What is the recommended type and degree of rotation for a PA Oblique 2nd Finger?
Medial, 45 degrees (lateral rotation for 3rd, 4th, and 5th fingers)
Where should the CR be directed for a PA projection of the 4th Finger?
The 4th Proximal Interphalangeal Joint
A lateral of the 3rd finger requires what specific projection type? (Lateromedial or Mediolateral)
Lateromedial for the 3rd, 4th, and 5th fingers, Mediolateral for the 2nd finger
An AP projection of the thumb requires the CR to be directed where?
1st metacarpophalangeal joint
What is the centering point for a PA projection of the hand?
Third metacarpophalangeal joint
What type of hand projection should be utilized for localization of a foreign body?
In a fan lateral lateromedial projection of the hand, what relationship should the digits have to the IR?
Digits should be parallel to the IR
Where should the CR be directed for a PA projection of the wrist?
Perpendicular to the IR, directed to midcarpal area
The correct rotation for a PA Oblique Wrist is how many degrees?
45 degrees, also true for PA Oblique Hand
A true lateral (lateromedial) projection of the wrist is evidenced by superimposition of what two structures?
Ulnar head superimposed over the distal radius
A PA Axial Scaphoid with Ulnar Deviation of the Wrist requires what specific CR adjustments (angle, direction, and centering point)?
CR angled 10 to 15 degrees proximally (toward elbow), centered to the scaphoid
A PA Scaphoid with the hand elevated on a 20 degree angle sponge and utilizing ulnar deviation is known as what method?
What are some other names for the tangential, inferosuperior projection of the wrist used to evaluate for carpal tunnel syndrome?
Carpal Canal (Tunnel), or Gaynor-Hart method
What type of CR angle and centering point is required for the Gaynor Hart method of the Wrist?
25 to 30 degrees to the long axis of the hand with a hyperextended (dorsiflexed) wrist, directed 2 to 3 cm (1 inch) distal to the base of the third metacarpal
What is the minimum distance required past the wrist and elbow joints that must be included on an AP projection of the forearm?
3 to 4 cm (1 to 1 1/2 inches)
What structures must be superimposed to demonstrate true laterality on a lateromedial projection of the forearm? Think of both the wrist and elbow joints.
Wrist joint: Head of ulna superimposed over the radius. Elbow joint: Humeral epicondyles superimposed.
An AP projection of the elbow requires the humeral epicondyles (interepicondylar plane) to be ___________ to the IR
A lateral oblique elbow (external rotation) best demonstrates which areas?
The radial head and neck (and tuberosity) which become free of superimposition by the ulna.
A medial oblique elbow (internal rotation) best demonstrates which areas?
The coronoid process of the ulna and the medial epicondyle and trochlea of the humerus.
Name the aspects which make up the three cocentric arcs of a true lateral (lateromedial) projection of the elbow.
Trochlear sulcus, double ridges of the capitulum and trochlea, and the trochlear notch of the ulna.
The AP partial flexion elbow series requires two images centered to the mid-elbow joint (2 cm or 3/4 inch distal to midpoint between epicondyles) with what distinction between the two images?
One image with forearm parallel to the IR, one image with the humerus parallel to the IR.
A trauma axial lateral (coyle method) projection of the elbow for the coronoid process requires what CR angle?
45 degree CR angle from the shoulder. Elbow flexed 80 degrees, hand pronated.
A trauma axial lateral (coyle method) projection of the elbow for the radial head requires what CR angle?
45 degree CR angle toward the shoulder. 90 degree elbow flexion, hand pronated.
An AP projection of the humerus requires the epicondyles of the elbow to be ________________ to the IR.
A lateral projection of the humerus requires the epicondyles of the elbow to be _____________ to the IR.
A neutral projection of the humerus or shoulder generally puts the humeral epicondyles at what angle from the plane of the IR?
What type of respiration is recommended for a transthoracic lateral projection of the humerus (trauma situation)?
Orthostatic (breathing) technique, minimum of 3 seconds exposure time, but 4-5 seconds is desirable.
An AP shoulder with external rotation (which is also an AP proximal humerus) places the epicondyles of the distal humerus parallel to the IR. This demonstrates the ____________ in full profile.
An AP shoulder with internal rotation (which is also a lateral proximal humerus) places the epicondyles of the distal humerus perpendicular to the IR. This demonstrates the ____________ in full profile.
AP projections of the shoulder require what specific centering point?
1 inch inferior to the coracoid process, or approximately 2 inches inferior to the lateral portion of the AC joint.
What projection of the shoulder requires the patient positioned supine, arm abducted 90 degrees and externally rotated with the palm up, and CR angled medially 25 to 30 degrees directed horizontally to the axilla and humeral head.
Inferosuperior axial - Lawrence method
The posterior oblique shoulder projection used to demonstrate the glenoid cavity (Grashey method) requires what rotation of the body toward the affected side?
35 to 45 degrees, remember to abduct the arm slightly with the arm flexed and in neutral rotation
A scapular Y lateral shoulder projection, which is commonly performed as a PA oblique, involves having the arm abducted slightly (but not pulled across the body) and what range of rotation of the patient's body?
An AP scapula, which utilizes a breathing technique and has the patient's arm abducted 90 degrees along with supination of the hand, requires what specific centering?
CR perpendicular to midscapula, centered 2 inches inferior to the coracoid process (level of axilla) and 2 inches medial from the lateral border of the patient.
A lateral projection of the scapula (Y view) to specifically demonstrate the body of the scapula requires what arm position (of the affected side) by the patient?
Patient reaches across their chest and grasps the opposite shoulder; to show the acromion and coracoid process, drop the arm behind the back or to the side
When positioning for an AP clavicle, the medial aspect of the clavicle corresponds to the ________________ and the lateral aspect of the clavicle corresponds to the _________________. (landmarks)
An AP Axial Clavicle requires what specific CR angle and direction?
15 to 30 degrees cephalad.
A PA Axial Clavicle requires what specific CR angle and direction?
If completing an AP projection of the Acromioclavicular Joints (bilateral), what is the minimum SID that should be used, and what is the minimum measure of weights that should be used?
72 inches; 8 to 10 lb minimum weights, attached to the wrists, not held with the hands, less weight (5 to 8 lbs) may be used for smaller/asthenic pts
Centering for an AP bilateral with and without weights AC joints is at a midpoint between the AC joints, or ___________ above the jugular notch.
An AP projection of the toes requires what specific CR angle and direction?
10 to 15 degrees towards the calcaneus, to place the CR perpendicular to the phalanges
An AP oblique projection of the toes should be centered at the __________ of the toe of interest.
Metatarsophalangeal joint
For an AP oblique projection of the toes, the leg and foot should be rotated 30 to 45 degrees medially for the _____________ digits and rotated laterally for the _____________ digits.
1st, 2nd and 3rd rotated medially, 4th and 5th rotated laterally.
For lateral projections of the toes, the leg and foot should be rotated ______________ for the 1st, 2nd, and 3rd digits, and rotated ______________ for the 4th and 5th digits.
Medially (lateromedial projection) for 1st, 2nd, 3rd; Laterally (mediolateral projection) for the 4th, 5th.
A tangential projection of the sesamoids/toes with the patient prone requires dorsiflexion of the foot so that the plantar surface forms a _______________ angle from vertical.
Why is the prone position for the tangential projection of the sesamoids/toes preferred, as compared to a supine patient position?
Prevents Increased OID, increased magnification, loss of definition. Remember to direct the CR tangentially to the posterior aspect of the first MTP joint.
An AP axial projection of the foot requires what specific centering and CR angle?
Centered to the base of the third metatarsal, CR angled 10 degrees posteriorly (perpendicular to the metatarsals).
An AP oblique projection of the foot normally requires what rotation (direction and degrees)? What is the alternate AP oblique projection of the foot (rotation direction and degrees)?
Medially, 30 to 40 degrees; Laterally, 30 degrees (less oblique required because of the natural arch of the foot).
What does the medial oblique foot demonstrate, and what does the lateral oblique foot demonstrate?
Medial: 3rd through 5th metatarsals free of superimposition; Lateral: the space between the 1st and 2nd metatarsals, and between the 1st and 2nd cuneiforms
A lateral foot (mediolateral or lateromedial, lateromedial can produce a more "true" lateral but is more uncomfortable for the patient) requires a ________ degree flex of the knee and how much collimation proximal to the ankle joint?
45; 1 inch (2 to 3 cm) proximal to the ankle joint.
What is a specific type of injury that may be demonstrated by using AP axial weight-bearing and lateral weight-bearing projections of the foot?
Injury to structural ligaments of the foot such as a lisfranc joint injury
A plantodorsal (axial) projection of the calcaneus requires dorsiflexion of the foot and what specific CR angle and centering point?
CR 40 degrees cephalad from the long axis of the foot, directed to the base of the third metatarsal
For a lateral (mediolateral) projection of the calcaneus, a true lateral places the lateral malleolus __________ to the medial malleolus.
A plantodorsal axial projection of the calcaneus requires the patient to be positioned _____________, whereas a dorsoplantar axial projection of the calcaneus generally requires the patient to be positioned ___________.
An AP projection of the ankle demonstrates which two portions of the ankle joint space?
Medial and superior mortise aspects; lateral is closed.
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An AP oblique mortise projection of the ankle requires what rotation of the entire leg and foot?
15 to 20 degrees medial rotation, places intermalleolar line parallel to the IR
An AP oblique medial rotation of the ankle (NOT mortise) to demonstrate the distal tibiofibular joint requires what rotation of the leg and foot?
A mediolateral lateral (mediolateral preferred due to patient comfort, even though lateromedial may achieve a true lateral easier) projection of the ankle would require the CR to be directed to the ____________.
AP stress projections of the ankle, which require a physician or other health profession to hold or manipulate the body part, are used to demonstrate what pathologies?
Pathology involving ankle joint separation, secondary to ligament tear or rupture.
An AP projection of the lower leg (tibia and fibula) can utilize an SID of _____________ to reduce divergence of the x-ray beam and include more of the body part.
A lateral - mediolateral projection of the lower leg (tibia and fibula) can utilize what adjustment to the body part/IR to ensure that both joints are included on an image.
Lower leg placed diagonally on a 14X17 inch IR, requiring a minimum SID of 44 inches.
For a true AP projection of the knee, the leg is generally rotated ____________ to place the interepicondylar line parallel to the plane of the IR.
3 to 5 degrees internally/medially
An AP oblique projection of the knee, with medial rotation of 45 degrees, generally demonstrates what open joint space?
The proximal tibiofibular joint.
An AP oblique projection of the knee, with lateral rotation of 45 degrees, demonstrates which specific body parts in profile?
The medial condyles of the femur and tibia
The lateral recumbant (mediolateral) projection of the knee requires 1) ________ degrees flexion of the knee. 2) __________ degrees angle and direction of the CR. 3) CR directed to a point __________ to the medial epicondyle.
1) 20 to 30 degree flex of knee 2) 5 to 7 degree cephalad 3) 1 inch (2.5 cm) distal
What are the recommended guidelines for determining CR angle on an AP projection of the knee for the following ASIS to tabletop measurements; <19 cm = _________. 19 to 24 cm = _________. >24 cm = ___________.
<19 cm = 3 to 5 degrees caudad. 19 to 24 cm = 0 degree angle. >24 cm = 3 to 5 degrees cephalad.
What is the specific centering point utilized for an AP projection of the knee?
1/2 inch (1.25 cm) distal to the apex of the patella.
For a lateral recumbent projection of the knee, what adjustment is made to the CR angle for a short patient with a wide pelvis, and what adjustment is made to the CR angle for a tall patient with a narrow pelvis.
7 to 10 degrees cephalad for a short patient with a wide pelvis, 5 degrees cephaland for a tall patient with a narrow pelvis.
AP weight-bearing knee projections for an average sized patient require what CR angle?
No angle (CR perpendicular to IR) for average sized patient; 5 to 10 degrees caudad for a thin patient.
Describe patient and part positioning for the PA Axial - Intercondylar Fossa Holmblad Method, which requires the CR to be perpendicular to the IR and lower leg, directed to the midpopliteal crease.
Patient kneeling on all fours, IR under affected knee, leaning forward 20 to 30 degrees, which creates 60 to 70 degree knee flexion.
Describe patient and part positioning for the PA Axial - Intercondylar Fossa Camp Coventry Method, which requires the CR to be perpendicular to the lower leg, directed to the midpopliteal crease.
Knee flexed 40 to 50 degrees, which necessitates a 40 to 50 caudad CR angle to match the degree of flexion.
An AP Axial - Intercondylar Fossa projection, or Beclere Method, requires what specific flexion of the knee along with what specific CR angle and centering point?
40 to 45 degree knee flex, CR angled to be perpendicular to the lower leg (40 to 45 degrees cephalad), directed 1/2 inch (1.25 cm) distal to apex of the patella
A PA patella requires how much rotation of the knee to align the interepicondylar line parallel to the plane of the IR?
5 degree internal rotation of the anterior knee.
The Merchant method (tangential patella projection) requires what specific knee flexion and what specific CR angle?
Knee flexed 40 degrees over the end of the table (using a merchant board), CR angled 30 degrees caudad from a horizontal plane.
The Settegast method (tangential patella projection) requires what specific knee flexion and what specific CR angle?
Patient prone, knee flexed 90 degrees, CR tangential to patellofemoral joint space (15 to 20 degrees from lower leg).
The Hughston method (tangential patella projection) requires what specific knee flexion and what specific CR angle?
Knee flexed 50 to 60 degrees from full extension of lower leg, CR angled 45 degrees cephalad or tangential to patellofemoral joint space.
How much rotation of the leg is required for an AP projection of the femur (seperate rotation amounts for the proximal femur vs. the distal femur)?
Proximal femur: 15 to 20 degrees internal rotation; Distal femur: 5 degrees internal rotation (as with an AP knee).
For a proximal lateral mediolateral projection of the femur, the upper IR margin should be placed at the level of what bony landmark to ensure inclusion of the hip joint?
Which exam type utilizes a special "Bell-Thompson" type of ruler with radiopaque markings and generally consists of three exposures per side of the body?
Long bone measurement radiography, can be lower limb or upper limb, used to measure limb length discrepancies
Which radiograph involves an image of the non-dominant hand placed palm down on the IR, with collimation to include the entire hand as well as 1/3 of the forearm?
___________ is a series of radiographs, performed systematically to cover the entire skeleton or the anatomic regions appropriate for the clinical indications (such as a metastatic survey, or a pediatric abuse survey).
Bone Survey, or Skeletal Survey
____________ is an imaging technique used to evaluate joints using a fluorscopically guided injection followed by an additional imaging scan in a seperate modality (CT or MRI)