processed by computers. This technology allows for real-time viewing, enhanced image manipulation, and easier storage and sharing of medical images.

  2. What is pixels and their impact on spatial resolution?

     1. Pixels: The smallest discrete units or elements that make up a digital image. Each pixel represents a single point of information, typically a shade of gray in a radiograph.

     2. Impact on Spatial Resolution: The size of the pixels affects spatial resolution. Smaller pixels can capture finer detail, resulting in higher spatial resolution and sharper images. Larger pixels reduce spatial resolution, causing a loss of detail and image sharpness.

  3. What is contrast resolution and its controlling factors in the digital image?

     1. Contrast resolution is the ability of a digital imaging system to distinguish between differences in the density or intensity of tissues. It reflects the system's ability to differentiate between subtle differences in gray levels.

     2. Controlling Factors:

        1. Bit Depth: Refers to the number of gray levels a pixel can display. Greater bit depth allows for better contrast resolution.

        2. Post-Processing Capabilities: Adjustments like windowing and leveling can enhance contrast in digital images, allowing for better visualization of soft tissues.

        3. Detector Sensitivity: The sensitivity of the digital detector influences the ability to capture contrast differences between tissues.

  4. What are the 2 types of pixel sizes?

     1. Acquired Pixel Size: The pixel size determined by the physical dimensions of the detector elements in the digital imaging system. This is influenced by the sampling frequency and the detector’s construction.

     2. Displayed Pixel Size: The size of the pixels when the image is displayed on a monitor. This can vary depending on how the image is scaled or zoomed, and it affects the perceived resolution of the image.

  5. What is spatial resolution and its controlling factors in the digital image?

     1. Spatial resolution in digital imaging is the system's ability to resolve or distinguish small, closely spaced objects in an image. It is influenced by:

        1. Pixel Size: Smaller pixel sizes improve spatial resolution by capturing finer detail.

        2. Matrix Size: Larger matrix sizes (more pixels) increase spatial resolution by providing more data points across the image.

        3. Sampling Frequency: Higher sampling frequencies capture more data points per unit area, leading to improved spatial resolution.

        4. Detector Element Size: Smaller detector elements provide better spatial resolution by improving the system's ability to detect fine details.

  6. What is detective quantum efficiency (DGE)?

     1. Detective Quantum Efficiency (DQE) measures the efficiency of a digital imaging system in converting the x-ray signal into a useful image. It assesses how well the detector system captures and utilizes the incoming x-rays, and how effectively it translates this into image quality.

     2. Higher DQE indicates better image quality with lower patient dose, as the system is more efficient at converting x-ray photons into image data with less noise and better contrast.

  7. What are the 3 factors that influence scatter radiation?

     1. Patient Thickness: Thicker body parts produce more scatter radiation due to increased x-ray interactions within the tissue.

     2. Field Size: Larger x-ray fields expose more tissue, which increases scatter radiation. Collimation to reduce field size can minimize scatter.

     3. kVp (Kilovoltage Peak): Higher kVp settings increase the energy of the x-ray beam, which in turn increases the production of scatter radiation.

  8. What is the concept of the signal-to-noise ratio (SNR)?

     1. Signal-to-Noise Ratio (SNR) refers to the comparison between the useful signal (actual anatomical information) and background noise (random variations not related to the image). A higher SNR means the signal (image detail) is much stronger than the noise, resulting in clearer, more diagnostic images.

     2. Increasing SNR improves image quality by reducing the impact of noise, which can obscure fine details.

• Noise – random disturbance that obscures or reduces image clarity

  1. The number of x-ray photons that strike the receptor

  1. What is the dynamic range of digital imaging systems?

     1. Dynamic range is the range of exposure values that a digital imaging system can accurately detect and display. It reflects the system's ability to capture both very low and very high levels of radiation and display them as varying shades of gray.

     2. Wider dynamic range allows digital systems to display more subtle differences in tissue densities, improving image quality by providing better contrast resolution across a wide spectrum of exposures.

Digital Imaging Equipment

• What are the major components of a storage phosphor-based digital system (PSP)?

  1. A PSP (Photostimulable Phosphor) system is one of the technologies used in computed radiography (CR). Its major components include:

     1. Imaging Plate (IP): This is the heart of the PSP system. It contains a photostimulable phosphor layer that stores the latent image when exposed to x-rays.

     2. Cassette: The imaging plate is housed in a cassette that protects the plate from light and handling during the imaging process.

     3. CR Reader: After exposure, the cassette is placed in the CR reader, where a laser scans the imaging plate to release the stored energy in the form of light.

     4. Photomultiplier Tube (PMT): This component amplifies the light signal emitted from the imaging plate.

     5. Analog-to-Digital Converter (ADC): Converts the light signal into a digital signal, which is then processed to form a digital image.

     6. Workstation: The digital image is displayed on a computer workstation, where it can be enhanced, manipulated, and stored.

  • Describe how an image is recorded, processed, and viewed with a PSP system.

    1. Image Recording: During exposure, the x-rays pass through the patient and interact with the photostimulable phosphor layer in the imaging plate, storing energy as a latent image.

    2. Image Processing: The exposed cassette is inserted into a CR reader, where a laser beam scans the imaging plate, releasing the stored energy in the form of light. This light is collected by the photomultiplier tube, which amplifies it. The analog signal is converted into a digital signal by the ADC.

    3. Image Viewing: The digital signal is processed and displayed as an image on a computer monitor. The image can then be enhanced (e.g., adjusting brightness and contrast), stored in a PACS (Picture Archiving and Communication System), and shared for diagnosis.

  • What is teh importance of correct centering, collimation, use of lead masking, and use of grids to the overall quality of the digital image.

    1. Correct Centering: Proper alignment of the x-ray beam with the area of interest ensures that the anatomy is accurately represented in the image. Miscentering can result in image artifacts, distortion, or anatomy being cut off.

    2. Collimation: Reducing the field size to the area of interest decreases scatter radiation, which improves image contrast and reduces patient dose. It also improves image quality by preventing unnecessary exposure to surrounding tissues.

    3. Lead Masking: Helps to prevent exposure from stray radiation or scatter, especially in CR systems where unused portions of the imaging plate may cause artifacts. It limits the amount of radiation reaching the non-imaged areas.

    4. Use of Grids: Grids are essential when imaging thicker body parts or using high kVp. They absorb scatter radiation before it reaches the image receptor, enhancing image contrast and quality.

  • What are the specific differences and similarities between PSP and digital radiography (DR)?

    1. Similarities:

       1. Both PSP and DR are digital imaging systems that capture x-ray images as digital data.

       2. Both systems convert x-ray energy into a digital format for viewing, processing, and storage.

       3. Both can be integrated into PACS for easy image sharing and storage.

    2. Differences:

       1. PSP (Computed Radiography): Uses an imaging plate that must be physically transported to a CR reader for processing. The process is somewhat similar to traditional film but involves digital technology.

       2. DR (Direct Digital Radiography): Uses flat-panel detectors or charge-coupled devices (CCD) to directly capture the image as digital data without the need for a cassette or processing step. Images are available almost instantly.

       3. Speed: DR is faster than PSP because there is no need to transport cassettes or perform additional processing.

       4. Portability: PSP systems are more portable and versatile, especially in fieldwork or mobile imaging, as they do not require the large, stationary detectors that DR systems use.

  • What are the terms: RACS, RIS, HIS, and DICOM.

    1. PACS (Picture Archiving and Communication System): A system used for storing, retrieving, managing, and sharing medical images digitally. It allows radiologists and physicians to view images from different locations and share them easily.

       1. Picture- digital medical image

       2. Archiving- electronic storage of images

       3. Communication- routing(retrieval/send) and displaying of image

       4. System- specialized computer network that manages the complete system

       5. ”virtual film library”

    2. Advantages of PACS

       1. Elimination of physical storage

       2. Rapid transfer of images

       3. Simultaneous viewing of images from multiple locations

       4. Elimination of misplaced, damaged, or missing films

       5. No chemical processing

    3. RIS (Radiology Information System): A software system that manages patient data and imaging orders within a radiology department. It tracks patient scheduling, records reports, and integrates with PACS and HIS.

    4. HIS (Hospital Information System): A comprehensive system used to manage all aspects of hospital operations, including patient records, billing, and administrative tasks. It often integrates with RIS for a seamless flow of information.

    5. DICOM (Digital Imaging and Communications in Medicine): The standard format for medical imaging that ensures compatibility between different imaging equipment and systems. DICOM allows images to be shared and viewed across various platforms.

  • Compare and contrast differently sized image receptors between metric and English units of measurement.

    1. Image receptors (IRs) are often referred to by their sizes, which can be expressed in both metric and English units:

       1. Metric Units: IRs are typically measured in centimeters (cm). Common sizes include 24x30 cm, 35x43 cm, and 18x24 cm.

       2. English Units: In the English system, sizes are usually expressed in inches. The same receptors mentioned would correspond to approximately 8x10, inches 10x12 inches, 14x17 inches, and 11x14 inches.

          1. The choice of size depends on the anatomical region being imaged and the clinical requirements.

          2. Most places use digital imaging; 3 standard sizes

14x17, 16x16, or 17x17

• What are specific digital imaging terms and acronyms?

  1. Pixel (Picture Element): The smallest unit of a digital image, contributing to spatial resolution.

  2. Matrix: The grid of rows and columns that make up a digital image. The larger the matrix, the greater the image resolution.

  3. Bit Depth: The number of bits used to define each pixel's shade of gray, affecting contrast resolution.

  4. Exposure Index (EI): A numerical value that indicates the amount of radiation used to produce an image.

  5. SNR (Signal-to-Noise Ratio): The ratio of useful image signal to background noise, affecting image clarity.

  6. Saturation: A condition where an image receptor receives too much radiation, resulting in a loss of image detail.

  7. Dynamic Range: The range of exposure intensities a digital imaging system can detect, from the lowest to the highest signals.

Radiation Protection

• What are the 3 methods to reduce exposure to patients and staff?

  1. Time: Minimize the time spent in the radiation area to reduce exposure.

  2. Distance: Maximize the distance from the radiation source, using the inverse square law, which states that exposure decreases with the square of the distance.

  3. Shielding: Use barriers such as lead aprons, walls, or shields to absorb or block radiation.

  • List and define the traditional units and International System of Units (SI units) of radiation measurement and the conversion factors used to convert between systems.

    1. Traditional Units:

       1. Exposure: Roentgen ®

          1. Used for measurements in air

       2. Absorbed Dose: Rad (radiation absorbed dose)

          1. Used for patient dose purposes

       3. Dose Equivalent: Rem (roentgen equivalent man)

          1. Used for worker protection purposes

    2. SI Units:

       1. Exposure: Air KERMA

       2. Absorbed Dose: Gray (Gy)

       3. Dose Equivalent: Sievert (Sv)

    3. Conversion Factors:

       1. 1 Roentgen (R) = 2.58 × 10⁻⁴ C/kg

       2. 1 Rad = 0.01 Gy

       3. 1 Rem = 0.01 Sv

  • What are the specific annual dose-limiting recommendations of whole-body effective dose for the general population and occupationally exposed workers?

    1. General Population:

       1. Whole-body effective dose limit: 1 mSv/year (0.1 rem/year)

    2. Occupational Workers:

       1. Whole-body effective dose limit: 50 mSv/year (5 rem/year)

  • What is ALARA?

    1. ALARA (As Low As Reasonably Achievable) is a safety principle designed to minimize radiation exposure and doses by implementing reasonable measures to reduce radiation risks.

       1. Always wear personnel monitor

       2. Mechanical holding devices– sponges, sandbags, tape

       3. Close collimation – optimal radiographic exposure factors

       4. Cardinal rules of radiation protection – time, distance, shielding

  • Apply the principles of ALARA to a given hypothetical situation.

    1. In a scenario where a radiologic technologist is performing a fluoroscopic procedure:

       1. Time: Reduce the amount of time the fluoroscopy machine is on.

       2. Distance: Step back as far as possible from the radiation source.

       3. Shielding: Use lead aprons and thyroid collars to protect exposed body parts.

  • What are the different types of personnel dosimeters?

    1. Film Badge: Contains a piece of film that darkens when exposed to radiation.

       1. Worn at waist or chest level; or on collar during fluoroscopy outside lead apron

    2. Thermoluminescent Dosimeter (TLD): Uses materials like lithium fluoride to measure radiation exposure.

    3. Optically Stimulated Luminescence (OSL): Uses crystals to measure radiation exposure when stimulated by light.

    4. Pocket Ionization Chamber: Provides immediate readings but is less commonly used due to fragility and cost.

  • Define and provide examples of effective does (ED).

    1. Definition: A measure that reflects the risk of harm from radiation exposure, considering both the absorbed dose and the type of tissue exposed.

    2. Examples:

       1. Chest X-ray: 0.1 mSv (10 mrem)

       2. Abdominal CT scan: 10 mSv (1000 mrem)

  • What are the specific methods to reduce exposure to the technologist during fluoroscopic and radiographic procedures?

    1. Use lead shielding (aprons, gloves, thyroid collars).

    2. Stand at a distance from the patient and beam.

    3. Limit the time of exposure.

    4. Use collimation to reduce the size of the radiation field.

    5. Use protective barriers and move to protected areas during exposure.

    6. Monitor personal dose with dosimeters.

  • Describe the 7 methods to reduce exposure to the patient during radiographic procedures.

    1. Collimation: Restrict the beam to the area of interest.

    2. Shielding: Apply gonadal, breast, and thyroid shields when appropriate.

    3. Proper Positioning: Ensure accurate positioning to avoid repeats.

    4. Optimal Technique: Use the lowest exposure settings possible for quality imaging.

    5. Image Receptor Sensitivity: Use appropriate image receptors with high sensitivity to reduce dose.

    6. Automatic Exposure Control (AEC): Utilize AEC to minimize unnecessary exposure.

    7. Pulsed Fluoroscopy: Use pulsed modes to minimize exposure.

  • What are the major types of specific area shields and how should they be applied during radiographic procedures?

    1. Gonadal Shielding: Used to protect reproductive organs.

    2. Breast Shields: To protect breast tissue during chest imaging.

    3. Thyroid Shields: For protecting the thyroid gland.

    4. Lead Aprons: General body shielding during procedures.

  • What is the patient dose terminology for a specific region of the body?

    1. Skin Dose: The amount of radiation delivered to the skin.

    2. Organ Dose: The radiation dose absorbed by specific organs.

    3. Effective Dose: A calculated value considering the type of radiation and the sensitivity of the tissue exposed.

  • What methods ensure a dose to the patient is minimized when using digital imaging systems?

    1. Use low-dose protocols.

    2. Adjust technical factors based on patient size.

    3. Use automatic exposure controls (AEC).

    4. Apply image processing algorithms that enhance quality at lower doses.

    5. Collimation to reduce unnecessary exposure.

    6. Avoid retakes by ensuring correct positioning.

  • What is the Image Wisely and Image Gently initiative and its purpose?

    1. Image Wisely: An initiative aimed at reducing radiation exposure in adult medical imaging.

    2. Image Gently: Focuses on minimizing radiation exposure in pediatric imaging, ensuring that children receive the lowest dose necessary for effective diagnosis.

Powerpoint Questions:

1. A projection in which the CR is parallel to or greater than a 10 degree angle along the long axis of the body or part?

2. A projection that merely skims a body part?

3. A projection in which the CR is parallel to or greater than a 10°angle along the long axis of the body or part? Axial projection

4. A projection that merely skims a body part? Tangential projection

5. A specific oblique position in which the patient is lying down with their right anterior aspect of the body is closest to the IR?

6. A body position in which the patient is lying on the abdomen with the x-ray beam directed horizontally?

7. A general body position in which the head is lower than the feet?

8. A specific oblique position in which the right anterior aspect of the body is closest to the IR? Recumbent RAO position

9. A body position in which the patient is lying on the abdomen with the x-ray beam directed horizontally? Dorsal decubitus position

10. A general body position in which the head is lower than the feet? Trendelenburg position

11. When the anode heel rule is applied, the thicker aspect of the anatomy should be placed under the cathode end of the x-ray tube. True or False?

12. What is the primary controlling factor for radiographic contrast?

    1. mAs

    2. kVp

    3. SID

    4. Focal spot size

13. The intensity of light that represents the individual pixels in the digital image on the monitor is the definition for:

    1. Brightness

    2. Contrast

    3. Density

    4. Noise

14. A random disturbance that obscures or reduces clarity is the definition for:

    1. Noise

    2. Resolution

    3. SNR

    4. Distortion

15. A low SNR digital image can be enhanced through post-processing techniques.

    1. True

    2. False

16. The SI unit equivalent for Rad is:

    1. Coulombs/kg of air

    2. Gray

    3. Sievert

    4. Curie

17. What is the annual dose limit for a technologist per year?

    1. 5 mSv

    2. 15 mSv

    3. 50 mSv

    4. 500 mSv

18. What minimum lead thickness or equivalency must a protective apron possess when worn for a fluoroscopy procedure?

    1. 0.5 mm Pb/Eq

    2. 1.0 mm Pb/Eq

    3. 1.5 mm Pb/Eq

    4. 2.5 mm Pb/Eq