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X-Ray Final Review

Things you should know before writing the CAMRT

QuestionAnswer
Flexion/extension views of the cervical spine assess: Anteroposterior vertebral mobility. Frequently performed to r/o whiplash type of injury or to follow up after spinal fusion surgery. Also may be performed prior to surgery for intubation on a patient with arthritis.
The CR angle for an AP coccyx is: 10 degrees caudad.
What is an ERCP? What does it stand for? Endoscopic retrograde cholangiopancreatography. It's done to diagnose biliary and pancreatic conditions.
A ball catcher's view is done to: Assist in detecting early radiologic changes needed to diagnose rheumatoid arthritis.
Orthostatic hypotension is: Low blood pressure due to standing upright (dizziness after getting up from a supine position)
How are the greater and lesser trochanters demonstrated on a x-table lateral hip x-ray: They are demoed at about the same transverse level.
What body part is perpendicular to the CR when doing an intercondylar fossa (tunnel view): The long axis of the tib/fib
What do you do if a nurse forgets to chart a medication? Must bring any omissions to their attention - any item that has not been documented on the chart is considered to be "not performed" in a court of law.
On an oblique L-spine, the pedicles are sitting too far posterior on the vertebral bodies. How do you correct this? The patient is over rotated - you must oblique them LESS.
Where does a Swan-Ganz catheter sit? What does it do? Location = right or left pulmonary artery Purpose= Measure central venous pressure, measure wedge pressure, measures systolic, diastolic, and mean pressure, withdraw blood samples, to give fluid or inject drugs.
Do you do a scoliosis AP or PA? PA - reduces dose to breasts and gonads. (*note - in real life we normally do it AP)
Foreign bodies that are inhaled normally go into what lung? The right lung (the bronchial tree on the right is wider and more vertical). If the foreign body is radiolucent you would do a 'forced expiration' view. (*note in real life at a non-children's hospital - you would normally NOT do a forced view)
Salter Harris fracture: Fracture through the growth plate. (so you would NOT see this fracture in an adult)
What x-rays can you do in a pigg-o-stat? Chest, T-spine, L-spine and upright abdomen. (*note - in real life the L-spine and abdomen are not always recommended to do in a pigg-o-stat as the baby is up high on the seat and it could be unsafe)
Bennett's fracture: Oblique fracture of the base of the first metacarpal.
Difference between spondylolysis and spondylolithesis: Spondylolysis= a defect in the pars interarticularis without displacement. Spondylolithesis= forward displacement of a vertebra over a lower segment, usually of the 4th or 5th lumbar, frequently due to spondylolysis.
What part of the gown is considered sterile during surgery? From the waist (level of the sterile table) to the shoulders in front and from the sleeves from about 2" above the elbow to the cuffs (the cuffs are NOT considered sterile)
Which vessel ascends through the cervical transverse foramina? Vertebral arteries.
When the elbow can't be fully extended for an AP view, what should you do? 2 AP projections - one with the forearm parallel to the IR and one with the humerus parallel to the IR. (partial flexion views)
Injection site for a myelogram: Subarachnoid space by spinal puncture, most commonly at the L2/3 or L3/4 interspace, or at the cistema magna between C1 and the occipital bone.
What breathing should be used when x-raying a soft tissue neck? Slow inspiration so that the trachea is filled with air.
What does quantum mottle indicate? An insufficient quantity of photons has stricken the IR - due to low mAs/time factor.
At what vertebral level do the kidneys sit? Between T12 and L3.
What position best demonstrates anterior/posterior displacement on a fractured mandible? Lateral view.
What is the purpose of performing non-weightbearing and weight bearing views of the AC joints? To demonstrate dislocation, separation and function of the joints.
What pathology is seen during an esophagus or GI exam that is associated with cirrhosis of the liver? Esophageal varices.
If a patient has a history of trauma to their lower right posterior ribs, what are the recommended projections? Straight AP and a Right Posterior Oblique (RPO).
The C-spine on a supine patient is being examined. The patient is in the RPO position with the CR 20 degrees cephalad. What is best demonstrated? The left intervertebral foramina.
What is a nosocomial infection? An infection acquired in the course of medical care.
MPD for a student? tech? pregnant tech? Student = 1mSv (same as the general public) Tech = 20mSv Pregnant tech = 4mSv (Source: SC 35)
Where is the lesser tubercle visualized on a lateral projection of the humerus? The lesser tubercle is shown in profile medially, partially superimposed by the lower portion of the glenoid cavity.
On an AP odontoid view - the teeth obscure the odontoid, how do you fix this? The head needs to be tilted back to align the lower portion of the upper incisors with the base of the skull. If the patient is in a c-spine collar then you would angle your tube cephalad to "throw" the teeth up.
Define situs inversus: Total or partial transposition of the body organs to the side opposite the normal.
CT Window width affects: CT Window level affects: Width = Contrast Level = Density/brightness
Why is it important to know a patient's creatinine level before injection of contrast? To check kidney function because injection of contrast is contraindicated by impaired kidney function.
What vessels do the R and L vertebral arteries originate from? The R and L subclavian arteries.
How much must mAs be changed to see a difference in density? 30%
If a trauma patient has not had his/her neck cleared, how do you turn this patient? How many people are needed? Log roll - 5 people are needed.
How is rotation assessed on the Caldwell view of the skull? Equal distance from the lateral border of the skull to the lateral border of the orbits on each side.
What view best demonstrates Osgood Schlatter's? Lateral view of the affected knee.
What are the four associated heart abnormalities of the Tetralogy of Fallot? 1. High ventricular septal defect 2. Pulmonary stenosis 3. Overriding aorta 4. Right ventricular hypertrophy
What four major vessels provide blood to the brain? R and L internal carotid arteries R and L vertebral arteries
Your patient can only dorsiflex 80 degrees for the plantodorsal projection of the calcaneus, how do you adjust the CR? Increase the angle to 50 degrees cephalad. (the TOTAL angle between part and CR equals 130 degrees)
Where do boxer's fracture occur? Neck of the 5th metacarpal.
What does DNR mean on a chart? Do Not Resuscitate.
Does a high grid ratio have a smaller or larger focusing range than a low grid ratio? Smaller focusing range.
Name the pathology in which the kidneys are joined at their lower poles: Horseshoe kidney.
Where does a Zenker's Diverticulum occur? Upper part of the esophagus.
The purpose of a hysterosalpingography is to demonstrate: The uterine cavity and the patency of the uterine tubes.
What controls the actual thickness of a CT slice? Prepatient collimator.
What is the most common clinical indication for a postoperative (t-tube) cholangiogram? Residual calculi.
What rib attaches to the sternal angle? The 2nd rib.
What must be included on an AP projection of the thumb? Entire thumb and trapezium.
Define hemoptysis: Coughing up blood.
If your patient can't sit/stand for a lateral chest x-ray and has pneumonia in the R lung, which view would you do? Right lateral decubitus. (*When looking for FLUID you want the affected side down. When looking for AIR you want the affected side up)
Brittle bone disease is also known as: Osteogenesis Imperfecta. Seen as multiple fractures in different stages of healing.
What sphincter allows food to pass into the duodenum? Pyloric sphincter.
What x-ray would you do querying a Monteggia fracture? Forearm x-ray. A Monteggia fracture is a fracture of the ulna with dislocation of the radial head.
What additional x-ray would you do after doing x-rays of a fractured hip? Supine chest x-ray. The patient will be going to surgery to have it repaired and the chest x-ray will be needed for anesthesia purposes.
What device would be inserted into a patient with a hemothorax? Chest tube.
A test to insure that radiation intensity is doubled when radiographic mA is doubled is called: Linearity test.
Ideally, the cathode end of an x-ray tube should be positioned to take advantage of the anode heel effect. Where should the cathode be placed for an AP t-spine? Toward the feet.
What is the main clinical indication for a skeletal survey? Multiple myeloma. Other indications include plasma syndrome, non-accidental trauma and differentiating between myeloma and metastatic disease.
What 2 body areas are examined in a BMD? Lumbar spine and hips.
Name the sinuses demonstrated on the lateral view of the skull: All 4 paranasal sinuses are demonstrated: Frontal, Maxillary, Sphenoid, Ethmoid.
What carpal bone is susceptible to avascular necrosis and why? Scaphoid - the blood supply enters from the distal portion of the carpal bone and can get cut off when the bone is fractured.
What is cholelithiasis? Presence of gallstones.
Allowing a patient to fall off a stretcher because you neglected to put up the side rails is an example of: Negligence.
What 3 vessels branch off of the Celiac trunk? L. gastric artery, Splenic artery, Common Hepatic artery.
The acceptance value for the x-ray field congruency test should not exceed the SID by what percentage? 2% Source: SC 35
A reduction in brightness at the periphery of the image captured with an image intensifier tube is referred to as: Vignetting.
The therapeutic radiologic procedure designed to dilate or reopen stenotic or occluded areas within a vessel is termed: Percutaneous transluminal angioplasty.
What sinus is projected through the open mouth on the Waters view for sinuses? Sphenoid.
Most common place for a renal calculi to lodge: Ureterovesical junction.
When a patient is supine, barium will pool in the ____ of the stomach: Fundus.
What pathology is indicated by the "apple core" sign? Colon Cancer.
Decreasing the field size from 35x43 to 18x24 will do what to the density and the amount of scatter radiation? It'll decrease both density and scatter radiation.
The number of grid strips or grid lines per centimetre is called: Grid frequency.
What bony pathological condition is associated with a diabetic foot? Bacterial osteomyelitis.
During an enteroclysis procedure, the tube is inserted into the nose to what final destination before the procedure starts? Duodenojejunal flexure, near the ligament of Treitz.
Who is in charge of radiation protection during an exam? The technologist.
If your patient is in an RPO, what SI joint is being demonstrated? Left SI joint (side up)
Define epistaxis: Nosebleed.
How would you find out the allergies of an inpatient who doesn't speak english? Check their medical chart.
When x-raying an AP L-spine, why are the knees bent? To reduce the normal lumbar curvature of the spine in order for the intervertebral joints to be well demonstrated.
In which view is the lateral border of the cecum best demonstrated during a double contrast study of the large bowel? Left lateral decubitus.
Why are glucagon and buscopan injected intravenously during gastric procedures? To slow down the transit time of the barium.
Which vertebral bodies must be seen on an AP axial c-spine? C3-T2.
Define intussusception: Telescoping of one part of the intestine into an adjoining section causing intestinal obstruction.
A lateral ankle x-ray demonstrates the fibula over the anterior half of the tibia, what error occurred? The forefoot was elevated, you need to depress the forefoot and elevate the heel.
On an AP Axial (Townes) projection, the dorsum sellae and posterior clinics are projected superior to the foramen magnum. What error occurred? The patient's chin was not tucked enough or your CR was not angled caudad enough. You need to lower the chin a bit or angle more.
What is the occupancy factor (T) of an x-ray room? 1. Source: SC 35.
How many posterior ribs should be visualized on an adult PA projection of the chest taken on inspiration? 10.
Which body habits shows the biggest change in stomach position when moving from supine to upright? Asthenic.
Why do you lower a fainting patient to the floor and elevate the feet? To get blood supply to the brain so no permanent damage is done and consciousness is regained.
What is a ureterocele? Ballooning of the lower end of the ureter into the bladder.
An ER stretcher patient's leg is medially rotated 15 degrees; the leg cannot be moved. How do you angle the tube to open up the proximal tibiofibular joint? Angle the tube 30 degrees medially (to equal a 45 degree medial oblique)
What age range do you need to obtain an LMP before performing x-ray examinations? Females of child bearing age (11-55 years) Source: SC 35
Define atelectasis: A collapsed or airless state of the lung.
The primary factor controlling contrast is: Kvp.
Why is is necessary to show soft tissue on a lateral c-spine? To ensure that the pre-vertebral fat stripe is included.
What is the trendelenberg position? Patient's head is lower than the rest of the body.
The single most effective means of radiation protection during mobile radiography is: Distance.
What is the most common arterial site for catheterization in selective angiography? Femoral artery.
What part of the heart pumps deoxygenated blood into the pulmonary artery? Right ventricle.
HVL represents: Half Value Layer represents the amount of aluminum required to decrease the intensity of the beam by half.
An infection of bone caused by pus-producing bacteria is called: Osteomyelitis.
Which type of oxygen delivery system should be used on patients with chronic lung disease? Venturi mask.
The most inferior border of the bladder lies at the level of the: Greater trochanter.
On an AP ankle, the foot must be flexed 90 degrees in order to open the _____ joint. Tibiotalar.
Which artery would be specifically catheterized for a selective angiographic study of the stomach, liver and pancreas? Celiac artery.
Magnification in fluoroscopy results in a higher dose because: The ABC (automatic brightness control) increases the mAs to maintain the brightness level.
You imaged a patient's ankle. The patient requested to know if it was broken or not and you gave the patient the information. What is this a breech of? CAMRT Code of Ethics.
If AEC was selected for a lateral skull x-ray and the cell was centred over the petrous ridges, how would the cranial vault appear? It would be over exposed.
The risk of a severe allergic reaction to an iodine contrast injection is greater with patients that have a history of: Renal failure, allergy to seafood (iodine) or asthma.
Blood pressure is measured by what instrument? Sphygmomanometer.
What are the three cardinal principles of radiation protection? Time, Distance, Shielding.
Describe the radiographic signs of Crohn's disease: Narrowing of the lumen (string sign), dilation of the bowel proximal to the lesion, cobblestone appearance and skip lesions.
Why is a chest x-ray taken on a patient who has had an myocardial infarction? To determine if the lungs are becoming congested as a result of left-sided heart failure.
What is the difference between a thrombus and a embolus? Thrombus = a mass of coagulated blood or clot that usually adheres to the wall of a vessel. Embolus = a thrombus that breaks free and enters the blood stream with the potential of becoming lodged in a vessel, which results in an occlusion.
Created by: 609870327