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RADT 318 TRAUMA
Review of important concepts for final exam
| Question | Answer |
|---|---|
| What is the minimum that an operator should stand from the x-ray tube during exposure with a c-arm or portable unit? | 6 feet |
| how far apart should the minimum two views be obtained from each other for trauma radiography? | 90 degrees |
| T/F: when imaging a trauma extremity, the intial view should have both joints included | True |
| T/F: when imaging a trauma extremity, a follow up film (i.e. post reduction) would only need one joint visualized on the image | True |
| If it is impossible to get both joints on an image for a trauma extremity, which joint should be included? | joint nearest injury |
| to avoid grid cutoff when performing trauma views, what should a radiographer do? | orientate grid lines parallel with angled beam path |
| when a bone is displaced from a joint | dislocation |
| a partial dislocation | subluxation |
| "bruise" type injury | contusion |
| a forced wrenching or twisting of a joint that results in a partial rupture or tearing of suppporting ligaments without dislocation | sprain |
| a break in a bone | fracture |
| describes the manner in which fragmented ends of bone make contact with each other | apposition |
| anatomic alignment of ends of fractured bone fragments wherein the ends of the fragments make end-to-end contact | anatomic apposition |
| ends of fragments are aligned but pulled apart and are not making contact with each other | lack of apposition |
| a fracture wherein the fragments overlap and the shafts make contact but not at the fracture ends | bayonet apposition |
| describes the direction or angle of the apex of the fx | apex angulation |
| distal part of the distal fragments angled toward the midline | varus |
| distal part of the distal fragments are angled away from midline | valgus |
| a fx that does not break through the skin | simple (closed) |
| a fx in which a portion of the bone breaks through the skin | compound (open) |
| a frx that does not traverse through the entire bone | incomplete (partial) |
| buckle of the cortex, no complete break in the cortex | torus fx |
| fx on one side of the bone only | greenstick |
| fx is transverse or near right angle to long axis of bone | transverse |
| fx passes through bone at an oblique angle | oblique fx |
| fx where bone has been twisted apart | spiral |
| fx resulting in bone that is splintered or crushed at the site of impact; two or more fragments | comminuted |
| type of double fx where two fx lines isolate a distinct segment of bone resulting in 3 pieces of bone | segmental fx |
| fx with two fragments on each side of a main wedge shaped separate fx | butterfly fx |
| bone is spintered into thin sharp fragments | splintered fx |
| fx where one fragment end is driven into the other fragment end | impacted |
| interatricular fx of the posterior lip of the distal radius | barton's |
| fx of the distal phalanx caused by ball striking the end of an extended finger | baseball |
| longitudinal fx which occurs at the base of the first metacarpal extending into CMC | bennett's |
| fx most commonly involves distal fifth metacarpal | boxer's |
| fx of the wrist displaced posteriorly | colles' |
| fx of the wrist with anterior displacement | smith's (reverse colles') |
| fx occurs through the pedicles of the axis with or without displacement of C2 on C3 | hangman's |
| interarticular fx of radial styloid process | hutchinson's (chauffeur's) |
| fx of the proximal half of the ulna and dislocation of radial head from being struck with forearm raised | monteggia's |
| fx of distal fibula with frequent fx of distal tibia or medial malleolus | pott's |
| fragment of bone is spearated or pulled away by attached tendon or ligament | avulsion |
| fx from direct blow to the orbit | blowout (tripod) |
| fx that involves isolated bone fragment | chip |
| vertebral fx caused by compression type injury with a decreased anterior vertebral body vertical dimension | compression |
| fragment depressed; sometimes called ping-pong fx; appears in the skull | depressed fx |
| fx through the epiphyseal plate | epiphyseal fx |
| classification system for epiphyseal fx | salter-harris classification |
| fx due to disease process within the bone | pathologic |
| fracture with lines radiating from a central point | stellate |
| fx from a nontraumatic origin | stress (fatigue) |
| fx of the ankle joint that involves the medial, lateral, and posterior malleoli of distal tibia | trimalleolar |
| comminuted fx of the distal phalanx | tuft (burst) |
| stands for open reduction, internal fixation; refers to surgical procedure to realign a fx | ORIF |
| what view would demonstrate a AAA | dorsal decub |
| what view would demonstrate free intraperitoneal air? | LLD |
| what must be included on a LLD of the abdomen? | diaphragm of side up |
| what are the three cardinal rules for radiation protection? | time, distance, shielding |
| of the three cardinal rules, which is the most effective? | distance |
| what should the beam be aligned with for a portable chest? | perpendicular to the sternum |
| what should the CR be aligned with for an AP abdomen? | iliac crests (perpendicular) |
| what degree of angulation and direction should the CR be directed for a AP oblique sternum? | 15-20 degrees mediolaterally (right to left) for LPO position |
| what SID should you have for a lateral sternum | as much as possible or minimum of 40 |
| what breathing instructions are used for the LPO sternum | shallow breaths |
| what breathing instructions are used for the lateral sternum | full inspiration |
| when imaging ribs above diaphragm, what breathing instructions should you use? | full inspiration |
| when imaging ribs below the diaphragm, what breathing instructions should you use? | full expiration |
| in the immobile trauma patient, what CR angle would you use for oblique ribs | 30-40 degrees |
| when using a mobile fluoroscopy unit in a vertival position in the O.R., if the II is tilted 30 degrees away from surgeon, the dose to the face and neck region will increase by a factor of? | four |
| If performing an imaging procedure for pneumothorax, what position do you place the patient in? | With side of possible pneumothorax up |
| If performing an imaging procedure for a patient with a suspected pleural effusion, what position do you place the patient in? | with possible affected side down |
| T/F: you can remove immobilization devices that may cause an artifact on a patient's resulting radiographs prior to imaging | False - this is not within a technologist's scope of practice |
| If a patient's hand is in the flexed position and patient is unable to flatten out the hand, how should you proceed with imaging the fingers? | attempt to get parts of interest parallel to IR |
| A patient presents for elbow series but is unable to supinate arm. How do you proceed with obtaining an AP type view? | Find the epicondylar plane and align IR parallel then direct CR perpendicular to this plane |
| If you need a lateral humerus on a patient with a suspected humeral fx, what alternative method could you use? | transthoracic lateral with separate distal humerus view |
| Your patient arrives to ER on backboard for a clavicle x-ray. The patient is skinny. What CR angle will you use for your AP axial? | 30 degrees |
| What angle would you use for the AP axial clavicle on a football line man (big guys on the front row)? | 15 degrees |
| how do you determine the degree of angulation for a lateral scapula on a trauma patient? | palpate medial and lateral borders then come in parallel to this plane |
| If needing to demonstrate a shoulder dislocation, what view would be best on a trauma patient who cannot roll? | transthoracic |
| What degree of angulation should be implemented for an oblique foot when the patient cannot rotate foot or lower leg? | 30 to 40 degrees |
| How do you determine CR angulation for a trauma ankle? | Align angle to be parallel with long axis of foot |
| What degree of obliquity is required for a mortise view? | 15 degrees |
| How do you determine CR angulation for a trauma lower leg? | Align angle to be parallel with the long axis of foot |
| How much do you angle on an AP knee for ASIS to tabletop measurement of 25 cms? | 3-5 degrees cephalic |
| Why would a doctor need a lateromedial oblique knee on a trauma patient? | Provides an unobstructed view of the fibular head and neck |
| What degree of angulation should be used for a lateromedial oblique knee on a trauma patient? | 45 degrees from AP |
| What are three methods for obtaining a lateral hip image on a trauma patient? | danelius-miller, sanderson, clements-nakayama |
| what must be determined for proper CR alignment for the danelius-miller method? | position of the femoral neck; CR perpendicular to femoral neck |
| what must be determined for proper CR alignment and angulation on the sanderson method? | rotation of foot |
| why would we use the clements-nakayama method? | if patient has bilateral hip fx or is unable to raise unaffected leg |
| when is a grid indicated? | if part is greater than 10 cm thick |
| what breathing technique would be used on a transthoracic shoulder or humerus? | breathing to blur out lung markings |
| For a patient with a pelvic fx, where would the CR be directed? | to the center of the IR when the IR is placed with top of IR 1" above iliac crest |
| why might a "low pelvis" be ordered? | following hip surgery for view of hardware placement |
| where would CR be directed for a "low pelvis" | pubic symphysis |
| kV range for lateral hip according to textbook | 80-90 |
| kV range for a pelvis according to textbook | 80-90 |
| kV range for lower limb according to textbook | 55-85 |
| kV range for a lateral cervical according to textbook | 75-85 |
| kV range for a swimmer's lateral according to textbook | 80-95 |
| kV range for lateral t-spine according to textbook | 85-95 |
| kV range for a lateral lumbar according to textbook | 90-95 |
| kV range for a shoulder, scapula, or clavicle according to textbook | 75-85 |
| kV range for a upper limb according to textbook | 60-70 |
| kV range for an abdomen according to textbook | 80-90 |
| kV range for a chest according to textbook | 90-125 |
| What is meant by arthroplasty? | total joint replacement |
| Define laminectomy | removal of bone (lamina) from the vertebra to stop impingement on a nerve |
| alternate name for baseball fracture | mallet fracture |
| alternate name for hutchinson's fx | chauffeur's fx |
| alternate name for reverse colle's fx | smith fx |
| alternate name for simple fx | closed fx |
| alternate name for blowout fx | tripod fx |
| alternate name for greenstick fx | hickory stick or willow stick fx |
| alternate name for stress or fatigue fx | march fx |
| who is responsible for the radiation protection for all personnel in a trauma room? | technologist |
| how should CR be directed for trauma lateral cervical spine | horizontal beam and perpendicular to part and IR |
| what is the recommended SID for trauma lateral cervical spine | 60-72" |
| how much angle is required for an AP Trauma c-spine | 15-20 degrees |
| where is the CR directed for an AP Trauma c-spine? | lower thyroid cartilage (C4) |
| what should the CR be directed parallel to for an AP C1-2 on a trauma patient | parallel to lower margin of upper incisors to base of skull line |
| what's an alternative to the AP C1-2 open mouth projection for a patient who cannot open his/her mouth? | angle CR cephalad 35-40 degrees |
| where should CR be directed for alternate AP Axial C1-C2? | just below mentum |
| where is the CR centered for a trauma swimmer's lateral? | C7-T1 |
| what is meant by a compound angle? | CR angle with both a mediolateral/lateromedial angle and cephalad/caudal angle (2 angles) |
| what type of angle is used on a AP Axial Trauma Oblique c-spine? | 45 degree lateromedial angle with 15 degree cephalad angle (compound angle) |
| how is CR centered for an AP Trauma Thoracic? | T7 |
| how is CR centered for a Trauma Lateral thoracic | horizontal beam to T7 centered in the posterior half of thorax |
| how is CR centered for an AP trauma Lumbar? | midline to L3-L4 |
| how is CR centered for a trauma lateral lumbar? | horizontal beam perpendicular to IR at the level of L3-L4 |
| how is the CR directed for a lateral elbow in the supine patient | CR projects parallel to the interepicondylar plane |
| how much elbow flexion is required for the Coyle method for radial head? | 90 degrees |
| how much elbow flexion is required for the Coyle method for coronoid process? | 80 degrees |
| what is the CR angle for the coyle method for radial head? | 45 degrees toward shoulder |
| what is the CR angle for the coyle method for coronoid process? | 45 degrees away from shoulder (caudal) |
| If the CR is directed mediolaterally from right to left, which ribs would be demonstrated on a supine trauma patient? | left |
| CR for a PA thumb | 1st MCP |
| what do you use for cr alignment for AP humerus | CR should be perpendicular to the epicondyles/epicondylar plane |
| how do you align CR for lateral humerus | CR should be parallel to the epicondylar plane |
| for a lateral scapula on a trauma patient, how do you direct the CR? | CR should be parallel to the scapular body (have patient reach across if possible to pull scapula out a little bit) |
| when using an angled CR, what should you do with your grid to avoid grid cutoff? | turn grid crosswise so that the grid lines run parallel with the direction of beam travel |
| how do you determine CR angulation for an AP foot in patient who cannot bend knee to place foot flat on table/stretcher? | align IR with the plane of the foot, align CR to be perpendicular to IR then angle posteriorly 10 degrees |
| if patient cannot rotate foot, how would you achieve an oblique foot? | angle lateromedially 30-40 degrees in relation to the plantar surface of the foot |
| what is CR aligned to for an AP ankle? | CR should be parallel to the long axis of the foot midway between the malleoli |
| how would you align the CR for an AP Mortise if the leg can't be rolled? | align for an AP then add 15-20 lateromedial angle |
| how do you align CR for AP lower leg | align to be parallel with the long axis of the foot |
| how many IRs are required for a lateral lower leg? | generally 2 unless you are able to turn and support the IR in a diagonal position |
| do you still angle on an AP trauma knee? | yes if it is warranted - 3-5 degree cephalad ASIS to TT measurement of 24cm+; 3-5 degrees caudal for less than 19cm |
| what do you use for knee positioning in a trauma situation for alignment of the CR? | femoral condyles |
| what does the CR come in perpendicular to for an AP Trauma Femur? | condylar plane |
| how do you place an IR for an AP pelvis | top of IR 1" above iliac crest |
| how do you place an IR for a "low pelvis"? | centered to pubic symphysis |
| how can you locate the hip joint on a trauma patient? | 1-2" medial to ASIS and 3-4" inferior to ASIS |
| true/false: it is possible to shield all patients for a pelvis image | true |
| if lesser trochanters of the femurs are projected medially on an AP pelvis, what do you need to do? | internally rotate patient's femora approximately 15 degrees if no hip fx suspected |
| if you are unable to place anatomy into the center of the grid for a Danelius-Miller method, what should you do? | turn grid so that grid lines are vertical to prevent grid cutoff |
| what can you use to provide uniform density on a inferosuperior axial hip? | compensating filter |
| what do you align the IR with for a Sanderson method? | IR should be parallel to long axis of the foot |
| what two methods can be employed for a trauma lateral hip if the unaffected side cannot be elevated/lifted out of the way? | Sanderson and Clements-Nakayama method |
| How much CR angle is needed for a Clements-Nakayama method? | CR angled posteriorly 15 degrees and perpendicular to femoral neck |
| What is another name for subluxation of the elbow joint? | Nursemaid's elbow |
| When performing follow-up studies on a known fracture of a long bone, how many joints must be included on the film? | one |
| If an LPO of the sternum is done with a 15-20 degree angle from right to left, how much angle would you do on an asthenic patient? | 20 - takes more angle to get the sternum off the spine |
| What's a drawback to a trauma PA thumb vs. an AP thumb? | Increase in OID, decrease in Recorded Detail, Increased magnification |
| technique conversion for small-medium dry plaster cast | Increase mAs 50%-60% or +5-7 kV |
| technique conversion for large plaster or wet cast | Increase mAs 100% or increase 8-10 kV |
| technique conversion for fiberglass cast | Increase mAs 25%-30% or +3-4 kV |
| If patient is unable to flex the knee due to trauma for a "sunrise" view of the patella, what other position could be utilized (besides AP and Lat) to demonstrate the patella | oblique (usually medial rotation) or trauma lateromedial oblique |
| Greenstick fractures occur in what patient population? | Pediatrics |
| Which gender has more trauma occur? | Male |
| What age group is more likely to have trauma occur? | 18-24 yo |
| According to the NTDB 2012 report, what is the least common source of trauma injury? | firearm |
| Radiographer's role in trauma includes what duties? | Perform quality diagnostic imaging procedures Practice ethical radiation protection Provide patient care |
| Which trauma patient status would warrant immediate reporting to a physician | Loss of consciousness (unresponsive to voice or touch) Pale or bluish skin pallor (cyanosis) Bluish nail beds Seizures Increasing abdominal distention and firmness to palpitation |
| What are qualities of a trauma radiographer? | Speed Accuracy Quality Positioning Practice standard precautions Immobilization Anticipation Attention to detail Attention to ED protocol and scope of practice Professionalism |
| what are radiopaque arrow markers used for in penetrating trauma injuries? | identifying entrance and exit wounds |
| CR centering and alignment for AP Skull | Parallel with OML, centered to glabella |
| CR centering and alignment for AP Reverse Caldwell on trauma patient | Angled 15 degrees cephalad to OML (find OML and subtract 15 degrees), centered to nasion |
| CR Centering and alignment for Trauma AP Towne view | Angled 30 degrees caudal to OML (find OML and add 30 degrees not to exceed 45), centered to pass through the EAMs and exit foramen magnum (basically at the hairline) |
| CR Centering and alignment for AP Reverse Waters | Align CR parallel with MML, center to acanthion |
| CR Centering and alignment for AP Modified Reverse Waters | Align CR parallel with LML, center to acanthion |
| Size of IR/field size necessary for headwork views | 10x12 |
| orientation of IR for CTL skull | crosswise with anatomy (long axis of IR/lightfield running anterior to posterior NOT superior to inferior) |
| what must be included on lateral skull? | all aspects of the skull from anterior to posterior border and superior to inferior border |
| what must be included on lateral facial bones | superimposed facial bones, greater wings of sphenoid, orbital roofs, sella turcica, zygoma and mandible |
| What is the centering point for a CTL skull? | 2" superior to EAM |
| What is the centering point for a CTL facial bones? | midway between outer canthus and EAM (on zygoma usually) |
| The opposite but equal position of an LAO is | RPO |
| The opposite but equal position of an RAO is | LPO |
| On a trauma patient to achieve a RPO position on a patient that you cannot roll, which way would you angle your x-ray beam? | from left to right across the MSP |
| On a trauma patient, in order to achieve a LPO on a patient that you cannot roll, which way would you angle your x-ray beam? | from right to left across the MSP |
| A trauma patient with a known fracture who has the fracture realigned by the ER doctor and then set in a cast. The ER doctor just performed a nonsurgical ______ _______ procedure | closed reduction |
| What is demonstrated on an AP skull | frontal bone, crista galli, IAC, frontal and anterior ethmoid sinuses, petrous ridges fill orbits |
| What is demonstrated on an AP Reverse Caldwell? | frontal bone, superior orbital fissures, frontal and anterior ethmoid sinuses, petrous ridges projected in lower third of orbits |
| What is demonstrated on an AP Towne? | Occipital bone, petrous pyramids and foramen magnum demonstrated (dorsum sellae and posterior clinoids seen in foramen magnum opening) |
| What is demonstrated on an AP Reverse Waters? | nasal septum, infraorbital margins, maxillae, zygomas, anterior nasal spine; petrous ridges projected below the level of the maxillary sinus |
| What is demonstrated on an AP Modified Reverse Waters? | Orbital floors are perpendicular (less distortion of orbital rims); petrous ridge in lower half of maxillary sinus |
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hschmuck1
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